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 26, 2012

Relational Infertility: When partners don't agree

I am part of an email listserv for the Mental Health Professional Group of the American Society for Reproductive Medine, in which mental health professionals discuss psychological issues surrounding infertility.  This week there was a fascinating discussion of what do when there is in impasse in couple therapy, in which one member of the couple wants to pursue having a child, but the other member does not.  Perhaps there is a disagreement about what method of family building to use--one person is against using donor gametes, or adoption.  Other times, the conflict centers around whether or not to have a child, or another child, at all.  On the listserv, there were different suggestions about how to be helpful in this situation, but all the clinicians agreed that these are usually very difficult and painful situations for the couple involved.

I have come to realize that there are actually many different types of infertility.  Of course, there is your garden-variety medical infertility, which in some ways, though emotionally painful, is a bit more clear cut.  There is also situational infertility, in which an individual or couple cannot pursue having a family because of their circumstances, for example, if a family member develops a serious illness, or a financial crisis occurs.  But when the members of a couple seriously disagree about if and how to have a child, then relational infertility occurs.  This type of infertility often coexists with medical and situational infertility. 

In many ways, relational infertility can be the most painful type of infertility of all.  With medical or situational infertility, the causes are usually out of anyone's control.  But when the family-building impasse is caused by a choice, the feeling is that things could be different--if only the other person would change their mind.  In a couple, such a conflict can be very difficult on a relationship.  Both partners have to face the dilemma of either having some serious regrets and resentments for the road not traveled, or conversely ending an important relationship.  This is because it is often very hard to create a compromise in these situations--you can't have or not have a baby half-way. 

One of the things that struck me about the discussion on the listserv is that my colleagues, like myself, didn't have any easy answers for dealing with such a dilemma.  I suspect that this is because there simply isn't one.  Having, or not having, children is one of the most important life decisions a person can make.  At times, the importance of these desires can override the desire for being in the relationship.

However, if you find yourself in this type of conflict with your partner, there are some steps you can take to try to resolve the situation.  The most important thing you can do is try to listen to your partner very carefully.  Even if you don't agree with their perspective, it is important to try and understand it.  Try to put yourself in your partner's shoes and see things from their point of view.  If you can develop empathy for what your partner is feeling, you may be able to become less rigid in your own position, and a solution may be possible.

In cases of relational infertility, it is also important to consider whether or not other underlying issues and conflicts you are experiencing as a couple are coloring your feelings regarding having a family.  For instance, if there are problems with emotional closeness and support in the relationship, one of the partners may be more hesitant to add on the additional work and stress of having a child.  Certainly, if one of the partners is already having doubts about continuing the relationship, he or she may not want to make the additional commitment of having a child together.

In addition, at times an individual's psychological issues can contribute to an relational infertility impasse.  For example, one couple with whom I worked was locked in conflict about whether to continue fertility treatments--the wife wanted to stop, whereas the husband desperately wanted to continue to try for a baby.  Over time, it became clear that the wife had deep-seated doubts about her own ability to parent successfully.  These doubts were rooted in her experiences growing up with her own parents.  As she became more aware of these issues, and her husband developed a greater understanding and empathy for her feelings, the couple was better able to decide together what their future would hold.

With relational infertility, the stakes are very high.  I think it must be very hard to be the person who kept a partner from his or her dream of having a child.  Conversely, it must also be extremely difficult to feel that one's partner is resentful about parenting, or not fully committed to a child.  Ending a relationship of long-standing can also be extremely painful. Thus, if you find yourself in this situation, think carefully before you act or make your final decision.  Seeking couples therapy with a therapist knowledgeable about infertility would be very helpful in negotiating such an important and life-changing decision.

Friday, January 13, 2012

Infertility treatment and the "Type A" personality

I can only imagine what must be like to be able to get pregnant and have children easily, without much effort.  The analogy that comes to mind is the ease with which I taught myself to read, at age three.  Watching public television along with my older brother, I learned the letters, their sounds, and how to put them together very quickly.  I had my own library card by the time I was in preschool.  Reading never felt like work--it was just something I did, and I took it for granted that I could read whatever I wanted. I had no idea that this was an exceptional experience, so I couldn't understand, and was probably insensitive to, other children to whom reading didn't come quite so easily. 

Of course, while reading was my strength, other academic struggles presented themselves.  My poor visual-spatial skills have created constant fodder for jokes for my friends and family.  Math, physics, and chemistry did not come naturally.  However, I was still able to achieve good grades in these subjects in school by working hard and pushing myself.

Society seemed to support my view that hard work was the only necessary ingredient for success.  After all, I learned that watching public television too.  In high school, I once remarked to my social studies teacher that a person could do whatever they wanted to in life as long as they worked hard enough.  A wise man, he sighed, took off his glasses, and told me that was completely untrue.  I argued with him, but he simply insisted--a person cannot do whatever they want just by working hard, as different people have different abilities, and there is also the involvement of luck. At the time, I felt he was being negative and discouraging, and I did not believe him.

Well, I believe him now.

Like almost everyone, I assumed that when I wanted to get pregnant, it would happen according to my schedule and my timeframe.  I couldn't fathom that it might not happen when I wanted it to, much less at all--and if so, there might be very little I could do about it.

In the early stages of infertility treatment, I clung to my approach of working hard in order to achieve my goal.  When treatment started going badly, I resolved to fight harder, to do more, and to keep pushing myself.  I felt that if I just tried hard enough, I would get pregnant.

When it finally began to dawn on me that no matter how hard I tried, I couldn't overcome certain biological problems, it caused a great deal of emotional turmoil.  Not only was I very upset about my infertility; my entire world-view had been shattered.

I know that my story is far from unique because I hear it from my clients every day.  In so many cases, infertility is the first real life stumbling block that cannot be overcome by hard work.  Like me, my clients also must grapple with their grief and anger about infertility in the midst of developing a new approach to solving problems.

If you are reading this blog, chances are that you are also a hard-working, high-achieving sort of person yourself.  If you too are struggling with the fact that your typical life strategies aren't working with your infertility treatment, know that you are definitely not alone.

It's important to realize that however hard you work at your infertility treatment, it will not be the deciding factor in whether or not is successful--that ultimately, success is left in the hands of biology, chance, and perhaps fate.  By acknowledging this, you can let yourself off the hook a bit, and see that your don't need to work as hard as you have, perhaps exhausting or depleting yourself in the process.

On the other hand, it's important not to stop working hard altogether.  Although hard work cannot ensure that treatment is successful, it can give you the best opportunity you can have to get pregnant.  By making sure you understand your diagnosis and treatment options, and by following your treatment protocols to the letter, you can at least ensure that you've given treatment the best try possible.  That's important later on--you don't want to feel that you have regrets that you could have done more.

In the end, it's like so many things--a balancing act.  We must work hard enough to make sure we get the best treatment possible, but then we have to acknowledge that there is a limit to what our hard work can achieve.  Once we've done everything we can do to further treatment, then we should rest, and try to focus on other areas of our life.  This, of course, is easier said than done.  But by recognizing that hard work alone doesn't cure infertility (or many other problems, for that matter) we can have more energy to devote to other aspects of our lives, thus making infertility treatment more bearable.

Friday, January 6, 2012

Not-normal is the new normal: Infertility in perspective

I apologize for not posting as much as I would have liked to in the past several weeks.  I've been in a sleep-deprived haze, and had difficulty even thinking in coherent sentences--much less writing them.  Things are better now, thankfully, as I am back at work again.

During my break, I've had another opportunity to think about my own infertility and what it has meant in my life.  For me, the bottom line is this--infertility was a real deviation from the "normal" life I had envisioned for myself.  Like everyone who experiences infertility, I was forced to give up my dreams and expectations about how I would have a family.  This was difficult and painful in and of itself, but on top of this, I had to work extremely hard in infertility treatment and in our adoption.  After all, nobody makes you get IVF, or adopt--it is a choice, and you must make the process happen.  As we all know, these processes are difficult, time-consuming, and sometimes heartbreaking.

Even after I had children, I still struggled with not feeling "normal", and a bit envious of others who were able to take the typical path to parenthood. My adopted daughter, fine now, initially had some health issues that took quite a bit of time to resolve.  In my pregnancies, my body, ever uncooperative in the reproductive arena, continued with its contrary ways.   However, as time has passed, although I still don't feel "normal", I'm around enough parents, kids, and families to realize that pretty much every one of them has some sort of issue or problem that makes them "not-normal" also.  I mention this because when I was undergoing infertility treatment, it was so painful for me to be around babies, kids, and their hangers-on that I didn't get close enough to see the details of the situation.  I imagined that everyone else was having a perfect life--certainly a better life than me.   Many of my clients have echoed similar sentiments. 

Once I started to let go of my expectations of "normalcy", everything started to seem clearer.  It was, emotionally speaking, a much less complicated task to just do what I needed to do in my particular situation to have a family.   I guess if I had to do it all over again, I wish I would have let go of these worries about being normal much earlier in the process than I did.  I think I could have saved myself a lot of anguish, and had more energy left for the formidable tasks that were at hand.

If you also find yourself feeling bad because your situation is not "normal", I hope you can learn from my mistakes, and try to move past this worry, because I don't really believe there is a "normal" way to have a family.  There are just different ways to have a family, and they all have the potential to be wonderful and problematic, all at the same time.  Try to keep in mind that the fertile world has its share of problems too, and that although you must take a different path, it is not a lesser one.

Also, I'd like to wish everyone the best of luck with all of their adventures in the New Year.  If you have any questions, or suggestions of topics you'd like me to address, I'd love to hear them!  Please don't hesitate to comment or send me an e-mail at lisarouff@gmail.com.