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!

Friday, February 17, 2012

Not quite free to be you and me: Infertility treatment and the recogntion of our limitations

I have come to the conclusion that it is all Marlo Thomas' fault.

As a child growing up in the 1970's, I was raised on a steady diet of "Free to Be You and Me" encouragement--women, it seemed, could have it all.  They could be whatever they wanted--being professionally successful and a mother was no problem.  There were no limits. All a girl had to do was to do her best, and work as hard as she could.  This message seems to be permanently woven into every fiber of my being.  Even though I now know this is not always true, it seems like I constantly default back to this belief. I somehow manage to forget that I, like us all, have limitations, some insurmountable. Every time in my life it again proven that hard work can't solve everything, it stings just as much.  Over, and over, it is an unpleasant, and unwelcome, surprise.

Now I understand what Ms. Thomas was trying to accomplish.  For much of our history, women were discriminated against, and discouraged from entering the professional world.  I am enormously grateful that my generation of women received the encouragement and opportunities that we have.  And of course, I recognize much of the wisdom of Ms. Thomas' teachings.  In almost all areas of life, attempting to solve problems through effort and hard work is a very successful strategy.  I also believe that without trying, we may never know what we can accomplish. 

My problem with the "free to be mentality" is this--if for some reason you couldn't do whatever you wanted, then logically you could conclude that you hadn't worked hard enough or tried your best.  A problem that couldn't be solved with hard work didn't exist in this scenario.   If there were no barriers to your success, there could be no other explanations for your failures.  It is all on you.  I'm sure this logical corollary was completely unintended by Ms. Thomas.

Despite this, whenn it comes to infertility, this type of thinking can be extremely problematic.  IInfertility is not a problem that can usually be solved by effort and hard work alone.  Physical variables, and frankly, luck, seem to be the trump card in many cases.  Thus, despite all the efforts made to fix the problem, it is often experienced  psychologically as a profound personal failure.  Lest this just be my issue, nearly every infertility client with whom I have ever worked has expressed strong concerns that their infertility was somehow their fault, and that the reason that they couldn't have a baby was because they had done, or were doing, something wrong.  In all of these cases, the problems, whether they could be fully identified or not, lay outside of the person's sphere of control.

In my case, infertility turned out to be more than the inability to have a child, but realization that my philosophy of living was fundamentally flawed.  I suppose that's a good thing, because it's more realistic. In learning to accept the limitations of our bodies when it comes to creating a baby, we learn that not all things are possible after all.  This is a painful but important realization, for there will be other aspects of life in which we will also be unable to achieve our goals.

On the other hand, my infertility would have been much easier for me to cope with if I had considered the possibility that there were going to be many things in life I wasn't going to have the ability to do, and that was how it was for everyone.  It didn't mean I was a bad person, flawed, cursed, or lazy.  It was just unfortunate that my talents didn't lie in this particular direction.  Based on my clinical experience, I suspect this is the same for others as well. 

As for hard work, I still believe in its value.  When I recently discussed this issue with my mother (the one who relentlessly played the "Free to Be" album, and in many other ways promoted the omnipotence of hard work during my childhood), she was unmoved.  "Look," she said, "You have lots of problems with infertility.  And yet you still have children.  You worked hard to make it happen.  Marlo Thomas was right."  And I really do see her point, especially if you look at the big picture. 

But like most of us, during infertility treatment, I couldn't look at the big picture, mostly because it wasn't drawn yet.  So all I saw were a series of physical failures, despite maximum effort and worry on my part.  It took a while to realize that hard work wasn't going to solve the problem alone.  During that time, my self-esteem was in tatters.  It has taken years to reorganize my way of thinking, and to come to terms with my physical, intellectual, and emotional limitations. 

If you are reading this, I just hope you can learn all of this much faster than I did.  While we all can and should try to achieve our goals, we must forgive ourselves, if through no fault of our own, we cannot.  In that way, I think we can be most free to truly be ourselves.

Thursday, February 2, 2012

Misperceptions, Misinformation, and Infertility Treatment: Psychological Implications

Last week, as part of his campaign in the Republican primary in Florida, Newt Gingrich stated that if he were president, he would appoint a commission to investigate IVF clinics, as embryos (and to his way of thinking, life) are created there.  There are probably some political machinations and implications of this pledge that I don't fully understand.  However, it did get me thinking--what exactly does Mr. Gingrich think that such an investigation is going to find?    Somehow, Mr. Gingrich seems to believe that embryos are being developed for the wrong reasons or capriciously destroyed or mistreated.  The irony here, I think, is that no one values the sanctity of human life more than those who are infertile.  People going through the physical, emotional, and financial hardships of IVF value their embryos, and the children they might possibly create, above anything else in the world. 

But Mr. Gingrich is not alone in his misperceptions of and mistrust in infertility treatment.  A day after his announcement, I found myself explaining to a group of other mothers at a preschool fundraiser that the Octomom was not the norm in infertility treatment.  One woman thought that in IVF, the patient was forced to transfer back all the embryos that had been produced in their cycle, and thus higher-order multiple births were the norm.  A long discussion of embryo cryopreservation and medical ethics ensued.  The mothers seem surprised to learn that the Octomom's doctor was investigated on ethics charges, that most reproductive endocrinologists try to avoid multiple births, and the field is moving towards single embryo transfer.  All they knew about IVF came from sensationalist headlines describing the exception to the rule.

These views are often furthered by inaccurate portrayals of infertility treatment and IVF in movies and on television.  I am often stunned by the countless examples of medical inaccuracy of television shows when it comes to reproductive issues.  For instance, the show Private Practice, which frequently features themes of infertility and infertility treatment, has on multiple occasions depicted infertility treatment incorrectly.  My favorite instance involved a doctor using a microscope in the room with a patient to fertilize an just-retrieved egg, only to immediately transfer it back and pronounce her successfully pregnant, much to the joy of all in the room.  Anyone who has ever actually done IVF knows its just not that simple! It amazes me that television shows wouldn't hire a consultant to make sure they were getting their facts straight.

In addition to getting the facts wrong, television shows and the movies often portray infertility treatment in a more sinister light, pulling from the extreme situations in the news that get all the attention.  Thus, the general public tends to develop a skewed sense of infertility treatment.  For instance, a recent episode of CSI Miami focused on the murder of a sperm donor who fathered over 100 children, all of whom became suspects in the criminal investigation.  Although there have been cases where one sperm donor has produced a high number of offspring, I suspect again this is much more the exception than the norm.  However, if this is the major exposure that most people have to the idea of sperm donation, they will tend to look at it in a more negative light.  I suppose stories about wholesome people with a medical struggle doing the best they can to have a family just don't get the ratings.

My concern about the negative portrayals of infertility treatment in politics and the media is that it perpetuates the already preexisting stigma surrounding infertility.   For individuals undergoing infertility treatment, it is exhausting and demoralizing to continually have to fight stereotypes of their treatment.  The effort involved in managing the reactions of others colors every social interaction involving treatment and infertility, and takes a lot of energy.  When, as in infertility treatment, energy is in short supply, it seems a shame to have to use it to protect ourselves from judgements of others based on misinformation.  Even though I've been around infertility for a long time, and have many opportunities to process my feelings regarding it, it still felt burdensome to set the preschool moms straight about the Octomom situation.

In addition, suggestions like Mr. Gingrich's that some secret evil is going on in infertility clinics can cause individuals in treatment to question themselves unnecessarily--although they can't see how they are doing something wrong.  Almost all of the clients I work with have carefully considered, without any prompting from me, how their infertility treatment plan fits in with their sense of morality and ethics.  IVF isn't the kind of thing that people enter into lightly.   Thus, when someone in a prominent public position intimates that what they are doing is suspect, without specific information to back it up, they spend a lot of energy and time questioning themselves.  If they are already feeling shame about being infertile, they may be especially sensitive about such suggestions.  This adds to the pain of an already difficult situation, and is, as far as I can tell, completely unnecessary.