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!

Wednesday, October 27, 2010

This is your brain on fertility drugs: psychological side effects of medication

Usually, at the RE's office, new patients are told that fertility medications may make them "a little moody". This is not exactly true--ask any IF veteran, and she will tell you that they have the potential to make you VERY moody. At no time was this more clear to me than during my two month stint on Lupron Depot to treat my endometriosis. After throwing my body into sudden menopause, complete with hot flashes and night sweats, I also realized I now felt extremely upset all the time. If something wonderful happened, I still felt upset. If something upsetting happened, I felt inconsolable. I was in a constant state of wanting to yell and/or sob and/or punch someone in the face. Not only is that bad for business in my line of work, it was also extremely unpleasant. Clearly, I needed to develop new coping strategies to avoid jail time--and fast!

William James to the rescue!

When I first studied psychology in my undergraduate days, I learned about William James and his theory of emotion. One of the founders of the field of psychology, James believed that emotions resulted from the experience of a physical stimulus--e.g., you see a dangerous situation, begin running, and then become afraid--rather than the other way around--you see a dangerous situation, become afraid, and then start running. To be honest, this theory never made a great deal of sense to me. I was convinced that my body responded to my thoughts and emotions, and not vice versa. However, that all changed when I started becoming a habitual user of fertility drugs.

As I described above, while taking fertility medications, I had many physiologically-based experiences that caused my emotions to careen out of control. And unfortunately, I know I'm not alone. In my practice I've heard many instances of normally calm and mild-mannered women, once on the "sauce", suddenly finding themselves screaming and harming their normally beloved crystal. Yes, being infertility treatment is stressful--but many of the reactions I've seen are so far away from the person's normal coping strategy that it's safe to assume medication was a factor.

These experiences have made me question my assumption that emotions are always a direct result of our thoughts. Now, I believe that James was really on to something--sometimes are feelings are based on bodily experiences and sensations, and not the other way around. James himself suffered from a great deal of physical illness during his life, so perhaps he experienced this first hand.

You may be thinking to yourself (especially if you happen to be taking fertility medications right now), "Okay, Dr. Smartypants, who cares? Why are you telling me this? How is exactly is William James going to help me now?" The important point is this--infertility medications mess with your body's ability to react appropriately to the stimuli around you. So if your body feels physiologically upset--adrenalin and cortisol levels elevated--your brain will look at your current circumstances to try to find a reason. If it can't find a really obvious one, it is just going to assume it's one of the things going on in front of you right now. And if you start reacting to relatively innocuous stimuli as if they are the source of your body's upset sensations, well, that's when the trouble starts. But even worse, if you get into a truly upsetting situation, your body will push the panic button and trigger the flight or fight response. During that physiological experience, it's very hard to stay calm and keep a clear head, which many of our modern-day crises require us to do.

In my Lupron Depot days, I experienced this constantly. My natural reaction was to respond to the events going on before me, as if they were the thing that was causing all my inner turmoil. But after a few weeks, I realized that no matter how I reacted or how I changed things in my life, I still felt just as upset as before. Because of my hormonal changes, I was now in an constant state of flight or fight arousal. The only way I could survive would be to use my brain to overrule my emotions and my body's natural tendency to respond. Otherwise, I was going to be in for countless pointless arguments with store clerks and crying jags at the mall--not to mention alienating my husband, family and friends.

Rule No 1--Don't react!

As a psychologist, I am very interested in feelings, especially initial reactions. I normally advise people to pay close attention to those emotions and try to be true to them if they can. However, when you are taking infertility medications, I recommend the opposite strategy. My first rule of coping with the emotional side effects of being on infertility drugs is this: Don't react! The medications have decreased your ability to appropriately respond to your environment. So you have to try very hard not to respond to any seemingly upsetting event right away. Take a breath, and before you say or do anything, cognitively evaluate the situation. Is it really as big of a deal as it feels like right at this moment? Will getting outwardly upset help this situation in any way at all? If the answers to those questions are yes and yes, then you can take the brakes off and respond. But I think you will be surprised at how many times the answers to those questions will be no's. By putting your thoughts back in charge, you can select a more productive course of action.

Rule No. 2--Enlist the support of others

Another important coping strategy is to get a significant other, such as a spouse or partner, family member, or friend to help you evaluate your emotional responses to current life situation. This should be someone who understands your predicament, and agrees--in advance--to be available to you to process your feelings. When you are upset, they can remind you to calm down and go over the details of what just happened to help you figure out the best reaction. Husbands can be great for this, but sometimes men have difficulty truly understanding how hormones can have such a large effect on emotions. Because they don't typically experience the hormone fluctuations that women do even in a normal menstrual cycle, they haven't lived this "from the inside". So it may be necessary to enlist the backup support of a friend or family member just in case they have a hard time understanding the gravity of the situation.

Rule No. 3--Avoid stressful situations

If you are in a treatment cycle at the moment, chances are you are probably doing this anyway, but I'll add a quick reminder that now is not the time to voluntarily take on anything stressful. So perhaps you might want to postpone that incredibly complicated house renovation, or having the queen over for dinner. In infertility treatment, stress is plentiful, so you can be sure there will be enough stress to keep you occupied!

A final note to all the newbies out there....

If you've just begun infertility treatment, chances are you have taken or will be taking Clomid soon. In my experience, this drug is one of the worst in terms of causing emotional side effects. I frequently refer to it as "suicidal ideation in pill form", and I'm only joking a little. If you are taking Clomid and suddenly find yourself feeling very depressed and upset, it may be a result of the medication. (Of course, if it doesn't resolve relatively quickly after your cycle is over, you should definitely get those symptoms evaluated by a mental health professional.) I hope that Clomid will be the key to your success, but if it isn't, take heart--the FSH drugs don't seem to cause such severe reactions.

Wednesday, October 20, 2010

The end of the line? The decision to end infertility treatment

A reader asked me to address the issue of how you can tell if you should stop infertility treatment. This is a very important question, and one that is perhaps impossible to answer. However, I am going to try my best to share my thoughts on this subject, for whatever they are worth.

Sometimes the decision to end treatment is basically made for you. A biological event occurs, like being diagnosed with a serious illness, that makes continuing in treatment unwise. In other cases, diagnostic information comes to light that makes the possibility of success so unlikely that continuing in treatment is pointless. Also, financial or practical considerations may arise that make it simply impossible to continue in treatment. However, in most cases, the situation is not so clear cut, and it becomes a judgment call as to whether or not you should continue.

The way I think about the decision to terminate infertility treatment is centered on one of my fundamental beliefs--that we should try whenever possible to anticipate what our future selves will think about our decisions, in order to minimize future regrets. Having children (or not having them) is a very important, life changing decision. Thus, I feel it is extremely necessary to really think about how you will feel about your choices ten, twenty, or thirty years in the future. As an example of what can happen when you do not take your future self into consideration, I would like to tell the story of a lovely woman that I know from my hair salon. She is now in her late 80's and is suffering from some cognitive dementia, so although she has met me several times, she does not explicitly remember talking to me before. Despite this, she always sits down with me and tells me her story, each time with more nuance and detail. In a nutshell, she and her husband had a baby when she was in her early twenties, but sadly, he was stillborn. She wanted to try to have another baby, but her husband was insistent that they should not. He felt if God wanted them to have a baby, he would have let their first baby live. As time went on, she still wanted to have a child, and suggested that they adopt. Again, her husband was adamantly against this--to him, God obviously did not want them to have a child, and besides, he was not interested in raising "someone else's children". She loved her husband and wanted to stay with him, so she put her dreams aside, and stayed with him through thick and thin. Every time she told me this story, she stated that although she is very sad about not having a child, she feels she must come to peace with it. But it seems to me if you are telling this (and only this) story sixty years later to a relative stranger at the hair salon, you may never come to peace with the decision. Although she has led a rich and full life, and has wonderful extended family that make sure all of her needs are met now (including making sure her hair looks fabulous), I am pretty sure that remaining childless was not the right choice for her. And the deep regret that she expresses is the kind of thing I think we all want to avoid.

If it's over, you'll know

So given that you want to make sure that in the future, you do not have profound regrets, how do you tell when it's time to call it quits with infertility treatment? My personal and clinical experience has taught me this: when it's time to quit you will know it. You will feel it, almost as a physical sensation--something like, "I can't do this anymore, it's bad for me." Your self-protective mechanism will kick in, and saving yourself will become the most important goal. I vividly remember the moment of my decision to quit infertility treatment. I had a break at work, and was pacing back in forth in my office when I realized that although I didn't want to stop trying IVF, I had run out of treatment options. If I kept going, it would be sort of like gambling--the odds were stacked against me. I had the profound sense that I would be really hurting myself if I continued, and to no good end. I acknowledged that I was really bad at getting pregnant--but maybe there was something else at which I was good, and it made more sense to put my energy toward that. We turned to adoption, and so far I have never regretted that decision.

But the heart wants what it wants...

However, if you feel in your heart of hearts that you would like to continue, but that maybe you shouldn't because it is expensive, time-consuming, or other practical concerns--then it is a different story. In this case, I think that if you could logistically make it happen, you should probably continue in treatment. Infertility treatment has a time-stamp on it, so you don't want to be looking back 10 or 20 years down the line, when you don't have the option anymore, and wishing you tried when you had the chance. The heart wants what it wants, and if continuing is what is in your heart, I think it is important to try to honor that. Whether or not it results in a baby, at least you will have the closure of knowing you tried everything you could to achieve your goal.

I know that this way of thinking comes at a price, usually financial. I personally hate the fact that money can be such a primary factor when it comes to decision making about creating a family. But money can usually be earned or borrowed, although admittedly not without significant sacrifice. However, having a child is such an important part of life that it may be worth taking on more financial risk or burden in order to maximize your chances.

As for the time, logistical difficulties, and other inconveniences involved with infertility treatment, I would urge you to remember that although it may be difficult in the near-term future, if you avoid these things now, you may be feeling regret later for many years.

As in so many things in life, we must balance our short-term needs with our long-term goals. It is never easy, but I think you should keep in mind that this is one of the most important decisions you will ever have to make. This will help give you the necessary perspective--and courage--to do what you need to do to protect your future happiness.

Wednesday, October 13, 2010

Infertility treatment, love and courage

In infertility treatment, it's pretty easy to name the negative processes at play. The longing for, and not yet having, a child. The uncertainty and waiting for answers. The invasive, expensive, and time consuming medical treatments. The soul-crushing losses and disappointments. The havoc it can wreak in important relationships. The list goes on and on.

And yet, in my practice, intermingled among the pain and the losses, I can see moments of incredible heroism. Amazing acts of generosity and compassion. And profound expressions of love for an unborn or unknown child, made through hard work, risk-taking, and physical and emotional sacrifice. In order to survive all the difficulties, I feel it is important to step back and acknowledge these amazing moments and the profound impact they can have.

Chances are, your own personal struggles with infertility also contain such positive, love-filled, and heroic moments. But it may be hard at times to see them, because the pain of the situation obscures them from view. In this post, I will discuss the role of love and heroism in infertility treatment.


Infertility boils the desire and love for a future child down to its essence. When a baby doesn't come the easy and fun way, it forces the hopeful parents to really think about what they are doing. Now, in order to have a child, they must give something up, starting with their privacy and intimacy in the baby-making process. As treatment progresses, the sacrifices continue, whether they are physical, logistical, financial, or emotional. And sometimes, if it becomes clear that parenting will only take place through using donor gametes or adoption, they must give up their own genetic connection to their future child.

I feel that at the end of the day, the thing that gets most people through all of these sacrifices is their love for their wished-for child. In a "normal" situation, this love would be taken for granted, as the assumption is something like, "I love my child because he or she is created by and similar to me". But when this is all stripped away, it becomes clear that most people have the capacity to love a child no matter how he or she was created or if the child is genetically similar to them or not. People in infertility treatment, because of their situation, know this first-hand. I feel there is something very powerful in this self-knowledge. Sometimes, people without fertility issues have expressed to me that they doubt they could ever go through the hardships of treatment or be able to love an adopted child. This always makes me feel sad for them, because I think what they are really saying is that they doubt their own capacity to attach to or love a child if the conditions aren't exactly perfect. Knowing for sure that you have the capacity to love and care for a child, no matter how they came to be in your family, puts you directly in touch with the best part of yourself, and the best part of human beings in general.


It has often been said that being brave is not acting heroically in the absence of fear; rather, it is being afraid and acting heroically anyway. Infertility treatment, if it doesn't work initially, often requires these moments of courage. We must keep trying when the stakes are high and the fear of disappointment is strong. Or perhaps we must muster up our courage to accept an unwanted truth or outcome, and to come up with a new plan to make our dreams of a family come true.
Many times, we must perform these courageous acts even when we are feeling hurt, scared, and angry at our situation. Although it is difficult, I frequently witness "ordinary" people rising to the occasion, and performing profound acts of heroism. Although these acts may be private in scale, they are just as courageous as many of the more public acts of heroism we see on the news.

I feel that experiencing yourself as courageous, even in the face of adversity, is very powerful. It puts you in touch with the best and strongest parts of yourself. Also, it is something you can take with you to the other difficult situations that will inevitably come up in life.

So in those tough and demoralizing moments in your infertility treatment, try to think of the ways you have been courageous and brave, and the ways your love has helped you to transcend significant difficulties. I think that you will be impressed and encouraged by what you have done--and this may help give you the strength to pursue your next step down the path towards creating your family.

Saturday, October 9, 2010

Infertility and competitiveness among women--a question

Here is a question for those out there in cyberspace who might be reading this blog...during your interactions with the "fertile" world, have you ever felt that women were using your infertility to somehow position themselves as "better" or "superior" to you?

I would like to hear about other people's experiences in this regard because this issue has confused me for years, both on a personal and professional level. I, as well as many of my clients, seem to have had this experience. However, because the social cues involved are usually not overt, I myself could never be sure if it was her or it was me--was I projecting my own competitive feelings onto her, instead of the other way around? An example that comes to mind occurred with a colleague with whom I briefly shared office space. This woman was familiar with my personal struggles with infertility. When she announced her pregnancy during a staff meeting, she made a particular point of telling me, in front of everyone, that I should drink that bottle of diet coke she had left in the office refrigerator--it wouldn't be a problem for me to drink all that caffeine and nutrasweet like it was for her. Now, at the time, I experienced that as rather hostile attempt at one-upmanship. But I suppose it could have been my issue with her pregnancy--who knows, maybe she really just didn't like diet coke going to waste. (As much as I love diet coke, I never could bring myself to drink that particular bottle.)

In my practice, I've heard clients recount numerous tales of belly-rubbing, insensitively-timed pregnancy announcements, and snide comments that sound, on the part of the pregnant ladies in question, suspiciously competitive to me. But again, I hear everything through the filter of the person who is describing the situation. So it is hard to know definitively.

My guess is that sometimes this type of competitiveness is occurring, because I think we all know people in our lives who, in order to maintain their own self-esteem, need to feel superior to other people. For them, I don't suppose infertility or pregnancy would be off-limits in those cases.

However, I also think that sometimes, it might indeed be projection of our own competitive feelings onto the other person, who is most likely caught up in her own life and not thinking about our problems at all.

Anyway, if you have any thoughts on this matter, I'd love to hear them! Hopefully, through sharing our experiences, we can gain greater clarity on this issue. Thanks for reading!

Thursday, October 7, 2010

Ambivalence--its role in decision making in infertiity treatment

Individuals in infertility treatment are often faced with difficult and life-changing decisions. Usually, there is no "right" option involved in these decisions. No one but you can decide, for instance, if you should keep going in treatment or if you should call it quits. Or if you should change RE's, or try a different clinic. Or if you feel comfortable with using an egg or sperm donor, and if so, how you feel about the disclosure of your future child's genetic origins. Or if you should start to pursue and adoption, and if so what type...the list of big decisions goes on and on. For almost all of these decisions, your choices, although they will be limited by your medical and financial circumstances, will be primarily based on your subjective preferences.

Figuring out your subjective preferences, however, may not be so easy. These situations are usually very complicated and involve emotions from many aspects of your life. Further, many of the types of decisions listed above are "workarounds". Already, they involve feelings about the loss of being unable to have a baby without treatment. So naturally, these types of decisions are going to bring up some negative feelings--even if, in the end, they are going to be the "right" option for you.

On the other hand, sometimes our negative reactions are telling us that an option would not be the right thing for us to do. It can be tricky to sort out when we are just experiencing "predictable" ambivalence, and when we should make rule out an option based on our negative feelings. In this post, I'll discuss some of the distinguishing features of the two types of negative feelings.


in graduate school, a former supervisor once told me, "ambivalence is the hallmark of mental health." At the time, I gave him the same puzzled look that I now routinely get when I say this during a session with a client. But with the benefit of time and experience, I increasingly understand the wisdom of his statement. To be able to be conscious of and tolerate, at the same time, both positive and negative feelings about a person or situation (e.g., ambivalence), and still be able to function successfully, requires psychological maturity and sophistication.

When it comes to the types of decisions that come up in infertility treatment, ambivalence is practically a given. Even so, many of my clients have been concerned when they experienced negative feelings about a family building option,especially initially. They have worried that this means they shouldn't even consider the option, even if it may be the most practical or probable solution. In fact, in my work, if I hear a client express uniformly positive feelings about issues such as the ones listed above, I usually become concerned. My worry is that they aren't consciously dealing with some important feelings--and this might cause them problems in the future.

As an illustrative example, I would not expect someone to be thrilled upon deciding to use a gestational carrier, especially during their initial considerations. So feeling okay about the decision of using a gestational carrier might look something like, "I'm sad that I won't be able to myself be pregnant with my child, but I'm happy that I will be able to become a parent to a newborn". Tolerating feelings of disappointment, loss and perhaps envy along with the excitement of the pregnancy and anticipation of becoming a parent--that's the cost of doing business in this situation.

When no means no

There are times, however, when your negative feelings are telling you something important--that you are fundamentally uncomfortable with the option before you. This will look different than the types of ambivalent feelings I described above. One difference is that in ambivalence, the intensity of the negative feelings tends to lessen over time. Once you start grieving the losses these decisions involve, the benefits of the decision seem more prominent. However, if your negative feelings are telling you that this is not the right decision for you, they tend to remain present, and even increase in intensity--until you respond to them.

Another way to distinguishing factor between the two sets of negative feelings is how you feel after making the decision. I have observed this difference many times in both myself and my clients. If you have made the right decision for yourself, you will tend to feel a sense of resolve and peace mixed in with all of the anxiety the situation produces. Although you are aware of the downsides involved in your choice, you still fundamentally feel that no matter what the outcome, this decision is the best for your current situation.

On the other hand, if you continue to have consistent feelings of unease, repetitive nagging doubts, or continued intense negative emotions, you probably need to take a step back and reexamine your decision. It may be that you have decided to do something (or, as many times is the case, not to do something) that really isn't right for you. The good news is that even though you may have to change course, you can use these feelings to help guide you to a decision that does feel more in line with what works best for you in your life.