This blog addresses various emotional aspects of experiencing infertility. It is written by a clinical psychologist who specializes in infertility counseling. Thank you for reading, and best of luck with your journey!

Monday, July 29, 2013

Tales from the other side: setting realistic expectations of life after infertility

When I was struggling with infertility, having a child was almost like finding the "holy grail".  I was convinced that if I could just start my family, all of my problems would be solved.  I must add that most of this expectation was held unconsciously; regardless, boy was it ever wrong!  I am fortunate to be the mother of three (at this moment) reasonably healthy children, but I can't say I have ever approached the nirvana of a relatively problem-free existence.

I know from my clinical experience in working with individuals and couples struggling with infertilty that I am not alone in this belief.  Perhaps it's one of those working fictions that we need to keep us going during difficult times.  If we really recognized that difficult times don't really end, but just lead to difficult-in-a-different way times, we might just curl up in a ball and call it a day.  However, the usefulness of this fiction often dissipates after the infertility struggle is, at least overtly, over.  Often, I see people struggle with the expectation that once their child or children arrive, they should be over-the-moon happy all of the time.  When they don't always feel this way, they worry that they are not grateful enough, or that after they have endured, they are somehow not "doing it right".  Of course, it is their expectation that is inaccurate...most likely, their feelings are completely normal and expectable give their current situation,

In order to create a more realistic picture of life after infertilty, I will describe some of the more common experiences I have witnessed in the lives of others as well as my own life.

1.  Pregnancy after infertility is often filled with anxiety.

Instead of shouting with joy from the rooftops, many newly pregnant infertility patients are riddled with anxiety and fear.  This is usually quite the opposite of what they expected.  They live anxiously from beta to beta and ultrasound to ultrasound.  Every early pregnancy symptom is examined and reexamined.  As the pregnancy progresses, the anxiety dissipates somewhat, but it never totally goes away.

2.  Childbirth and breastfeeding can be difficult and can add to the already negative feelings you may have about your body.

For many infertile women, childbirth and breastfeeding seem like an opportunity to finally be and feel "normal".  That's great if everything works out the way you hoped.  Unfortunately, many women with infertilty are at at higher risk for difficult childbirth and breastfeeding troubles.  For some women, having an unexpected c section or milk production issues can feel like another body "failure", adding to their still painful feelings about their infertility.

3.  Your child isn't going to be perfect, and you aren't going to be the perfect parent, no matter how hard you try.

Of course, this is true of any child and any parent.  However, many parents who have a history of infertility have lingering, unconscious expectations that because they have been so committed to building their family, they need to be perfect parents.  When they fail at the impossible, they can be too hard on themselves.  Sometimes, they may unconsciously  blame themselves or their infertility for whatever difficulties their child might be having, even though chances are, it's completely unrelated.

These are just a few experiences I have noted, and I would love to hear about the experiences and observations of others, so please leave a comment!

Also, even though the parenting experience isn't a perfect one as we may have envisioned, it can be very rewarding--perhaps more so if we free ourselves of unrealistic expectations.

Thanks so much for reading, and as always, I look forward to your comments and questions!

Wednesday, July 24, 2013

More decisions; medical decisions, emotions, and infertility treatment

I often think that if I ever were to write a book on psychological issues, it would be on how individuals make decisions about their medical care.  I find it fascinating and sometimes frightening how much emotional issues can affect and impair the ability to make good health care decisions.  Unfortunately, I have seen this lead to very sad and perhaps avoidable negative outcomes,  in the area of infertility and in other types of illness as well.

In this post I will discuss some emotional issues that commonly interfere with the ability to make sound medical decisions.  The first, and perhaps most serious problem is an overuse of the denial defense.  We have all heard stories in which a person notices some significant medical change, like a lump, and copes with their anxiety about it by using denial.  They do not seek medical treatment and often don't alert loved ones about the problem until it is too late.  My own father-in-law, a dear, wonderful, and educated man, ignored the warning signs of his colon cancer for years.  When the family finally became aware of and responded to the problem, it was too late, and he died a few weeks after his diagnosis.

In the infertility world, this can occur when individuals fail to seek treatment even though they meet the criteria for infertility.  They often trust that it will "just happen when the time is right".  Meanwhile, the clock is ticking, and if there are ovarian reserve issues at play, time may be running out.  I sometimes see women in their late 30's or early 40's remain convinced of their ability to conceive naturally with their own eggs, despite much objective evidence to the contrary.  Perhaps in some of these cases there is an underlying ambivalence about having a baby, but regardless inaction at this crucial time may ensure that they lose whatever opportunity of using their own eggs that remains.

Another type of emotional issue that can impair medical decision making is feelings about the doctor-patient relationship (or transference as we psychodynamically trained therapists like to call it).  Feelings of loyalty to a doctor may make it difficult for some people to seek a second opinion.  They may have idealized their doctor and be unable to recognize or admit that their doctor has missed something or made a mistake.  Alternately,  they may find it difficult to trust others, especially medical professionals, and therefore are unable to provide a complete symptom picture, leading to under diagnosis or misdiagnosis, which then unfortunately only increases their mistrust.  Even if they do receive the correct diagnosis, their feelings of mistrust prevent them from following treatment recommendations, which can have tragic effects.

As you can see, making sound medical decisions requires the ability to deal with your feelings directly, and to be able to acknowledge anxiety-producing situations.  It also involves the ability to trust and value the opinion of others, but not so much so that you cannot examine these opinions critically.  These emotional abilities are not always easy to obtain.  In an emotionally charged situation such as infertility treatment, it is even harder to apply these skills.  Thus, it is important, when you are making treatment decisions, to take a moment and think about whether you are using denial, or if your emotions about your doctor could be interfering with your ability to critically examine their recommendations.

As always, thank you for reading, and please feel free to contact me with any questions, comments or suggestions you may have!

Wednesday, July 17, 2013

Decisions, decisions: a few thoughts about deciding how many embryos to transfer

One of the difficult parts of an IVF cycle comes near the end when the decision about how many embryos to transfer back must be made.  From a medical standpoint, this decision can be difficult because there are no hard and fast rules; every individual situation is different and involves multiple factors such as embryo quality, maternal age, prior treatment history, etc.

From a psychological standpoint, the decision about the number of embryos to transfer can be tricky as. Well.  Usually, these decisions need to be made quickly because the information about the embryos is only available right before the transfer. Further, by this point in the cycle, emotions and hormone levels as running high, making clear and rational thought a challenge.

Perhaps most importantly, however, is the fact that by the time a person is usually facing their IVF transfer, they have been dealing with infertility for a while.  Thus, they are naturally desperate for the whole thing to be over and done with as soon as possible.  The idea that putting another embryo or two back might increase their chances of success, meaning they could be on their way to parenthood very soon, is quite seductive.  If financial issues are a concern, an increased chance of success in fewer cycles is also a strong motivation.

I hear many clients tell me that their ideal outcome of an IVF cycle would be twins.  "Two for the price of one," and "buy one, get one free," are common refrains.  I totally understand that sentiment.  I think I may even have said those things regarding my own treatment at one point or another.  However, part my practice involves working with people who have experienced perinatal loss and/or who have given birth prematurely and whose children have spent an extended time in the neonatal intensive care unit.  Many of these people began their path to parenthood via IVF, and transferred multiple embryos.  There experiences in the NICU are often extemely difficult, traumatic, and of extended duration.  All of them have expressed a wish that someone had really helped them understand the risks associated with multiple pregnancies before their IVF transfer.

In addition, even if things work out medically, my work with the parents of multiples has taught me that having twins or triplets can sometimes be hard on a relationship as well, especially if there are other life stressors occurring simultaneously.

I don't mean to be full of doom and gloom here, as I know many healthy and happy families with twins and triplets.  But I do urge people to really educate themselves about the medical and psychological risks associated with multiple pregnancies before they get to transfer day, so they are prepared.  The good news is that with today's improvements in embryo freezing technology, single embryo transfer is a more viable option with a greater chance of success.

Sometimes the decision about how many embryos to transfer is made for you by the situation; you may only have one viable embryo, or the quality of the embryos may suggest transferring multiple embryos.  If you do end up with a choice, then you need to weigh the risks of multiple pregnancy against the emotional and physical wear and tear of doing another frozen embryo transfer.  After seeing the problems that can arise with multiple pregnancies, I find myself recommending single embryo transfer more often these days.

Of course, the decision about how many embryos to transfer back is a personal one, and can only be made by you and your partner.  Just be sure that you have all the facts, so you can make the choice that is best for your situation.

Wednesday, April 10, 2013

Infertility, pregnancy, and self-esteem

I was picking up my daughter at a class the other day, when I overheard one of the other mothers talking to the school director.  "Did my daughter tell you our news?" she asked excitedly.  It turned out that this woman was unexpectedly pregnant, after undergoing infertility treatment to conceive her children.  Her face was all aglow, and she went on and on about how she was finally normal, finally experiencing a miracle.  To her credit, the school director told her, "Well, I think all your children are miracles," but that really didn't even slow her down.

I left feeling uneasy, and frankly, a little irritated by what I had overheard.  I was also irritated at myself--shouldn't I be as happy for this woman as she was for herself?  After all, she was experiencing the holy grail of infertility treatment--the spontaneous pregnancy.  As I further considered my reaction, I realized that what was really bothering me was this woman's assertion that now, and only now that she had achieved a pregnancy without treatment, that she was normal.  That now, she could feel good about herself.

The more I work in the field of infertliity, the more I am able to see how much we, as a society, tie the concept of fertility in with our sense of self-esteem.  If a woman can be pregnant and successfully deliver a baby, she's normal and good; if she can't, she's something else--at best someone to feel sorry for, and at worst someone who God/the universe is trying to tell that she doesn't really deserve to be a mother anyway.

The pain that this societal assumption causes is immense.  Further galling, anyone who thinks rationally for any amount of time about this assumption will realize it is patently and ridiculously untrue.  Of course we all know supremely fertile women who are failing miserably at parenting; and we all know (and might well be) supremely infertile women who will make amazing parents once their infertility crisis is resolved.

I guess this is why I felt so annoyed with the woman at my daughter's class-a feeling of "et tu, Brute?"  After all, she is one of us--and yet she still bought into the fertility=normal/good equation hook, line, and sinker.

After a long and protracted battle with infertility and my body in my quest to have children, I have come to realize that I can't let my infertility define how I feel about myself.  It was all beyond my control anyhow, and even if it wasn't, I can't feel worse about myself because of it.  In the same light, I can't feel like I'm a better, normal/good person because today my lungs are functioning well.  That's out of my control too.  Instead, I must judge myself on how I respond to my circumstances, and how I treat others in my life. 

I hope if you are struggling with infertility, you try to do the same; remember that fertility, or infertility is not the measure of a person.  Our efforts, our choices, and our treatment of others are much more valid criteria for self-assessment.

Thursday, March 7, 2013

The light at the end of the tunnel: aging out of expectations of fertility

When I was in the throes of infertility treatment, I remember often reading and hearing that infertility was just a life phase, and that over time, it would resolve itself one way or the other. Life would go back to normal. Of course, this was intended to give me hope, and strength, but instead of finding it comforting, it just made me want to throw up.  I could already see then, as I can confirm now, that there was no way I was ever going to be the same person after going through all of that pain and disappointment.

In that way, it seems that infertility never ends--even when the struggle is over, our perspectives and relationships have changed.  However, I can say that one of the silver linings of getting older is that now no one is expecting me to be able to have babies anymore!  As I approach my mid-forties, I no longer am asked whether or not I am going to have children, or have more children.  People just assume that it's all done with, and because of my age, I am not very likely to become pregnant--and here is the important part--JUST LIKE EVERY OTHER WOMAN MY AGE.  Yes, I've found myself back in the "normal" group again.  It took a decade or two for everyone else to catch up with me, but now we are all in the same boat.

I can't tell you what a sweet relief I have found this to be.  It almost takes the sting out of my encroaching wrinkles and grey hairs--almost.  Now that the book is closed and the dust is settled, it occurs to me that most women my age had their children quite some time ago, and that they haven't defined themselves by their ability, or inability, to get pregnant for quite some time.  They have left all that behind and have moved on to other aspects of their lives.  Perhaps that's one of the problems with infertility--it can imprison us in the "reproductive phase" of our lives for extended periods of time, but without the easy ability to complete the phase successfully.

Thus, although the emotional changes infertility causes never fully leave us (nor, in my opinion, should they) it does seem that society's expectation that we go forth and multiply does, thankfully, come to an end.  As for me, I notice the difference in myself when I am social situations with people I don't know very well.  For years, every time I met someone new, I had been unconsciously bracing myself for the questions about babies and pregnancy, whether they actually arose or not.  Now I can observe myself feeling much calmer and lighter in these situations, knowing that the questions just aren't going to come up.  Although that's not a complete end to the "infertility" phase of my life, it certainly feels much better, and it isn't as much of a constant presence in my mind.

Wednesday, January 30, 2013

The Infertility Therapist gets cranky, part III: a study of dubious usefulness

Perhaps I'm just in a cranky mood, but I was shocked to open my January 2013 issue of Fertility and Sterility and discover an article entitled, "Attractiveness of women with rectovaginal endometriosis: a case control study" (Vercellini, Buggio, Somigliana, Barbara, Vigano, and Fedele).  I first thought that surely the article couldn't be about what I thought was about, but a closer examination revealed that I was correct.  The authors spent considerable time and effort to compare women with different types of endometriosis--rectovaginal, ovarian and peritoneal, along with women with other gynecological conditions--on the variables of BMI, breast size, waist to hip ratio, and age of first coitius.   They were also evaluated for attractiveness by a panel of four judges.  According to the findings of the study, it turns out that women with rectovaginal endometriosis are considered to be significantly hotter than the women with the other conditions.  So ladies, if that's you, you have my congratulations.

Can someone out there in the blogosphere please enlighten me as to 1) why this study was conducted in the first place and 2) why it was accepted for publication in a major scientific journal?  The study authors argue that different types of gynecological disorders might be due to different genetic phenotypes, which would cause women to have different types of appearances.  But is that really going to be helpful to science?  Are doctors really going to start diagnosing the type of gynecological disorders a patient has based on how attractive they seem or when they lost their virginity?  Especially when we can already diagnose these disorders using things that seem a bit more reliable, like ultrasound images, DNA testing, or surgical reports.

Endometriosis is a complicated disorder that causes a great deal of pain and suffering.  Heck, I even have it myself (although not, as you may have guessed, the kind that makes a girl look appealing to a panel of four trained judges).  Isn't there a better way to work on finding a treatment and a cure?  In my opinion, infertility patients deserve better than an objectifying and demeaning study like this one, which seems to serve no one's interests.

Wednesday, January 23, 2013

Top tips for surviving infertility treatment, day ten--recognize your own strength!

In infertility treatment, it's all too easy to focus on what's gone wrong, and on what you can't seem to do.  It is harder to take a step back and see things from a broader perspective, in which it becomes clear all that you have done, and all that you have learned.  Almost all of us are changed by our experiences with infertility, and I feel mostly in a positive way.  We know that we can be strong, and tough, and brave, even when the stakes are high.  We learn that we can endure more than we thought we could.  We learn new and better ways of coping with stress and difficult feelings. We see how much empathy we can have for others experiencing similar difficulties.  We show ourselves that our capacity to love is strong, and profound.

When you are feeling down about how things are going, I would encourage you to take a step back, and look for your own private moments of heroism.  Think about all the things you have learned, and the distance that you have come.  I'm confident that you will find a great deal of good mixed in with all of the bad. 

Recognizing your own strength can restore some of the self-esteem that infertility can erode away.  And above all, remember:  infertility is a medical, biological problem over which you have little or no control.  It isn't a referendum on your character, and it isn't some sort of cosmic message that you wouldn't make a good parent.  You are more than the functioning of your organs or cells.  You are just as good as anybody else! 

I wish you all the best of luck in your infertility treatment, and would love to hear how things are going.  If  you have any questions, comments, or suggestions, please leave me a comment, or email me at lisarouff@gmail.com.