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!

Thursday, January 20, 2011

Infertility and third party reproduction in the public spotlight: psychological implications

I think it's safe to say that infertility and third party reproduction is in the public eye now more than ever. For instance, the reality show Guilana & Bill has followed the celebrity couple Guilana and Bill Rancic through 2 IVFs, one ending in miscarriage and another ending in a BFN. Numerous celebrities have announced the births of their children created through some form of third party reproduction. News reports, articles, and documentaries about the growing practice of international egg donation and surrogacy have been published and aired. It seems that when it comes to infertility treatment and third party reproduction, almost everyone has a strong, if perhaps not well-informed, opinion.

In her blog, Dawn Davenport at Creating a Family wrote a really wonderful post, found here, about the media coverage of and public response to Nicole Kidman and Keith Urban's daughter's birth via a gestational carrier. In it, she excerpts some of the many negative comments that can be found on the internet about their use of a gestational carrier. As you can imagine, some folks out there in cyberspace are not supportive of Kidman's and Urban's decision, suggesting that Kidman didn't want to ruin her figure with a pregnancy, or decrying the use of a gestational carrier/surrogate as dehumanizing or morally wrong.

As the spotlight shines on our little corner of the world, I find myself wondering about what all this attention, both positive and negative, means psychologically for individuals experiencing infertility in their own, less public lives. On the one hand, I think that increased public awareness of the issues involved in infertility could be beneficial to those currently experiencing it. Perhaps seeing a couple on television deal with a miscarriage and failed treatment cycle could help watchers become more empathic to their friends, family members, and neighbors who are in the same situation. Also, if the public increasingly understands infertility as a medical condition, there may be more public support for increased health insurance coverage.

However, I think that the negative commentary now floating around out there adds a new wrinkle of difficulty to the already complicated psychological terrain of infertility. The negative comments people feel compelled to make about the family building choices of celebrities seem to fall into two categories. The first is that somehow the celebrity him or herself is personally to blame for their situation, rather than having a medical condition. She waited too long, she is too selfish and vain, etc. The second category has to do with the idea that the celebrity is somehow circumventing God's will or fate--e.g., if it's meant to be it will happen, so using IVF, or a surrogate, or whatever, is therefore wrong.

Although I always suspected that some people felt this way about infertility treatment and the choices it involved, in my own personal and professional life I've never had anyone express these criticisms to my face. Perhaps they were thinking it, but I didn't have to deal with it explicitly. Not so anymore. Yesterday, I read an interview in which Guiliana Rancic repeatedly defends herself against public commentary (presumably from people she has never met) that she has caused her infertility by being too thin. This struck me--I mean, it's bad enough to figure out what to say to your insensitive Aunt Maisy who always suggests you just need to relax, or maybe it's just "not meant to be", but to have to start arguing with people you've never met? Although Ms. Rancic is the star of a reality television show and thus has opened up her life to public opinion, it is hard not to take the negative comments made about her situation, or those of other celebrities, and apply it to ourselves, however obliquely.

Of course, it is perhaps only a minority of people out there in the world who have such intense negative feelings about infertility treatment. But with the cloak of anonymity and the ability to publicly express themselves instantaneously at the touch of a button, they can make a big difference in the psychological climate surrounding infertility--and I would argue it's not a good difference. If people person are already inclined, albeit unfairly, to blame themselves for their infertility (and most infertile individuals struggle with this from time to time) negative comments such as these can be used to support this erroneous belief. Fodder for self-criticism is, after all, only a short internet search away.

Although it is possible to avoid reading negative opinions and comments about infertility, it does take effort. And I feel that even if we ourselves never read a word of this stuff, other people do--and this changes the emotional landscape in which we find ourselves.

I am very curious about others' experiences in this regard. I would love to hear your thoughts and stories about how the increase in news coverage around infertility has (or hasn't) affected you. Please leave a comment if you can! And as always, if you have any questions you think I can answer, or any topics you think it would be helpful for me to address in my blog, I'd love to hear from you.

Thanks for reading, and have a great ICLW!

Thursday, January 13, 2011

"Other people's children": Fears about adoption and donor gametes

During infertility treatment, it sometimes becomes evident that in order to have a family, one or both of the prospective parents may be unable to contribute their own genetic material to the creation of their future child. Of course, this is a big loss, and something to be grieved over time. As clients move forward through this grief and consider their alternatives, they often express the same fear--that they will be unable to have a fully satisfying parenting experience because they will be raising "other people's children".

This is a complicated issue because when you adopt, or use donor eggs or sperm to create your family, in a very basic, concrete sense you actually are raising "other people's children". In fact, there are an additional one or two "parents" swirling around in the mix. This causes us to reconsider how we define what makes a "parent", and what is necessary for the parental connection to occur.

I would argue that it is indeed possible to have a fully satisfying parenting experience raising a child who genetically originated from other people. In fact, research has shown that most parents who do adopt or use donor gametes to build their family are very satisfied and fully involved parents, and are happy with their choice to do so. But I would also argue that it is a different parenting experience than having and raising a genetically related child.

Being aware of and comfortable with genetic contributors of our children seems to be emphasized in more adoption community than it is in the infertility world. Indeed, open domestic adoptions, in which there is some contact with the birth parents, are very common. With children created through third party reproduction, it is more possible to not disclose the genetic origin of these children to others, even including the child involved.

In both the infertility and adoption literature, this subject has been discussed in depth. To this discussion I would like to add, however, two points that I have not seen mentioned with frequency--the psychological constructs or images the parents develop about their child's genetic origins. The first concept I would like to discuss is how the expectations we develop based on genetic relatedness and family resemblance can affect our parenting experience. From a psychological perspective, when one parents a genetically related child, there is at least the possibility of explaining things about that child from a genetic viewpoint. That Junior has his father's eyes, his mother's laugh, and his Uncle Charlie's love of striped socks, may or may not in reality be true--but these are the hypotheses we create, seemingly reflexively. When parenting a genetically unrelated child, all bets are off, especially if little is known about the genetic parents, as in the case of international adoption, or using anonymous egg and sperm donation. If my adopted daughter, about whose biological parents I know nothing, misbehaves, is it something I did? Is it her genetically-endowed temperament? Is it a mismatch of her environment, which includes me, plus genetics? This difference adds another layer of complexity to the parenting situation.

Although this thought process may seem worrisome to prospective parents, I think in reality it is often found to be beneficial, because it allows you to view the child with an open mind, without as many preconceived notions. I actually find this process a wonderful part of parenting my daughter. It's like having Christmas everyday--without having a genetic template with which to evaluate her behavior, appearance, and characteristics (again, which may or may not be true)--she is always a surprise to me. Every day I learn something new about her. I am sure that her beauty, outgoing personality, charisma, and social skills are genetic gifts from her birth parents and not environmentally endowed from me, and I am constantly amazed at how well she navigates complicated social terrain. I am surprised she to see she can learn to spell so easily but memorizing her multiplication tables for her is difficult and seems unimportant. I am never quite sure what she will do next, good or bad. Without prior assumptions based on genetics or family resemblance, we have more freedom to be more creative in learning about each other.

This isn't to say, however, that I don't have my own inner constructions of what her genetic parents may be like. Indeed, this the second point I would like to discuss--the way in which psychologically the genetic parents may be present in the parenting experience. Whether or not the child's genetic origins are disclosed to anyone else, it is clear that the parents know the truth. Thus even in the cases where parents know little or nothing about the biological parents, they often develop a psychological image of what these people are like. For instance, I have an idea that my daughter's biological mother was much like my daughter--beautiful, outgoing, and a bit of a risk taker. In my fantasy, it is easy to see how she got herself into trouble, but also how in the end she tried to do the right thing by making the difficult decision to give my daughter up for adoption. Whether or not this fantasy in any way resembles reality (and we'll probably never know if it does), it does impact my parenting experience. For instance, I may worry more about her getting pregnant as a teenager, or feel the need to set more limits with her. When the time comes, my reaction may have little to do with the reality of what my daughter's predilections are in this department.

I have often seen this same phenomena occur with parents whose children were conceived with egg and/or sperm donation. With the little information we have about anonymous donors, we can construct similar types of fantasies about our child's genetic origins. Thus, the psychological parenting experience necessarily includes these other genetic parents.

Again, although this might sound intimidating to some at the outset, in reality, it usually isn't a problem, as long as the parents can acknowledge this and feel comfortable with it from the outset. Although it may create a somewhat different parenting experience, in no way creates an inferior one.

As to the fundamental question of whether or not we can fully love and attach to "other people's children", I would like to offer a personal vignette about my first night as a mother. We first took custody of our daughter, in India, when she was three months old. A week before she came into our care, she had been recently discharged from the hospital because she had developed a very severe case of pneumonia, in which her lungs collapsed and she went into congestive heart failure. Miraculously, she survived this three-week ordeal, but when we were given custody of her, she was extremely thin--only 7 pounds. The first day we had her, I realized she was wheezing and breathing too rapidly. A doctor's visit and x-ray quickly turned into an emergency hospital admission, and we were told she had either RSV or pneumonia. We were placed in a rather dirty public ward of an inner city Indian hospital. She got an IV and was placed in an oxygen tent, and I was terrified. I didn't know anything about taking care of babies, particularly an unfamiliar, sick, and frightened one (by the way, every time she took a look at me, she started crying in fear). I recall sitting on the floor, which was covered in old newspapers for some reason, crying on my cell phone to my mother back in the USA. Then I realized I had to get myself together. This little baby was my responsibility--there was no one else who was going to do it. At that point, I went into full mother-protection mode--managing her care as best I could, calling doctors in the USA for consultations, and yelling at the nurses who didn't want to wash their hands between patients that if they wanted to touch my daughter, they needed to use my hand sanitizer first. Although they seemed irritated by this request, they did comply. I didn't eat, I didn't sleep, and I stood guard over her day and night. And there was absolutely no thought that this was really someone else's child, because there was no room for that. She was my child because she was my responsibility.

By third day of my daughter's hospital stay, she looked at me and smiled. I smiled back. I tickled her, and we both laughed. Even the dirty-handed nurses laughed. I was filled with a rush of profound love, and I like to think she felt the same. I tell clients all the time that the fundamental thing that creates a parental connection with a child isn't DNA--it's time spent with and caring for that child. The more you do it, the more attached you are going to be to each other. It's really that simple.

So although people worry that parenting "other people's children" is going to somehow be problematic, in reality, this very rarely comes to pass. Although it will be a different type of parenting experience, it still provides rewards in abundance.

Thursday, January 6, 2011

Climbing up the mountain: Infertility treatment from the long view

A few months back, a client and I created a metaphor that I feel captures the experience of infertility. In this metaphor, the task of building a family is akin to climbing a big mountain. This mountain is criss-crossed with thousands of different paths and passes of varying levels of difficulty. Most women are able to follow an easy path, without much of a climb. But for those of us struggling with infertility, the easy path is blocked. Instead, we find ourselves assigned to one of the paths less traveled. All of these passes are harder than the standard path, but some of them are harder and longer than others. In many cases, we must climb the mountain without seeing any evidence that the summit is in view. We may climb for a while, and find that yet again our path is blocked, forcing us to change course, often with great difficulty. We may be lucky enough to find others with whom we can climb alongside, and that makes the journey easier. Conversely, we may find that we are forced to climb alone.

At times, the climb can be unpredictable. The path can become incredibly steep and rocky, and the weather can change for the worse. Occasionally, something terrible happens and there is an avalanche. Sometimes, we make the difficult decision that the cost of climbing the mountain is too high, and we make our way back down--and find another mountain to climb.

Usually, however, if we keep climbing, the path eventually clears and becomes smooth, and the sun starts shining. The top of the mountain, with its beautiful view, comes into sight. We are most likely quite changed by our journey--hardened, seasoned, matured, and incredibly grateful to have made it to the top.

As someone who's spent a lot of time on this mountain, both personally and professionally, I've observed that if someone is really determined to have children, then they will make it over this mountain, no matter what. It may take more time than they'd hoped, and they may have to change course more than once to surmount the obstacles before them. But mainly, they just have to keep climbing.

However, during the climb, it is very difficult to feel confident that it's all going to turn out alright in the end. After setbacks occur, we can come to feel that nothing is ever going to get easier, and that bad outcomes are inevitable. It's hard to realize that even though it is not in plain view, the top of the mountain is there waiting for us. At these points, we must use our courage, and the support of others to help us keep going.

The client with whom I collaborated on this metaphor, after a long and difficult journey, recently found her own short-cut over the mountain, just when all hope seemed lost--a true miracle. But even without such a dramatic miracle, we can still climb to the top. Despite everything, no matter how you get there, or what path you end up taking, the view from the top is the same. Perhaps, if you've been forced to take a longer and more difficult path, you will appreciate the view that much more.