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!

Tuesday, March 20, 2012

Is reproduction a virtue? Attribution theory and infertility

I was on Facebook the other day, and one of my friends, who is really a lovely and kind person, posted a status update saying how wonderful Beyonce was for giving birth vaginally. I was taken aback, because not only is it none of my business how a celebrity gives birth, but to be honest I'm not sure how much choice we all have in these matters. If Beyonce had been forced, due to medical reasons, to have a C section, would she be any less wonderful? Of course, this was just a status update, but the sentiment it expressed epitomizes something that has been bothering me for some time. When it comes to fertility and childbirth, there seems to be, in some circles, a cultural assumption that if things go well, it is more than just good luck. It is evidence of the inherent goodness and moral correctness of the person involved. Beyonce is wonderful because she could conceive and deliver her baby the "right" way. Those of us who can't are presumably not. This kind of thinking is usually painful to those struggling with infertility, and it is, at its base, unfair. As I know too well, infertility almost stems from one or more medical issues, which cannot be easily controlled. A lack of infertility is of course a desirable and fortunate thing. It usually occurs, however, without a great deal of effort. It is the same principle as my not being congratulated for possessing working fingers and toes. I'm grateful for them, but they are more an indication of my good fortune in terms of appendages rather than of any inherent effort, goodness, or ability on my part. Why would such an illogical belief system about fertility be so common? I wonder if this is an example of an attribution error. According to Heider,a psychologist working in the 1950's, we tend to explain others' behavior based on internal characteristics, such as their personality traits. In contrast, we tend to attribute the cause of life events in our own life to external circumstances, such as luck or chance. Thus, my Facebook friend attributes Beyonce's birth experience, about which she feels positively, to positive characteristics she believes Beyonce possesses. On the other hand, I might attribute my own infertility to factors beyond my control. I could go on forever about the different types of pain and self doubt that erroneously attributing ease of conception and delivery to internal personality traits causes those struggling with infertility....but I won't because if you have found this blog, you most likely know what I mean. Instead, I will reiterate that it isn't true. When I mentioned this blog post idea to my mother, she told me, "Make sure you write that although some people may think like this, it really is a reflection of their own failings, such as a lack of empathy, or their own thoughtlessness. So often people say stupid things, or just don't think things all the way through!". I suspect that Mom is right. If you find yourself struggling with this issue, it may help to remind yourself that people make these sorts of attribution errors all of the time, and that it really isn't a valid understanding of the situation. By seeing these errors for what they really are, we may be more free to create our own, more positive meanings of our experiences.

Monday, March 5, 2012

Getting "the donor egg talk"

For a women undergoing infertility treatment, hearing that her only or best chance at pregnancy is donor eggs is usually a fairly upsetting experience.  Many times, she senses it is coming--repeated poor response to follicle-stimulating medication lets the realization sink in over time.  In other instances, it comes a shock.  Testing reveals that despite her youth and health, she is entering menopause early.  In either case, getting "the talk" from the RE is a dreaded and painful event.

Of course, learning that one cannot be biologically related to her child is a huge loss, one that takes time to process and to grieve.  In addition to this, I often hear women blame themselves for their situation.  The refrain of "if only I had known" is a common one, even though of course there was no way to predict the situation.  Perhaps more damaging, I also often hear confessions of shame and self-loathing.  A woman may feel terrible that she can't do what other women do effortlessly, and hate herself for being unable to easily give her partner a child.  Again, as it is a completely uncontrollable situation for her, there is no "solution" for these types of feelings.  Using another, presumably more fertile, women's eggs can feel like a slap in the face.

In addition, if the woman decides to go forward and use donor eggs she is now faced with the prospect choosing an egg donor, which is never an easy decision. She must decide whether or not to use an known or anonymous donor, and deal with the complications that result from either decision. Further, she must manage a complicated treatment cycle with many players, including the egg donor, her agency, a couple of attorneys, and of course, the IVF clinic staff. She must also figure out how she is going to pay for the donor fees and for the treatment, often not covered by insurance.

All in all, this situation is pretty overwhelming for most people.  If you are faced with the prospect of using donor eggs and are feeling upset and stressed out, I'd say that most likely, your response is normal and indicative of good mental health.  I often tell my clients that if they were in a difficult situation and were not upset by it, that would be a big red flag for me.  The main thing is to try to deal with your upset feelings in a helpful and productive manner. To that end, I have a few suggestions for how to navigate this complicated emotional situation. 

1.  Give it time to sink in.

Usually, the first reaction to the donor egg talk is often shock and intense emotional distress.  Even though you might see the writing on the wall, it still hurts to hear "officially" that the chances of having a genetically-related child is small.  It is important to give yourself time to be upset about this, and cry if you need to (and you probably will).  Don't expect yourself to go back to work right away, or see people with whom you don't feel comfortable expressing your true emotions.  This is one of those situations in which you may need to press the "pause" button on your life in order to give yourself time to react and recover.

2.  Watch out for denial.

A common reaction to this sort of news is to deny the severity of the situation.  I have often seen women, upon hearing this news, get very angry at the doctor who delivered it, feeling that he or she may have ulterior motives.  Since they might be getting their period every month and otherwise feel normal, they question why donor eggs would be necessary.  Although it is possible for doctors to be wrong, to be honest I have never really witnessed a case where an RE suggested donor eggs unnecessarily.  I suspect that most RE's dread giving the "donor egg talk" as much as their patients dread hearing it, because it feels bad to have to deliver disappointing news to people they want to help.

Sometimes, a women in denial about her fertility potential, in spite of overwhelming evidence to the contrary, persists on, trying to find a doctor who will perform IVF with her own eggs, or pursuing alternative treatments in the hopes of a miracle.  While miracles can happen, they often aren't likely, and pursuing them for too long can exhaust a couple's financial and emotional resources.  This can make the process of infertility treatment even more traumatic and depleting.

3.  Be kind to yourself.

Being faced with the decision of whether or not to use donor eggs is a traumatic event.  It usually prompts what I have come to call an "infertility meltdown".  There will be a period of grief and mourning, as well as times of anger at the situation.  As it is a time of crisis, it is very important to treat it as such and to take good care of yourself emotionally.  Allow yourself time to cry, and to think about your feelings.  It will most likely be helpful to discuss them with a partner or a close confidante.  Recognize that things like going to baby showers or being around pregnant women may be especially painful right now.  In this difficult time, it may be necessary on a temporary basis to protect yourself from events and people in order to cope with your feelings.  Also, keep an eye out for negative self-thoughts.  Try to remember that producing a quality egg is an involuntary act, and that pregnancy is only nine months out of a whole lifetime of parenting.  I feel we cannot judge ourselves just by what we cannot do.  Rather, we also need to take into account all of our strengths and accomplishments, not the least of which is sticking it out in infertility treatment in order to try to create our families.