The emotional, existential, and grief-laden work of trying to have a child — held seriously, by a therapist who knows the territory.
IVF and Other Assisted Reproduction Therapy
The medical side of fertility treatment is well covered by clinics, fertility specialists, and reproductive endocrinologists. The emotional and existential side is less well covered, and often the part that costs the most. The anxiety. The grief that does not have a clean place to land. The toll on the partnership. The way the calendar starts to organize itself around cycles, two-week waits, and appointments. The slow erosion of being a private person inside your own body. The decisions that no one outside the experience fully understands. This page is for people in any phase of that work.
I bring clinical training and personal familiarity with the territory of assisted reproduction, which means clients do not need to start from the basics to be understood.
Norman Klaunig, MA, LPC, NCC | Texas LPC #89856 | English and German
At a glance
Who this page is for: Individuals and partners going through fertility evaluation, IUI, IVF, donor cycles, surrogacy considerations, embryo decisions, or recovering from any of the above; people grieving infertility, failed cycles, pregnancy loss, or the long process of deciding to stop
What this work addresses: The grief, anxiety, identity questions, decisional weight, partner-dynamic strain, isolation, religious and existential questions, and trauma layer that often accompany assisted reproduction
Cluster home: Primarily Grief; bridges Existential and Life Transitions
Therapist's background with this territory: Clinical training plus personal familiarity, including with IVF anxiety
Therapist: Norman Klaunig, MA, LPC, NCC
License: Texas LPC #89856
Office: 1528 W Contour Dr, Suite 102, San Antonio, TX 78212
Service area: Online statewide in Texas; in person in San Antonio
Languages: English, German
Insurance accepted: BCBS, Curative, Medicare (traditional Medicare and BCBS Medicare Advantage plans)
What this work is for
The emotional life of fertility treatment is its own clinical territory, and most general therapy does not have a specific frame for it. The pace and structure of cycles, the felt loss of bodily privacy, the unique grief of repeated near-misses, the way hope and despair learn to coexist in the same week — these have a particular shape, and people who have not been through it often miss it.
Therapy for IVF and assisted reproduction holds that shape. It does not replace medical care, and it does not offer false reassurance about the outcome. What it does is make room for the inner experience that the medical side does not have time to address.
The anxiety of the wait
Anyone who has been through assisted reproduction can tell you about the waits. The wait between starting stims and retrieval. The wait between transfer and the first beta. The wait between the first beta and the second beta. The wait until the first ultrasound. The wait through the early weeks of a pregnancy after loss. The longer wait between cycles. The waits do not get easier with repetition; many people find them harder.
This anxiety has particular features:
• It is anticipatory — you are waiting for information that has not arrived
• It is high-stakes — the information will matter
• It is not actionable — nothing you do during the wait changes the outcome
• It is recurrent — it returns every cycle again
• It is socially difficult — most people in your life cannot fully understand the intensity
Therapy during fertility treatment is often, in part, the work of making the waits survivable. This is not about positive thinking. It is about regulation, presence, and a relationship to uncertainty that does not require you to pretend.
Pregnancy after loss
The decisions
Partner dynamics
Identity questions
Religious and spiritual dimensions
For people who have lost a previous pregnancy and are now pregnant again — through IVF or otherwise — the experience is rarely the simple relief that those around them expect. Pregnancy after loss carries an additional weight: the body remembers, the calendar remembers, every milestone arrives with the question of whether this one will be different. The work in therapy is not to push past the anxiety. It is to make room for it while you live through the pregnancy, and to address the trauma layer where the previous loss left one.
Assisted reproduction involves a series of decisions that are unusually consequential and often unusually private. Among the most common:
Whether to start treatment
Which protocols to try, and whether to keep trying after a cycle fails
Whether to consider donor gametes (egg, sperm, embryo) and how to think about the children that may come from those decisions
Whether to consider surrogacy or other gestational arrangements
Decisions about embryos: how many to create, what to do with remaining embryos, whether to test
When and how to stop
Whether and how to pursue other paths to parenthood (adoption, kinship care, child-free life)
Many of these decisions are not just practical. They touch on identity, family, ethics, religious framework, partner alignment, and the long question of what you can live with. Therapy is one of the few places these decisions can be talked through in the depth they deserve, without anyone pushing you toward a particular answer.
Assisted reproduction puts a particular kind of pressure on partnerships. Partners often process the same events differently. One person may be ready for a next cycle when the other is not. One person may grieve a loss out loud while the other goes quiet, and each may misread the other. Decisions about donor gametes or surrogacy may surface differences that did not exist before. The medical demands themselves often fall asymmetrically on the partner whose body is involved.
I primarily work individually, but the partnership is almost always in the room as part of the work. When couples therapy is the right modality for what is happening between partners, I will tell you so, and we can talk about referral.
Fertility struggles tend to surface identity questions that do not have clean answers:
Who am I if this does not work
What is my body if my body cannot do this
What does parenthood mean if it does not arrive in the way I expected
What is womanhood, manhood, partnership, family, as I understood them, if any of those terms are getting reorganized by what is happening
Where is my life going if this part of it is taking this long
These questions belong in therapy. They tend to deepen as fertility work continues. The existential frame from [existential therapy → /existential-therapy] is part of how this work is held.
For people whose religious or spiritual framework is involved in their thinking about reproduction, family, or suffering, fertility work often surfaces difficult and unanswered questions. Why is this happening? What does it mean? What does my tradition say about IVF, donor gametes, and embryo decisions? What if my tradition's answer is not the answer I can live with? What does prayer, practice, or faith do during a wait that cannot be controlled?
The grief inside fertility struggles
Grief is the core clinical territory of this page. The grief of trying to have a child is real grief, and it is one of the most disenfranchised forms of grief in our culture. People around you, including people who love you, often do not know what to say. Some say things that make it harder. Some default to silence. Some keep asking when you are going to have kids. None of it is what you need.
The losses inside fertility work include:
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Most people who eventually pursue assisted reproduction had a version of how this would go that did not include any of this. The fact that it is going this way is itself a loss — of the easier version, of the privacy, of the body that was supposed to do this on its own.
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Chemical pregnancies. Ectopic pregnancies. First-trimester loss. Later loss. Stillbirth. Each of these is a real bereavement, and each tends to be minimized by people who have not been through it. "At least you can try again" is not a useful sentence to a person grieving a pregnancy. The grief deserves the space it would deserve in any other framework. (For pregnancy and infant loss specifically, see also [grief counseling → /grief-counseling].)
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Each cycle that ends without a pregnancy carries its own loss, and over time those losses accumulate. The grief over a failed cycle is often discounted because there was no pregnancy to lose. The grief is real anyway.
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Each cycle that ends without a pregnancy carries its own loss, and over time, those losses accumulate. The grief over a failed cycle is often discounted because there was no pregnancy to lose. The grief is real anyway.
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One of the quieter losses is the loss of a settled relationship to your own body and your own future. Fertility work tends to take both of those apart in ways that do not always rebuild cleanly.
When the path changes or ends
Some assisted reproduction journeys end with the arrival of a child. Some end with a different path to family — adoption, donor gametes, surrogacy, kinship care, blended family. Some end with a child-free life, whether by choice or because the body did not allow another outcome. Each of these endings has its own grief and its own work of integration. Therapy does not predict which ending you will have, and it does not push you toward any particular one. It accompanies you through whichever one arrives.
Approaches and frames
I draw from in this work
Existential and meaning-focused therapy
Grief work, including for disenfranchised grief and pregnancy loss
Anticipatory grief frameworks
Trauma-informed care, where the work has involved medical trauma, pregnancy loss, or emergency interventions
IFS-inspired parts work
Mindfulness-based regulation and somatic work for the waits
Couples-informed thinking for partner dynamics
Spiritually integrated approaches where the client wants to bring spirituality in
Get in touch
When you are ready
The inner experience of fertility treatment is heavier than the medical side often has time to acknowledge. If you are ready to bring it somewhere it can be held,
the free 15-minute consultation is a low-pressure place to start.
Click this link to choose a day and time for a free, confidential consultation or schedule a session.
FAQs
Frequently asked questions
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Yes. Infertility itself is a form of ongoing loss — a chronic, recursive grief over what is not happening — and the emotional weight of long-term fertility struggles can be substantial even without a discrete pregnancy loss. The clinical territory of this page covers the full arc, from initial difficulty conceiving through extended treatment, and not just the moments of overt loss.
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Either, both, or anywhere in between. Some clients begin therapy before starting treatment to prepare for the emotional weight of the process. Some come during active treatment, often around a particular cycle or wait that has become too much to carry alone. Some come after a loss or after stopping treatment, when the deferred emotional work surfaces. Each starting point is workable. The work follows the territory wherever you arrive in it.
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Yes. This is one of the most common sources of strain in fertility work, and it is rarely a sign that the partnership is in trouble. Different people process this experience differently, and partners often arrive at different decision points at different times. Individual therapy can help you understand your own answer with more clarity, and can help you communicate it without the partnership becoming the place where the pressure of the fertility work gets discharged. Where couples therapy is the right modality, I will tell you so.
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Yes, and it is part of why this work exists. Donor gamete decisions often surface grief that does not always fit into pre-existing language — for the genetic version of a child you may not have, for what you imagined your family would look like, for the privacy of how your family was formed. The grief does not negate your love for the child who may come from a donor arrangement. Both are real. Therapy makes room for both.
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The honest answer is: not in a way I am willing to claim. There is some research suggesting that lowered stress and psychological support are associated with improved well-being during fertility treatment, but the evidence for therapy directly improving conception or live-birth rates is mixed and far less clear than people sometimes assume. I do not promise outcomes. What I promise is that the inner experience of fertility treatment can be held in a way that does not require you to carry it alone.
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There is no formula. What can help is taking the decision out of the cycle-by-cycle pressure, looking at what stopping would mean (emotionally, relationally, practically, in terms of identity), looking at what continuing would mean, and recognizing that the answer is often not a single moment but a slow recognition. Therapy can help you locate where you actually are in that recognition, and what would be needed for you to know when you knew.
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It will follow the framework you bring. Many religious clients want their tradition in the room as part of how they are thinking about reproduction, family, suffering, and decisions; others have left a religious framework and want to work with what that leaving has meant. Either way, the work is psychotherapy — not religious counseling — and it does not require you to land in any particular place. See [spiritually integrated therapy → /spiritually-integrated-therapy].
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That partner often has less visible weight to carry, and the imbalance can create its own difficulty — for both partners. The non-medical partner frequently experiences anticipatory grief, helplessness, secondary anxiety, guilt about not being able to share the physical experience, and the particular loneliness of watching someone they love
For fees, insurance, telehealth setup, and in-person availability, see the FAQ page.
Further reading
These are credible nonprofit and professional sources for information on infertility, fertility treatment, and pregnancy loss.
RESOLVE: The National Infertility Association. https://resolve.org/ — The leading U.S. nonprofit for infertility advocacy, support, and education.
American Society for Reproductive Medicine (ASRM) — Patient Resources. https://www.reproductivefacts.org/— ASRM's patient-facing site, with extensive information on diagnosis, treatment, and outcomes.
American Psychological Association — Infertility. https://www.apa.org/topics/families/infertility — APA's hub on the psychological aspects of infertility and treatment.
Postpartum Support International — Pregnancy and Infant Loss. https://www.postpartum.net/ — Resources for perinatal mood disorders and pregnancy/infant loss.
Center for Prolonged Grief (Columbia University). https://prolongedgrief.columbia.edu/ — Leading research center for prolonged grief, relevant for compounded losses, including reproductive loss.
Understand. Heal. Grow.
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Understand. Heal. Grow. —