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, August 25, 2011

Our emotional relationship with embryos created in IVF: some thoughts

I have been having a problem lately keeping the pet fish in our tank alive. Despite my best efforts at following all of the rules (feeding properly, changing the water often, etc), watching the fish closely, and medicating them if necessary, I have somehow become the fish equivalent of the Grim Reaper. All of this has been upsetting, but also has felt eerily familiar. When I noticed the latest victim floating at the top of the tank at 4 am today, it occurred to me that this is because this is very similar to how I have felt about the many embryos my husband and I created through our IVFs--despite all my best efforts, I couldn't seem to keep most of those alive either.

In some ways, the argument about when life begins seems like a nonstarter to me. I know all too well that an embryo is not necessarily a person. True, it contains the potential to become a person--perhaps, if all the conditions are right. But I also know that an embryo can break your heart. When people bemoan the thousands of embryos that are frozen in storage at IVF clinics around the world, it shows me that they haven't spent enough time hanging around with embryos. I know that many of those embryos would never have a chance of becoming a baby in the first place.

It is a interesting side effect of our modern age that we can now develop an emotional relationship (albeit a probably one-sided one) with embryos. During an IVF cycle, it is very easy to develop fantasies about the embryos we create. Looking at their pictures, we can imagine them growing into our beloved children. We pin all of our hopes on them. It seems to be almost a universal psychological aspect of IVF, especially in the first couple of cycles. A friend of mine, during her first IVF, created 24 embryos. She celebrated, sure she would get pregnant with that kind of haul. "It's enough for a baseball team!", she exclaimed, as we popped the champagne. She didn't get pregnant, though, and none of those embryos survived to Day 5. She didn't get pregnant in any of her ensuing IVFs, either. Not to worry, she and her husband adopted two incredibly smart, lovely girls, and are completely happy with their family, as they should be.

As for me, my first IVF was not so fruitful. I had 4 embryos that had any serious chance of success. I remember planting four plants in my garden to commemorate them. The plants later died. One of the embryos got me pregnant, only to miscarry at 7 weeks. To honor him (chromosomal testing revealed it was a boy), I planted a shrub in my garden, only it didn't take root. The next spring, I kept waiting for it to start to grow again, to no avail. I think I finally gave up in July. I planted St. John's Wort in the same spot instead--for its antidepressant properties if nothing else.
It did just fine.

Such experiences, along with the experiences I witness among my clients, make me wonder if getting emotionally attached to embryos is at all wise. However, the same experiences also make me wonder if getting attached to embryos is somehow unavoidable. Even the most veteran, jaded IVF patient seems to harbor secret, unspoken fantasies about his or her embryos, although they are long past the point of celebrating them or commemorating them in a garden. What makes this so hard is that although not all embryos are going to turn into babies, some indeed do--and it's hard to definitively tell which ones are capable of doing that at the outset. In contrast to my first IVF cycle, my last cycle was with our one last, remaining, frozen embryo, created four years ago. We cycled to complete our infertility story, but without expectation that it would result in a baby. Now, at 33 weeks pregnant, it appears this embryo had other plans, and we are hoping for a good outcome in October. But to be honest, I never would have guessed it was possible.

If you are undergoing IVF, I would caution you to try to remember that an embryo is a possibility, not a promise, of a child. However, if you find yourself having lots of feelings and fantasies about your embryos, I think that's probably par for the course. The important thing is to acknowledge how you feel and give yourself permission to process these feelings, no matter what happens in your cycle.

Monday, August 15, 2011

A bad news week for infertile and adoptive parents; public perceptions of the infertile

Stolen children in Guatemala and China placed for adoption, and babies secretly created abroad via donor egg, donor sperm, and surrogacy for adoption in the US--it wasn't exactly been a "feel good" week in the infertility and adoption world. A judge in Guatemala recently ruled that an adopted child living in the United States be returned to her birth parents in Guatemala years after she was kidnapped and placed in the Guatemalan foster care system. According to the birth mother, she searched for her daughter for years but was not allowed by the Guatemalan government to investigate orphanages or foster homes in her attempts to find her daughter (more here). Whether or not the order is valid in the United States or will be followed is unclear at this time. In another news story, abuses of the family planning officials in a poverty-stricken province of China were described. Allegedly, government officials took children away from poor families unable to pay exorbitant fines and bribes, and placed them for international adoption. Presumably, they received a share in the donations Chinese orphanages receive for completing the international adoption (more here). In a third news story, a prominent adoption and third party reproduction attorney pled guilty to charges of fraudulently presenting several babies carried by a surrogate as available for adoption because their original intended parents backed out of the situation. These "original intended parents never existed". Rather, the babies were created at the request of the attorney in the Ukraine using donor eggs and sperm. The prospective adoptive families then paid $100,000 to $150,000 to assume the surrogacy costs and adopt the babies (more here).

All of these news stories are in their own ways shocking, horrible, and tragic. I cannot imagine the pain of parents having their children taken from them, and then finding that the government is either complicit or unhelpful in finding them again. Likewise, for the adoptive parents of the Guatemalan girl, I can only imagine their pain at being faced with the possibility of giving up their beloved child. Further, the adoptive parents of the babies of the surrogacy ring must be coping with many feelings as well, among them betrayal at being misled about their child's genetic and legal origins.

In addition, stories like this make me worry because it seems to reinforce a stereotype of those experiencing infertility--that we are out of control, so crazy that we will do anything to get a baby, even if it means stealing, lying or paying exorbitant sums of money. And that somehow, because of that, all of the above cases are actually all our fault. If you read the internet comments on the above news stories, you will see that my fear is justified.

Of course, this perception belies all facts. In none of the three stories described above did an adoptive parent do anything illegal or immoral. In fact, they were defrauded and abused just like the birth parents, presented with a child legally cleared for adoption, when in fact they were the victims of kidnapping or created under false pretenses. The guilt, desperation, and greed all lay on the other side of the equation--corrupt or unresponsive government officials, and the legal experts who are supposed to help them make sure that everything is above-board in the first place.

Further, the above stories are exceptions. The vast majority of adoptions are done in a legal manner, and end up happily for the children and parents involved. But those wonderful stories, which happen every day, don't make the newspapers or the rounds on the internet.

I've worked with a quite a number of infertile individuals, and I myself struggled with infertility for a long time. Not once have I ever, ever heard someone seriously contemplating stealing a child or doing anything illegal in order to have a family. Someone might make an idle comment, in the same way we might wish to win the lottery, or be in Hawaii instead of Chicago during a cold February day. But I've never heard any serious intent behind it, even though the desire to have children was powerfully intense.

As for myself, at only one point did I ever have the urge to steal a baby. This occurred before I had my own children, when someone left their baby, unattended, in a corner of a restaurant in which I was dining for over an hour (the baby was awake, by the way). I had the thought that whoever left that baby by itself there probably didn't deserve to have that baby, and it crossed my mind to pick up the infant carrier and walk out of the restaurant. But of course I didn't do that. Instead I pointed out the situation to the restaurant staff, and I left the restaurant without the baby.

At its base, infertility is a medical condition. As a society, we don't perceive people with cancer, heart disease, or broken bones as desperate and depraved in their search for a cure. So it seems unfair that infertility is still frequently associated with such negative perceptions.

It is truly a shame that the bad actions of a few individuals cause harm to the lives of so many. Although international adoption is controversial, it also has provided love and happiness to many children who otherwise, in their birth countries, would have had limited chances of finding their own families. Yet news stories like this tend to make it even more difficult for these adoptions to occur.

Likewise, surrogacy and donor gametes have helped countless individuals and couples create their beloved families. When the normal standards that govern these situations are bent, this is all the general public tends to see.

The public perception that somehow these unusual situations are caused by the intense, out of control desires of infertile individuals creates numerous problems for those struggling with infertility. People often can feel more ashamed or embarrassed by their medical condition, and they are less likely to discuss the situation with others. Not only is this difficult for them psychologically, it also makes it harder to advocate as a group for important things like medical insurance coverage for infertility.

It is my hope that as a community, we can help to correct these public misconceptions about infertility. Frequently, public perception changes with one person, and one story at a time. It isn't until people meet someone and get to better understand their situation that their prejudices are called into question. Although discussing infertility is a sensitive subject, it may be that if others can better understand our situation by hearing about it from us, they will think twice next time before they say something unhelpful or untrue.

Thursday, August 4, 2011

Flexibility and infertility

Lately, I've been thinking a lot about my infertility and family building career, which began in earnest twelve years ago. Perhaps, this is because, as time marches on, it is coming to a seemingly definitive end. It's been quite the adventure, to say the least, but the question that I keep coming back to is this: How did I, a woman with very serious infertility problems, manage to end up with children in the end?

As I review all the twists and turns my husband and I encountered, I have stumbled upon a few factors that I believe, ultimately, contributed to our success. Several of these factors were not in our control, but to me the most important one was flexibility, the willingness to try a different direction, even if it was not our first inclination. I can't say this was a virtue on our part, but rather a necessity--mainly because what we originally wanted, which was to have children "naturally", genetically related to both of us, and on our own time table (not to mention without significant expense), was simply not possible.

I was particularly reminded of the importance of flexibility as I read Holly Finn's excerpt of her book about her own infertility struggles in the Wall Street Journal a couple of weeks ago (which can be found here). I was moved by the following portion:

"After a recent procedure failed—we got just two eggs, and neither was fertilized—I revisited decisions and doctors.

I went back to Doc S. and asked straight out: Would a sane person bother trying again? He said, "I don't think there's anything insane about what you're doing." But he gives me a less than 5% chance of a cycle working, down from 10% to 15% when I started, and he brings up the possibility of donor eggs. That's code for "time's up."

The success rate with donor eggs is 80% on the first transfer. Many people turn to this option (one out of 10 IVF cycles in the U.S., at last count), though nearly none admit it. I can imagine using this option if I were with a man to whom I would love to give a child, but right now, I'd be match-making a couple of strangers in my womb.

I know that it's not just genes that you pass down to a child; it's also your spirit and what you believe. Still, I resist having someone else's baby.

It's because of my thumbs. The left one is long, skinny and straight—very feminine. The right is squat, thicker and curved—definitely masculine. The first is my mother's; the second, my father's. They're exact replicas. My sister has them too.

There's something about being able to see where at least some of your parts are from.

I could really identify with Ms. Finn's struggle. Part of being flexible in regards to infertility treatment requires us to experience loss. Without being able to mourn what you won't ever have, it's difficult to move on to what you could have. Although I sincerely hope Ms. Finn's treatment with her own eggs is successful, it may be that she is not medically capable of producing a child with her own eggs. That is, of course sad and unfair--but is it worth, as they say, throwing out the baby with the bathwater? This is a personal choice, of course, that we can only make for ourselves. In the end, when faced with analogous circumstances, I have chosen to hold the goal of being a parent as primary, and the genetic connection as secondary. That may not be the best choice for everyone, but it seemed to work for us. For instance, adopting our daughter from India was an amazing, albeit challenging experience, one that I would never trade for anything. However, if you'd told me a few years prior to the adoption that I was going to do that, I never, ever would have believed you. Things change.

Dawn Davenport, at Creating a Family.org, wrote a really wonderful blog post this week that also addresses this point (found here), on whether or not a child of adoption (or created in any infertility treatment for that matter) might feel that they arrived in the family as a result of "second best choice". Ms. Davenport uses the analogy of ending up in Lisbon rather than Paris as a result of circumstances, only to learn that she actually loves Lisbon far more than she could have predicted. I've also read a similar travel analogy used in regard to loving a child with special needs. Either way, the sentiment is beautiful and rings true to my own experience. Although we may really want things, in truth, we may not always be able to get them. This is not just true of infertility--it occurs in all aspects of life. Sometimes, when we refuse to give up on a specific desire, it prevents us from being open to all the other possibilities we may have.

Of course, in the case of my family, we weren't just flexible--we also got lucky. We managed to adopt in India before the process became much more difficult and restrictive. For once, we fell on the right side of the treatment success statistics. We also had jobs that provided us with time off and health insurance. We also were fortunate to have a supportive network of family and friends. For all these factors, I am incredibly grateful. But in spite of them all, without being flexible about how we achieved our goals, we just couldn't have built our family. For us, it seemed to be the most important underlying principle of our journey.

By the way, while you are reading the blog over at Creatingafamily.org, be sure to also read Ms. Davenport's post about a Dear Abby column about the appropriateness of an adoption fundraiser. It's one of the best infertility blog posts I've read lately, and really combats a lot of the prejudices and stereotypes that those of us with infertility experience!