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!

Saturday, November 20, 2010

A infertility Thankgiving story....what I know now and what I wish I knew then

Each week, as I search for a topic for this blog, I find myself reliving in my mind the various stages of my own long infertility career. That, plus the onset of the holiday season, has reminded me of my very first infertile Thanksgiving. A decade later, as I look back at that day, I now realize it was a microcosm of sorts for all of the issues that I would face in the coming years. And with the distance of time, I can now see facets of the situation that had until now gone unrecognized.

The day before we traveled home for that Thanksgiving, I had just learned that my first treatment cycle, a Clomid/IUI cycle, had failed. Like most newcomers into fertility treatment, I was convinced I just needed a "little help", and that this would do the trick. I was shocked and devastated to find out it didn't work. That, plus the sudden and unwelcome arrival of a few extra pounds, (thanks to Clomid and progesterone) left me feeling rather depressed. My husband was not in touch with his own feelings regarding our infertility diagnosis and the failed cycle and seemed surprised that I was so upset by it--so we were definitely not on the same wavelength.

My parents, with whom we were staying, were aware of our infertility problems, but as they had never experienced anything similar, they didn't yet really understand what we were going through (although now, with so many years of experience, they are experts!). I'm not sure what my brother or sister-in-law knew at the time--I know they were aware of the fact that we had been trying to have a baby for over a year, but I don't recall now whether or not they yet knew we were in treatment.

In any event, we were all gathered around the Thanksgiving table when my brother announced, "We're pregnant!" My father, ever the kidder, wanted to know how my brother, along with my sister-in-law, could possibly be pregnant. My mother seemed unusually reserved. My sister-in-law told her own mother that she could stop nagging her now about how she needed to start a family because she wasn't getting any younger (by the way, my sister-in-law and I were both the same age--30--at the time). A mild argument ensued between the two of them as to whether or not this sort of nagging was appropriate. My husband sat next to me in shocked silence.

As I realized the import of what my brother had said, I was flooded with emotion. I felt completely blindsided; I felt an uncomfortable level of envy; I felt like I wanted to cry; I felt like I wanted to scream. Instead, I tried to keep a smile on my face and offered my congratulations, asking about her due date, morning sickness, etc. And then I worked hard to keep from crying. Needless to say, it was a very long evening.

After we left my brother's house, the tears began to fall. My parents, particularly my mother, was extremely sympathetic to my feelings. In retrospect, I was lucky that I didn't have to hear that I should just be happy for my brother, which, in the midst of everything, I was.

Thanks to my brother's announcement, my husband was now starting to get in touch with his own feelings of anger, sadness, and loss about our situation. But because I was so overwhelmed with my own feelings, I don't think I was much help to him with them. That Thanksgiving, we returned home feeling dejected, discouraged, and left behind.

This story seems to have so many of the classic elements of the infertility experience, with its surprise pregnancy announcement, sibling rivalry issues, and implicit messages that it might be all my fault because I "waited too long". In addition, my husband and I also fell into the typical relational pattern of couples experiencing infertility--we were processing emotions with different, almost incompatible different coping strategies, and at completely different times. However, in reexamining the situation, I now can see other equally important elements that at the time I missed.

Infertility has a subtle ripple effect

Of course, when my brother made his pregnancy announcement, my focus was mainly on myself, although I did notice that my mother seemed very quiet. When I recently asked her about this, she told me that when my brother said he and his wife were going to have a baby, she felt terribly conflicted. On the one hand, she was happy for him, but she knew that this news would cause me a great deal of pain. She felt that she had to keep me as her main focus at that moment, because I was the one that was hurting. Now I realize that my infertility took something from my mother too--the freedom to experience and express her happiness about the arrival of her first grandchild.

That realization made me think about my brother and sister-in-law. I imagine they were very excited to make their announcement and probably expected more of an excited reaction from my parents. I'm sure they felt hurt and confused as to why we weren't all jumping up and down and popping open the champagne. So again, my infertility took something away from them too--their hope for an enthusiastic welcome for the newest member of the family.

Of course, it all turned out alright. I honestly can't imagine life without my nephew, who is a wonderful boy, and my family is even closer than it was a decade ago. But still, I now realize my medical problems had a farther-reaching effect than I originally noticed.

The pain (mostly) goes away

Another thing that strikes me as I review this situation is how much less it hurts me now. Although I am still in touch with the feelings of sadness, envy, and melancholy of a decade ago, they are much less intense now. This is something I think it is very important to keep in mind, and something I tell all my clients--over time, you can work through your painful feelings and they will become much less intense. Even if you are feeling pretty lousy now, you can be confident that as long as you are processing your emotions, you won't be feeling that way forever.

A bit of perspective...

As I gain a little bit of distance in time from my active infertility treatment, I realize now that although it was fairly awful, it is probably not going to be the worst thing that will ever happen to me. I say this knowing that in terms of the infertility world, my situation would be classified as a "worst case scenario". In fact, this is one of the things I am thankful for this year--that so far I have survived it and lived to tell the tale. As time passes, I have seen my friends and family face their own difficult struggles, and I know that although the content of my struggle may be different than others, the process of overcoming difficulties in our lives is the same for us all.

I hope that you will have a very happy Thanksgiving holiday no matter where you may be in your journey of infertility. I am also very thankful that you are reading my blog, and would love to hear your comments, questions, and thoughts!

Tuesday, November 16, 2010

Upsetting things people say, and what to say back: self-protection during infertility treatment

If there is one thing that I have learned from my own infertility, it is that people can say some rather insensitive and mindless things! Enduring countless questions about when you are going to start a family, admonishments that you certainly aren't getting any younger, and other helpful "advice" can wear on a person, especially a person who is already experiencing a lot of stress and disappointment. The holidays, with their many family and social engagements, especially seem to be a hotbed of activity in this regard.

It's hard to know how to respond to these types of comments. I myself still struggle with this issue, and many of my clients describe similar dilemmas. In this blog, I will outline some creative strategies of responding to these situations that may be useful.

Striking a chord

I think one of the hardest aspects of responding to upsetting comments is that they often stir up our own feelings of inadequacy or self-blame about our infertility. As I have discussed in a prior post, it is quite common for individuals experiencing infertility to worry that somehow their medical problems are caused by their actions, beliefs, or feelings, despite all evidence to the contrary. Thus, hearing, "You just need to relax" for the zillionth time can reinforce our feelings that we are somehow doing something wrong, and that is the root of the problem. Our emotional reaction doesn't take into account that rather than a lack of relaxation, there are medical issues at play--and the speaker likely does not have any expertise in this area. In addition, if infertility has already taken a toll on self-esteem, hearing about how so-and-so became impregnated merely by her husband looking at her can heighten feelings of inadequacy.

When you are experiencing negative feelings about yourself, it can be hard to formulate a response to the comment or question right in the moment. This is why I believe it is important to try to anticipate problematic comments or questions in advance. I'm not suggesting getting paranoid about it, but it can be helpful to consider what might be said or asked, and by whom. As you start thinking in this way, you will find that certain situations call for such comments, and that certain individuals can be counted on to say something insensitive or unfortunate. Planning in advance can help you to develop a plan you can implement if and when verbal misfortune occurs.

They started it!

When responding to insensitive or inappropriate comments or questions, it is important to consider that although society teaches us to answer questions when asked, and to try to be polite no matter what, in reality we have much more freedom in terms of our responses. In my way of thinking, if somebody else has already crossed a social line, then all bets are off! We often fear breaking a social rule because we worry the consequences will be severe. After you try it in one of these situations, however, you will realize that in actuality we have much more flexibility than we may believe.

Let's say someone has just said something inappropriate or upsetting to you regarding infertility or family building. How do you respond? I have a few approaches you may not have previously considered that might work for you depending on your needs at the moment.


Sometimes saying nothing at all says the most. We are trained otherwise, but it is true that just because someone asks you a question doesn't mean you need to answer it. So many times, the questions that people struggling with infertility must endure are very intrusive. For instance, you probably don't go around asking fertile people with whom you are merely acquainted what sexual position they used to conceive their children. So a silent stare, and a change of subject, might be just the trick in these situations to set your boundaries in place.


Many times, instead of answering questions or responding to comments, I have found myself giving a little manners lesson to my unfortunate conversational partner. I don't know whether they found this to be a helpful lesson, but I do know it certainly made me feel better. I was especially inclined to do this when someone pressured me about not having children, and not getting any younger. I would tell them, "You know, let me give you a piece of advice. You really shouldn't be going around making these statements or asking people these questions. You never know if someone is having a problem having children or not, and if they are, the things you are saying can be very painful. I'm sure you wouldn't want to cause anyone to feel upset, so this is why I bring this up." This usually shut down the conversation right away, although not surprisingly, I never got the sort of thanks I felt I deserved for imparting this sage wisdom.

Be outrageous

Sometimes in these situations it is most effective to think outside the conversational box. The best example of that I can think of is not infertility related, but does illustrate the point. When I was growing up, my mother provided foster care and adoptive homes for orphaned cats. Sometimes, quite a few of them were with us. Of course, they had to eat, and my mother, being thrifty, wanted to buy the cat food when it was on sale. She would get embarrassed though, buying all the cat food because people would always ask her questions about how many cats she had, why she had them, and wasn't she crazy for having all of those cats? Finally, she got so tired of this that she sent my father to buy the cat food instead. He loaded his grocery cart full of cat food, and as usual, he was approached by a woman who wanted to know how many cats he had. With a straight face, he looked at her and said, "Ma'am, we don't have any cats." He left it at that, and rolled off his cart as she struggled to contemplate what other possible uses there could be for all of that cat food.

I am sure you can come up with similar zingers for your particular situation, especially with a little advance planning. Not only will you be able to protect yourself and effectively end the line of conversation or questions, but you also may enjoy doing so.

Get the heck out of there

Sometimes, none of the above strategies are going to work. You might already be so overwhelmed with emotion that you can't continue the conversation any more. In these cases, if it feels too hard to continue, then simply excuse yourself. Try to do something that will comfort you and help you feel better, whether it's a good cry in the bathroom or hanging up the phone and yelling at the wall. You can always deal with the consequences of exiting the situation later, and hopefully the person will understand. If they don't, then it doesn't reflect well on them, does it? Dealing with the difficulties of your own situation is probably hard enough--you don't need to worry about saving the feelings of everybody else too.

Tuesday, November 9, 2010

Couples issues in infertility treatment: some thoughts

Infertility treatment is not easy on a relationship. The logistical challenges and the emotional ups and downs involved are enough to challenge even the happiest couple. Although some couples may be able to navigate the bumpy terrain of infertility treatment without conflict, many others find it to be a tumultuous time in their relationship.

It seems that being in infertility treatment (or any other highly stressful situation for that matter)can aggravate any preexisting areas of conflict a couple might have. But more than that, I have noticed that different coping styles on the part of the members of the couples also produces a great deal of conflict.

To be honest, when people talk about gender differences in regards to expressing emotions, i.e., men are from Mars and women are from Venus, I usually get irritated. It bothers me to think of human beings as so stereotypically defined; are we merely just the product of biology and/or societal conditioning? Can't we choose how we will think and act? That's why I also find what I am about to write irritating--yet nonetheless I have found the following distinction to be useful:

Usually in each couple there is one individual who is more consciously in touch with their feelings, and who thus is more explicitly anxious and upset by the experience of infertility. And there is one individual who tends not to be as conscious of their emotions, not express them as much, and may in fact be in some level of denial about the severity of their situation. More often than not, in a heterosexual couple, the woman is the emotionally aware/anxious one, and the man is the one in the stoic/denial position. Of course this description doesn't fit everyone, but it is accurate enough of the time that despite my prejudices, I cannot deny its validity.

The good news

Although the above pattern has some problematic aspects, which I will discuss below, it can be a very adaptive pattern much of the time. The script I commonly see goes like this: the woman realizes there is a problem, and gets upset. The man feels that she is overreacting and that everything is going to be fine, if only they were more patient. Undaunted, the woman nonetheless springs into action, making appointments, beginning treatments, etc. If the man had his way, nothing might be done, and as infertility treatment is time-sensitive, opportunities might be missed. But by not panicking, and by continually pulling his partner back from the edge of the emotional cliff, he provides a stabilizing force for the couple. On balance, this "division of labor", if you will, allows the couple to move forward.

The not-so-good news

In this system, problems arise most commonly when a disappointment or setback occurs. The woman reacts immediately, becoming distressed and visibly upset. The man, although he may also be upset, tries to ignore these feelings, adopting a more stoic attitude. While the woman wants to discuss recent events and her feelings (sometimes to the exclusion of all else), the man eventually gets frustrated and does not wish to discuss the situation anymore. At this point, conflict arises, as the woman then feels her man is not emotionally "there" for her, and for his part the man feels that she is dwelling too much on her feelings. Further, the man may also feel frustrated that despite all of his efforts, he is unable to do anything to help the woman feel better about the situation--it is out of his control. This may make him feel worse about himself, and in combination with the stress of pushing down his own feelings of loss and frustration, he can then get a bit "crusty around the edges" (a clinical term :)). Eventually the tension erupts, and arguments ensue.

I have also observed a "delayed reaction" phenomenon with men; once the woman starts working through her feelings of loss or frustration and is doing a bit better, the man starts to become visibly upset. Perhaps as she is not as vulnerable, he finally feels like it is safe to process his own feelings. This can also cause conflict, because the woman feels that she is being pulled back into being upset about the situation again when she was just emerging from it. Also, if she felt unsupported in her feelings while she was going through them, she may be less than sympathetic now that he is distressed. Again, this causes a lot of tension in the relationship, which can produce conflict.

Coming back together

I have worked with many couples with the above types of conflict. What has been most helpful to them is to be able to understand each other's different coping styles. Realizing that their partner is not being willfully insensitive on the one hand, or overly emotional on the other, allows them to regain common ground and to feel that they are part of the same team. By acknowledging the emotional validity--and necessity--of both perspectives on their infertility experiences, most couples are able to reconnect and move forward together in their journey of building their family.

A postscript

This evening I came across another excellent article on the different emotional perspectives men and women can have during infertility treatment. It just came out today (I super-swear, I wrote my blog entry yesterday, before the article came out!) from the AFA. It covers a lot of the same ground, but makes some really interesting points. Here is the link:

Differing Perspectives article from AFA

Happy reading!

Wednesday, November 3, 2010

When you are "stuck"--impasses in infertility treatment

Infertility treatment is often a long and complicated process, sometimes involving difficult choices and courses of action. Naturally, individuals in infertility treatment may need to stop and take time to consider their choices. In addition, sometimes a complete break from treatment, to recover both emotionally and physically from its demands, is necessary in order to continue in the long run.

However, sometimes what starts out as a break or a time of contemplation can turn into in an impasse, in which the individual or couple is unable to move forward. Unfortunately, such impasses are common. The noted psychologist Alice Domar, Ph.D., who specializes in working with infertility issues, recently published a study that examined the reasons people drop out of infertility treatment. She predicted that financial or insurance reasons would be the primary reason for dropping out of treatment. Instead,she found that emotional stress was the most common reason, with 50-65% of couples citing it as their main reason for ending treatment. I suspect that many of the couples who dropped out of treatment despite having the financial resources to continue were at an impasse in their treatment.

What makes an impasse different from a break? In my mind, there are a few defining characteristics. One is the duration of time involved. For example, if the planned break of a couple of months now extends to the better part of a year without other extenuating circumstances changing, it is likely that an impasse has occurred. Also, if the topic of infertility treatment is avoided or rarely discussed, this may be another sign that you are at an impasse. Conversely, if infertility issues are frequently discussed, but in an a ruminative fashion, with the same content and the same outcome, this could be another indication that there is an impasse.

Experiencing an impasse can cause delays in infertility treatment. Of course, delays can be very problematic from a biological perspective, as a woman's ovarian reserve and egg quality tends to decline as she ages, sometimes quite rapidly. But biology aside, delay can also be problematic from a developmental perspective. Having children can be seen as a developmental milestone which produces increased psychological growth. Also, people can feel left behind watching their peers create create families and have new experiences, when they have so far been unable to achieve this goal. Thus, delays caused by an impasse can have damaging and far-reaching effects.

In this post, I will discuss a few of the common causes of an impasse, and offer some suggestions for addressing this problem.


In my practice, I have seen impasses occur when someone wants to deny a painful truth about their infertility. As an example, I once worked with a married woman in her mid-forties who desperately wanted to have a child. Despite her age, history of infertility, and extremely elevated FSH level, she refused to consider the possibility that she could not use her own eggs to start her family. She became enraged when RE after RE suggested that she consider using donor eggs or adoption. Instead, she chose to try some risky alternative treatments, and was very disappointed when they did not produce a pregnancy. When I suggested that she needed to mourn the loss of having a genetic connection to a child, she became angry with me as well. Although this example is a bit extreme, it demonstrates how denial can keep us stuck and unable to move forward with a treatment plan that has the best chance of success.

Fear of failure and the defense of withdrawal

Another very common cause of an impasse in infertility treatment is the fear of failure. Feeling that you would be unable to cope with another failure or loss can sometimes cause an emotional paralysis, in which you know you want to continue in treatment but nonetheless are unable to move forward. You might withdraw from infertility treatment, and even from discussing the topic of infertility. I experienced this myself when I reentered infertility treatment after the adoption of my oldest child. Although I knew I wanted to try again, it took me over a year to make an initial appointment with a new RE. Many times during that year, I started to make the appointment, but was flooded with memories of all of my previous failures, and was unable to complete the phone call. When I finally did make the appointment, I was surprised at how relieved and peaceful I felt--a sign that the impasse was gone.

Unresolved couples issues

Sometimes, when a couple is unable to move forward with a decision or with the next step of their treatment plan, it can be a sign that there are other issues involved. If the couple is feeling disconnected from each other, for example, they may be unable to feel safe discussing emotionally charged issues. Or if one member of the couple is having doubts about continuing the relationship, they may start dragging their heels in terms of making decisions or beginning a treatment cycle. Alternately, there may be differences in terms of decision-making styles or core values that might cause an impasse in treatment. Usually, once the issue is resolved, the couple is able to move forward in their treatment.

Diagnosing and dealing with an impasse

How can you tell if you are experiencing an impasse? My first suggestion is to evaluate your treatment path, choices, and current timeline using this perspective. If there are delays that are not caused by other identifiable factors, then you might indeed be stuck.

If you do feel you are experiencing an impasse, it is then important to closely examine your feelings about your current situation. Is there something going on that is difficult to accept? Are you afraid of moving forward because you won't be able to handle it if treatment fails? Can you think of any couples issues that might be affecting your relationship?

As a final suggestion, if you are stuck at an impasse, you may want to consider discussing this with a third party, such as a good friend or a therapist. By this point, if you could have resolved things on your own, you probably already would have. Sometimes getting another perspective can really help you realize how you are stuck, and what you can do to start moving forward again.