Grief Resources

by Band Back Together | Aug 15, 2018

What Is Grief?

Grief is a normal human response to the loss of something or something significant. Grief is a journey toward healing and recovering from this significant loss. Grief reactions may be felt in response to physical losses (the death of a loved one) or in response to symbolic or social losses (divorce, loss of job). Either type of grief reaction involves something being taken away.

Read more about loss.

Read more about help with grieving.

Coping with the loss of someone or something you love is one of life’s biggest challenges. Often, the pain of loss can feel overwhelming. You may experience all kinds of difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt your physical health, making it difficult to sleep, eat, or even think straight. These are normal reactions to significant loss. But while there is no right or wrong way to grieve, there are healthy ways to cope with the pain that, in time, can ease your sadness and help you come to terms with your loss, find new meaning, and move on with your life.

Before healing from grief may begin, one must accept and manage the pain of loss. Grief is as individual as each person experiencing it. There is no right or wrong way to grieve.

Grief is a very natural process but we, as highly intelligent humans, often think we can ignore our bodies and hearts and just “get on with it.” Pay attention to your body, your heart, your soul and your family. They will never lead you astray.

Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense your grief will be. You may associate grieving with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief, including:

1. Divorce or relationship breakup
2. Loss of health
3. Losing a job
4. Loss of financial stability
5. A miscarriage
6. Death of a pet
7. Selling and moving from the family home
8. A loved one’s serious illness
9. Loss of a friendship
10. Traumatic responses
11. Retirement
12. Loss of a dream

Even subtle losses in life can trigger a sense of grief. For example, you might grieve after moving away from home, graduating from college, or changing jobs. Whatever your loss, it’s personal to you, so don’t feel ashamed about how you feel, or believe that it’s somehow only appropriate to grieve for certain things. If the person, animal, relationship, or situation was significant to you, it’s normal to grieve the loss you’re experiencing. Whatever the cause of your grief, though, there are healthy ways to deal with the pain and eventually come to terms with your loss.

What Are Some of the Symptoms of Grief?

While loss affects people in different ways, many of us experience the following symptoms when we’re grieving. Just remember that almost anything that you experience in the early stages of grief is normal—including feeling like you’re going crazy, feeling like you’re in a bad dream, or questioning your religious or spiritual beliefs.

Emotional Symptoms of Grief:

Shock and disbelief. Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting them to show up, even though you know they’re gone.

Sadness. Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.

Guilt. You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.

Anger. Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.

Fear. A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.

Physical Symptoms of Grief:

We often think of grief as a strictly emotional process, but grief can and will involve physical problems, including:

• Fatigue
• Nausea
• Lowered immunity
• Weight loss or weight gain
• Aches and pains
• Insomnia

Normal Patterns of Grief:

Grieving is a highly individual experience; there’s no right or wrong way to grieve. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and how significant the loss was to you.

Inevitably, the grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

Several patterns of grief have been identified and documented, but it is important to remember that grief is as individual as the person experiencing it.

Early Phase of grieving is marked by shock, dismay and disbelief. It leaves a person feeling unproductive, dazed and mechanical as they try to function. This phase of grief may last hours, minutes, days or weeks, although thanks to psychological numbing, the person may not remember what has happened during this period.

Middle Phase of grief is marked by much intense pain with more intense reactions. The middle phase lasts many months. Even after life seems to be back to normal, a chance remark can cause those feelings to resurface.

Late Phase of grief is the process characterized by glimmers of hope, renewed sense of coping and a returning sense of well-being, and a renewed belief in life.

What Are The Five Stages of Grief?

The Five Stages of Grief were postulated by Elizabeth Kubler-Ross after interviewing 500 dying patients. It describes, in five separate stages, the model by which people cope with and handle grief, tragedy, and catastrophic loss.

These stages have been accepted as the Five Stages of Grief, although these stages are not meant to be completely linear or chronological stages. Nor does everyone dealing with a catastrophic loss experience the five stages in the same manner. Some stages may be missed, some re-experienced, while some may get stuck in one stage.

Grief is as unique as the person experiencing it.

1. Denial and Isolation. Commonly, when a person is faced with a catastrophic event, they feel denial. Their reaction is one of shock and disbelief: “I’m fine,” or “This cannot be happening to me.” Denial is a built-in coping mechanism allowing the pain to seep through the numbness in small increments. If all the pain hit at once, it would be debilitating. Those grieving may isolate themselves from social contacts while denying the loss.

2. Anger. The individual experiencing the loss realizes that denial cannot continue. The person becomes outraged, envious, and full of anger. Anger can be healing. While the anger may be directed toward no one at all, it may spill out into the grieving person’s relationships with other people. The anger shouldn’t escalate to a dangerous level, but a healthy amount is therapeutic. The anger you feel is an indication of the intensity of your love and loss. “Why me?” and “Who can I blame?” are common reactions during this stage of grief.

3. Bargaining. After the anger abates, those who are grieving enter a stage of bargaining with God. This stage is reminiscent of childhood days when children plead with their parents. It’s almost as though the bereaved is saying, “Now that I’m no longer angry, can I have a little more time?” Someone in this stage of grief may say things like, “Please just let me see my child get married” or “Please let me have a few more minutes with my loved one.”

4. Depression. When the bereaved realizes they cannot deal their way out of this situation, reality sets in. Depression leads to sadness, grief, as the full weight of what they have lost or are in the process of losing sinks in. The bereaved cries and mourns and wonders how they can continue. It may be helpful for those in this stage of grief to talk through their feelings with a counselor or even good friends. This stage, along with the others, will ebb and flow over weeks, months, or possibly years.

5. Acceptance. Acceptance is the most confusing stage of grieving. Though the bereaved accepts that they have experienced a significant loss, they are never truly “over it.” People on the outside of the situation will assume the bereaved has moved on. During acceptance, the bereaved learns how to live their “new normal.” It’s much like learning to walk again but without a limb. It will NEVER be like it was, but life can can be lived again.

Abnormal Grief Reactions:

Anticipatory Grief is the emotional response that occurs before the loss itself. The emotional response has many of the characteristics of grief itself with a couple exceptions. With anticipatory grief, one hopes that the loss one anticipates will not occur. The uncertainty and wishing it would happen while dreading the finality of the loss make the grieving process more unstable.

Chronic Sorrow is the presence of pervasive grief in people with chronic illnesses, their caregivers, and the bereaved. It’s thought to be a normal response to an incomplete or ongoing loss.

While grieving a loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and eventually, find a way to pick up the pieces and move on with your life.

1. Acknowledge your pain and loss
2. Accept that your grief can trigger many different and unexpected emotions
3. Understand that your grieving process will be unique
4. Seek out face-to-face support from people who care about you.
5. Support yourself emotionally by taking care of yourself physically.
6. Recognize the difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy as they share many symptoms, but there are ways to tell the difference. Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will still have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Other symptoms that suggest depression, not just grief, include:

Types of Grievers:

Grief is a very complicated emotion and one who is deeply grieving may feel as though he or she is “grieving wrong”. There are several types of grievers – none are wrong. All are normal:

The Intuitive Grievers

A person who is an Intuitive Griever feels the experience of grief with great intensely. He or she may be helped by expressing his or her grief emotionally, often by crying. One of the best ways for the Intuitive Griever to cope with his or her grief is to express his or her emotions about the grief freely and openly, possibly in a group setting.

Common Characteristics of Intuitive Grievers include:

• Expresses his or her feelings openly.

• Anguish is expressed with sorrow with tears.

• An Intuitive Griever is not afraid to find support in other people.

• He or she allows the proper time to fully experience the inner pain.

• During the grief process, he or she may become physically exhausted or riddled with anxiety.

• During the grief process, he or she may experience long periods of confusion.

• The confusion may make way toward an inability to concentrate.

• Has the ability to openly discuss the grief.

• May benefit from support groups.

The Instrumental Griever

The Instrumental Griever feels grief, but less intensely and more physically. He or she may use thinking and problem-solve as ways of coping with the grieving experience. The Instrumental Griever must have a tangible, physical way to express the grief. He or she may be reluctant to talk about feelings.

Common Characteristics of Instrumental Grievers Include:

• He or she may push aside feelings of grief in order to cope with the present situation.

• Chooses active ways of expressing grief.

• May be hesitant to discuss his or her feelings.

• May use humor to express his or her feelings as well as to manage anger.

• Feelings may only be expressed in private.

• Needs – and seeks – solitude to reflect upon the grief and adapt to the loss.

• He or she may not find a support group setting an ideal place to discuss his or her feelings.

The Dissonant Griever:

The Dissonant Griever handles grief one way but feels uncomfortable with the manner in which they experience grief. A Dissonant Griever may feel that openly expressing his or her feelings about the grief may be inappropriate. Or, an Instrumental Griever may feel guilt and shame for being unable to express his or her emotions about the grief in the way that an Intuitive Griever can.

These conflicting feelings make it uncomfortable for the Dissonant Griever to deal with their grief and, therefore, harder for them to grieve

What Is Complicated Grief?

Complicated grief is grieving that is incapacitating, usually over a long period of time, and involves disorganized, depressed behavior. Professional help is always needed in cases of complicated grief.

Symptoms of Complicated Grief:

• Excessive focus on the loss
• Continued and intense longing/pining
• Difficulty accepting the loss
• Feeling numb or detached
• Distracting or consuming sorrow
• Feelings of bitterness
• Difficulty enjoying life
• Depression
• Trouble moving on
• Difficulty performing normal routines
• Withdrawal from family and friends
• Thoughts that life is pointless
• Irritability or agitation
• Distrust

Abbreviated Grief: Abbreviated grief is grief that is short-lived but genuine. It may occur in situations in which the deceased is quickly replaced (by remarriage or something similar).

Absent Grief: Absent grief is a situation in which there are no outward signs of grieving following the loss of a loved one. Absent grief may be grief that is stuffed down deep inside only to emerge in other ways like irritability, anger, or depression.

Ambiguous Loss: Ambiguous loss is a loss that is unseen or unaccepted socially as a “valid” loss. This may include a miscarriage, loss of a pet, or losing someone who has been slowly dying.

Converted Grief: Converted grief is grief that is displayed through excessive physical or psychological symptoms that are not linked by the person to their loss.

Delayed Grief: Delayed grief involves the postponement of grief for weeks, months and years. Delayed grief can abruptly be ended by subsequent losses or losses of others that are similar to their own.

Disenfranchised Grief: Disenfranchised Grief is a type of sorrow not publicly or socially recognized and the reality of the loss is unrecognized by society. Society may, in fact, stigmatize the grieving of the loss. This may occur with abortions, suicide, drug overdose, or other socially unacceptable deaths.

Distorted Grief: Distorted grief is morbid grief reaction in which anger and guilt are the two distorted types of emotions displayed.

Inhibited Grief: For those who have inhibited grief, there is some outward evidence that the person is grieving, but his or her reactions are less than expected in respect to the loss. This may occur with people who have unresolved issues with the dead or other negative emotions regarding the loss.

When You Should Call The Doctor:

If you’re experiencing symptoms of complicated grief or clinical depression, call your doctor (if you don’t have a therapist yet) right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.

• Contact a grief counselor or professional therapist if you:
• Feel like life isn’t worth living
• Wish you had died with your loved one
• Blame yourself for the loss or for failing to prevent it
• Feel numb and disconnected from others for more than a few weeks
• Are having difficulty trusting others since your loss
• Are unable to perform your normal daily activities

Memorial pages on Facebook and other social media sites have become popular ways to inform a wide audience of a loved one’s passing and to reach out for support. As well as allowing you to impart practical information, such as funeral plans, these pages allow friends and loved ones to post their own tributes or condolences. Reading such messages can often provide comfort for those grieving the loss.

Of course, posting sensitive content on social media has its risks. Memorial pages are often open to anyone with a Facebook account. This may encourage people who hardly knew the deceased to post well-meaning but inappropriate comments or advice. Worse, memorial pages can also attract Internet trolls. There have been many well-publicized cases of strangers posting cruel or abusive messages on memorial pages.

To gain some protection, you can opt to create a closed group on Facebook rather than a public page, which means people have to be approved by a group member before they can access the memorial. It’s also important to remember that while social media can be a useful tool for reaching out to others, it can’t replace the face-to-face support you need at this time

Grief in Children:

Naturally children will display grief differently than adults. Children who are unable to express their complex feelings of loss may act out through increased demands for food, love, and attention or exhibiting babyish behavior. Because children have a limited ability to consider the world outside their own sphere of influence, they may blame themselves for a loss. It is important to address this concern with children and reassure them that the loss was not their fault.

If your grief is so intense that you have thoughts of suicide, please pick up the phone and dial 911.

In addition, the National Suicide Prevention Hotline is open 7 days a week, 24 hours per day: 1-800-273-8255.

Additional Grief and Grieving Resources:

GriefShare is an international website which helps individuals locate local grief recovery support groups in the US, Canada, UK, New Zealand, Australia, and South Africa. 

GriefNet.org allows people who are grieving to set up an online memorial to their loved ones. 

Page last audited 8/2018

Infertility Resources

by Band Back Together | Aug 11, 2018

What Is Infertility?

Most people will have the strong desire to conceive a child at some point during their lifetime. Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year. As a result, infertility has come to be defined as the inability to conceive within 12 months. This diagnosis is therefore shared by 15% of couples attempting to conceive. We generally recommend seeking the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier.

Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

• A woman’s body must release an egg from one of her ovaries (ovulation).
• The egg must go through a Fallopian tube toward the uterus (womb).
• A man’s sperm must join with (fertilize) the egg along the way.
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

Infertility is a disease of the reproductive system that impairs the ability to conceive a child. Infertility may be diagnosed after a couple has been having well-timed, unprotected sexual intercourse for a full year.

Infertility may also be diagnosed if a woman is under age thirty-five and has suffered multiple miscarriages (also called “recurrent pregnancy loss” or RPL).

While infertility can be one of the most isolating challenges a couple can face, being infertile is not uncommon. In fact, 10-15 percent of couples in the US are infertile.

Infertility can be caused by one single problem in either partner, or a combination of factors that lead to a couple being unable to conceive – or carry – a pregnancy to term.

There are many safe treatments that can help a couple overcome infertility and successfully carry a child to term.

What About Infertility Treatments And Insurance?

Fifteen states have either an insurance mandate to offer or an insurance mandate to cover some level of infertility treatment. Eight of those states have an insurance mandate that requires qualified employers to include IVF coverage in their plans offered to their employees: Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island.

A study published in the New England Journal of Medicine (August 2002) found that the percentage of high-order pregnancies (those with three or more fetuses) was greater in states that did not require insurance coverage for IVF. The authors of the study noted that mandatory coverage is likely to yield better health outcomes for women and their infants since high-order births are associated with higher-risk pregnancies.

The Affordable Care Act (ACA) does not require coverage for infertility treatments. Those states with an infertility mandate that covers IVF may have chosen an Essential Health Benefits (EHB) benchmark plan that includes the IVF mandate. The EHB impacts the individual and small group markets only in each state.

What Are The Types of Infertility?

For many couples, having a child or children is one of the most important goals in their lives. Many people long to be parents and understandably so. Having children can bring great joy and purpose to our lives. Unfortunately, it is not easy for every couple to get pregnant and have a child.

In other cases, a couple may be able to have a child but then struggle to conceive or carry a second child. When a couple struggles to have a child, it is called infertility.

Infertility can take two forms: primary and secondary, but many of the causes and treatments are the same for each type of infertility.

They vary slightly, but overall are caused by the same problems and treated in the same ways. The biggest difference with these two different forms of infertility is the way that they may be perceived by others and the way that they may make you, as a couple, feel.

This resource page will focus upon Primary Infertility.

1.Primary Infertility is a diagnosis for couples who haven’t been able to conceive after a year of well-timed, unprotected sexual intercourse without any other children. Primary infertility refers to the type of infertility that a couple would be diagnosed with when they are unable to have a child at all.  A couple suffering with primary infertility is a childless couple that has never been able to conceive a pregnancy or has never been able to carry a pregnancy in order to achieve a live birth.

Having primary infertility can often lead perspective parents into a truly hopeless feeling. If you are unable to have a child, you may feel like it is impossible for you and that you will never have a child at all. You may long desperately to know what it is like to be a parent and have a child, and it is likely that you fear that you will never know that feeling.

These are all completely normal and understandable feelings.

2.Secondary Infertility occurs when couples have been pregnant at least once, but are unable to become pregnant again. This is the type of infertility that many people are unaware of. It is not uncommon to not realize that a couple that already has a child or children can suffer from infertility which is exactly what secondary infertility is.

Secondary Infertility is diagnosed when a couple has conceived a pregnancy and achieved a live birth before but is unable to achieve another pregnancy and live birth. Basically, the couple has a child or children, but is now unable to continue having children.

Secondary infertility comes with its own specific set of problems. It is not uncommon for people to lack understanding of what you are going through. Many people may look at it like since you already have a child or children, that it isn’t a big deal that you aren’t able to have more.

You even may struggle with a feeling of guilt for being unhappy about not being able to have more children. You may feel like you should be happy just having the child or children that you already have. It is important to remember that just because you want more children, it does not mean that you aren’t happy with the child or children that you do have.

It is still hard and unfair when you are unable to choose the size of your family, even if you are able to have one or some children. 

Risk Factors for Infertility:

While these are all risk factors for infertility, many times, couples find that none or many of these apply to their situation

Age. A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility. Men over age 40 may be less fertile than younger men are and may have higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.

Tobacco use. Smoking tobacco or marijuana by either partner reduces the likelihood of pregnancy. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.

Alcohol use. For women, there’s no safe level of alcohol use during conception or pregnancy. Avoid alcohol if you’re planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.

Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. A man’s sperm count may also be affected if he is overweight.

Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.

Exercise issues. Insufficient exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight. Too much exercise can lead to ovulation problems.

Stress – unfortunately, we all face an enormous amount of stress in our lives and stress is thought to be a factor in infertility for some

Poor diet – eating a proper diet is imperative for both partners in order to achieve – and maintain – pregnancy

Sexually transmitted infections (STIs) – many times a person has an STI and is unaware of it. Unfortunately, some of these STIs can lead to infertility if left untreated

Hormonal Issues – Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

What Are The Symptoms Of Infertility?

Most couples are able to conceive a pregnancy within the first six months of well-timed, unprotected sexual intercourse. After 12 months of well-timed, unprotected sexual intercourse, about 90% of couples will achieve a pregnancy.

The remaining 10% will eventually conceive – with or without ART (assisted reproductive technology).

The primary symptom of infertility is the inability for a couple to become pregnant after a year of well-timed sexual intercourse. Other symptoms – such as abnormal menstrual cycles or hormonal problems – may not be noticed until after a couple has been unable to achieve pregnancy.

It’s time to make an appointment to see a doctor (begin with your normal gynecologist who may refer you to a doctor who specializes in fertility treatments) if any of the following symptoms are noted:

• Maternal age is over 34 and the couple has been trying to conceive for at least six months.
• You’re age 35 to 40 and have been trying to conceive for six months or longer
• You’re over age 40
• You menstruate irregularly or not at all
• Your periods are very painful
• You have known fertility problems
• You’ve been diagnosed with endometriosis or pelvic inflammatory disease
• You’ve had multiple miscarriages
• You’ve undergone treatment for cancer
• Past history of endometriosis or pelvic inflammatory disease.

Men should see a doctor if he has:

• Known low sperm count
• History of testicular, sexual, or prostate problems.
• You have a low sperm count or other problems with sperm
• You have a history of testicular, prostate or sexual problems
• You’ve undergone treatment for cancer
• You have testicles that are small in size or swelling in the scrotum known as a varicocele
• You have others in your family with infertility problems

What Causes Infertility?

Conception involves a complex process of ovulation and fertilization. Conception is not an isolated event but part of a sequential process involving ovulation (release of egg from ovary) gamete formation, fertilization (union of sperm and egg) and implantation into the uterine wall.

All of the steps during ovulation and fertilization need to happen correctly in order to get pregnant. Sometimes the issues that cause infertility in couples are present at birth, and sometimes they develop later in life.

Infertility causes can affect one or both partners. In general:

• In about one-third of cases, there is an issue with the male.
• In about one-third of cases, there is an issue with the female.
• In the remaining cases, there are issues with both the male and female, or no cause can be identified

What Are The Causes of Male Factor Infertility?

There are a great deal of things that can affect production of sperm, sperm count, sperm motility or the ability of the sperm to effectively fertilize the egg. The most common causes of male factor infertility are:

Paternal age over forty. Fertility may decrease with age for some men.

Abnormal spermatogenesis (creation of sperm) or function of the sperm. This can be caused by genetic defects, scarring from infections, or undescended testicles.

Issues with sperm delivery, which can include premature ejaculation, painful intercourse, retrograde ejaculation, genetic diseases, or structural problems with the male reproductive system.

Environmental overexposure to things like chemicals, pesticides

Heat (such as frequent use of a sauna or hot tubs) which can lower sperm count and impact sperm production.

Lifestyle issues: obesity, poor nutrition, smoking, substance abuse, or overuse of alcohol.

Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.

Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.

Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana or taking certain medications, such as select antibiotics, antihypertensives, anabolic steroids or others, can also affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise the core body temperature and may affect sperm production.

Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

What Are The Causes of Female Factor Infertility?

While the causes may overlap or vary, these are the most common cause of female infertility:

Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — may also interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, injury or tumors.

Uterine or cervical abnormalities, including abnormalities with the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilized egg.

Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.

Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, radiation or chemotherapy treatment, and smoking.

Endometriosis – the tissue lining the uterus grows and implants itself outside of the uterus, causing damage to the major organs, including the reproductive organs.

PCOS (Polycystic Ovarian Syndrome) – is a condition in which the hormone androgen is elevated and causes ovulatory disorders.

Hyperprolactinemia – elevated levels of the hormone that stimulates lactation in women who aren’t pregnant or nursing can also affect ovulation.

Uterine Fibroids – benign tumors in the wall of the uterus are common – rarely they can cause blockage to the Fallopian tubes, inhibiting ovulation. More frequently, fibroids interfere with the implantation of a fertilized egg into the wall of the uterus.

Pelvic Adhesions – bands of scar tissue from previous surgeries, appendicitis, or other infections of the pelvic region can impair fertility.

Thyroid Problems – Hypothyroidsim or hyperthyroidism can impact fertility by interrupting the normal menstrual cycle of a woman.

Cancer and Cancer Treatment – cancers – especially those that affect the reproductive system, can severely impact a woman’s fertility. And the treatment of cancers – radiation and chemotherapy – can affect a woman’s reproductive function.

Medications – certain medications can temporarily affect fertility in women. Generally speaking, when the medication is stopped, fertility returns to normal.

Early Menopause – defined as the absence of menstruation and depletion of ovarian follicles prior to age 40. While it’s unknown why some women enter early menopause, it can be caused by disease, radiation, smoking, or chemotherapy.

Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman’s fertility. Genetic abnormalities also can make conception and pregnancy less likely

How Is Infertility Treated?

Treatment of infertility depends on the root cause for the infertility. Up to 60% of those considered technically infertile became pregnant (numbers do not include IVF) upon receiving fertility treatments of treatments aimed at curing the underlying cause.

One out of every five couples diagnosed as infertile eventually becomes pregnant without treatment.

Treatment for infertility may be as simple as education about the proper timing for sexual intercourse to become pregnant.

Medications may be prescribed to promote ovulation, treat infections, or clotting disorders.

Assisted Reproductive Technology Procedures like IUI (intrauterine insemination) and IVF (in vitro fertilization) may be used.

How Is Infertility Prevented?

It’s extremely important to remember that most causes of infertility have nothing to do with you and your partner not practicing proper habits. Most of the time, infertility is not preventable. However, here are some things you can try to do to prevent infertility:

Couples

Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Having intercourse beginning at least 5 days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs at the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.

Men

For men, although most types of infertility aren’t preventable, these strategies may help:

• Avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility.
• Avoid high temperatures, as this can affect sperm production and motility. Although this effect is usually temporary, avoid hot tubs and steam baths.
• Avoid exposure to industrial or environmental toxins, which can impact sperm production.
• Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
• Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.

Women

For women, a number of strategies may increase the chances of becoming pregnant:

• Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, such as marijuana or cocaine.
• Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
• Exercise moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
• Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility

How To Cope With The Emotional Aspect of Infertility:

Whether you are coping with infertility or someone you love is trying to ride the roller coaster of infertility, there are a lot of emotions associated with infertility and the inability to get pregnant easily.

Here are some tips for coping with infertility:

Find and locate others (perhaps through a support group) that are experiencing the isolation and challenges of infertility. It’s a very lonesome time for many couples – having someone(s) around who are able to understand exactly what you are going through can be a lifesaver.

Don’t be afraid to tell others what you are going through – if they do not know, it’s impossible for them to be sensitive to what you are going through.

Be prepared to deal with the assholes who don’t understand WHY you feel so saddened about being unable to easily conceive. Prepare a list of comebacks to dish out to anyone who wants to trivialize what you’re going through.

Protect your feelings. If going to a baby shower is going to be tremendously challenging for you, simply do not go. Send a gift card and be done with it. You have enough things to deal with – don’t borrow trouble.

Be honest with your partner about your feelings, but do not expect your partner to mimic your feelings exactly. No two people grieve alike.

Speaking of grief, infertility is a loss and is allowed to be mourned. Being unable to conceive a child can be one of the greatest losses you will ever face.

If your grief and sadness become too powerful, don’t be afraid to talk to a mental health professional. He or she can help you as a sounding board and help to teach you coping strategies.

Additional Infertility Resources:

Resolve provides timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.

The InterNational Council on Infertility Information Dissemination, INC. (INCIID – pronounced “inside”) is a nonprofit organization that helps individuals and couples explore their family-building options. INCIID provides current information and immediate support regarding the diagnosis, treatment, and prevention of infertility and pregnancy loss, and offers guidance to those considering adoption or child-free lifestyles.

March of Dimes – Guidance and information for couples who are trying to get pregnant.

Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss – a book focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.

Page last audited 8/2018

How To Help A Friend Through Miscarriage

by Band Back Together | Aug 9, 2018

What Is A Miscarriage?

Miscarriage is the term for a pregnancy that ends on its own within the first twenty weeks of gestation. Miscarriage is the most common type of pregnancy loss, yet one of the most misunderstood and often glossed-over types of loss. An early pregnancy loss is an often viewed as a discounted loss.

It’s time to break down that stigma and talk openly about miscarriages, the loss we feel, and how we can help a friend who is mourning an early pregnancy loss.

Read more clinical information about miscarriage here.

This page isn’t intended to be clinical – it’s how to help yourself – or someone else – cope with a miscarriage.

Miscarriages are a fact of pregnancy. It happens. It’s the most common complication of early pregnancy. Oftentimes nobody knows why. Unfortunately, it’s something that happens to a lot of women.

In fact, between 20 percent and 25 percent of pregnancies end in miscarriage, three percent of them after 16 weeks. One minute someone’s life is filled with expectations of a new baby, a new family member! Someone mom had real hopes and dreams for. Pretty much every waking minute while pregnant is devoted to thinking about their baby, and then the next minute it’s all gone.

It’s tough to know what to say when a friend breaks the news. Traditionally, women wait until they’re three months along before sharing the news, but increasingly, women are telling their big news before then. This, I believe, is a very good thing.

Women originally wanted to wait until they learned the baby made it past the risky first trimester. But what if she does miscarry? She carries her grief alone? The statistics tell us that’s a lot of women carrying a very heavy burden without support. We think telling people about the pregnancy earlier is better. If you do miscarry, you have a support group to help you through something that hasn’t always been recognized as the extremely difficult event that it is.

Women who miscarry haven’t always been offered the same level of sympathy and comfort as a woman who lost a child that’s been born. Most miscarriages happen early in the first trimester, so the mom-to-be doesn’t look pregnant. That, coupled with the fact that there is no body to bury, causes people to forget a woman is actually mourning the very real and very painful loss of a child, not to mention the accompanying guilt that a woman who has had a miscarriage is likely to feel even though it isn’t her fault

How To Help Yourself While Grieving A Miscarriage:

Having a miscarriage or early pregnancy loss may bring about a whole host of emotions – sadness, guilt, anger, feelings of failure. The time following the loss may be incredibly painful, especially if this wasn’t your first pregnancy loss. You may feel withdrawn and unable to sleep. You may feel moody and unpredictable. The emotions you feel after a miscarriage are impossible to predict – each day may bring about new feelings.

Here are some ways to cope with a miscarriage.

There is no right or wrong way to grieve a miscarriage. Some people may be devastated, barely functional for months, while others feel it’s merely a blip on the radar. THAT IS OKAY. It does not mean that you are a “bad person” or that you weren’t meant to be a mother – it simply means that you’re grieving in your own way.

Remember, the miscarriage is not your fault. It is not due to anything you did wrong – miscarriages just happen. And coping with a miscarriage is really hard.

Ask a friend or trusted loved one to share that the pregnancy you’ve announced has ended if it’s too hard for you to talk about. There’s no shame in asking for help.

Allow yourself your feelings. It’s really easy to try to dismiss the early pregnancy loss as “being so early” or “better now than later,” but a loss is a loss. And every loss deserves to be grieved.

There is no timeline for grief. For some people, it’s a couple of days. Others grieve a miscarriage for several months. Some people may be devastated for much, much longer. Whatever your grief timeline is, accept it.

Take all of the time you need to grieve.

Don’t close yourself off from other people. Sometimes, it feels painful to talk about the pregnancy loss, but sharing your story – here on Band Back Together or elsewhere – can make you feel more connected to others who may understand what you are going through.

Take care of yourself. When you’re feeling at your absolute worst, it’s often hard to provide self-care, but that’s when it’s most important.

Don’t feel guilty about failing to meet your obligations. Take some time off work, take some time off from the housework, and give yourself permission to just be. Even if you’re physically well, taking some time to process the loss is very important.

If you feel up to it, do something with your hands. Plant a garden, bake some cookies, knit something. Sometimes, using your hands can free up your mind to process and heal.

Know and watch for the signs of postpartum depression in yourself, especially if this is your first child. Just because the pregnancy ended in miscarriage does not mean you are immune to postpartum issues. Read more about the signs and symptoms of postpartum depression here.

If you feel like you simply cannot cope with the loss of your baby, don’t hesitate to talk to a therapist. There is no shame in seeking help for being unable to cope with such a tragic loss.

If you’d like to, plan a small memorial service for your baby. Invite close friends and relatives and plant a tree or a flower in honor of your lost little one.

Do not expect that your partner will grieve the loss of your baby in the same way. Men and women grieve miscarriages in very different ways. Women look for support and express their feelings openly, while men hold their feelings about the miscarriage inside. Men also may feel as though they need to be “strong” and “brave” for their partner.

If you have older children, don’t be afraid to cry in front of them.  They probably have already picked up on your sadness, and may need reassurance that they are not the cause of it.  If it’s just too painful to let them see you cry, that’s okay, too.  Ask a friend to entertain them while you tend to your needs for a bit.

Find any support groups for pregnancy loss in your area. Your doctor or midwife may be able to suggest local support groups for early pregnancy loss.

Write your feelings down. If it’s in a journal, in a word document, on your blog, or here on Band Back Together, it can help to put all of your feelings down in one place.

How Do I Help A Friend Going Through A Miscarriage?

Remind yourself that a loss is a loss, and everyone grieves their losses differently. Just because you didn’t (or don’t think you would) feel a certain way, everyone is entitled to their feelings – especially when it comes to a loss.

Validate and acknowledge your friend’s feelings. When a baby is lost, all of the dreams parents have for their child are lost too.

Be supportive if the family wants to have a funeral or memorial for their lost child.

If your friend has taken pictures of the baby, be sure to look at them, just as you would any other baby pictures. This, after all, is what your friend has left of his or her child.

Check in on your friend. Call, send a text, email, or visit them every few days. While they may not be able to immediately get back to you, knowing that you are thinking of them will mean an enormous amount to them.

If they’re up for it, take your friend out for a cup of coffee, a movie, anything to get them out of the house. The grief may make leaving the house alone a tremendous burden.

Allow your friend to grieve openly and honestly – we are noneof us alone.

Encourage your friend to take the time she needs to grieve – time off from work, from household chores, and other commitments that may be difficult to handle.

If you see your friend developing signs of postpartum depression, don’t hesitate to let her know what you see, in the most non-judgmental way possible. Hormones can be out of whack, even if the baby didn’t survive. This may be especially shocking when a woman miscarries her first child and doesn’t know if she will have postpartum depression.Read more about the signs, symptoms, and treatment of postpartum depression here.

Frequently ask your friend how she is doing and listen – really listen – to what she has to say. If there are gaps in the conversation, don’t prattle on, just sit and be near her.

There is no time limit on grief and grieving, so don’t expect your friend will “be better in two weeks,” or “two months.” A miscarriage can be a life-changing experience.

Remember that her needs are going to be ever-changing, as is the way it goes with all grief and grieving. Be flexible and remember that what she needs today may not be what she needs tomorrow.

Sometimes, all your friend may want is someone to be near her. If that means sitting quietly and holding her hand while you watch television together, so be it.

Arrange some kind of chore list with her family and friends so that she can have simple chores, like taking her older kids to school or cooking dinner, taken off her hands for a while.

Prepare meals for her and the family that are simply heat and eat. Those who are grieving often forget about eating or are too overwhelmed to think about cooking. Having something simple available will make it easier for her and the family to eat.

Hire someone (or do it yourself) to clean your friend’s house. It may be a chore to even get out of bed in the morning, let alone clean the kitchen.

A couple months after a miscarriage, most of the support will have dropped off, which increases feelings of loneliness and isolation. Make sure that you continue to support your friend.

Buy the family a Christmas ornament (or some keepsake) with the baby’s name on it (if they named the baby). They may never display the ornament, but it will be in a treasured place for them.

Remember to use the baby’s name (if the baby was named) when talking to the family. So many forget that the baby was here – that he or she did exist – and hearing that name will make the parents feel like the baby hasn’t entirely been forgotten.

Help the her return or send back any baby gifts received that she does not want to keep. This is entirely up to the mother’s discretion.

Offer to help pack up any reminders of the baby, if your friend wants them put away. It can be a huge burden for your friend to have to pack those items away.

What Should I NOT Say To My Friend Who Has Suffered A Miscarriage?

Many times, people who are grieving a miscarriage are comforted by those who love them. Unfortunately, certain types of comfort may not actually help the grieving mother.

Here are some things not to say to someone who has just suffered a miscarriage.

Do not say, “It was God’s will.” That sounds an awful lot like, “Your baby is supposed to be dead.” Those words sting more than you can imagine.

Do not say, “Better now than later.” It’s not comforting to anyone but the person who says it.

Do not say, “The baby must’ve had something wrong with it.” Even if it’s true, it’s a hurtful sentiment.

Do not compare grief. Yes, it was tragic that your pet hamster died, and nothing diminishes that, however, it is unhelpful for many people to hear that sort of thing when their loss is so fresh.

Do not say, “I know just how you feel…” and launch into the story of the death of someone you know and love. No two losses are the same. While you may have experienced complicated feelings when you lost someone you love, it is entirely unfair to make the person grieving a fresh loss comfort you.

Be wary of discussing your own miscarriage(s), or someone else you know that suffered miscarriages, especially if the stories end with, “…but went on to have a healthy pregnancy,” or “….and continued having miscarriages.” Some people find these stories comforting, while others will be insulted.

If the baby was lost in the second trimester or beyond, do not use the word “miscarriage,” unless the mother herself uses it.

Don’t offer to help unless you mean it.

Also, if you offer to help, offer to help with specific things.

Do not ask “do you need help?” or “What do you need from me?” because chances are, in the midst of grief, the mother will be unable to tell you what it is that she needs.

Don’t forget the dad. Even if he’s being stoic about the early pregnancy loss, he, too, is grieving. Remember that the mother and father both lost a baby.

If the family has older children, don’t forget about them.  Even if they aren’t old enough to comprehend exactly what has happened, even the youngest toddlers know when their parents are sad. They may be confused and need reassurance that the sadness isn’t their fault.  Offer to spend time with them – take them to a playground, play a board game, let them talk about how they are feeling.

This Is Not Supportive After a Miscarriage:

Giving advice.

Criticizing what you have heard.

Minimizing the miscarriage e.g. “That’s okay, you were only three months.”

Using cliches e.g. “It was God’s will” or “You’ve already had one healthy child.”

Talking about your own story of loss. Some identification may be helpful, but keep it to a minimum. This is not about you.

Not allowing the person to express emotions such as guilt, shame, and anger.

Taking over completely may cause potential feelings of helplessness and powerlessness.

Fixing it (you cannot take the grief away).

If you have more suggestions not listed here, please email bandbacktogether@gmail.com and we will add them to our list

Page last audited 8/2018