When Infertility Ends in Reproductive Loss
When infertility leads to pregnancy loss, the grief can feel unbearable — a collision of heartbreaks that shakes one’s identity, purpose, and hope. Learn how reproductive mental health professionals help individuals process compounded grief, find meaning, and begin to heal.
When Hope Turns to Heartbreak
Chloe’s reproductive endocrinologist referred her to therapy after noticing how emotionally depleted she’d become during treatment.
For three years, Chloe and her husband, John, have been battling infertility. Three rounds of IVF brought brief moments of hope — and three devastating losses. The most recent loss occurred at 20 weeks. Since then, Chloe has struggled with depression, anxiety, and a growing fear that she’ll never carry a baby to term.
The couple plans one final IVF attempt before ending treatment. Chloe is open to adoption, but John remains unsure. As the eldest child of two physicians and a lifelong high achiever, Chloe describes her inability to conceive as “the biggest failure of my life.”
When she finally meets with a reproductive mental health therapist, Chloe admits she’s exhausted — emotionally, physically, and spiritually. She doesn’t know where to turn or how to recover from the pain of losing not just her pregnancies, but the future she imagined.
“I feel like I’ve failed at the one thing I wanted most.”
— Chloe, fertility patient
Chloe’s story is not unique. Many people facing infertility also endure reproductive loss, and the compounded grief can be one of the most profound psychological challenges an individual can experience.
The Overlapping Trauma of Infertility and Loss
A diagnosis of infertility alone can trigger intense emotional distress, often described as an existential crisis that shakes one’s sense of identity and purpose. Research shows that infertility patients experience depression and anxiety at rates similar to those facing serious medical illnesses (Rooney & Domar, 2018).
A landmark study by Alice Domar (1992) found that women undergoing fertility treatment were twice as likely to experience depressive symptoms as those not in treatment. More recent research shows that up to 56% of fertility patients report depressive symptoms, while 15–30% experience anxiety disorders (Howard et al., 2025).
When infertility is followed by reproductive loss (such as miscarriage, stillbirth, or pregnancy termination) the psychological toll multiplies. These experiences can disrupt one’s sense of safety, identity, and meaning, leading to complicated grief, PTSD, or marital strain (Bhat & Byatt, 2016).
“To experience both infertility and loss is to grieve the same dream twice.”
Understanding Reproductive Loss
Reproductive loss can take many forms, each carrying its own emotional and physical challenges:
Miscarriage: Loss before 20 weeks, occurring in about 10% of known pregnancies (ACOG, 2018).
Recurrent Pregnancy Loss (RPL): Two or more consecutive miscarriages, affecting 2–6% of couples (ASRM, 2021).
Stillbirth: Loss after 20 weeks, affecting about 2% of pregnancies (Markin, 2025).
Termination for Fetal Anomaly: The decision to end a wanted pregnancy due to severe or fatal diagnosis.
Elective Termination: While not always classified as reproductive loss, some individuals experience grief and shame afterward.
Each form of loss represents a profound interruption in a person’s reproductive story, the imagined path to parenthood.
Why Reproductive Loss Feels Different for Fertility Patients
For individuals like Chloe, who have fought tirelessly to conceive, reproductive loss carries a unique emotional burden.
Anxiety During Pregnancy: Years of uncertainty make even a confirmed pregnancy feel fragile.
Compounded Grief: Failed cycles, negative tests, and miscarriages stack one atop another, intensifying the pain.
Self-Blame and Guilt: Many patients internalize failure, believing they did something wrong or their body “betrayed” them.
These overlapping losses can make it difficult to find hope or envision life beyond treatment. Working with a reproductive mental health professional can help patients reframe their experiences, process grief, and rebuild meaning.
Frameworks for Healing and Growth
Several therapeutic models help patients conceptualize their experiences and move toward healing.
1. The Stages of Grief (Kübler-Ross, 1969)
Though not linear, these stages help individuals understand their emotional landscape:
Denial: Shock and numbness protect against overwhelming pain.
Anger: Rage at oneself, others, or fate.
Bargaining: “What if I try one more cycle?” — a desperate search for control.
Depression: Sadness and withdrawal as reality settles in.
Acceptance: Integrating the loss into one’s life, not erasing it.
Recognizing these stages normalizes emotional responses and fosters self-compassion.
2. The Reproductive Story (Jaffe, 2011; 2017)
Clinical psychologist Janet Jaffe, Ph.D. describes the reproductive story as the lifelong narrative we build around becoming a parent.
From childhood, many of us envision growing up, forming families, and having children. When infertility or loss interrupts that narrative, it feels like the story has been rewritten without consent.
Therapy helps patients acknowledge the loss of their original story and begin to author a new one — one that honors the past but embraces possibility.
“Healing begins when we learn to rewrite our reproductive story.”
3. The Resiliency Model (Leon, 2023)
Psychologist Irving Leon, Ph.D. identifies key components that foster resilience after reproductive loss:
Active Coping: Balancing grief with the rhythms of daily life.
Meaning-Making: Exploring purpose and understanding amid pain.
Continuing Bonds: Honoring the pregnancy through rituals or remembrance.
Secure Attachments: Building or repairing supportive relationships.
Positive Emotions: Cultivating gratitude and optimism through journaling, mindfulness, or small joys.
Post-Traumatic Growth: Transforming trauma into strength — through advocacy, faith, or renewed empathy for others.
The Role of the Reproductive Mental Health Professional
Reproductive mental health specialists are uniquely trained to help patients navigate infertility, loss, and reproductive trauma. Their support can include:
Distinguishing between grief and clinical depression.
Guiding couples through communication challenges.
Using evidence-based approaches like CBT, EMDR, or grief therapy.
Helping patients integrate loss and rediscover hope.
For Chloe, therapy represents a lifeline — a place to process, to name the pain, and to start imagining a future that feels possible again.
Finding Light After Loss
The journey through infertility and reproductive loss can feel endless. But healing is possible: not through forgetting, but through transformation.
Many who’ve walked this path find renewed meaning in advocacy, parenting through alternative paths, or simply living with deeper empathy and gratitude.
With compassionate care and professional support, those grieving reproductive loss can rediscover resilience, connection, and hope.
“Healing doesn’t mean moving on — it means moving forward with love.”
If You’re Struggling
If you or someone you love is coping with infertility or pregnancy loss, you’re not alone. A reproductive mental health professional can help you find strength, compassion, and a path toward healing.
Learn more: seleni.org/therapy-services
For Mental Health Professionals
At the Seleni Institute, we offer specialized fertility coursework designed for mental health professionals who want to expand their practice and better support clients utilizing and navigating third-party reproduction.
Our evidence-based CE courses will help you:
Understand the psychosocial dimensions of fertility care.
Gain confidence in conducting evaluations and consultations.
Apply ASRM guidelines in clinical practice.
Support clients with empathy, clarity, and competence through one of the most complex experiences of their lives.
Explore our coursework and join the growing community of mental health professionals advancing reproductive care.
References
ACOG Committee on Practice Bulletins. (2018). Early Pregnancy Loss. Obstetrics & Gynecology, 132(5), e197–e207.
ASRM. (2021). What Is Recurrent Pregnancy Loss? Retrieved from reproductivefacts.org
Bhat, A., & Byatt, N. (2016). Infertility and Perinatal Loss: When the Bough Breaks. Current Psychiatry Reports, 18(3), 31.
Domar, A. D., Broome, A., Zuttermeister, P. C., Siebel, M., & Friedman, R. (1992). The Prevalence and Predictability of Depression in Infertile Women. Fertility and Sterility, 58(6), 1158–1163.
Howard, L. M., et al. (2025). Women’s Reproductive Mental Health: Current Evidence and Future Directions. World Psychiatry, 24, 196–215.
Hutner, L. A., Catapano, L. A., Nagle-Yang, S. M., Williams, K. E., & Osborne, L. M. (2022). Textbook of Women’s Reproductive Mental Health. American Psychiatric Association.
Jaffe, J. (2017). Reproductive Trauma: Psychotherapy for Pregnancy Loss and Infertility Clients from a Reproductive Story Perspective. Psychotherapy, 54(4), 380–385.
Jaffe, J., & Diamond, M. O. (2011). Reproductive Trauma: Psychotherapy with Infertility and Pregnancy Loss Clients. American Psychological Association.
Leon, I. (2023). Resilience in Reproductive Loss. In Covington (Ed.), Fertility Counseling: Clinical Guide and Case Studies. Cambridge University Press.
Markin, R. (2025). Psychotherapy for Pregnancy Loss: A Relational Perspective. National Register of Health Service Psychologists.
Rooney, K. L., & Domar, A. D. (2018). The Relationship Between Stress and Infertility. Dialogues in Clinical Neuroscience, 20(1), 41–47.
Schwerdtfeger, K. L., & Schreffler, K. M. (2009). Trauma of Pregnancy Loss and Infertility for Mothers and Involuntarily Childless Women. Journal of Loss and Trauma, 14(3), 211–227.
