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!

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.

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.

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!

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!

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.

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!

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!

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!

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!

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!