Welcome to IVF Today, Episode 209: IVF & Hope Hangovers.

Hello, hello, hello my friends! Welcome back to the podcast. I'm hoping you're doing so well today.

Hope has become a frequent topic on this podcast. To me, it's a massive double-edged sword when it comes to infertility and IVF. Hope is touted as "THE" thing you need to cling to throughout your infertility journey. The special sauce, if you will. But hope also becomes the fall guy when you experience heartbreak.

While I believe hope is essential to creating a full and meaningful life, I also think the idealized version of hope is misunderstood, easily manipulated, and often unrealistic within the realities of infertility and IVF.

Hope is such a key component of the IVF experience that, if you listened to "The New IVF This" a few episodes ago, you heard me include hope as one of the four terrains we navigate.

I take hope very seriously.

So, in that spirit, I want to talk about the crash that happens after we "let" ourselves hope.

If you've been on this journey for a while, I bet you know exactly what I'm talking about.

You get good news.

Maybe you respond better to stims than expected. 

Maybe you get a fantastic fertilization report. 

More embryos make it to blast than you thought would. You have a euploid embryo. Your lining looks great. 

The transfer goes perfectly. 

You get a positive pregnancy test. 

Your first beta is strong.

And despite all of the protective or coping skills you've developed, despite everything you've been through, despite the part of your brain screaming, Don't get ahead of yourself...

A little crack opens.

Maybe.

Maybe this is the one.

Maybe this will finally work.

Maybe we'll finally get to have this.

And then something happens.

Maybe you get bad news. Maybe the numbers don't rise as expected. Maybe the transfer fails, or the pregnancy ends.

Or—and I think this is really important—maybe nothing bad has happened at all.

Maybe you're still sitting back in uncertainty.

Back in the waiting.

Back in that place where there's no new information to hold onto.

And suddenly, the hope that felt so good yesterday feels terrifying or dangerous today.

So, you crash. And I mean EPIC ESPN highlight reel of NASCAR or Formula 1 CRASH.

And then comes the sentence I think nearly every person who has experienced infertility has said in some form:

I knew I shouldn't have gotten my hopes up.

That's what I want to call a hope hangover.

And the hangover isn't just disappointment.

It's what happens when we connect the pain we're feeling now to the hope we let ourselves feel before it.

It wouldn't hurt this much if I hadn't gotten so excited.

I should have known better.

And that's where hope becomes the fall guy.

Because when something painful happens, our brains want to know:

How could I have protected myself from this?

And hope is right there, looking sheepishly around, just waiting to be blamed. 

I think we logically know -I couldn't control whether the embryo implanted.

I couldn't control whether it kept developing.

I couldn't control what showed up on the ultrasound.

I couldn't control the outcome.

So we take logic and we say- maybe I could have controlled how much I hoped.

And if I could control how much I hoped, maybe I could control how much this hurt.

That's a very compelling argument.

It also creates an emotional contract that I don't think delivers what it promises.

Because now we've given hope responsibility for something it never controlled:

The outcome.

And that's where I want to spend some time today.

Not convincing you to be hopeful. Not telling you to "just stay positive." And absolutely not telling you that everything happens for a reason or that you just need to believe this will work. If you know me, you know that’s not how I work. 

I want to talk about what hope actually is, why the crash after hope can feel so intense, and how we can experience hope without asking it to become certainty.

Because this is one of the biggest misunderstandings about hope:

Hope is not a prediction.

"I hope this works" doesn't mean:

"I know this will work."

It doesn't even mean:

"I think this will work."

In it’s truest form, hope is simply:

I know what I want.

I think we tend to use hope, optimism, and certainty almost interchangeably-consciously and subconsciously- especially in infertility spaces.

But they're not the same thing.

Optimism says:

I think this is going to work.

Certainty says:

I know this is going to work.

Hope says:

I want this to work, and I'm willing to acknowledge the possibility that it might.

Hope doesn't require you to ignore statistics, forget previous failures, or manufacture confidence you don't feel.

Hope can exist right alongside uncertainty- because it always has!

If you think about it, uncertainty is kind of a prerequisite for hope.

Hope exists in the space between what we want and what we know.

And that's exactly what makes it such a vulnerable feeling. 

Because hope requires us to get close enough to possibility to see it.

And after repeated disappointment, possibility itself can start to feel dangerous.

If I calculate the due date, suddenly there's a due date I can lose.

If I imagine telling my family, there's a conversation I may never get to have.

If I think, Maybe this is our baby, I've emotionally moved toward that possibility.

Again, I'm not saying you should or shouldn't do any of those things.

I'm saying it makes sense that they can start to feel dangerous.

Possibility creates emotional exposure.

So we try to reduce the exposure.

Don't calculate the due date.

Don't say "when." Say "if."

Don't get too excited.

Stay realistic.

Stay guarded.

And another thing, maybe pessimism isn't always the absence of hope.

Maybe sometimes pessimism is an attempt to manage our exposure to hope.

If I don't let myself get too close to the possibility, maybe I won't have as far to fall.

And I know some of you are thinking:

But Emily, it DOES hurt more when I let myself hope.

And I believe you.

And let me tread lightly here, because I often remind you that if the thing you desperately want doesn't happen, it's going to devastate you whether you spent the last two weeks rehearsing the devastation or whether you allowed yourself to feel hopeful.

But that doesn't mean the answer is, So you might as well hope!

That's just assigning hope another job.

What I'm saying is that pessimism cannot guarantee protection from grief, just like hope cannot guarantee a favorable outcome.

Emotional contrast is real and can be very destabilizing.

Going from:

Holy shit. Maybe we're having a baby.

to:

We're not having a baby.

can feel very different from going from:

I don't think this worked.

to:

It didn't.

Hope creates expansion. It lets you emotionally move toward a future. And when that future disappears, the contraction is brutal.

So yes, hope may affect the experience of disappointment.

But here's the distinction:

Hope can change the distance of the fall without being responsible for the ground you landed on.

Hope may change the emotional contrast.

It did not create the outcome.

And when we confuse those two things, the obvious solution becomes:

Don't hope next time.

And that's where bracing comes in.

Bracing is really just preparing ourselves emotionally for the worst, so if it happens, it doesn't hurt as much.

I think this makes sense.

This is especially true if you have been blind-sided by something before.

You may have gone in for an ultrasound thinking you were going to hear a heartbeat but didn't. Or maybe you thought your transfer would work and you saw a negative test result. Or maybe you were celebrating five embryos and then found out that none were euploid.

Your brain remembers those experiences.

So next time?

We are going to try to keep things real. We are going to try to keep our expectations in line. We are going to try to remember all the ways things can go wrong. We are going to be aware of all the possibilities this time around.

Because if I cannot control whether something painful occurs, maybe I can at least try to ensure it doesn't catch me off-guard.

And I think there is something positive here too.

Because there is a difference between preparation and pre-suffering.

Preparation is when you ask yourself:

If this doesn't turn out like I want it to, what will I need?

Maybe you decide you don't want to get PGT results at work. Maybe you tell your partner what you'll need from him/her on beta day. Maybe you decide whether you want people checking in on you or leaving you alone. Maybe you think about what your next steps could be.

That is preparation.

That is taking advantage of the agency you have.

Pre-suffering is different.

Pre-suffering says:

Let me experience some of the pain now so I don't have to experience as much later.

So, we rehearse the devastation over and over again. We constantly visualize the worst-case scenario. We refuse to let ourselves enjoy today's good news because tomorrow could bring bad news. We try to put a down payment on the grief in advance.

Unfortunately, though, there is no emotional "layaway" program where enough anxiety paid upfront equates to less grief later.

Wouldn't that be great?

No. I've already worried for 37 hours this week. If the transfer fails, I've covered most of the emotional balance.

Unfortunately, grief doesn't care about that payment plan.

And I'm not writing this so you can judge yourself for bracing.

What’s the first rule of IVF This? We don’t use the awareness we are creating against ourselves. You can’t do any of this “wrong.” The goal is ALWAYS curiosity and compassion-mmm’kay?

I want us to understand exactly what we are expecting bracing to accomplish for us.

Because maybe bracing reduces surprise. Maybe bracing gives you a feeling of stability. Maybe bracing does make a tough situation feel more manageable.

But bracing causes problems when we expect it to give us assurances that it can't give us:

That if I hurt enough now, I won't hurt as much later.

Because you can spend the entire two-week wait convinced your transfer failed and still be crushed when the beta confirms it.

You can recognize that miscarriage is possible and still be devastated by miscarriage.

You can recognize the statistics. You can recognize the attrition rates. You can continuously remind yourself every single day:

This might not work.

And if it doesn't work?

It can still level you.

Recognizing that pain is possible and experiencing pain are two completely different things.

And I think this is where we sometimes assign pessimism a role that it cannot reliably fulfill.

We ask pessimism to protect us from grief.

Maybe pessimism can protect us from some of the surprise. Maybe pessimism can change the emotional contrast.

But pessimism cannot guarantee protection from grief.

And hope cannot guarantee a successful outcome.

Neither hope nor pessimism has that kind of authority.

So, maybe the question isn't:

Should I hope or should I protect myself?

Because that question suggests that hope and self-protection are mutually exclusive.

Maybe the question is:

What am I expecting this emotion to do for me?

Am I allowing fear because fear exists inside me today? Or am I using fear because I believe fear will protect me from tomorrow?

Am I feeling hopeful because hope is available to me today? Or am I forcing myself to feel hopeful because I believe that's what I'm supposed to do?

I don't believe the goal is to choose the "correct" emotion.

I believe the goal is to stop assigning our emotions responsibilities that they can't fulfill.

Hope cannot guarantee the outcome.

Fear cannot prevent the outcome.

Pessimism cannot guarantee protection from grief.

And none of them need to.

They can simply be the emotions we are experiencing as we navigate through something profoundly uncertain.

This brings me back to the sentence at the center of the hope hangover:

“I knew I shouldn't have gotten my hopes up.”

Because once we know the outcome, hindsight enters the conversation.

And hindsight can be an absolute dick-face during infertility.

Once we know how something ended, our brains go backward and re-interpret everything that happened before it through the information we have now.

I knew that line wasn't dark enough.

I knew something felt off.

I knew I shouldn't have gotten excited.

I should have known better.

But here's the problem:

You know now.

You didn't necessarily know then.

The version of you calculating the due date didn't have the beta result yet.

The version of you celebrating your embryos didn't have the PGT report yet.

The version of you who let herself think, Maybe this is finally it, was reacting to the information she had available at the time.

Then you got new information.

But instead, we tend to judge our past selves based on information they didn't have access to. We do a complete retrospective evaluation now with complete information, when those decisions we are evaluating were based on incomplete information. 

And that's when the hope hangover starts turning into shame.

Because now we're not only grieving what happened.

We're criticizing ourselves for experiencing joy, excitement, relief, or hope before we knew it would happen.

We turn hope into evidence that we were naive. That we got carried away. That we should have been more realistic. That somehow we failed to adequately protect ourselves.

But you cannot protect yourself with information you do not have yet.

You do not need to punish the version of you who hoped simply because she did not know how the story would end.

She wasn't stupid.

She wasn't naive.

She didn't jinx anything.

She didn't fail to protect you.

She was in a moment where more than one outcome was still possible, and she allowed herself to acknowledge the one she wanted.

That's it!

That's hope.

And this is why I believe it's so important that we stop treating hope like certainty.

Because if hope means, I know this is going to happen, then yes, when it doesn't happen, we feel like we were wrong.

But if hope means:

I know what I want, and I am willing to acknowledge that it's possible...

Then there is nothing to prove wrong about.

You wanted it.

It was possible.

Then you learned what happened.

The outcome can be absolutely devastating without making your hope before a mistake.

The reason why I don't want the message from this podcast to be "I should just allow myself to be hopeful" is simple.

If I tell myself that, then I am giving hope another obligation in addition to everything else infertility forces upon me. It also says that there is a right way to be hopeful and a wrong way.

There is no right or wrong way to be hopeful.

You don't have to be hopeful.

You don't have to believe every morning that this is going to work.

You don't have to search for the good in every situation.

You don't have to create hope if it IS NOT available to you.

However, I also don't want you to let fear of a future hope hangover dictate which feelings you can feel today.

You do not have to choose hope. You just don’t have to fear it.

If hope appears today, maybe you let it appear. Allow it to be there. Like sitting on a park bench and a squirrel comes and sits near you. 

If you receive positive news and excitement appears along with it, maybe you let yourself feel excited.

If you find yourself thinking about a potential due date, you don't have to stop yourself because you fear you are getting ahead of yourself.

And if tomorrow you feel terrified?

Ok.

If the next day you are sure it didn't work?

Ok.

If the day after that you hear a small voice inside you say, "But maybe..."

Ok.

These are emotional states, not problems that need to be resolved.

Nor are they predictions.

They are simply the emotions you are feeling as you navigate uncertainty.

I believe one reason we give hope so much responsibility is because we are told to embrace it.

Embrace it.

Protect it.

Never lose it.

Believe.

And on the opposite side, once we have experienced enough pain, we try to keep hope out.

Don't get excited.

Don't get ahead of yourself.

Don't let yourself believe.

Both of these approaches treat hope as though it holds a great deal more power than it does.

Maybe hope does not have to be something we desperately hold onto with a vice-like grip.

Maybe hope isn’t something we need to protect ourselves from.

What if hope can simply be hope?

Hope can come and go.

Hope can be loud one day and barely accessible the next.

Hope can co-exist with fear.

Hope can co-exist with doubt.

Hope can co-exist with the understanding that this may not work.

Hope was never intended to provide certainty.

Maybe hope's sole purpose is to provide us with occasional opportunities to envision something we desperately desire and state:

Maybe.

Not certainly.

Not I know.

Not this must happen.

Simply...

Possibility

And if tomorrow provides you with different information, then tomorrow you will meet that information with the version of you who exists tomorrow.

You do not have to make today's hope responsible for knowing it in advance.

This brings me back to agency.

You cannot control outcomes by limiting your emotional experiences.

However, you do possess agency around how you care for yourself while moving through this experience.

You can recognize when you are bracing yourself.

You can prepare for potential outcomes without suffering them before they happen.

You can permit hope when it appears without insisting that it remain omnipresent.

And when a hope hangover occurs, you can recognize the desire to reflect backward and declare:

I shouldn't have been hopeful.

Try instead:

I was hopeful because I wanted something. Then I received new information. And now I get to care for myself in this moment.

That's all.

There is no requirement for emotional autopsies.

No punishment.

No lessons learned about how hopeful you will be permitted to be next time.

Just meeting yourself where you are at this moment.

So the next time you find yourself in a hope hangover declaring to yourself, "I knew I shouldn't have allowed myself to be hopeful," I want you to remember:

Hope was not the problem.

You were reacting to the information you possessed at that time.

You perceived possibilities.

You recognized what you wanted.

And you allowed yourself, even if only momentarily, to declare:

Maybe.

You do not have to cling to hope.

You do not have to create hope.

And you do not have to protect yourself from hope.

Hope can exist without being mandatory.

If you are someone who struggles with this issue, or if you would like to include a little more hope into your infertility journey without feeling compelled to create positivity or certainty, I wish to remind you that I provide a complimentary one-hour coaching session entitled Take Back Your Life.

Take Back Your Life is a complimentary coaching session designed for us to examine where you currently stand; what aspects of your journey seem most challenging; and how you can begin establishing a little more agency within your infertility/IVF journey.

If you would like to schedule a complimentary session, please visit my website located at ivfthiscoaching.com.

Ok my friends. That’s what I have for you today. I hope you have a wonderful week, and remember to be kind to yourselves, always.