It was autumn of 2010 when Amy Warren and her husband decided it was time to give their nearly two-year-old daughter a sibling. The Toronto-based mom was a young 34 and figured getting pregnant would be a cinch—it had been the first time around when Amy and her husband tried for just a few months before conceiving. So it made perfect sense that they expected she’d be pregnant with baby No. 2 in a flash.
But 2010 came and went, and so did 2011. “After a frustrating year of not getting pregnant, my doctor suggested we go to a fertility clinic,” says Amy. The couple went in January 2012, but they didn’t feel a connection with the clinic’s doctors, who pushed for in vitro fertilization (IVF) before recommending other options. “We had just bought our first house and the numbers didn’t add up to undergo IVF at the time. We decided to investigate other options first,” she says. So the couple kept trying and, with each passing month, faced more disappointment when they learned Amy wasn’t pregnant. When they were still baby-less by the end of the year, they went to another clinic wanting answers.
Recognizing the signs of postpartum depression There wasn’t a smoking gun as to why Amy wasn’t pregnant, so she tried the clinics’ different suggestions. “We tried everything under the sun. I did a lot of cycle monitoring, tried herbal teas, a gluten-free diet and acupuncture. We tried intrauterine insemination (IUI) three times.” When it felt as if they were out of options, they agreed to try IVF and good news finally followed—their first attempt was successful. By the end of 2013, after a strenuous and draining three years and two months of trying, and a diagnosis of unexplained secondary infertility, Amy had a bun in the oven. Their healthy baby boy arrived the next summer.
That could have been the end of the couple’s story, but something wasn’t right. Amy says she didn’t bounce back quite as effortlessly—physically or emotionally—as she had after her first child was born. “Nothing came easy—breastfeeding, milk supply, sleep. I was exhausted and had a five-year-old to take care of.” Plus, she was still settling into a new neighbourhood, which made her feel even more isolated during the maternity leave. “I didn’t have my sister or close friends nearby like my first mat leave. I spent a lot of time on my own with my son. In those first few months, I remember feeling restless, unsure and I was overthinking things.”
Even after getting pregnant, Amy says a “dark cloud lingered” over her. “Feelings of stress, worry and disappointment with my body didn’t just evaporate when I found out I was finally expecting or when my long-awaited baby arrived. There were unresolved feelings of frustration and sadness that festered in my head and heart. I was screaming inside and felt so alone,” she explains. Her restlessness, moodiness and irritability contributed to anxiety. “Irrational worries paralyzed me. I needed to go out, but I could think of a dozen things to worry about and it seemed easier to cancel plans. I was in a fog. My dreams had come true, but I didn’t feel like my happy ending had arrived.”
Depression after successful IVF
We know postpartum depression (PPD) and postpartum anxiety are common for new mothers, whether they conceive naturally or via fertility treatments. The risk of PPD is about 13 percent (rates vary from about 11 to 20 percent), and estimates for other postpartum mood disorders such as anxiety are even higher. But those rates might spike for women who have had fertility issues. One study in the Journal of Midwifery and Women’s Health says the risk of PPD (mild, moderate and severe) may be closer to 25 percent in women who receive fertility treatments.
You might think that parents who have struggled to conceive would be even more overjoyed when the baby finally arrives (“You have your baby—why would you be depressed?”), but that isn’t always the case. “Most people think that having a baby after such an arduous process of fertility treatments means that those women would be instantly happier than those who didn’t conceive,” says Lila Z. Hakim, a psychologist who focuses on fertility counselling and trauma psychology in Toronto. She says that these stories are all too common, adding that many of her patients underestimate how exhausting and stressing fertility treatments, pregnancy and birth actually are. “They’re surprised when they don’t feel as joyous as they thought they would post-birth. Their mood may eventually improve over time as they have reached their goal of parenting one or more children, but the difficulties of the postpartum period and parenting are often underestimated and this can be confusing for parents.”
Marina Golts, a psychiatrist in Toronto in Mount Sinai Hospital’s perinatal mental health department, recalls one mother in her 20s who landed in her office six weeks after delivering a baby girl. After unexplained infertility, the mom had endured six unsuccessful intrauterine inseminations (IUIs) and two IVFs over two years. She conceived with the first IVF but miscarried at 11 weeks; the second IVF was used with progesterone suppositories and she carried to term. Her obstetrician referred her to Golts when she reported tearfulness, an inability to bond with the baby, breastfeeding struggles, low appetite and insomnia. She was diagnosed with postpartum depression.
“She had obsessional thoughts of dropping her baby while walking up the stairs or her baby drowning in the bathtub. She had no desire to harm her infant,” Golts says. “But she did exhibit a lot of shame and guilt about feeling depressed after delivering a much-wanted, healthy baby. She said she was so focused on conceiving that she didn’t expect the changes that would happen once the baby came home.” Those changes centred around her loss of freedom and identity, and she found the caregiving boring and isolating.
For Amy, that long-awaited fulfilment was also elusive. “Even though that chapter of not getting pregnant had closed, it was like the vault of unresolved emotions I had buried deep inside me was ready to burst open at any minute. Closure didn’t come when I first held the baby in my arms.”
Dara Roth Edney is a Toronto-based social worker and reproductive counsellor. She, too, found herself dealing with PPD after having a baby using a surrogate. She’d tried to get pregnant for years—going for insemination, IVF and even surgeries—without success. When nothing worked, her doctor suggested a gestational surrogate. She and her partner eventually had two daughters who were carried by surrogates. “People view having a baby as a solution to infertility. Having a baby solves the problem of not having a child, but it doesn’t resolve reproductive losses,” she says. “Some people spend four, five, six years undergoing multiple treatments and surgeries. All that sadness, fear and anxiety that’s felt every single day doesn’t just disappear when a baby is born,” she says.
Not only are postpartum mood disorders a worry for women who undergo fertility treatments, but preexisting conditions before or during pregnancy can wreak havoc on hopeful parents—and could be precursor to mental health issues post-birth.
“Some of these women spend their pregnancies thinking that every twinge they feel in their body is a miscarriage coming,” says Roth Edney. For couples who have gone through reproductive losses, she says, “Every time they have an ultrasound, they’re waiting to find out their baby has died. By the time the baby is born, they’re still living with anxiety and waiting for the other shoe to drop when friends and family think they should be welcoming their baby.”
And that’s where the guilt comes in, which just perpetuates the despair, melancholy and worries that those who’ve suffered from PPD often report. “Often women who’ve dealt with infertility feel out of control. They don’t understand why their bodies won’t do what other women’s will,” says Roth Edney.
That’s why support for postpartum mood disorders ideally happens before baby arrives. “It’s important to try to access happiness before the baby is born,” says Roth Edney. “After spending so much time being negative, it’s time to look at the ways in which you can open up your heart to the concept that you’ll have good news and this will be the time your fertility treatment works.” That doesn’t mean you won’t have normal fears before and after the baby is born—it’s pretty safe to say that all soon-to-be and new parents have feelings of fear, deal with exhaustion and, quite frankly, don’t always know what to do once the little one is home.
Help and recovery
If you feel sad, scared and anxious, it’s important to let your healthcare provider know. “A referral to a mental health professional is an important step to moving toward dealing with the traumas, grief and losses of the last several years,” says Hakim. With an expert, you’ll work through those emotions, your mood and anxiety. You might also require medication, which is quite common. “They say it takes a village to raise a child. Well, it takes a few educated and focused reproductive-health professionals working together to help someone move out of PPD to feel connected with their baby, their partner and themselves,” Hakim adds. “The woman’s view of the future, including the possibility of having another child through fertility treatments or adoption, is eventually raised and explored as she starts to stabilize.”
As for Amy, it was seven months postpartum when she realized it was time to seek help. “A cousin noticed I was acting differently and flagged my husband. She suspected postpartum anxiety because she’d been through it. My husband and I googled it together and I agreed to see my doctor that week. It was like an aha moment. I finally knew what was going on with me,” she says. Amy started to improve with counselling and anti-anxiety medication.
“Looking back, it makes sense that after years of disappointment trying to get pregnant, then going through high-stress fertility treatments, I would be more susceptible to anxiety. I wasn’t starting that postpartum period with a clean slate in a state of bliss. I was carrying emotional and physical baggage into my new postpartum world,” she says. “I wish I would have cut myself some slack after all I’d been through, emotionally and physically.”
Three years later, Amy says she’s at peace with her experience. “It’s important for other women going through anxiety after infertility to know that they’re not alone. You may feel an odd sense of ‘What now?’ You were used to spending all that time trying to have a baby,” she says. “Don’t suffer in silence, and be kind to yourself—you’ve been through so much. Know that it will get better.”