I am a clinical psychologist who has been in practice for 40 years and an Adjunct Associate Professor at University of Michigan Medical Center for 20 years. While my training was in traditional psychodynamic therapy, my current approach is more eclectic and Rogerian in its emphasis on empathic engagement with the client as the primary vehicle of change. My initial interest in reproductive loss was based on having a number of child cases in which perinatal sibling loss was an important unrecognized dynamic.

I am a clinical psychologist who has been in practice for 40 years and an Adjunct Associate Professor at University of Michigan Medical Center for 20 years. While my training was in traditional psychodynamic therapy, my current approach is more eclectic and Rogerian in its emphasis on empathic engagement with the client as the primary vehicle of change.

Fertility counselors see an array of clients who may be diverse in terms of countries of origin, ethnicity, race and/or cultural background. This chapter identifies principles to guide this conversation. These principles include understanding how we consider race, ethnicity and culture, and emphasize the importance of not essentializing race, ethnicity and culture. The chapter continues with a brief overview of the meaning and consequences of infertility in various places worldwide and among migrant and racial minorities in particular, how this can affect access to, use of and experiences with fertility treatments and assisted reproductive technologies (ARTs). Finally, we offer considerations for racially and culturally sensitive clinical approaches in fertility counseling.

Trauma occurs when the ability to envisage our future and feel safe in the world is no longer possible. While trauma is often a one-time horrific occurrence, it can also be chronic in nature.Indeed, reproductive trauma can encompass both types of anguish: the frightening and painful loss of a miscarriage, with massive bleeding and the potential need for surgery, or the seemingly endless cycle of hope and despair during fertility treatments. Sadly, for our patients, it is not uncommon to experience both infertility and pregnancy loss, and like a soldier on the battlefield, it can be protracted, leaving deep psychological wounds. This chapter not only explores the trauma that occurs in reproductive patients, but also how we, as fertility counselors, cope with being on the battlefield with them.