Infertility and Emotional Resilience

Most people who have grappled with infertility have developed their own narratives about this experience and how it has shaped their lives. I often am amazed at how many people have found a silver lining in their infertility cloud. This past week has provided several experiences that heighten for me the connection between infertility and emotional resilience.

My first experience was with a group of about 20 women, ages 25 to 60, who conduct workshops and training sessions in their communities about issues affecting families. They had asked me to speak with them about my book When You're Not Expecting, and I encouraged them to ask questions and offer observations during the course of my presentation. Well, I had only spoken a few moments when the conversation turned quite quickly to their own personal experiences with infertility. Who would have imagined that 15 of these women had difficulties conceiving, pregnancy lossses, or lived in a childfree marriage? No matter what the experience was for each, the way in which they shared their infertility experiences ultimately came down to "It's not what I expected, but I know I am a more understanding and compassionate adult because of learning how to come to terms with my infertility." Personal examples ranged from adapting professional goals so they could be more generous in helping troubled families to ways that they redefined their own families that put them in closer touch with young nieces and nephews. The tone of the meeting was definitely upbeat, although there was a fair amount of Kleenex passed around the table as various women delved into their emotions to connect with the shared topic of infertility. What struck me very poignantly was how each person disclosing her thoughts had moved from emotional pain to resilience as she found a new way of shaping her future than the one she initially had envisioned.

My second experience this week occurred when I was interviewed live on our local public radio station about my book. Call-ins are a part of this particular radio hour and, once again, the callers shared their infertility and adoption experiences. One man expressed with zest how the pain of his infertility was eclipsed by the joy of adoption; a female caller spoke matter-of-factly about medical reasons that she could not risk a pregnancy, sharing her sadness that her husband's curly red hair wouldn't be passed along to their children, then moving on to talk about the emotional happiness her family shared 25 years ago as they adopted their two children.

In both of these experiences I was taken with how easily people could delve into their pasts and retrieve memories of unanticipated reproductive losses, the need to regroup emotionally, the capacity to find a new pathway, and the emotional growth that they now attribute to their infertility journey. I hope this can be especially heartening to any readers who are trying to make sense of your own infertility, since it is clear that emotional upheaval is expectable, but emotional resilience also can be an outcome of infertility.

New research on stress and infertility

For years there has been a dialogue between physicians and their infertile patients about whether stress is a cause of infertility or the result of infertility. Current research has shown that the stress levels of women with infertility are equivalent to women with cancer, AIDS or heart disease, so there is no question about infertility resulting in enormous stress. The breaking news published online in the journal Fertility and Sterility and summarized this week in the Science section of the New York Times, ( Old Maxim of Fertility and Stress Is Reversed ) is that women who stopped using contraceptives took longer to become pregnant if they had higher saliva levels of the enzyme alpha-amylase -- a biological indicator of stress. Specifically, women with the highest concentrations of alpha-amylase were 12 percent less likely to become pregnant each month than those with the lowest levels.

So what are the implications of this new research? The researchers say theirs is the first study to link a biomarker for stress with delayed conception in normal, healthy women, and they suggest that identifying ways to reduce or manage stress may be a low-tech solution for some couples diagnosed with infertility. Alice Domar, executive director of the Domar Center for Mind/Body Health at the fertility center Boston IVF, responded to the research findings by saying "This is one more piece of the puzzle that's adding up to the same conclusion: that stress is not necessarily a good thing for our reproductive system." Her 2004 book, Conquering Infertility, addresses the mind/body connection and suggests practices ranging from mindful meditation to yoga that can help women reduce the stress caused by their infertility.

So we are coming full circle: acknowledging the obvious, that infertility causes stress, and now addressing the scientific evidence that stress delays time of conception in healthy women. The researchers remind us that stress is the one consistent factor that shows an effect on how long it takes to get pregnant, of all the lifestyle factors studied to date. More surprising is that even low levels of stress can have an impact on conception.

Dr. Domar advocates that mind/body techniques can decrease physical symptoms of stress such as insomnia, headaches, abdominal pain and fatigue as well as psychological symptoms such as depression, anxiety, hostility and tearfulness. She cites recent research that has shown that women who participate in mind/body programs in conjunction with treatment from their physician have significantly higher pregnancy rates than women who receive medical treatment only.

With these intriguing studies, if you are a woman hoping to become pregnant (remember that the alpha-amylase study used data from 274 healthy women who had just started trying to conceive), certainly you will want to reduce your stress as much as possible in an effort to enhance conception. If you have been diagnosed with infertility, you are already in the midst of a stressful experience; seeking an infertility clinic that incorporates counseling, mind/body interventions and stress management strategies can provide you with new stress reduction techniques. In my book When You're Not Expecting, I provide information on how to locate a counselor or a support group, as well as lists of resources for help with mental health concerns, including stress.

Each of our responses to the stress of infertility is unique to our particular circumstances. Yet this recent research is a red flag that we should actively try to address our own stress levels in an effort to assist our physicians in their efforts to help us achieve a healthy pregnancy.

A Vacation from Infertility?

In my large library of books on infertility, I could find only one with "vacation" in the index. And, no surprise, that book ("When You're Not Expecting") was written by me! In today's blog I'll offer my thoughts on why a vacation from infertility can be such an important and challenging issue to consider.

The very word "vacation" tends to elicit memories from our earlier lives of restful and restorative times that we have tucked away, simply because they have been memorable in such a positive way. And then all of us have memories, perhaps better forgotten, of vacations filled with stress, mishaps, unmet expectations, and other disappointments. So we begin this blog already aware that the word "vacation" can be a double-edged sword.

On one edge of the sword are the lost vacations. These are the vacations never taken because you need to use your savings for infertility treatment or costs associated with adoption or surrogacy. Or these are the vacations never taken because you need to be close to home for clinic visits and treatments. Or these are the vacations not taken because the family members who would join you all have infants, toddlers and pregnant relatives in their midst. And that would be a lost vacation from your perspective.

So how about the other edge? Is there an alternative to lost vacations?
We need first to consider whether we are talking about a vacation or a vacation from infertility. If we're talking about a vacation, you and your partner need to make time in your crowded lives to decide how to avoid the lost vacation syndrome. One strategy could be to plan an inexpensive vacation (think close to home, bed and breakfasts, camping, new experiences big on spontaneity but low in cost). Another strategy might be to see whether a clinic in the vicinity of your destination could administer straightforward tests and procedures. And still another strategy would be to break the news gently to your family that you and your partner are taking a vacation this year where reminders of your infertility are at a minimum -- much as you love tiny nieces, nephews, pregnant sisters and doting grandparents, you and your partner need some vacation time to restore your own emotional energy.

And it is this issue of restoring your emotional energy that is actually behind the concept of an infertility vacation. This vacation probably will not be on the beach or in some yet-unexplored new environment (although it could be). An infertility vacation is a choice made by couples who feel their lives have been so consumed by their infertility that they have lost sight of themselves in the process. They decide to take several months off from treatment, not to touch adoption applications, not to investigate surrogate possibilities, and not to time intercourse with fertile times of the month.

So why would one come to the point of considering such a vacation? Well, I suspect I really don't need to elaborate on the obvious for most of my readers who are infertile, but in the spirit of hoping that loved ones and health care providers may be reading too, I'll elaborate briefly. Being infertile can consume your life: your schedule is no longer your own (in my book, one chapter is subtitled "When Life is on Hold"), you are constantly facing decisions that relate to your diagnosis or treatment, you may feel as though you are stuck too long in a particular treatment regimen, side effects from treatment (which can include weight gain and mood swings) are debilitating and, to top it off, your sex life is suffering. Who wouldn't need a vacation from this?

Well, yes, but an infertility vacation also means losing valuable months of treatment and medical continuity. Depending on your age, you may be feeling as if each month is a precious opportunity not to be wasted. So now the question becomes whether taking a few months away from infertility might enable you and your partner to rejuvenate your relationship, to see how it feels to be a family of two indulging yourselves with more spare time, more flexible schedules and more focus on restoring your own resilience. This is not a vacation meant for decision-making, but the mental and physical rest from treatment may give you enough new perspective after a few months that you are ready to begin facing new options, new decisions and new support systems.

Dr. Seuss, author of "Oh, The Places You'll Go!" has identified The Waiting Place as one detour that both children and adults face during their travels through life. Individuals with infertility will identify with Seuss's depiction of this involuntary life pause, as well as his assurance that life can move forward in new ways after a wretched waiting period.

So, in the spirit of encouraging you to appreciate that both vacations and involuntary waiting involve double edged swords, I hope you will take time to consider how several months of an infertility vacation might offer an opportunity to open your sensibilities and awareness to new ways of thinking about your life.

And, while I'm on the topic of vacations, I will be taking one of my own for the next month: no computer, no academic reading, but hopefully some time for rest and relaxation. I look forward to resuming my blog and reconnecting with faithful and new readers in mid August.

Infertile? Feeling Left out of "The Club?"

Infertility has many dimensions, and the longer you are infertile the more dimensions you are likely to explore. One of the more challenging is how to handle relationships with good friends who have become pregnant or who are new parents. These women, often very preoccupied with how to anticipate or to juggle the new role of motherhood, seem to attract one another like magnets. Whether through childbirth prep classes, La Leche meetings, playgroups, or just the coincidence of several acquaintances becoming pregnant within months of one another, these women often bond together to form what I refer to in my book as "The Club." Happily (or apprehensively) counting the months until their due dates, new Club members seek out more experienced ones for advice on everything imaginable. All very well, unless you, grappling with infertility, are on the outside looking in.

The first sign of discomfort with Club members may come in an ob-gyn's waiting room. There the literature tends to focus on pregnancy and early parenting. Nothing on infertility. And the conversation tends to focus on pregnancy, nursing, labor and delivery apprehensions. Nothing on pregnancy loss, IVF or adoption. In other words, women with infertility feel in the minority, feel silenced, and feel hurt in the presence of talkative Club members.

In the early 1980's, Helen Hooven Santmyer finished 50 years of writing ...And Ladies of the Club. This 1,334 page novel refers to a small Midwestern town literary club whose members are involved from 1868-1932 in their town's political, cultural and social changes. The author, a determined individual, was in her 80's before giving birth to this book, which subsequently remained for weeks on the New York Times best seller list. So why do I think of Ms. Santmyer as I write this blog?

Well, let's see. She hung in there, as many women with infertility do, hoping that her efforts to produce might ultimately meet with success. She appreciated the support system that women can offer to one another, even as political and social change efforts pre-1932 were couched in the context of a literary club. She poignantly portrayed lifelong friendships, as well as the tensions and difficulties that threatened them. And she depicted women who, for whatever reasons, departed from the Club or never were included in it.

So, although that book is not directly about clubs of fertile women, it is about women supporting other women, juggling roles, sustaining friendships and meeting life challenges head on. And Club non-membership is, both in the Santmyer book and in the lives of women with infertility today,one of the challenges for which there are few road maps.

Non-membership tends to be an issue only for those women not in The Club. Club members assume that their doors are wide open to women who are pregnant; they just don't realize how stifling it can feel to be frozen out of a conversation because you have no reproductive stories to contribute. Or maybe you do, but who wants to hear about a chemical pregnancy, a miscarriage or hormone shots?

So how can women avoid the hurt of being sidelined from the Club because of infertility? If we assume the hurt is caused by unintended insensitive behavior, one strategy is to take your pregnant and parenting friends and co-workers into your confidence. Or, if you don't want to do this, see whether a close friend will pass along whatever details you are willing to share, along with hints of ways others could demonstrate their support. This could include not shouting new pregnancies from the rooftop, not waving sonogram pictures every which-way, not making a big deal about new maternity clothes and swollen ankles, and not expecting your presence (or presents) at baby showers.

Another strategy may be to distance yourself from some Club members, especially those who are unable to contain their pregnancy or parenting excitement and enthusiasm. In their place you can tighten your relationships with empathic friends and make friends with empty-nesters or women who are not setting their sights on motherhood. You may also find that an infertility support group offers the kind of Club membership that you need right now.

Some individuals will benefit from a direct approach. These are the folks who don't "get it" when the grapevine spreads word of your infertility, but who are capable of changing their behaviors if told specifically what they can do to help you feel better supported.

And then there will always be a few people who are so focused on their own needs that they have no plan to consider yours. These folks won't miss you when you close the door on your relationship. Unless they're family members, in which case things get more complex. Under those circumstances you can try the direct approach of speaking about what you need from them; you can write a letter emphasizing your expectation that they will take your needs into consideration; or, as a last resort, you can engage someone else in the family to run interference for you. Whichever route you choose, the takeaway message is that you deserve to protect yourself from selfish and manipulative behavior.

So, even though the subtitle of my Club book chapter is "on the outside looking in," this blog is less about being envious than it is about being articulate. Don't be shy about telling others what they can do to help you feel supported. Be clear about behaviors that are hurtful. Enlist your friends to help with this if it feels too overwhelming. And remember that new friends can be found in many places where the topics of pregnancy and parenting are not on anyone's tongues.

You're Infertile and Your Friend is Pregnant -- How to Cope?

The emotional challenges of infertility increase whenever your support network feels shaky. And, for many of us, either because we have been cautious about sharing news of our infertility, or because our network is fairly small to begin with, the news of a close friend's pregnancy can feel like an especially damaging lightening bolt. It may reverberate through your network, causing everyone to wonder how you're "handling it." It pushes your own buttons about how you can continue to be a good friend as you are aware of your own jealousy and envy. And it stimulates so many questions about your ongoing relationship (Can we remain friends? Can I count on her sensitivity? Will other friends forget about me and my feelings as they celebrate her pregnancy? Will I cringe as I look at her swelling abdomen? Will she be willing to talk with me about how our friendship can coexist with her motherhood?).

Of course so much depends on the history and the nature of your relationship. Let's consider a few scenarios:

This "friend" may actually be your sister or your cousin -- in other words, you go "way back," share many memories, have ongoing ties with other family members, and probably have some experience in ironing out rough spots that have developed in your relationship. But, for now, the uniqueness of this relationship is that she is plunk in the middle of your family. So it feels as if this pregnancy will echo and reverberate around the family system, with other relatives wondering how they can be sensitive to you and attentive to her news. Just keep in mind that if you and she can talk about this between yourselves and vow to be as emotionally open and clear as possible, other family members will take their cues from both of you.

This friend may be someone in your infertility network who, like you, has struggled with her reproductive health. If so, she will be apprehensive for months about whether this pregnancy is a healthy one, and her own anxieties about this may interfere with her capacity to focus on your ongoing infertility concerns. So your relationship with her will be complex: at the very time she may appear as a beacon of hope that pregnancy can happen to someone with infertility, she also will have her own worries about burdening you with her pregnancy concerns. So, the bottom line is that you and she will need to be as aware as possible, both of one another's needs, and of your own needs as you determine how or whether to lean on each other. It is possible that each of you will decide that certain topics are still good to share, whereas the strong shoulders of other friends are more suited for other topics. And, as her pregnancy continues, you will constantly need to revisit your relationship and how you can remain emotionally responsive to each other. Should she experience a pregnancy loss or some unexpected pregnancy complications, you both will learn still more about how resilient your relationship can (or cannot) become.

And then your friend may be "just" a friend. But friends come in many shapes and sizes, so you'll need to think about your shared history, how you have worked through past difficulties, her empathy as you've struggled and coped with infertility, and whether she has plenty of other friends with whom she can discuss her pregnancy and plans for motherhood. And, just as you will do with a sister, a cousin or a member of your infertility network, it will be easier to move forward in your relationship if you and she can be clear as possible about how to keep your communication open.

Although I began this blog with the assumption that your friend is pregnant, we should keep in mind that an impending adoption can bring about many of the same responses between you and your friend. If she is adopting, she may share your experience with infertility. Or she may be a single "mom-to-be" by choice. Or she may be a lesbian. Or she may have chosen adoption as a way to expand her family for a wide range of reasons. However, she is progressing along this adoption pathway with high hopes for motherhood, and it will be challenging for her to contain her excitement as she anticipates the arrival of her child. So you and she, as with any other pregnant friend, will need to be as open as possible about how to move forward in your friendship.

So, what are some of the topics that you and your friend are likely to need to discuss? Here are a few:

• How do you feel about hearing about the details of her pregnancy? How does she feel if you would prefer she keep these details to herself? Does she have other friends with whom she can have these pregnancy discussions?


• Is it difficult for you to be with her as her abdomen swells, as she wears maternity clothes, and as she looks increasingly pregnant? Can e-mails and phone conversations substitute for in-person lunches, coffees and walks in the woods?


• Will it be painful for you to be included in/invited to her baby shower? If so, will she understand and be willing to help other friends and family members to be sensitive about your absence?


• Is it likely you will be asked to be her baby's godmother? If so, you need to think this through carefully. To accept this new role will cause you to have feelings of obligation and responsibility that will guide your connections with this baby for many years.


• If there is a christening, a baptism or a bris, will it be painful for you to attend? Will she be supportive of your decision and help other friends and family to support you in this choice?


• After the baby is born, what sort of contact will be most comfortable for you? This may not be something you can know in advance, but you and your friend should keep all options open, which can include baby-less lunches/coffees/healthy walks as opportunities to spend time with your friend.

At any time during her pregnancy and early motherhood, both of you will want to check in with each other about whether there are things you need to revisit in your evolving relationship. Remember that this is a two way street and each of you wants to understand how to be as thoughtful as possible about the issues that arise, many of which will be unexpected (think of your baby-less times being interrupted by mutual friends descending to ask your friend about the baby, as they compare notes on their own pregnancies and new motherhood experiences. Those of you who have read the chapter entitled "The Club" in my book When You're Not Expecting, will understand this example all too well).

Another decision you may find yourself making, either during your friend's pregnancy or during her months of new motherhood, could have to do with expanding your own friendship network. It isn't to say that your friend will be less available to you (which certainly is very possible), but to emphasize the creativity you can use at this time. Not only may you need more friends without pregnancies or young children, but you also may want to find friends who can distract you from the challenges of your infertility. So, with that in mind, consider befriending individuals/couples who happily think of their lives as child-free, individuals/couples who are empty nesters, and individuals/couples who share interests or hobbies you would like to develop more fully.

A friend's pregnancy may arrive like a bolt from the blue, but once you've caught your breath you can use this new event as an opportunity to think more purposefully about what you need and can offer in a friendship. Remember to keep the emphasis on mutuality, on open communication and also on expanding your friendship network in new ways.

Pregnancy Loss: How to respond with compassion

So, you have just learned of the pregnancy loss of a friend, a relative, a co-worker or an acquaintance. You want to offer an appropriate response, but you're not sure what that might be. In this blog we'll look at the considerations you'll want to keep in mind as you offer a comforting response.

A number of readers of my most recent blog have written to me, asking how to respond when learning of a pregnancy loss. You have acknowledged the awkwardness of not knowing what is the "right thing" to say, as well as the lack of familiarity with what the term pregnancy loss might encompass. And you are aware that, all too often, the world just turns its head when learning of a pregnancy loss. There may have been no bulging abdomen, no sonogram being passed around, maybe not even a public announcement of the pregnancy. Or there may have been all of these things plus more. What is missing in both circumstances is any ritual whereby comfort can be extended to the grieving couple. There are no Hallmark cards, no funerals, no gravestones, no memories to be shared among the mourners. Only a void. And it is into this void that you may decide to venture, with the hope that you are able to offer some support and comfort.

So let's consider a few things that will influence your thoughts about how to reach out to the couple. Keep in mind that a pregnancy loss may mean something different to each of them; also keep in mind that both are sad, so please do not fall into the trap of asking one partner how the no-longer-pregnant partner is doing. It is true that the woman has lost the pregnancy, but both of them have lost the dream of becoming birth parents to this baby, and both of them deserve a genuine expression of your sorrow.

Although pregnancy loss can mean a miscarriage or a stillbirth, it also can come about as a result of the agonizing decision of the parents to terminate the pregnancy, either because of learning the results of prenatal genetic testing or because a multi-fetal pregnancy reduction has been advised by the couple's physician who fears for the outcome of the pregnancy if the woman attempts to carry all fetuses to term. Some couples are comfortable sharing this decision with others, but many anticipate they will be harshly judged for their decision to terminate the pregnancy and they decide to present the pregnancy loss as a miscarriage. Regardless of how open the couple may be about the circumstances surrounding their loss, you will want to empathize with their sadness and to ask how you can help.

For some couples, the pregnancy loss is a dimension of their infertility. They may have had difficulty conceiving; they may have had earlier pregnancy losses; this may be a loss from an ectopic pregnancy (where the embryo begins to develop outside the uterus, often in a fallopian tube); or they may be told after an IVF procedure that, although they had a chemical pregnancy, the hormone levels did not rise sufficiently to sustain hope that the fetus would develop. For any couple grappling with infertility, a pregnancy loss is a terrifying reminder that they cannot take birth-parenthood for granted. Another, less discussed, form of loss occurs when a couple has made a plan to adopt, and the birth mother either loses the pregnancy or decides to keep the infant after its birth. The prospective adoptive couple has invested so many hopes in this adoption, that the loss will be a devastating end to what may have been years of infertility. So, with infertility as a backdrop, any form of pregnancy loss feels especially devastating.

Some people assume that the attachment to a pregnancy grows in proportion to the number of months the pregnancy was sustained. It is more accurate to let the couple tell you what this loss means to each of them, because that will enable you to understand more fully the emotions they had attached to this pregnancy, regardless of how far along it had progressed. And hearing from the couple will prevent you from saying hurtful remarks like "It's probably for the best," or "You can always try again." Instead it will feel more supportive to say "This is such a difficult time for you. Please tell me how I can be helpful/ let me know when you feel like a visit/ tell me if I can bring over some food (books, flowers) or run some errands for you." And then prepare to be a good listener.

Being a good listener is a gift, since it involves being emotionally present, accepting both anger and tears, and hearing various versions of events time and time again as the grieving person tries to make sense of this loss and what the future might hold. Although it may be tempting to offer what I call "false reassurances" ("I'm sure you'll be a parent some day," "You will begin to feel better soon,"), be aware that this response is more a reflection of your discomfort with the current sadness than it is an accurate prediction of hope for your friend. Try to be patient with the time your friend needs to absorb this sadness and to make sense of it.

Some couples decide that they want to have a quiet service to honor this baby who will never be born. Whether conducted by a spiritual leader or created by the couple and their loved ones, such a service can enable supportive friends to reassure the couple and their family of ongoing emotional support and compassion for their loss.

Some grieving couples appreciate the opportunity to talk about how they can memorialize this child whom they had hoped to parent. Keep in mind that many would-be parents have already discussed (and perhaps chosen) names, selected (or envisioned) nursery colors and decor, and begun to save items for the baby scrap book like congratulations cards and sonogram photos. For them this is not a pregnancy loss so much as the death of their dream child. In my book When You're Not Expecting, I mention couples who plant a memorial garden, donate to a children's library or a day care center, or identify a cause that they commit to in memory of their dream child.

Even months after a pregnancy loss, there can be a number of painful reminders that cause the pain to resurface. The previously-anticipated due date is one symbolic time. Celebrations of others' pregnancies and births can be emotionally difficult. Even the sight of a nursing mother or a father cuddling a newborn can evoke waves a sadness. These and other reminders of lost opportunities may be mentioned by someone who has lost a dream child, and your empathic response will be very much appreciated.

So, the take-away message to the question of how to respond with compassion is

• There are many ways in which pregnancy loss can occur. Communicate your wish to be a good listener so that you can understand the particular meaning this loss has for each member of the couple.
• Remember that the partner of the pregnant woman deserves to be recognized as someone who is entitled to grief, rather than being seen solely as the stoic comforter and protector.
• If infertility is a backdrop to this pregnancy loss, you will want to appreciate the couple's feelings of failure and desperation as they fear they may never become birth parents.
• Be patient, and let the couple know that you understand it takes time to grieve such a poignant loss and to make sense of how their lives have changed.
• Be aware of the mixed emotions couples may feel when being invited to celebrate news of pregnancies, births, or other events associated with successful reproduction.

Pregnancy Loss and Discounted Grief

The grief following a pregnancy loss is unique. Couples often feel uncomfortable sharing information about this loss and acquaintances, many of whom may not even have known of the pregnancy, are unfamiliar with how to respond. Why is this? Typically pregnancy loss can be relatively invisible unless you choose to share this information. There are no rituals to help you mourn this loss. There are no Hallmark cards. Your physician probably relates to this loss in terms of your physical recovery. So what do you do with the feelings that assail you and your partner once you realize that you no longer are "almost parents?"

Each person will experience a pregnancy loss differently, which means that you will need to be clear with relatives and friends about what they can do to be helpful. If you need privacy, say so. If you need people to run errands for you, let them know. If you need emotional shoulders to lean on, patient visitors, good listeners, then choose your loved ones carefully, because people differ in the extent to which they can tolerate your sadness without feeling obliged to cheer you up.

You also need to be prepared for the unexpected: the person who last saw you wearing maternity clothes who expresses surprise that you now have a waistline; the acquaintance who has heard about your loss and seeks to comfort you by suggesting that perhaps this is "for the best," or "you can always try again;" the person who expresses surprise that, weeks later, you are still feeling sad instead of getting back to "normal," whatever that is. And it isn't just people -- how about the advertisements for everything from diaper services to baby gear that continue to crowd your mailbox, your phone calls and your e-mail? It seems as if your pregnancy is on automatic pilot for the retail world.

There is another dimension that also is important to have in the forefront of your awareness. Typically even one's most sensitive relatives and friends will see the person who lost the pregnancy as the one deserving of sympathy and attention. Her partner, on the other hand, tends to be asked "How is she doing?" and "Is there anything I can do to help her?" What's wrong with this picture? Do people not appreciate that the partner also has had life hopes and dreams derailed? Do they not recognize the emotional upset that comes with supporting a formerly pregnant loved one as well as figuring out how to handle one's own grief? Do others really feel that you are not entitled to heart-wrenching sadness unless it was your body that bore the pregnancy?

So, along with sorting out your own emotions when others may be confused or insensitive, you also will want to talk openly with your partner about how each of you is handling this sad time in your lives. And be sure to talk about what you need your partner to do to offer comfort to you. It is important to respect that the two of you may have different ways of working through your sadness, but keeping the channels of communication open is a significant challenge.

And it is important to be aware of sources of support that are probably present in your community: spiritual leaders, professional counselors, support groups (many of which you can learn about from the social worker of your local hospital), as well as books and chat rooms that focus on pregnancy loss. This is a time to indulge yourself in taking time to regain your emotional equilibrium, even if the rest of the world seems to be expecting you to have put this loss behind you. In my book, When You're Not Expecting, I emphasize the opportunity to use pregnancy loss as a time to grow emotionally, to bond more sensitively with loved ones, and to decide how to move forward with life following this poignant jolt to your hopes and dreams. So don't let anyone discount your grief -- you are entitled to it. And, with support, hopefully you will find your own ways of weaving it into a new and more resilient emotional perspective.