Struggling with infertility? An interview about the need for support with psychologist Anders Möller

Many people who are suffering from infertility need support. Infertility is not a choice, and can be a long and difficult journey. Psychologist Anders Möller answers your questions and offers ideas for what support can look like for you.

Who are you?

In the mid-1970s, I started working as a psychologist in a hospital. One of the areas I came in contact with there was involuntary childlessness and infertility.

At that time, there was no IVF, but affected couples had to undergo many examinations in order for them to possibly receive treatment or donated gametes.

It was clear to me very early on that infertility was to be regarded as a life crisis. I was captivated by the fact that the problem was so all-encompassing.

It touches us as individuals, as couples, and as patients, and it really raises questions about life and our existence at its core. However, there was very little research on the psychological aspects of infertility, both internationally and in Sweden, and the little research that existed was neither well done nor well thought out.

Therefore, I decided to do a study of couples struggling with infertility. This became my doctoral dissertation, which I defended in 1985 (Psychological aspects of infertility, Department of Psychology at the University of Gothenburg). After this, I have continued to work with this problem at various hospitals and fertility clinics.

Many who struggle to have children experience grief. How can you mourn something you have not really lost? 

Many ask this question. To me, it's clear that you can just as easily mourn dreams, hopes and desires that are not fulfilled the way you would mourn anything else.

The dreams, hopes and desires can also have even more weight than anything that has actually existed because they are unlimited and unseen.

This in turn makes it more difficult to imagine and provide a concrete value, which can make the process longer and more complicated.

When the desires for a child are unmet, many things are challenged for us. We all need belonging, to be a part of something. It can be about feeling connected with our partner, which we feel will increase if we have a child together, or belonging with other women and other men who have children.

A man once said to me, "Why can't I do what all other men can?" Many women may feel that they are not "real women" if they cannot have children, even if they know intellectually that this is not the case.

The connection we feel with the child we desired also goes unfulfilled if we cannot have children - but it can be fulfilled if we have children in some other way.

Everyone knows that for most people, the connection with their children is very central in life.

Children require a lot of time, commitment, thoughts and feelings from their parents. Just as much time, commitment, thoughts and feelings are devoted by couples who do not have children, for the child they do not have. This includes practical measures, such as doctor visits, medication intake, attempts to organize everyday life, etc.

Lots of emotions and thoughts about how it will go, what steps we should take next, how we should optimize the chances of success and much more are always a constant reminder for the couple. 

Maybe you can even say that belonging to oneself, or identity, is threatened when we do not have the children we so desperately desire, have dreamed of, and have assumed would happen all our lives. "Who am I if I do not have any children?"

We know from both Swedish and international research that most young people envision a future with children and family. There are those who don't, but the majority do.

In addition, young people are told that they should be careful to not become pregnant when they have sex. That gives them the idea that once they want to get pregnant, it will be easy.

We think that it's is only a matter of removing the contraceptive(s). People often talk about being "in the now" and maybe we're best at that during the adolescence. But we can never be completely in the present. Our view of ourselves includes both our past and future.

So, somewhere in their minds, most young people have thoughts or ideas about a future with children and family. We also know that from many different parts of society there are expectations that we will have children.

So, who am I if I do not have children? Who are we (as a couple) if we do not have children? We might have to reconstruct our life plan.

How do you deal with grief?

Grief is something completely natural, and it is a process that requires time and work. A first aspect is that one "acknowledges" to oneself that one feels grief, and that grief is justified.

Grief associated with difficulties in having children can be prolonged, and it is difficult to put your finger on. Firstly, fertility treatment is a lengthy process in itself, and secondly, it is very difficult to know when the process is over. Maybe the next IVF attempt will succeed, or maybe we can switch to donation treatment, or maybe there will be a new treatment method…

So, when should you put an end to it and begin the "final mourning process?" There is no good answer to that question.

What I suggest is that after each step in the investigation and treatment, you sit down and make an evaluation of what has happened. Discuss how you can or should proceed, and weigh the advantages and disadvantages.

The couple needs to discuss this carefully, ideally with staff at the clinic, and also preferably with another friend or relative.

The important thing is that you get to express your thoughts and feelings. Everything has a tendency to become clear when you articulate how you think and feel.

The end goal is to have your child, but on the way there, the costs can be high and you need consider what paths are reasonable for you.

In summary, one can say that:

• It is natural to mourn when you haven't been able to have your child.
• When you mourn, be with your feelings and thoughts. Let yourself really sit with them.
• It is important to express your thoughts and feelings.
• You do not need to be ashamed of mourning.
• Mourning takes time.
• To mourn is usually not an "either/or." Sometimes your grieving hurts and sometimes it feels almost good, only for it to hurt again in the next moment. Getting out of one's grief is thus not something that is done at a certain time, or once and for all. You might return to the emotions throughout life, but gradually they hurt a little less, and you can redirect your focus on other things in life.
• Grief can lead us to finding a new story that we may become friends with.