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, November 16, 2012

The fantasy of closure in infertility treatment

By the time a person enters into infertility treatment, they have already experienced a significant loss in terms of their expectations of having a family.  They have had to come to grips with the fact that they could not start their family the "normal" way, without medical intervention. However, for some infertility patients, this is just the beginning of a journey that involves numerous losses, disappointments, and other twists and turns. Every once in a while, the reality of the situation is revealed quickly and definitively; for most, however, the real nature of the problem only becomes clearer in slow motion--one failed treatment at a time.  To me, it's like freefalling down through space on an elevator, but agonizingly slowly, but without any idea of where the bottom floor is.

This is one reason that infertility wreaks such havoc with our emotional life.  While it's going on, it can feel like a constant stream of torture, filled with the worst kind of suspense.  Hope alternates with fear and despair, and of course, there is no definitive ending that can be reliably predicted. Time seems to slow down to a standstill. When looking at others' lives, I can see that these things do come to an end, and usually happily so; but while I was myself living in the midst of it, I had no confidence that those days would ever be done.  I try to share this with my clients, that their struggle will most likely end, and happily so too; and while I am always thanked for my reassurance, I think I am very rarely believed.

Although many problems do tend to resolve themselves over time, infertility is not usually one of them.  To overcome it, you have to actively address the problem, and this is even more difficult when you don't know exactly what the problem is.  Many times, we never really get true clarity, and are forced to guess, making finding a solution difficult.  We usually don't have unlimited time, money, or treatment options.  Plus, as described above, we are usually in an emotionally upset and fatigued state when we must make these incredibly important decisions.

Thus, many of us find ourselves in situations where we cannot know what the best course of action would be--and yet we must, in spite of this, act anyway.  As my grandfather used to say, "You pays your money and you takes your choice!"  Whether it ends up to be a good or bad choice is many times also impossible to determine.  You may have embarked on exactly the right course of treatment for yourself, and it could still fail, just due to bad luck that time around.  Or not.  Too often, there is just no way to know.

All of these observations lead me to the conclusion that that because of the many unknowable variables inherent in infertility treatment, true closure is frequently impossible to obtain.  I have heard many clients long for this closure, understandably feeling that this would help them get over their trauma and losses, and move on with their lives.  However, the frequent impossibility of obtaining closure is yet another one of the traumas and losses those struggling with infertility may have to experience. Thus, sometimes we have to give up our quest for explanations, diagnoses, and certainty, because otherwise we will become even more exhausted and depleted.

The good news is that learning to live with this kind of ambiguity is a skill, and it can be learned.  It's not only helpful with dealing with infertility; life is full of situations that present little clarity, logic or fairness.  The key to to getting over something without clear closure is to accept that you are always going to have some sad and angry feelings about the situation.  Over time, these feelings will dim in intensity, and they will not unduly interfere with your life.  Too often in our culture, I think we feel a pressure not to experience our negative emotions.  If we aren't "happy" all of the time, then there is something wrong with us.  However, I think this is a fairly American and western concept, and an unrealistic one at that, given the trials and travails that can life can offer.  Once we accept that sad and angry feelings are a normal response, and a normal part of life, we don't feel as intense of a need to quell them with explanations and understanding. 

Thursday, November 8, 2012

The aftermath: The effects of infertility once the dust settles

I often hear from clients in the midst of a battle with infertility that they can't wait for their children to come so they can "just put this thing behind" them.  I suppose some people, perhaps who are more skilled at this denial than myself, may be able to do so--but the majority of us find that our infertility is something that we simply can't leave behind.  Even if our infertility is eventually resolved in a manner we feel good about, it still has long-reaching effects in our lives.

As an experiment, this week I tried to keep track of the different ways my own personal infertility came up even though our family is (finally!) complete.  Here's what I discovered:

1.  Having to tell the nurse at our pediatrician's office (again) that I don't know my adopted daughter's birth family's medical history.
2.  Fending off questions from a neighbor about whether I had used infertility treatments and/or donor eggs in the procurement of our youngest child, who is one year old, due to my elderly age.
3.  Having to justify to the school principal and school administration officials why my middle daughter should be "grandfathered" in and not have to lottery in to gain admission to her older sister's school, as they are "too far" apart in age.  Luckily, the school officials didn't really want to deal with my argument that because of my medical problems, I couldn't control the age spacing of my children, and they agreed to let her in the school.
4.  Listening with incredulity to the story of a woman who managed to get pregnant twice while faithfully taking birth control pills.

To me, I think that's a pretty typical week.  Even if I wanted to "put it behind" me, the world has a way of bringing it right back around to the forefront.

I don't think my experiences in this regard are atypical, either.  I am frequently struck by women telling me, that despite the many traumas they may have experienced, their infertility is the problems that still continues to haunt them.

Thus, although wanting to put infertility into the past is an understandable wish, it may not be a realistic expectation.  My personal recommendation is that it may be better off to expect that infertility will continue to be an issue, although hopefully in a less urgent and intense manner.  That way, when you get the insensitive questions or difficult situations, at least you won't be surprised, disappointed, or filled with self-blame.