Compassion in Three Directions: How Infertility Disrupts the Flow of Kindness

Infertility affects one in six adults worldwide, according to the World Health Organization, and its psychological toll falls disproportionately on women. Beyond the physical demands of hormone stimulation, egg retrieval, and repeated treatment cycles, women navigating fertility care frequently report depression, guilt, shame, anxiety, and self-judgment. A new descriptive qualitative study published in Current Psychology by Tuğçe Atasayar of Antalya Bilim University and colleagues at Akdeniz University offers an unusually detailed map of how these women experience compassion—not only toward themselves, but also as something they give to others and receive from the world around them. The findings suggest that compassion behaves less like a fixed personality trait and more like a circulatory system, one that infertility can throw dangerously out of balance.

The research team interviewed sixteen women receiving assisted reproductive treatment at two private in vitro fertilization centers in southern Türkiye. Participants were married, aged between 18 and 49, and diagnosed with female-related or unexplained infertility; women with male-factor diagnoses were excluded. Each woman took part in a face-to-face, semi-structured interview lasting 40 to 50 minutes, conducted without spouses present so that participants could speak freely. Interviews ran from February to August 2024, and recruitment stopped once data saturation was reached—the point at which successive interviews produced no new codes or themes. The researchers then applied Braun and Clarke’s six-step thematic analysis, transcribing interviews verbatim, coding them inductively, and refining themes through iterative group discussion until a coherent structure emerged.

The analysis yielded three main themes: the experience of compassion during the infertility process, the determinants of that experience, and its reflections in women’s lives. What makes the study distinctive is its grounding in Paul Gilbert’s Compassionate Mind Theory, which conceptualizes compassion as three interconnected flows—compassion directed toward oneself, compassion extended to others, and compassion received from others. Most previous research on infertile women has focused narrowly on self-compassion, typically measured with quantitative scales. By listening to women describe all three directions of compassion in their own words, the Turkish team captured a phenomenon that single-construct studies tend to miss: the way a blockage in one flow can cascade through the others.

The starkest finding concerned self-compassion, which most participants reported being unable to summon. Some women said they had never even reflected on the concept before the interview prompted them to. Others described treating themselves with a harshness they would never direct at another person, saying things to themselves they would hesitate to utter aloud for fear of causing hurt. Several reported punishing themselves through isolation, deliberately withdrawing from friends and family. One participant put it plainly: she was often harsh toward herself and criticized herself constantly, yet still tended to give compassion to others while neglecting her own boundaries. The researchers interpret this pattern through Gilbert’s model of the threat system, in which shame and self-criticism actively inhibit the capacity for self-soothing.

At the same time, the physical and psychological burden of treatment appeared to inflate the women’s need to receive compassion from others. Participants described a heightened desire to be understood, accepted without judgment, and treated with sensitivity. Spousal support emerged as the most meaningful form of compassionate behavior—partners who normalized the situation and expressed understanding helped women stop blaming themselves and become gentler with themselves. But receiving compassion proved fraught. Well-meaning remarks such as “it will happen in time” were perceived as dismissive, and several women said they could feel the difference between genuine empathy and pity. When people failed to recognize that fine line, one participant explained, their words became hurtful rather than compassionate, and she began avoiding their support altogether.

This avoidance points to one of the study’s most conceptually interesting results: fears of compassion operating across all three flows simultaneously. Some women hesitated to show themselves kindness because they believed self-compassion would fuel hope, and that hope would magnify the devastation if treatment failed. Others perceived others’ compassion as pity, insincere, or emotionally overwhelming, and responded by refusing help. Still others became reluctant to extend compassion to anyone, having felt emotionally exhausted or exploited in past relationships. In Compassionate Mind Theory terms, these are classic examples of fear of compassion—compassion experienced as a threat or vulnerability rather than a soothing resource. Crucially, the study shows these fears interacting: a woman who cannot receive kindness becomes more self-critical, and a woman who cannot be kind to herself struggles to offer kindness outward, tightening a feedback loop of withdrawal.

The determinants of these patterns were rooted in biography and culture. Participants traced their difficulties to family experiences, early criticism, and past trauma; one described how growing up with a mother’s severe depression shaped the way she now relates to herself. Others reported developing patterns of excessive compassion toward others to maintain relationships or win acceptance, often at the expense of their own emotional well-being. The sociocultural context mattered too. In Türkiye, where the study was conducted, motherhood is widely regarded as a central component of womanhood, and traditional gender norms intensify the shame and inadequacy that infertile women report. Spirituality, faith, and a sense of fate also surfaced as resources, offering comfort, meaning, and hope that helped women respond to their suffering with greater acceptance.

Perhaps the most striking reflections of compassion—or its absence—were written on the body. Women who struggled to access self-compassion described emotional eating, weight gain, excessive sleeping, and neglect of self-care, behaviors they framed as coping mechanisms rather than genuine care. Those who managed to cultivate self-compassion reported healthier lifestyle habits, improved self-care, better sleep, and greater awareness of their own needs. These accounts align with a growing quantitative literature linking self-compassion to better sleep quality, more positive body image, and fewer disordered eating behaviors. Psychologically, the contrast was equally sharp: women cut off from compassion described loneliness, hopelessness, and repetitive self-critical thoughts, while those in the flow reported self-acceptance, resilience, and a sense of being more connected to others.

Compassion also shaped whether women stayed in treatment at all. Participants described compassionate care from healthcare professionals—being listened to, having a nurse hold their hand through an egg retrieval—as fostering trust, hope, and a sense of working toward a shared goal. One woman credited a nurse who stayed beside her throughout the procedure with making a second treatment attempt possible at all. Conversely, care perceived as purely technical, indifferent to emotional needs, increased stress and anxiety about future cycles and made disengagement more likely. The authors frame this as the compassion-from-others flow generating what Gilbert calls social safeness: the emotional security that allows regulation of distress and, ultimately, self-compassion to develop.

The study’s limitations are worth noting. The sample was drawn from two private clinics in a single country and was relatively homogeneous socioeconomically; only women’s perspectives were captured, leaving partners, family members, and clinicians unheard; and a single interview offers only a snapshot of experiences that evolve across treatment stages. The researchers also acknowledge that interpreting narratives through the framework of compassion flows reflects their analytic lens rather than the participants’ own vocabulary. Even so, the implications are concrete. The authors argue that compassion-based interventions for infertility should move beyond self-compassion training to address giving and receiving compassion as well, that clinicians should avoid dismissive or pitying language in favor of validation and emotional sensitivity, and that fertility centers should watch for compassion fatigue in patients who give support while receiving little. From a policy standpoint, they call for counseling services and compassion-focused support programs within assisted reproduction centers, alongside training that equips healthcare staff to deliver care addressing emotional as well as physical needs. In a condition affecting one in six adults, the message is that kindness—in all three of its directions—is not a soft adjunct to reproductive medicine but a measurable determinant of whether women cope, stay connected, and keep going.

Subject of Research: The experience of giving, receiving, and self-directed compassion among women undergoing infertility treatment

Article Title: Flow of compassion in self, for others, and from others in the shadows of infertility: a descriptive qualitative study

Article References: Atasayar, T., Deliktaş Demirci, A., Karaçar, Y., & Kabukcuoğlu, K. (2026). Flow of compassion in self, for others, and from others in the shadows of infertility: a descriptive qualitative study. Current Psychology, 45(19), Article 1577. https://doi.org/10.1007/s12144-026-10000-3

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10000-3

Keywords: infertility, compassion, self-compassion, IVF, qualitative research, Compassionate Mind Theory, compassion fatigue, mental health, reproductive medicine, women's health, empathy, psychological well-being