Fertility and grief: when hope lives alongside loss

Fertility can ask two people to hold hope, disappointment and uncertainty at the same time — but rarely in exactly the same way

Fertility has a peculiar relationship with grief.

Sometimes there has been a clear loss: a pregnancy, an embryo, a failed treatment cycle.

At other times, what is being grieved is harder to name.

The pregnancy that hasn't happened. The ease with which you imagined becoming a parent. The age you thought you would be when you had a child. The family you had already begun to picture. The belief that when you were ready, your body would simply cooperate.

There may be no single event around which other people know to gather. Nothing visible has necessarily disappeared.

And still, something can feel lost.

Psychological literature has long recognised infertility as a form of loss, and research describes grief, anxiety, anger and diminished self-perception among the emotional experiences associated with infertility and fertility treatment.

For couples, another complexity appears.

Two people can be living through the same fertility experience and find themselves in very different emotional places.

FERTILITY AND GRIEF: MOURNING AN IMAGINED FUTURE

One of the difficulties with fertility-related grief is that the object of the grief can remain psychologically present.

Decades ago, family researcher Linda Burns described infertility through the idea of boundary ambiguity: the wished-for child may become psychologically part of the family while remaining physically absent.

I find something very moving in that idea.

You can become attached to someone who does not yet exist.

Perhaps you have imagined their bedroom. Wondered whose eyes they might have. Calculated how old you would be when they started school. Thought about your partner as a father or mother.

The imagined child can already occupy space in a relationship.

This helps explain why fertility disappointment can feel so substantial even when somebody says, “But nothing has actually happened yet.”

Psychically, quite a lot may already have happened.

A future has been imagined.

And once imagined, it can also be mourned.

HOPE DOESN'T CANCEL GRIEF

Fertility treatment creates an unusual emotional position because grief rarely arrives neatly after hope has finished.

You may grieve one unsuccessful cycle while preparing for another.

Feel devastated by a result and still find yourself calculating when you could try again.

Begin accepting that one imagined route to parenthood may not happen while becoming curious about another.

Hope and grief can coexist.

Research examining grief during infertility treatment has found precisely this mixture: despair, anger, anxiety and frustration appearing alongside continued hope for pregnancy.

Psychodynamically, this capacity to hold contradictory feelings matters.

We sometimes imagine emotional health as arriving at one coherent position: I have accepted this, or I am hopeful again.

Real emotional life is rarely so tidy.

You can feel grateful for the possibilities medicine offers and furious that you need them.

You can want another cycle and dread it.

You can believe things might work and protect yourself from imagining that they will.

You can grieve and hope in the same afternoon.

Complexity is not confusion. Sometimes it is the most truthful response available.

COUPLES RARELY GRIEVE IN SYNCHRONY

The difficulty is that partners may not move between these states together.

One person may need to talk.

The other may become practical.

One begins researching the next treatment.

The other cannot bear to think about another clinic.

One cries.

The other makes dinner.

From inside grief, difference can easily be interpreted as absence.

Why aren't you as upset as I am?

Why do you keep talking about it?

How can you already be thinking about another cycle?

Why won't you talk about what happened?

The partner who becomes practical may be trying to hold the couple together.

The partner who keeps talking may be trying to make the experience real enough to be shared.

Neither response necessarily tells us how much somebody cares.

ESHRE's psychosocial guidance recognises relational as well as emotional needs throughout fertility treatment and specifically notes the importance of involving both partners in care.

Yet being involved in the same treatment does not mean having the same internal experience of it.

SOMETIMES ONE PERSON HOLDS THE HOPE

Couples also seem to distribute emotional positions between them.

One becomes hopeful.

The other becomes cautious.

The more one says, “I really think this could work,” the more the other finds themselves saying, “We need to be realistic.”

Eventually they can appear to occupy opposite sides.

But sometimes each is holding something that belongs to both.

The hopeful partner may be carrying the couple's capacity to imagine a future.

The cautious partner may be carrying the fear of another disappointment.

If either position becomes too rigid, conflict can follow. Hope starts to feel naïve. Realism begins to feel cruel.

There may be another possibility:

both feelings belong in the relationship.

The couple does not have to decide whether hope or fear is correct.

There needs to be enough space for both to be thought about.

THE LOSS CAN BE DIFFERENT FOR EACH PARTNER

Even when two people want the same child, they may not be losing the same thing.

For one partner, fertility difficulty may touch deeply on their relationship with their body.

For another, it may stir fears about being unable to give their partner something they desperately want.

There may be questions about masculinity or femininity, ageing, sexuality, genetic continuity, family expectations or becoming the parent you once imagined you would be.

And fertility treatment itself is rarely physically symmetrical.

One partner may undergo scans, injections, procedures and hormonal changes while the other watches.

This can create its own relational difficulty.

The person undergoing treatment may feel:

You cannot understand what this is doing to me.

The partner watching may quietly feel:

There is nothing I can do to make this better.

Both can become lonely inside the same experience.

WHEN OTHER PEOPLE DON'T QUITE SEE THE LOSS

Fertility grief can also be difficult because it is not always socially recognised.

There may be no funeral, no established ritual and no obvious language for what has happened.

Research on reproductive loss describes disenfranchised grief: grief that is minimised or insufficiently acknowledged by the surrounding culture.

People may try to reassure:

At least you can try again.

At least you know you can get pregnant.

You still have time.

Maybe it wasn't meant to be.

Often these sentences are attempts to offer hope.

But hope offered too quickly can feel like an erasure of what has just been lost.

Sometimes what is needed first is recognition.

This mattered.

You imagined something.

You wanted it.

It didn't happen.

There is something containing about another person being willing to stay there without immediately moving the story forward.

HOPE CAN CHANGE SHAPE

Hope does not always mean believing the next treatment will work.

Sometimes hope becomes quieter.

It may be hope for another cycle.

Hope for donor conception.

Hope for a different route to parenthood.

Hope for a life that is meaningful even while you do not yet know whether it will contain children.

Sometimes it is simply the hope that you and your partner can remain connected while neither of you knows what happens next.

That form of hope has less certainty in it.

Perhaps it also has more room.

WHAT CAN THE COUPLE HOLD TOGETHER?

A couple cannot remove the uncertainty at the centre of fertility.

They can create somewhere for it to exist.

That requires making room for different reactions without immediately translating difference into a judgment about love.

One partner can be hopeful while the other is frightened.

One can need to speak while the other needs some silence.

One can be ready to think about the future before the other.

The question becomes whether those differences can remain inside the relationship, rather than pushing each person into a separate emotional world.

There may be moments when you can say:

I don't need you to feel exactly what I feel. I need to know that what I feel has somewhere to go with you.

Perhaps that is one of the most intimate things a couple can offer each other during fertility treatment.

Not the promise that everything will work.

The experience of not having to carry the uncertainty entirely alone.

A QUESTION TO CARRY WITH YOU

When you and your partner seem to be responding very differently, ask:

What might each of us be carrying for the relationship right now?

Perhaps one of you is carrying hope.

Perhaps one is carrying fear.

Perhaps one is grieving what has happened while the other is trying to protect what might still happen.

You do not have to arrive at the same emotional place at the same time.

Sometimes the work is learning how to remain a couple while standing in different places.

SOURCES AND FURTHER READING

Burns, L.H. “Infertility as boundary ambiguity: one theoretical perspective.” Family Process, 1987. Burns describes the wished-for child as potentially psychologically present while physically absent, offering a useful framework for understanding infertility-related loss.

de Castro, M.H.M. et al. “Psychosocial Aspects of Gestational Grief in Women Undergoing Infertility Treatment: A Systematic Review of Qualitative and Quantitative Evidence.” International Journal of Environmental Research and Public Health, 2021. The review identified grief experiences including despair, anger, anxiety and loss of hope, alongside continuing hope for pregnancy.

Lang, A. et al. “Perinatal loss and parental grief: the challenge of ambiguity and disenfranchised grief.” Omega, 2011. Explores ambiguity and socially unrecognised grief following reproductive loss.

European Society of Human Reproduction and Embryology. Routine psychosocial care in infertility and medically assisted reproduction. ESHRE recognises emotional, relational, social and cognitive needs across different stages of fertility treatment.

Evidence checked: August 2026.

Venus of Now provides general education and reflection. This article is not personalised psychological, relationship or medical advice and does not replace consultation with an appropriately qualified professional.