When I was struggling with infertility, having a child was almost like finding the "holy grail". I was convinced that if I could just start my family, all of my problems would be solved. I must add that most of this expectation was held unconsciously; regardless, boy was it ever wrong! I am fortunate to be the mother of three (at this moment) reasonably healthy children, but I can't say I have ever approached the nirvana of a relatively problem-free existence.
I know from my clinical experience in working with individuals and couples struggling with infertilty that I am not alone in this belief. Perhaps it's one of those working fictions that we need to keep us going during difficult times. If we really recognized that difficult times don't really end, but just lead to difficult-in-a-different way times, we might just curl up in a ball and call it a day. However, the usefulness of this fiction often dissipates after the infertility struggle is, at least overtly, over. Often, I see people struggle with the expectation that once their child or children arrive, they should be over-the-moon happy all of the time. When they don't always feel this way, they worry that they are not grateful enough, or that after they have endured, they are somehow not "doing it right". Of course, it is their expectation that is inaccurate...most likely, their feelings are completely normal and expectable give their current situation,
In order to create a more realistic picture of life after infertilty, I will describe some of the more common experiences I have witnessed in the lives of others as well as my own life.
1. Pregnancy after infertility is often filled with anxiety.
Instead of shouting with joy from the rooftops, many newly pregnant infertility patients are riddled with anxiety and fear. This is usually quite the opposite of what they expected. They live anxiously from beta to beta and ultrasound to ultrasound. Every early pregnancy symptom is examined and reexamined. As the pregnancy progresses, the anxiety dissipates somewhat, but it never totally goes away.
2. Childbirth and breastfeeding can be difficult and can add to the already negative feelings you may have about your body.
For many infertile women, childbirth and breastfeeding seem like an opportunity to finally be and feel "normal". That's great if everything works out the way you hoped. Unfortunately, many women with infertilty are at at higher risk for difficult childbirth and breastfeeding troubles. For some women, having an unexpected c section or milk production issues can feel like another body "failure", adding to their still painful feelings about their infertility.
3. Your child isn't going to be perfect, and you aren't going to be the perfect parent, no matter how hard you try.
Of course, this is true of any child and any parent. However, many parents who have a history of infertility have lingering, unconscious expectations that because they have been so committed to building their family, they need to be perfect parents. When they fail at the impossible, they can be too hard on themselves. Sometimes, they may unconsciously blame themselves or their infertility for whatever difficulties their child might be having, even though chances are, it's completely unrelated.
These are just a few experiences I have noted, and I would love to hear about the experiences and observations of others, so please leave a comment!
Also, even though the parenting experience isn't a perfect one as we may have envisioned, it can be very rewarding--perhaps more so if we free ourselves of unrealistic expectations.
Thanks so much for reading, and as always, I look forward to your comments and questions!
Monday, July 29, 2013
Wednesday, July 24, 2013
More decisions; medical decisions, emotions, and infertility treatment
I often think that if I ever were to write a book on psychological issues, it would be on how individuals make decisions about their medical care. I find it fascinating and sometimes frightening how much emotional issues can affect and impair the ability to make good health care decisions. Unfortunately, I have seen this lead to very sad and perhaps avoidable negative outcomes, in the area of infertility and in other types of illness as well.
In this post I will discuss some emotional issues that commonly interfere with the ability to make sound medical decisions. The first, and perhaps most serious problem is an overuse of the denial defense. We have all heard stories in which a person notices some significant medical change, like a lump, and copes with their anxiety about it by using denial. They do not seek medical treatment and often don't alert loved ones about the problem until it is too late. My own father-in-law, a dear, wonderful, and educated man, ignored the warning signs of his colon cancer for years. When the family finally became aware of and responded to the problem, it was too late, and he died a few weeks after his diagnosis.
In the infertility world, this can occur when individuals fail to seek treatment even though they meet the criteria for infertility. They often trust that it will "just happen when the time is right". Meanwhile, the clock is ticking, and if there are ovarian reserve issues at play, time may be running out. I sometimes see women in their late 30's or early 40's remain convinced of their ability to conceive naturally with their own eggs, despite much objective evidence to the contrary. Perhaps in some of these cases there is an underlying ambivalence about having a baby, but regardless inaction at this crucial time may ensure that they lose whatever opportunity of using their own eggs that remains.
Another type of emotional issue that can impair medical decision making is feelings about the doctor-patient relationship (or transference as we psychodynamically trained therapists like to call it). Feelings of loyalty to a doctor may make it difficult for some people to seek a second opinion. They may have idealized their doctor and be unable to recognize or admit that their doctor has missed something or made a mistake. Alternately, they may find it difficult to trust others, especially medical professionals, and therefore are unable to provide a complete symptom picture, leading to under diagnosis or misdiagnosis, which then unfortunately only increases their mistrust. Even if they do receive the correct diagnosis, their feelings of mistrust prevent them from following treatment recommendations, which can have tragic effects.
As you can see, making sound medical decisions requires the ability to deal with your feelings directly, and to be able to acknowledge anxiety-producing situations. It also involves the ability to trust and value the opinion of others, but not so much so that you cannot examine these opinions critically. These emotional abilities are not always easy to obtain. In an emotionally charged situation such as infertility treatment, it is even harder to apply these skills. Thus, it is important, when you are making treatment decisions, to take a moment and think about whether you are using denial, or if your emotions about your doctor could be interfering with your ability to critically examine their recommendations.
As always, thank you for reading, and please feel free to contact me with any questions, comments or suggestions you may have!
In this post I will discuss some emotional issues that commonly interfere with the ability to make sound medical decisions. The first, and perhaps most serious problem is an overuse of the denial defense. We have all heard stories in which a person notices some significant medical change, like a lump, and copes with their anxiety about it by using denial. They do not seek medical treatment and often don't alert loved ones about the problem until it is too late. My own father-in-law, a dear, wonderful, and educated man, ignored the warning signs of his colon cancer for years. When the family finally became aware of and responded to the problem, it was too late, and he died a few weeks after his diagnosis.
In the infertility world, this can occur when individuals fail to seek treatment even though they meet the criteria for infertility. They often trust that it will "just happen when the time is right". Meanwhile, the clock is ticking, and if there are ovarian reserve issues at play, time may be running out. I sometimes see women in their late 30's or early 40's remain convinced of their ability to conceive naturally with their own eggs, despite much objective evidence to the contrary. Perhaps in some of these cases there is an underlying ambivalence about having a baby, but regardless inaction at this crucial time may ensure that they lose whatever opportunity of using their own eggs that remains.
Another type of emotional issue that can impair medical decision making is feelings about the doctor-patient relationship (or transference as we psychodynamically trained therapists like to call it). Feelings of loyalty to a doctor may make it difficult for some people to seek a second opinion. They may have idealized their doctor and be unable to recognize or admit that their doctor has missed something or made a mistake. Alternately, they may find it difficult to trust others, especially medical professionals, and therefore are unable to provide a complete symptom picture, leading to under diagnosis or misdiagnosis, which then unfortunately only increases their mistrust. Even if they do receive the correct diagnosis, their feelings of mistrust prevent them from following treatment recommendations, which can have tragic effects.
As you can see, making sound medical decisions requires the ability to deal with your feelings directly, and to be able to acknowledge anxiety-producing situations. It also involves the ability to trust and value the opinion of others, but not so much so that you cannot examine these opinions critically. These emotional abilities are not always easy to obtain. In an emotionally charged situation such as infertility treatment, it is even harder to apply these skills. Thus, it is important, when you are making treatment decisions, to take a moment and think about whether you are using denial, or if your emotions about your doctor could be interfering with your ability to critically examine their recommendations.
As always, thank you for reading, and please feel free to contact me with any questions, comments or suggestions you may have!
Wednesday, July 17, 2013
Decisions, decisions: a few thoughts about deciding how many embryos to transfer
One of the difficult parts of an IVF cycle comes near the end when the decision about how many embryos to transfer back must be made. From a medical standpoint, this decision can be difficult because there are no hard and fast rules; every individual situation is different and involves multiple factors such as embryo quality, maternal age, prior treatment history, etc.
From a psychological standpoint, the decision about the number of embryos to transfer can be tricky as. Well. Usually, these decisions need to be made quickly because the information about the embryos is only available right before the transfer. Further, by this point in the cycle, emotions and hormone levels as running high, making clear and rational thought a challenge.
Perhaps most importantly, however, is the fact that by the time a person is usually facing their IVF transfer, they have been dealing with infertility for a while. Thus, they are naturally desperate for the whole thing to be over and done with as soon as possible. The idea that putting another embryo or two back might increase their chances of success, meaning they could be on their way to parenthood very soon, is quite seductive. If financial issues are a concern, an increased chance of success in fewer cycles is also a strong motivation.
I hear many clients tell me that their ideal outcome of an IVF cycle would be twins. "Two for the price of one," and "buy one, get one free," are common refrains. I totally understand that sentiment. I think I may even have said those things regarding my own treatment at one point or another. However, part my practice involves working with people who have experienced perinatal loss and/or who have given birth prematurely and whose children have spent an extended time in the neonatal intensive care unit. Many of these people began their path to parenthood via IVF, and transferred multiple embryos. There experiences in the NICU are often extemely difficult, traumatic, and of extended duration. All of them have expressed a wish that someone had really helped them understand the risks associated with multiple pregnancies before their IVF transfer.
In addition, even if things work out medically, my work with the parents of multiples has taught me that having twins or triplets can sometimes be hard on a relationship as well, especially if there are other life stressors occurring simultaneously.
I don't mean to be full of doom and gloom here, as I know many healthy and happy families with twins and triplets. But I do urge people to really educate themselves about the medical and psychological risks associated with multiple pregnancies before they get to transfer day, so they are prepared. The good news is that with today's improvements in embryo freezing technology, single embryo transfer is a more viable option with a greater chance of success.
Sometimes the decision about how many embryos to transfer is made for you by the situation; you may only have one viable embryo, or the quality of the embryos may suggest transferring multiple embryos. If you do end up with a choice, then you need to weigh the risks of multiple pregnancy against the emotional and physical wear and tear of doing another frozen embryo transfer. After seeing the problems that can arise with multiple pregnancies, I find myself recommending single embryo transfer more often these days.
Of course, the decision about how many embryos to transfer back is a personal one, and can only be made by you and your partner. Just be sure that you have all the facts, so you can make the choice that is best for your situation.
From a psychological standpoint, the decision about the number of embryos to transfer can be tricky as. Well. Usually, these decisions need to be made quickly because the information about the embryos is only available right before the transfer. Further, by this point in the cycle, emotions and hormone levels as running high, making clear and rational thought a challenge.
Perhaps most importantly, however, is the fact that by the time a person is usually facing their IVF transfer, they have been dealing with infertility for a while. Thus, they are naturally desperate for the whole thing to be over and done with as soon as possible. The idea that putting another embryo or two back might increase their chances of success, meaning they could be on their way to parenthood very soon, is quite seductive. If financial issues are a concern, an increased chance of success in fewer cycles is also a strong motivation.
I hear many clients tell me that their ideal outcome of an IVF cycle would be twins. "Two for the price of one," and "buy one, get one free," are common refrains. I totally understand that sentiment. I think I may even have said those things regarding my own treatment at one point or another. However, part my practice involves working with people who have experienced perinatal loss and/or who have given birth prematurely and whose children have spent an extended time in the neonatal intensive care unit. Many of these people began their path to parenthood via IVF, and transferred multiple embryos. There experiences in the NICU are often extemely difficult, traumatic, and of extended duration. All of them have expressed a wish that someone had really helped them understand the risks associated with multiple pregnancies before their IVF transfer.
In addition, even if things work out medically, my work with the parents of multiples has taught me that having twins or triplets can sometimes be hard on a relationship as well, especially if there are other life stressors occurring simultaneously.
I don't mean to be full of doom and gloom here, as I know many healthy and happy families with twins and triplets. But I do urge people to really educate themselves about the medical and psychological risks associated with multiple pregnancies before they get to transfer day, so they are prepared. The good news is that with today's improvements in embryo freezing technology, single embryo transfer is a more viable option with a greater chance of success.
Sometimes the decision about how many embryos to transfer is made for you by the situation; you may only have one viable embryo, or the quality of the embryos may suggest transferring multiple embryos. If you do end up with a choice, then you need to weigh the risks of multiple pregnancy against the emotional and physical wear and tear of doing another frozen embryo transfer. After seeing the problems that can arise with multiple pregnancies, I find myself recommending single embryo transfer more often these days.
Of course, the decision about how many embryos to transfer back is a personal one, and can only be made by you and your partner. Just be sure that you have all the facts, so you can make the choice that is best for your situation.
Wednesday, April 10, 2013
Infertility, pregnancy, and self-esteem
I was picking up my daughter at a class the other day, when I overheard one of the other mothers talking to the school director. "Did my daughter tell you our news?" she asked excitedly. It turned out that this woman was unexpectedly pregnant, after undergoing infertility treatment to conceive her children. Her face was all aglow, and she went on and on about how she was finally normal, finally experiencing a miracle. To her credit, the school director told her, "Well, I think all your children are miracles," but that really didn't even slow her down.
I left feeling uneasy, and frankly, a little irritated by what I had overheard. I was also irritated at myself--shouldn't I be as happy for this woman as she was for herself? After all, she was experiencing the holy grail of infertility treatment--the spontaneous pregnancy. As I further considered my reaction, I realized that what was really bothering me was this woman's assertion that now, and only now that she had achieved a pregnancy without treatment, that she was normal. That now, she could feel good about herself.
The more I work in the field of infertliity, the more I am able to see how much we, as a society, tie the concept of fertility in with our sense of self-esteem. If a woman can be pregnant and successfully deliver a baby, she's normal and good; if she can't, she's something else--at best someone to feel sorry for, and at worst someone who God/the universe is trying to tell that she doesn't really deserve to be a mother anyway.
The pain that this societal assumption causes is immense. Further galling, anyone who thinks rationally for any amount of time about this assumption will realize it is patently and ridiculously untrue. Of course we all know supremely fertile women who are failing miserably at parenting; and we all know (and might well be) supremely infertile women who will make amazing parents once their infertility crisis is resolved.
I guess this is why I felt so annoyed with the woman at my daughter's class-a feeling of "et tu, Brute?" After all, she is one of us--and yet she still bought into the fertility=normal/good equation hook, line, and sinker.
After a long and protracted battle with infertility and my body in my quest to have children, I have come to realize that I can't let my infertility define how I feel about myself. It was all beyond my control anyhow, and even if it wasn't, I can't feel worse about myself because of it. In the same light, I can't feel like I'm a better, normal/good person because today my lungs are functioning well. That's out of my control too. Instead, I must judge myself on how I respond to my circumstances, and how I treat others in my life.
I hope if you are struggling with infertility, you try to do the same; remember that fertility, or infertility is not the measure of a person. Our efforts, our choices, and our treatment of others are much more valid criteria for self-assessment.
I left feeling uneasy, and frankly, a little irritated by what I had overheard. I was also irritated at myself--shouldn't I be as happy for this woman as she was for herself? After all, she was experiencing the holy grail of infertility treatment--the spontaneous pregnancy. As I further considered my reaction, I realized that what was really bothering me was this woman's assertion that now, and only now that she had achieved a pregnancy without treatment, that she was normal. That now, she could feel good about herself.
The more I work in the field of infertliity, the more I am able to see how much we, as a society, tie the concept of fertility in with our sense of self-esteem. If a woman can be pregnant and successfully deliver a baby, she's normal and good; if she can't, she's something else--at best someone to feel sorry for, and at worst someone who God/the universe is trying to tell that she doesn't really deserve to be a mother anyway.
The pain that this societal assumption causes is immense. Further galling, anyone who thinks rationally for any amount of time about this assumption will realize it is patently and ridiculously untrue. Of course we all know supremely fertile women who are failing miserably at parenting; and we all know (and might well be) supremely infertile women who will make amazing parents once their infertility crisis is resolved.
I guess this is why I felt so annoyed with the woman at my daughter's class-a feeling of "et tu, Brute?" After all, she is one of us--and yet she still bought into the fertility=normal/good equation hook, line, and sinker.
After a long and protracted battle with infertility and my body in my quest to have children, I have come to realize that I can't let my infertility define how I feel about myself. It was all beyond my control anyhow, and even if it wasn't, I can't feel worse about myself because of it. In the same light, I can't feel like I'm a better, normal/good person because today my lungs are functioning well. That's out of my control too. Instead, I must judge myself on how I respond to my circumstances, and how I treat others in my life.
I hope if you are struggling with infertility, you try to do the same; remember that fertility, or infertility is not the measure of a person. Our efforts, our choices, and our treatment of others are much more valid criteria for self-assessment.
Thursday, March 7, 2013
The light at the end of the tunnel: aging out of expectations of fertility
When I was in the throes of infertility treatment, I remember often reading and hearing that infertility was just a life phase, and that over time, it would resolve itself one way or the other. Life would go back to normal. Of course, this was intended to give me hope, and strength, but instead of finding it comforting, it just made me want to throw up. I could already see then, as I can confirm now, that there was no way I was ever going to be the same person after going through all of that pain and disappointment.
In that way, it seems that infertility never ends--even when the struggle is over, our perspectives and relationships have changed. However, I can say that one of the silver linings of getting older is that now no one is expecting me to be able to have babies anymore! As I approach my mid-forties, I no longer am asked whether or not I am going to have children, or have more children. People just assume that it's all done with, and because of my age, I am not very likely to become pregnant--and here is the important part--JUST LIKE EVERY OTHER WOMAN MY AGE. Yes, I've found myself back in the "normal" group again. It took a decade or two for everyone else to catch up with me, but now we are all in the same boat.
I can't tell you what a sweet relief I have found this to be. It almost takes the sting out of my encroaching wrinkles and grey hairs--almost. Now that the book is closed and the dust is settled, it occurs to me that most women my age had their children quite some time ago, and that they haven't defined themselves by their ability, or inability, to get pregnant for quite some time. They have left all that behind and have moved on to other aspects of their lives. Perhaps that's one of the problems with infertility--it can imprison us in the "reproductive phase" of our lives for extended periods of time, but without the easy ability to complete the phase successfully.
Thus, although the emotional changes infertility causes never fully leave us (nor, in my opinion, should they) it does seem that society's expectation that we go forth and multiply does, thankfully, come to an end. As for me, I notice the difference in myself when I am social situations with people I don't know very well. For years, every time I met someone new, I had been unconsciously bracing myself for the questions about babies and pregnancy, whether they actually arose or not. Now I can observe myself feeling much calmer and lighter in these situations, knowing that the questions just aren't going to come up. Although that's not a complete end to the "infertility" phase of my life, it certainly feels much better, and it isn't as much of a constant presence in my mind.
In that way, it seems that infertility never ends--even when the struggle is over, our perspectives and relationships have changed. However, I can say that one of the silver linings of getting older is that now no one is expecting me to be able to have babies anymore! As I approach my mid-forties, I no longer am asked whether or not I am going to have children, or have more children. People just assume that it's all done with, and because of my age, I am not very likely to become pregnant--and here is the important part--JUST LIKE EVERY OTHER WOMAN MY AGE. Yes, I've found myself back in the "normal" group again. It took a decade or two for everyone else to catch up with me, but now we are all in the same boat.
I can't tell you what a sweet relief I have found this to be. It almost takes the sting out of my encroaching wrinkles and grey hairs--almost. Now that the book is closed and the dust is settled, it occurs to me that most women my age had their children quite some time ago, and that they haven't defined themselves by their ability, or inability, to get pregnant for quite some time. They have left all that behind and have moved on to other aspects of their lives. Perhaps that's one of the problems with infertility--it can imprison us in the "reproductive phase" of our lives for extended periods of time, but without the easy ability to complete the phase successfully.
Thus, although the emotional changes infertility causes never fully leave us (nor, in my opinion, should they) it does seem that society's expectation that we go forth and multiply does, thankfully, come to an end. As for me, I notice the difference in myself when I am social situations with people I don't know very well. For years, every time I met someone new, I had been unconsciously bracing myself for the questions about babies and pregnancy, whether they actually arose or not. Now I can observe myself feeling much calmer and lighter in these situations, knowing that the questions just aren't going to come up. Although that's not a complete end to the "infertility" phase of my life, it certainly feels much better, and it isn't as much of a constant presence in my mind.
Wednesday, January 30, 2013
The Infertility Therapist gets cranky, part III: a study of dubious usefulness
Perhaps I'm just in a cranky mood, but I was shocked to open my January 2013 issue of Fertility and Sterility and discover an article entitled, "Attractiveness of women with rectovaginal endometriosis: a case control study" (Vercellini, Buggio, Somigliana, Barbara, Vigano, and Fedele). I first thought that surely the article couldn't be about what I thought was about, but a closer examination revealed that I was correct. The authors spent considerable time and effort to compare women with different types of endometriosis--rectovaginal, ovarian and peritoneal, along with women with other gynecological conditions--on the variables of BMI, breast size, waist to hip ratio, and age of first coitius. They were also evaluated for attractiveness by a panel of four judges. According to the findings of the study, it turns out that women with rectovaginal endometriosis are considered to be significantly hotter than the women with the other conditions. So ladies, if that's you, you have my congratulations.
Can someone out there in the blogosphere please enlighten me as to 1) why this study was conducted in the first place and 2) why it was accepted for publication in a major scientific journal? The study authors argue that different types of gynecological disorders might be due to different genetic phenotypes, which would cause women to have different types of appearances. But is that really going to be helpful to science? Are doctors really going to start diagnosing the type of gynecological disorders a patient has based on how attractive they seem or when they lost their virginity? Especially when we can already diagnose these disorders using things that seem a bit more reliable, like ultrasound images, DNA testing, or surgical reports.
Endometriosis is a complicated disorder that causes a great deal of pain and suffering. Heck, I even have it myself (although not, as you may have guessed, the kind that makes a girl look appealing to a panel of four trained judges). Isn't there a better way to work on finding a treatment and a cure? In my opinion, infertility patients deserve better than an objectifying and demeaning study like this one, which seems to serve no one's interests.
Can someone out there in the blogosphere please enlighten me as to 1) why this study was conducted in the first place and 2) why it was accepted for publication in a major scientific journal? The study authors argue that different types of gynecological disorders might be due to different genetic phenotypes, which would cause women to have different types of appearances. But is that really going to be helpful to science? Are doctors really going to start diagnosing the type of gynecological disorders a patient has based on how attractive they seem or when they lost their virginity? Especially when we can already diagnose these disorders using things that seem a bit more reliable, like ultrasound images, DNA testing, or surgical reports.
Endometriosis is a complicated disorder that causes a great deal of pain and suffering. Heck, I even have it myself (although not, as you may have guessed, the kind that makes a girl look appealing to a panel of four trained judges). Isn't there a better way to work on finding a treatment and a cure? In my opinion, infertility patients deserve better than an objectifying and demeaning study like this one, which seems to serve no one's interests.
Wednesday, January 23, 2013
Top tips for surviving infertility treatment, day ten--recognize your own strength!
In infertility treatment, it's all too easy to focus on what's gone wrong, and on what you can't seem to do. It is harder to take a step back and see things from a broader perspective, in which it becomes clear all that you have done, and all that you have learned. Almost all of us are changed by our experiences with infertility, and I feel mostly in a positive way. We know that we can be strong, and tough, and brave, even when the stakes are high. We learn that we can endure more than we thought we could. We learn new and better ways of coping with stress and difficult feelings. We see how much empathy we can have for others experiencing similar difficulties. We show ourselves that our capacity to love is strong, and profound.
When you are feeling down about how things are going, I would encourage you to take a step back, and look for your own private moments of heroism. Think about all the things you have learned, and the distance that you have come. I'm confident that you will find a great deal of good mixed in with all of the bad.
Recognizing your own strength can restore some of the self-esteem that infertility can erode away. And above all, remember: infertility is a medical, biological problem over which you have little or no control. It isn't a referendum on your character, and it isn't some sort of cosmic message that you wouldn't make a good parent. You are more than the functioning of your organs or cells. You are just as good as anybody else!
I wish you all the best of luck in your infertility treatment, and would love to hear how things are going. If you have any questions, comments, or suggestions, please leave me a comment, or email me at lisarouff@gmail.com.
When you are feeling down about how things are going, I would encourage you to take a step back, and look for your own private moments of heroism. Think about all the things you have learned, and the distance that you have come. I'm confident that you will find a great deal of good mixed in with all of the bad.
Recognizing your own strength can restore some of the self-esteem that infertility can erode away. And above all, remember: infertility is a medical, biological problem over which you have little or no control. It isn't a referendum on your character, and it isn't some sort of cosmic message that you wouldn't make a good parent. You are more than the functioning of your organs or cells. You are just as good as anybody else!
I wish you all the best of luck in your infertility treatment, and would love to hear how things are going. If you have any questions, comments, or suggestions, please leave me a comment, or email me at lisarouff@gmail.com.
Tuesday, January 22, 2013
Top tips for surviving infertility treatment, day nine: take the long view
Many times, it seems that the pace of infertility treatment can be excruciatingly slow. First, you have to wait to get a period, then have tests done and then wait for results. Even after treatment occurs, you often must wait nine or more days to find out if it worked, and even if it did, you must wait again to see if your hormone levels are rising properly, etc., etc. The waiting is so terribly difficult, especially because by this stage of the game, you are already probably "behind" on your life plan of when you would start your family.
Thus, it makes sense that people generally are in a big rush when it comes to infertility treatment. Being stuck in the process, not knowing how it is all going to turn out is very painful, so naturally we want to get through it as quickly as possible. However, sometimes it is necessary or prudent to wait--either until medically the situation is optimal, or until we can get an appointment with the doctor we think might be most helpful. Setbacks and delays are common. I remember one RE telling me during my treatment, "In the scheme of your life, it won't matter if you get pregnant now or a few months from now." I thought he was crazy (and I ended up getting pregnant five YEARS later) but now with the benefit of hindsight I see that what he said was true.
It's true that infertility treatment is painful and anxiety provoking. But it's also true that we have limited resources to devote to it and a limited biological window of opportunity to exploit--so sometimes it pays to take a couple of extra months to get everything lined up just right, to give ourselves the best chance we can have at treatment success.
If you find yourself rushing around, it might be wise to ask yourself if there is anything else you might be missing. And if your doctor or nurse is telling you to wait or slow down, chances are they have a pretty good reason.
In the end, it all comes down to taking the long view. You need to do everything you can do to the best of your ability to prevent having regrets later on down the line, when you can't do anything to change the situation. Try to think of how you might view your current decisions in ten or twenty years, and make sure they won't be likely to cause you future pain.
Thanks for reading, and I'll be back tomorrow with a final tip in this series. Have a great day!
Thus, it makes sense that people generally are in a big rush when it comes to infertility treatment. Being stuck in the process, not knowing how it is all going to turn out is very painful, so naturally we want to get through it as quickly as possible. However, sometimes it is necessary or prudent to wait--either until medically the situation is optimal, or until we can get an appointment with the doctor we think might be most helpful. Setbacks and delays are common. I remember one RE telling me during my treatment, "In the scheme of your life, it won't matter if you get pregnant now or a few months from now." I thought he was crazy (and I ended up getting pregnant five YEARS later) but now with the benefit of hindsight I see that what he said was true.
It's true that infertility treatment is painful and anxiety provoking. But it's also true that we have limited resources to devote to it and a limited biological window of opportunity to exploit--so sometimes it pays to take a couple of extra months to get everything lined up just right, to give ourselves the best chance we can have at treatment success.
If you find yourself rushing around, it might be wise to ask yourself if there is anything else you might be missing. And if your doctor or nurse is telling you to wait or slow down, chances are they have a pretty good reason.
In the end, it all comes down to taking the long view. You need to do everything you can do to the best of your ability to prevent having regrets later on down the line, when you can't do anything to change the situation. Try to think of how you might view your current decisions in ten or twenty years, and make sure they won't be likely to cause you future pain.
Thanks for reading, and I'll be back tomorrow with a final tip in this series. Have a great day!
Monday, January 21, 2013
Top tips for surviving infertility treatment, day eight--remember that "different" isn't bad
One of the things I have learned throughout my life is that people tend to have very negative initial reactions to things or events that are outside the realm of "normal". If you think about it, negative reactions to things or people that are different are probably the cause of most of the trouble in the world, including prejudice, wars, and everyday common social cruelties.
Infertility treatment provides plenty of opportunities for such negative reactions. By the time infertility treatment gets into full swing, "normal" has usually been left far behind. We are left trying to figure out how to deal with the fact that our families didn't come into being the "normal" way. What will we tell our children, our families, our friends, and those nosy folks who make inappropriate comments at the supermarket?
I've been struggling with this in my personal life for over a decade now, and because my oldest daughter is adopted and looks quite different than me, she and I have had our share of questions and comments about our deviations from "normal". I have always tried to emphasize to her and to others that being different doesn't mean things are worse somehow. Being different just makes us interesting. And interesting is good--we have a unique and special story to tell about how we became a family.
For the most part, I have been remarkably fortunate that when I present things in this light, people respond positively. It seems to help them challenge their own assumptions, and to feel a little better about themselves and world.
So remember, although you may be on a different path to parenthood that is outside of the norm, it doesn't necessarily mean it's bad. It just means it's different, and different can have it's own charms and wonders.
Thanks for reading, and I hope you had a great day!
Infertility treatment provides plenty of opportunities for such negative reactions. By the time infertility treatment gets into full swing, "normal" has usually been left far behind. We are left trying to figure out how to deal with the fact that our families didn't come into being the "normal" way. What will we tell our children, our families, our friends, and those nosy folks who make inappropriate comments at the supermarket?
I've been struggling with this in my personal life for over a decade now, and because my oldest daughter is adopted and looks quite different than me, she and I have had our share of questions and comments about our deviations from "normal". I have always tried to emphasize to her and to others that being different doesn't mean things are worse somehow. Being different just makes us interesting. And interesting is good--we have a unique and special story to tell about how we became a family.
For the most part, I have been remarkably fortunate that when I present things in this light, people respond positively. It seems to help them challenge their own assumptions, and to feel a little better about themselves and world.
So remember, although you may be on a different path to parenthood that is outside of the norm, it doesn't necessarily mean it's bad. It just means it's different, and different can have it's own charms and wonders.
Thanks for reading, and I hope you had a great day!
Sunday, January 20, 2013
Top tips for surviving infertility treatment, day seven--be skeptical
One difficult aspect of struggling with infertility is that it can seem like everyone is trying to sell you something. Whether it is infertility treatment itself, complementary treatments like acupuncture, nutritional supplements, or even mental health services like the ones I provide--someone stands to make a profit from your situation. Of course, the infertility industry is filled with many well-qualified, well-intentioned practitioners. Unfortunately, it also contains its share of individuals whose profit motivations may be larger than the benefits they can actually provide, and who aren't above preying on the deep desire their customers have to create a family in order to line their wallets.
This creates a challenge for those experiencing infertility, because they must make treatment and purchasing decisions in an ever-changing, complex and often confusing environment. Further, they must do so when they are upset, overwhelmed, and exhausted.
For these reasons, I advise my clients to be very careful about the treatment providers they select. Although the SART clinic success rates aren't perfect at discriminating quality treatment, at this point they are one of the only measures of clinic performance that we have. Thus, I strongly recommend that clients take them into account when making decisions about treatment providers. To my mind, going with a clinic with lower success rates and less experience is a decision that has to have a pretty strong justification--stronger than merely liking the doctors in question on a personal level.
Further, I always encourage clients to research their own diagnoses and conditions, and to familiarize themselves with the most recent treatment options. That way, they have a base of knowledge with which to decide if they feel a treatment recommendation would be a good fit for them. Clients often worry that they will be perceived by their doctors as "that patient" who questions everything, but in my experience it's the squeaky wheel that gets the grease. As long as they are polite and respectful when discussing their concerns, doctors seem to welcome their questions and appreciate their knowledge.
When it comes to choosing other treatment providers, I think again it pays to be a bit skeptical. Many therapists or acupuncturists advertise themselves as being experts in the area of infertility, but the truth is that some are more expert than others. Look for clinicians who focus on infertility for a significant percentage of their practice, and get recommendations and referrals from other infertility patients.
Of course, if someone is promising you something that no one else has, and it all seems to good to be true--than I'm afraid it probably is. Throughout the years, I've come across webpages and emails telling me that if I just paid some money to get the right advice, my infertility problems would be solved quickly and easily. I think it is especially important to be skeptical of offers like these. Also, if someone is offering services at a rate much lower than other practitioners in the area, I would also be very cautious about choosing that route.
I hope you have had a wonderful weekend. I will be back tomorrow with another tip for surviving infertility treatment.
This creates a challenge for those experiencing infertility, because they must make treatment and purchasing decisions in an ever-changing, complex and often confusing environment. Further, they must do so when they are upset, overwhelmed, and exhausted.
For these reasons, I advise my clients to be very careful about the treatment providers they select. Although the SART clinic success rates aren't perfect at discriminating quality treatment, at this point they are one of the only measures of clinic performance that we have. Thus, I strongly recommend that clients take them into account when making decisions about treatment providers. To my mind, going with a clinic with lower success rates and less experience is a decision that has to have a pretty strong justification--stronger than merely liking the doctors in question on a personal level.
Further, I always encourage clients to research their own diagnoses and conditions, and to familiarize themselves with the most recent treatment options. That way, they have a base of knowledge with which to decide if they feel a treatment recommendation would be a good fit for them. Clients often worry that they will be perceived by their doctors as "that patient" who questions everything, but in my experience it's the squeaky wheel that gets the grease. As long as they are polite and respectful when discussing their concerns, doctors seem to welcome their questions and appreciate their knowledge.
When it comes to choosing other treatment providers, I think again it pays to be a bit skeptical. Many therapists or acupuncturists advertise themselves as being experts in the area of infertility, but the truth is that some are more expert than others. Look for clinicians who focus on infertility for a significant percentage of their practice, and get recommendations and referrals from other infertility patients.
Of course, if someone is promising you something that no one else has, and it all seems to good to be true--than I'm afraid it probably is. Throughout the years, I've come across webpages and emails telling me that if I just paid some money to get the right advice, my infertility problems would be solved quickly and easily. I think it is especially important to be skeptical of offers like these. Also, if someone is offering services at a rate much lower than other practitioners in the area, I would also be very cautious about choosing that route.
I hope you have had a wonderful weekend. I will be back tomorrow with another tip for surviving infertility treatment.
Saturday, January 19, 2013
Top tips for surviving infertility treatment, day six--forgive yourself!
Today I've had the kind of day that has emphasized the need for self-forgiveness. I suppose that each life has some sort of quota for days like these (at least I hope so, anyway). However, a silver lining of today was that it reminded me of how important self-forgiveness is when you are going through infertility treatment. Because trust me, no matter how hard you try, mistakes are going to happen. You might snap at someone, or hurt someone's feelings. Perhaps you have regrets about doing a cycle of treatment at a certain clinic, or not trying another avenue of treatment. The list of potential mistakes, is, at least in my case, endless.
It's important to remember that infertility treatment is like anything else in life--there is a learning curve. It takes a while to get all the information and to get up to speed on the medical challenges you are facing. And it takes even longer to learn how to function with all of the stress that you inevitably find yourself facing. Therefore, it is imperative that you try to forgive yourself for whatever errors you think you might have made. No one does the "infertility thing" perfectly. There is no preparation for this phase of your life. I'm sure you are trying hard, and doing the best you can with things. After all, that's the most we can ever ask of ourselves.
I hope you had a better day than I did, and that you don't need to forgive yourself quite so much today as I do! In any event, I'll be back tomorrow, hopefully in a better mood, and with another tip for surviving your infertility treatment! Thanks for reading!
It's important to remember that infertility treatment is like anything else in life--there is a learning curve. It takes a while to get all the information and to get up to speed on the medical challenges you are facing. And it takes even longer to learn how to function with all of the stress that you inevitably find yourself facing. Therefore, it is imperative that you try to forgive yourself for whatever errors you think you might have made. No one does the "infertility thing" perfectly. There is no preparation for this phase of your life. I'm sure you are trying hard, and doing the best you can with things. After all, that's the most we can ever ask of ourselves.
I hope you had a better day than I did, and that you don't need to forgive yourself quite so much today as I do! In any event, I'll be back tomorrow, hopefully in a better mood, and with another tip for surviving your infertility treatment! Thanks for reading!
Friday, January 18, 2013
Top tips for surviving infertility treatment, day five--fight feeling like a failure
Feelings of failure are incredibly common among individuals struggling through infertility treatment. So often, I hear people telling me that they should somehow be able to transcend their physical problems, and because they can't, they feel a profound sense of failure and shame. Rationally, people can usually see that they have a physical problem over which they have limited or no control, and therefore the situation should not be conceptualized as a success or failure per se. Emotionally, however, it is almost always a different story. Even though it isn't reasonable or fair, they often still end up feeling awful about themselves.
In my opinion, these feelings of failure are one of the most toxic emotional aspects of dealing with infertility. They make an already painful, stressful, and difficult process harder. Worse yet, they are usually self-imposed, unlike nearly everything else about infertility.
Thus, it is important to try to confront these feelings of failure. I often tell clients that they wouldn't consider someone who had physically lost the use of their legs a failure because they were unable to walk a mile unassisted. Likewise, they wouldn't consider someone who was bravely enduring treatments for cancer a failure, no matter what the outcome. So why would they consider themselves a failure just because body parts x, y, or z were unable to do their part in the complicated process of reproduction? I encourage them to remember these things every time they start noticing those feelings of failure creeping up on them.
To me, if you are trying to achieve your goal of building your family, you can't be possibly be failing at it. Because there are so many things that can't be controlled about infertility treatment, you cannot be held responsible for the outcome. You might get lucky, or you might not. But little of that has to do with the effort put into treatment, or the desire for it to succeed.
I know in my own infertility journey, I have struggled with these feelings of failure myself quite a bit. Over time, I have come to the conclusion that I can't judge my life or my worth as a human being on the basis of my defective reproductive system. I have learned that it is more helpful to look at all the hard work, grit, and ingenuity I put into my own struggle to have a family. I hope that you do the same--I have a feeling that you will be impressed by what you see.
I hope you have a great weekend, and I'll be back tomorrow with another tip for surviving infertility treatment!
Thursday, January 17, 2013
Top tips for surviving infertility treatment, day four--it's okay to be bitter
As a clinical psychologist specializin in infertility, I cannot count the number of times I have heard a client lament the fact that he or she is feeling bitter about infertility. There usually is tremendous worry and guilt about feelings of bitterness. For some reason in our culture, bitterness is one of the most negatively viewed emotions. Of course, prolonged bitterness for years and years isn't a good thing, but a little short-term bitterness probably won't do lasting harm. After all, there is much to be bitter about when it comes to infertility. It is unfair and painful, and treating it is usually expensive, time-consuming, and fraught with stress. I think it is unrealistic to expect that a person going through infertility treatment wouldn't feel bitter at some point.
If you ever find yourself feeling bitter about infertility, I would encourage you to try to accept these feelings as a natural result of your situation. Most likely, they will be temporary. Thus, although they are not pleasant feelings to sit with, they are usually not cause for concern. By accepting and working through your bitter feelings, you are much more likely to be free of them in the long-run.
Thanks for reading, and I'll be back tomorrow with another tip!
If you ever find yourself feeling bitter about infertility, I would encourage you to try to accept these feelings as a natural result of your situation. Most likely, they will be temporary. Thus, although they are not pleasant feelings to sit with, they are usually not cause for concern. By accepting and working through your bitter feelings, you are much more likely to be free of them in the long-run.
Thanks for reading, and I'll be back tomorrow with another tip!
Wednesday, January 16, 2013
Top Tips for Surviving Infertility Treatment, Day Three--The Devil is in the Details!
Let me just warn you that the story I am about to relate will make you begin to seriously doubt my intelligence, but I am sharing it anyway in the hopes that my stupidity will not be all for naught. Remember folks, do as I say, not as I do!
During my first IVF cycle, I became acquainted with one of my least favorite parts of infertility threatment, progesterone in oil shots. Each night, my husband dutifully administered them, and I went hobbling about my business afterwards. In addition to all the physical pain and suffering they caused, the shots were having another unwelcome side effect. Although I didn't have a lot of bleeding with the initial injection, I was having a lot problems with (brace yourself here) oozing. Underpants, pajama bottoms, and sheets were getting seriously stained at a record pace. I began a complicated and time consuming regimen of soaking, washing, and bleaching, followed by a frustrated and expensive regimen of discarding and replacing. I was complaining about this to my ever-sensible best friend, who remarked, "Wow, Lisa. I think you should call the doctor. It can't be right that you are oozing through all of those band-aids you are using." Band-aids? Nobody told me to use band-aids! It had never occurred to me, and it probably still wouldn't have if she hadn't mentioned it. I'd still be trying to get out those damned spots.
Needless to say, a quicik trip to the medicine cabinet and my problem was solved.
Moral of the story here? You can't control the big stuff, but you can improve the process a bit by micromanaging it a little. Think it through, and try to figure out all the little things you can do to make the process more bearable. Things to read in the waiting room. Special little treats after each injection. Really good distractions to look forward to can also help! After our conversation, my friend bought me a box of sparkly band-aids that made me smile every time I saw them, and that did take the sting out of the injection just a little bit.
Have a great day and I hope you come back tomorrow for more tips!
During my first IVF cycle, I became acquainted with one of my least favorite parts of infertility threatment, progesterone in oil shots. Each night, my husband dutifully administered them, and I went hobbling about my business afterwards. In addition to all the physical pain and suffering they caused, the shots were having another unwelcome side effect. Although I didn't have a lot of bleeding with the initial injection, I was having a lot problems with (brace yourself here) oozing. Underpants, pajama bottoms, and sheets were getting seriously stained at a record pace. I began a complicated and time consuming regimen of soaking, washing, and bleaching, followed by a frustrated and expensive regimen of discarding and replacing. I was complaining about this to my ever-sensible best friend, who remarked, "Wow, Lisa. I think you should call the doctor. It can't be right that you are oozing through all of those band-aids you are using." Band-aids? Nobody told me to use band-aids! It had never occurred to me, and it probably still wouldn't have if she hadn't mentioned it. I'd still be trying to get out those damned spots.
Needless to say, a quicik trip to the medicine cabinet and my problem was solved.
Moral of the story here? You can't control the big stuff, but you can improve the process a bit by micromanaging it a little. Think it through, and try to figure out all the little things you can do to make the process more bearable. Things to read in the waiting room. Special little treats after each injection. Really good distractions to look forward to can also help! After our conversation, my friend bought me a box of sparkly band-aids that made me smile every time I saw them, and that did take the sting out of the injection just a little bit.
Have a great day and I hope you come back tomorrow for more tips!
Tuesday, January 15, 2013
Top Tips for Surviving Infertility Treatment: Day Two--Remember your body, not your RE, is the real boss
I was reminded recently of something that happened during the preparations for my first IVF cycle, so long ago now. The nurse was going over my schedule with me, and explained that my menstrual cycle would have to sync up with the "on" weeks for the IVF lab. "After this date," she stated with utmost confidence, "we will take control of your body and your cycle." I remember being very impressed with this idea. The doctor would take control of my recalcitrant reproductive system, and my problems would soon be solved! Boy, was I naive. My RE spent the next couple of years trying to "take control" of my cycle, and my body fought back. Eventually, even he had to admit defeat.
All of this made me feel pretty awful and did not do great things for my self-esteem. It was only later that I realized that I was not alone in having a body that didn't respond to medications in the typical way. In retrospect, I think it would have been helpful if someone told me this in advance, which is why I'm telling you now--expect delays because your body won't "cooperate". Cysts happen. Late periods happen. Lead follicles happen. Cancelled cycles happen. They happen all the time, and it doesn't mean that you are doing anything wrong, or even that treatment won't eventually work for you. It just means that infertility treatment is part art along with the science involved. That IVF schedule the doctor's office gives you is really all just a big guess about what they would like to happen. Expect that your real life cycle might be very different.
Thanks for reading, and come back tomorrow for more tips for surviving infertility treatment!
All of this made me feel pretty awful and did not do great things for my self-esteem. It was only later that I realized that I was not alone in having a body that didn't respond to medications in the typical way. In retrospect, I think it would have been helpful if someone told me this in advance, which is why I'm telling you now--expect delays because your body won't "cooperate". Cysts happen. Late periods happen. Lead follicles happen. Cancelled cycles happen. They happen all the time, and it doesn't mean that you are doing anything wrong, or even that treatment won't eventually work for you. It just means that infertility treatment is part art along with the science involved. That IVF schedule the doctor's office gives you is really all just a big guess about what they would like to happen. Expect that your real life cycle might be very different.
Thanks for reading, and come back tomorrow for more tips for surviving infertility treatment!
Monday, January 14, 2013
Top tips for surviving infertility treatment: Day One
I hope everyone is starting off 2013 well. I apologize for not having more new posts up lately. I seem to have gotten swollowed up with the business that comes with the holidays, the end of the year, and the many viruses floating around the Chicagoland area. To jump start myself back into writing more regularly, I thought I would try posting each day for the next ten days, albeit shorter posts. Each day during this period, I will be discussing strategies for getting through infertility treatment with some vestiges of your sanity intact.
Today's tip: Manage your "infertility relationships".
Relationships are one of the most important aspects to surviving infertility treatment, especially when it comes to your treatment providers. When someone feels their doctor, nurse or clinic is on their do side, they can weather a lot of turbulence in their treatment cycle. On the other hand, I've seen treatment cycles nearly being driven off the rails by a rude receptionist or a mistake made in the medical billing office.
Now, I know that you are probably paying that doctor or clinic a lot of money, so you might think that they should be be the one to manage the relationship too, right? I don't disagree with that, but the reality of the situation is that many doctors and clinics are very busy and are not always aware of the emotional subtleties involved. In order for you to get the most out of your treatment, you may need to take this role on for yourself.
Thus, I think it important to think about each staff member involved in your case. What role do they play? What do you need from then in order to feel comfortable and supported? Then, ask yourself if you think it will be easy to get what you need from this staff member. If so, great. If not, however, then you need to make a little assessment of the personality of the person in question, and try to figure out what would be the most effective strategy for getting what you need. Sometimes, you just need to take the emotion out of the situation for a second and just look at things from an operational perspective.
Once you have your strategy, you will reduce the element of surprise (at least unpleasant surprise) and you will be more able to immediately employ your strategy and improve the situation.
Let me know what you think, and look back tomorrow for more tips!
Today's tip: Manage your "infertility relationships".
Relationships are one of the most important aspects to surviving infertility treatment, especially when it comes to your treatment providers. When someone feels their doctor, nurse or clinic is on their do side, they can weather a lot of turbulence in their treatment cycle. On the other hand, I've seen treatment cycles nearly being driven off the rails by a rude receptionist or a mistake made in the medical billing office.
Now, I know that you are probably paying that doctor or clinic a lot of money, so you might think that they should be be the one to manage the relationship too, right? I don't disagree with that, but the reality of the situation is that many doctors and clinics are very busy and are not always aware of the emotional subtleties involved. In order for you to get the most out of your treatment, you may need to take this role on for yourself.
Thus, I think it important to think about each staff member involved in your case. What role do they play? What do you need from then in order to feel comfortable and supported? Then, ask yourself if you think it will be easy to get what you need from this staff member. If so, great. If not, however, then you need to make a little assessment of the personality of the person in question, and try to figure out what would be the most effective strategy for getting what you need. Sometimes, you just need to take the emotion out of the situation for a second and just look at things from an operational perspective.
Once you have your strategy, you will reduce the element of surprise (at least unpleasant surprise) and you will be more able to immediately employ your strategy and improve the situation.
Let me know what you think, and look back tomorrow for more tips!
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