She knew she needed more support.
The woman and her husband, a Bethesda couple now in their early 40s, were several years into their decade-long journey to become pregnant, and things weren’t working out the way they had hoped.
Ten is too many miscarriages, she remembers thinking. Each was devastating. She wasn’t sure she could become a mother, and she felt her friends and family didn’t know what to say. Her doctor told her that many families stop trying to get pregnant because the stress of each attempt becomes too much to manage.
So she decided to seek a different kind of support. She wanted someone who could help her talk through her grief and her options.
This led the couple to Sharon Covington, a licensed clinical social worker who runs the Center for Reproductive Mental Health in Bethesda. (Due to the sensitive nature of their story, the couple has asked that their names be withheld.) They began seeing Covington in 2016, at first weekly to work through the trauma of repeated miscarriages and infertility treatment; then the woman saw Covington for therapy once a month on her own, and once a month with her husband. They continued to see Covington for about seven years.
Covington helped them explore other options for building their family, including adoption, and actively work through the grieving process of pregnancy loss and letting go of their original plan of how to expand their family.
“People need a chance to support and understand their feelings about this,” Covington says. “They need to be able to grieve their loss and talk about alternative ways to have a family, either through donor eggs, donor sperm, donor embryo or adoption, or remain a family of two.” What she says she offers as a reproductive therapist is the chance to “process the experience they are going through in a safe environment.”
Forty years ago, Covington was working as a social worker when she experienced two late-term pregnancy losses and an early miscarriage. She says nothing in her career or personal life had prepared her for the unique feelings and grief from the losses. At that time, there was little support for families going through reproductive loss, what Covington calls “a very silent grief and loss.” In 1981 she started the Miscarriage, Infant Death and Stillbirth support group, which is now called MIS Share (Miscarriage, Infant loss and Stillbirth) and is still active (misshare.org).
“What I learned in these infertility and pregnancy loss groups is the unique nature of grief from the loss of the wished-for child and what an incredibly isolating experience it is, which creates a profound sense of personal shame that is hard to process and resolve,” Covington says. She began speaking to physicians about this, including Dr. Paul Feldman, who worked at Adventist HealthCare Shady Grove Medical Center in Rockville at the time. He asked if she would move her therapy practice into his OB-GYN office, which she did in 1983. In 1991, she teamed up with Drs. Michael Levy and Arthur Sagoskin to start Shady Grove Fertility, to provide support for the medical and emotional needs of patients going through treatment.
Reproductive mental health and fertility counseling is “counseling and supporting people who are struggling to have a family,” Covington says. In vitro fertilization has been around for almost 50 years, but as reproductive technology has expanded and people wait longer to have children, it has rapidly gained in popularity. Medical technology now allows eggs to be harvested from women; sperm, eggs and embryos to be frozen and used later; and embryos to be created in a lab using donor sperm and eggs and then transferred to a gestational surrogate.
Each person involved in third party reproductive technology is recommended by the American Society for Reproductive Medicine to have a “recipient consultation,” a single counseling session with a trained therapist. Sharon’s daughter, Laura Covington, also works at the center, where she is regularly involved in recipient and donor consultations. Laura, who has a Ph.D. in social work, describes these consultations as “more of an educational session, not an evaluation.”
“I’m there to provide information and for them to go through how the donation works and talk to them about future implications,” she says. Much of the discussion can focus on the emotional well-being of the adults involved and of their future child, including what and when to tell the child about their conception, which Laura recommends they do at an early age.
Laura estimates she does 15 to 20 recipient or donor consultations a month, and only a few are with donors the family knows personally. Many people who go through consultations return to her therapy practice, either for individual sessions or one of the support groups she runs for donor conception or queer family building. Many conversations involve what to do with remaining embryos, if they should try for a second child or when to stop fertility treatments.
“People go through trauma and hardship in order to get one child. The thought of going back and doing it again can be really hard,” Laura says. And for people who go through month after month of negative pregnancy tests, or multiple losses, “it can be isolating. They don’t always have others to understand or sit with them and just listen,” Laura says.
There are times when Laura has counseled clients to put things on hold and rethink the process. “Sometimes the couples aren’t on the same page at all—one is all ‘let’s do it,’ and the other is like ‘no.’ My role as a therapist here is to take a pause and step back to get support, or even to sit with sadness.” And sometimes the donors aren’t ready to proceed either. She recalls an egg donor discussing her own childhood trauma that she hadn’t yet fully processed. “I recommended for her not to move forward as a donor, and she actually agreed.”
In the 15 years that Laura has been practicing, she has seen more of a willingness for parents to share information with their children and be open about the process. Working in the Bethesda area, she encounters a range of people undergoing fertility treatments. Many are in their early 40s and may have delayed having children for multiple reasons. “Compared to rural areas, it’s more common to use donor conception [here], and there is more knowledge about it,” she says.
One of those couples with a new baby includes the Bethesda couple who’d struggled for so long.
In the spring of 2024, after waiting three years, an adoption match came together in less than a week. They sent Sharon a request for a session, staying mum about the true reason. When they met over Zoom, the woman lifted the baby girl off her lap—sharing this moment of joy that she had been waiting for.
“[Sharon] helped us move forward,” she says. “This isn’t what we pictured when we started this, but just because it was ‘second choice’ doesn’t mean it was ‘second best.’ It just means it didn’t happen first.”
This story appears in the November/December 2024 issue of Bethesda Magazine.
