When it doesn't happen: the first year of trying to conceive

“Your fertile window starts tomorrow.”

The notification lights up on her screen in the middle of a meeting. Nobody else sees it, but she feels it in her stomach. Month seven. Half a year ago she installed the app almost as a joke, convinced this would be a short phase she and her partner would one day laugh about. Now she knows by heart which day of her cycle it is, how many days are left until the test, and which friend she won’t reply to if she writes about the nursery again.

Nobody has given her a diagnosis. By medical standards there is no reason to worry yet. And yet something inside her is slowly changing — and she doesn’t talk about it, because it feels as if it isn’t “the right time” for that yet.

This post is about that period: about the year in which you don’t know yet. Not about diagnoses and procedures — those belong with a gynaecologist — but about what happens in your head, in your body and in your relationship when every month you hope again and every month you lose again.

A year nobody warns you about

When a couple decides to have a child, they rarely think about waiting. The story we know from films and from friends goes differently: you decide, stop contraception, and a few weeks later there are two lines on the test. For many couples it really is like that. For many others it isn’t.

The international glossary of fertility terms published in 2017 by Fernando Zegers-Hochschild and colleagues only speaks of infertility once a couple has not conceived after 12 months of regular unprotected sex. That threshold is worth knowing for two reasons. First, it tells you that a few months of waiting are normal and do not in themselves mean something is wrong. Second, it tells you that a year is a long time — long enough for a great deal to change that has nothing to do with hormones.

That threshold is not a rule you have to sit out. When it is time for a check-up in your case — for example because of age or known health issues — is something your gynaecologist can tell you best, and you don’t have to wait for a year to pass before having that conversation. In Slovenia the path usually begins with your chosen gynaecologist. And don’t forget: tests are not only a woman’s matter; the male partner is part of this path too.

Why waiting is so exhausting

The brain can cope with a lot, but it copes worst with uncertainty. Bad news you know is often easier than news you don’t know yet. In the first year of trying, uncertainty is not a one-off event but a rhythm: it repeats every month, and every month it ends in an answer you cannot hurry.

Jacky Boivin and Deborah Lancastle studied waiting periods in medicine — the time between a procedure and its result. They described how emotions intensify the closer the answer gets, and how hard it is to cope during that time, because there is nothing you can do to change the outcome. Their research mostly took place during assisted reproduction, but many couples experience the two weeks between ovulation and an expected period in a very similar way. Every bit of tiredness becomes a sign. Every twinge in the belly becomes a question. A body you used to take for granted turns into a screen from which you try to read the future.

And then the answer comes. Blood, or a single line on the test. Disappointment arrives in a second, while hope has to be rebuilt from nothing every month.

When a month becomes a calendar

Because you have no influence over the outcome, it is natural to hold on to what you can influence. A cycle-tracking app. Ovulation tests. A thermometer on the bedside table. A list of foods that are supposed to help and those that are supposed to harm. For some people this is fine, and it gives them a sense of doing what is in their hands.

For others something different happens. The calendar starts to shape everything: when you travel, when you go to a party, when you are allowed to be tired. Sex gets a date, and your partner’s role slowly turns into “I have to be available”. Control that was supposed to calm the anxiety actually feeds it — every piece of data opens a new question, and every question calls for more data. How closely the need for control and anxiety can be intertwined is described in the post Panic and control: why it strikes the person who holds it all together.

So the question is not whether tracking your cycle is good or bad. The question is whether it serves you or you serve it. If you feel more tense every time you open the app than you did before, that is information worth taking seriously.

A mind that won’t stop counting

“If it happened this month, the baby would be born in March.” “If it hasn’t happened by summer, we’ll have to …” “What if something is wrong with me?” Thoughts about what might be can spin for hours. You read forums, compare your symptoms with strangers’ and at one in the morning search for statistics that might calm you down — but they don’t.

In the knowledge base we call this circling of thoughts rumination. It is like chewing the cud: you don’t digest the same thoughts, you just keep bringing them back up without getting anything from them. Meanwhile the mind predicts the worst, because it feels like a way of preparing. Why it does this, and why preparing for a hundred disasters doesn’t bring peace, is described in the post “What if …”: why the brain would rather predict a hundred disasters than one calm day.

It is also common in this period for partners to talk about it in very different ways. A conversation like that might sound something like this (a composite dialogue, not a real person):

“It’s day twenty-six today. My breasts aren’t sore. Last month they were.”
“Maybe that doesn’t mean anything.”
“Or it means it’s not happening again. I read that …”
“Shall we go for a walk tomorrow? Just the two of us. Without all this.”
“I can’t think about anything else.”
“I know. Neither can I. I just don’t say it out loud.”

In that last sentence there is something she didn’t know until that moment: that she is not the only one counting the days.

When others share their news

In the first year of trying it feels as though everyone is pregnant. A colleague, a sister-in-law, a friend who “didn’t even really want a baby”. On social media there are ultrasound photos, gender reveals, bumps in front of the mirror. Each piece of news brings two feelings at once: joy for them and a sharp pain for yourself. And right after that, often a third: shame, because you couldn’t manage to be only happy.

Envy at a moment like that is not a sign of bad character. It is a sign that you want something very much and do not have it. You are allowed to take a day before you congratulate someone. You are allowed to mute, for a while, the profiles that make you feel worse. What constant comparison does to us is described in the post Comparing yourself on social media: what constant measuring does to the brain, and holidays, christenings and birthdays are the subject of the post When everyone around you is pregnant: holidays, christenings and birthdays.

Two people in the same wait

The first year of trying is also the year in which a couple forms patterns that can last a long time. Who tracks the cycle and who “just turns up when needed”. Who talks about fear and who hides it. Who looks for information and who would rather not know anything. These patterns are not chosen consciously; they simply happen — and that is exactly why it helps to notice them now, while there are no big decisions yet.

Partners often don’t experience this period in the same way. She feels every month in her body; he may only notice it when she tells him. That doesn’t mean he doesn’t care. It does mean that a shared experience takes some effort — telling, asking, listening. Arthur Greil and colleagues stressed in their review of the research that the experience of infertility is shaped not only in the body but also in relationships and in the environment a couple lives in — in what they tell each other, what their families expect and what the culture around them says about parenthood. What happens to the relationship if difficulties conceiving continue is described in the post Infertility as a test for a couple: what happens to the relationship.

Perhaps the most important question you can ask yourselves this year is not “when will it happen”, but “how are we doing while we wait”. You have no answer to the first. To the second you do — every single day.

What is in your hands and what isn’t

One of the most useful things you can do in a period of uncertainty is to separate what you can influence from what you cannot. Not so that you resign yourself to everything, but so that you don’t spend your energy fighting something you cannot move.

For the wait before a pregnancy test during treatment, Lancastle and Boivin tested a very simple form of help: a card with statements that help women look at the waiting in a new way — not with a promise that everything will be fine, but with a reminder that they will manage whatever comes. In a small study, women rated it as useful and feasible. The exercise below is built on that idea.

Life on hold

One of the quieter consequences of the first year is that life slowly goes on pause. You don’t apply for a new job because “I might be pregnant soon”. You don’t book a summer trip because “what if”. You don’t buy clothes because they might soon be too small. Each of these decisions makes sense. Together, they mean the year passes in life’s waiting room.

It helps to plan as if both outcomes were possible. A trip you can cancel. A project you can hand over. A course you can drop. It isn’t about “stopping trying” or “relaxing and it’ll happen” — those are the two pieces of advice people in this period least like to hear, and for good reason. It is about your life remaining yours now too, not only once it happens.

How you talk to yourself matters here as well. If after every period you hear a voice inside saying you did something wrong, that your body isn’t good enough or that you don’t deserve what others have, then that very voice takes away the strength you need for the next month. Kristin Neff, who brought the concept of self-compassion into psychological research, describes it as kindness towards yourself, an awareness that suffering is shared by many people, and the ability to notice pain without merging with it. More in the post Self-compassion instead of self-criticism: what Kristin Neff’s research shows and in the knowledge base under self-compassion.

Exercise: a card for the two-week wait

You can start this exercise this month, straight after your fertile days. It takes a few minutes a day.

1. Write a card. On a small piece of paper write three to five sentences that are true for you — not “everything will be fine”, but for example “Whatever happens, I will get through that day”, “This month I did what was in my hands” or “Whatever the test says, we are still us”. Let the sentences be yours, not from a book.
2. Read it morning and evening, until the day you know. You don’t have to believe every word. It is enough to read it.
3. Every day, do one thing that has nothing to do with your cycle — something you would do even if you weren’t trying. A walk, a book, cooking with friends.
4. When you notice yourself reading signs, name it: “I’m reading signs again.” Don’t argue with the thought or chase it away. Just notice it and return to what you are doing.
5. Agree on test day together. Where you will be, whether you will be together, what you will do afterwards — whatever the result. If the plan is made in advance, you don’t have to make decisions in the moment of disappointment.

The exercise won’t change the outcome. But it can change how you get through those days — and that is not nothing.

Where this post stops

Worry does not cause infertility. “Just relax and it’ll happen” is one of the most common and most painful sentences in this period. In a meta-analysis of prospective studies, Jacky Boivin, Emily Griffiths and Christos Venetis found that women’s emotional distress before treatment was not associated with a lower chance of the treatment succeeding. The research covered assisted reproduction, not trying naturally, but the message matters for you too: your worry is not to blame for it not happening. The exercises in this post are meant to make things easier for you, not to make it “finally work”.

Not every first year is hard. Some couples go through this time calmly, with more patience than they gave themselves credit for. If that is how it is for you, you don’t need to go looking for distress that isn’t there.

Medical questions belong with a doctor. This post does not answer questions about the cycle, tests or treatment options. If something worries you, see a gynaecologist — even before a year has passed. How distress shows up around this is briefly described in the knowledge base under infertility and distress.

When distress needs more than an exercise. If you haven’t slept properly for weeks, have lost interest in everything, are withdrawing from people or have thoughts that there is no point in living, turn to your GP or a psychiatrist. If you have thoughts of suicide, call the mental health crisis line in Slovenia on 01 520 99 00 (daily, 7 pm to 7 am) or the Samaritans helpline in Slovenia on 116 123 (24 hours a day), and in an emergency 112.

If you feel a conversation would help — on your own or with your partner — it is right to seek it now, not only once the year is up. As a therapist in training under supervision in marriage and family therapy, I hold sessions in person in Ljubljana, and I also work in English.

What to remember

• Professionally, infertility is only spoken of after 12 months of trying — but your gynaecologist will tell you when it is time for a check-up in your case.
• Waiting is exhausting because uncertainty is a rhythm that repeats every month.
• Tracking your cycle can help or it can feed anxiety — notice whether it serves you.
• Envy at someone else’s pregnancy is not bad character; you may take time before you congratulate.
• Worry does not cause infertility; kindness towards yourself helps you endure the wait.