I have come to the conclusion that it is all Marlo Thomas' fault.
As a child growing up in the 1970's, I was raised on a steady diet of "Free to Be You and Me"
encouragement--women, it seemed, could have it all. They could be
whatever they wanted--being professionally successful and a mother was
no problem. There were no limits. All a girl had to do was to do her
best, and work as hard as she could. This message seems to be permanently woven into every fiber of my being. Even though I now know this is not always true, it seems like I constantly default back to this belief. I somehow manage to forget that I, like us all, have limitations, some insurmountable. Every time in my life it again proven that hard work can't solve everything, it stings just as much. Over, and over, it is an unpleasant, and unwelcome, surprise.
Now I understand what Ms. Thomas was trying to accomplish. For much of our history, women were discriminated against, and discouraged from entering
the professional world. I am enormously grateful that my generation of women received the encouragement and opportunities that we have. And of course, I recognize much of the wisdom of Ms. Thomas' teachings. In almost all areas of life, attempting to
solve problems through effort and hard work is a very successful
strategy. I also believe that without trying, we may never know what we can accomplish.
My problem with the "free to be mentality" is this--if for some reason you couldn't do whatever you wanted, then logically you could conclude that you hadn't worked hard enough or tried your best. A problem that couldn't be solved with hard work didn't exist in this scenario. If there were no barriers to your success, there could be no other explanations for your failures. It is all on you. I'm sure this logical corollary was completely unintended by Ms. Thomas.
Despite this, whenn it comes to infertility, this type of thinking can be extremely problematic. IInfertility is not a problem that can usually be solved by effort and hard work alone. Physical variables, and frankly, luck, seem to be the trump card in many cases. Thus, despite all the efforts made to fix the problem, it is often experienced psychologically as a profound personal failure. Lest this just be my issue, nearly every infertility client with whom I have ever worked has expressed strong concerns that their infertility was somehow their fault, and that the reason that they couldn't have a baby was because they had done, or were doing, something wrong. In all of these cases, the problems, whether they could be fully identified or not, lay outside of the person's sphere of control.
In my case, infertility turned out to be more than the inability to have a child, but realization that my philosophy of living was fundamentally flawed. I suppose that's a good thing, because it's more realistic. In learning to accept the limitations of our bodies when it comes to creating a baby, we learn that not all things are possible after all. This is a painful but important realization, for there will be other aspects of life in which we will also be unable to achieve our goals.
On the other hand, my infertility would have been much easier for me to cope with if I had considered the possibility that there were going to be many things in life I wasn't going to have the ability to do, and that was how it was for everyone. It didn't mean I was a bad person, flawed, cursed, or lazy. It was just unfortunate that my talents didn't lie in this particular direction. Based on my clinical experience, I suspect this is the same for others as well.
As for hard work, I still believe in its value. When I recently discussed this issue with my mother (the one who relentlessly played the "Free to Be" album, and in many other ways promoted the omnipotence of hard work during my childhood), she was unmoved. "Look," she said, "You have lots of problems with infertility. And yet you still have children. You worked hard to make it happen. Marlo Thomas was right." And I really do see her point, especially if you look at the big picture.
But like most of us, during infertility treatment, I couldn't look at the big picture, mostly because it wasn't drawn yet. So all I saw were a series of physical failures, despite maximum effort and worry on my part. It took a while to realize that hard work wasn't going to solve the problem alone. During that time, my self-esteem was in tatters. It has taken years to reorganize my way of thinking, and to come to terms with my physical, intellectual, and emotional limitations.
If you are reading this, I just hope you can learn all of this much faster than I did. While we all can and should try to achieve our goals, we must forgive ourselves, if through no fault of our own, we cannot. In that way, I think we can be most free to truly be ourselves.
Friday, February 17, 2012
Thursday, February 2, 2012
Misperceptions, Misinformation, and Infertility Treatment: Psychological Implications
Last week, as part of his campaign in the Republican primary in Florida, Newt Gingrich stated that if he were president, he would appoint a commission to investigate IVF clinics, as embryos (and to his way of thinking, life) are created there. There are probably some political machinations and implications of this pledge that I don't fully understand. However, it did get me thinking--what exactly does Mr. Gingrich think that such an investigation is going to find? Somehow, Mr. Gingrich seems to believe that embryos are being developed for the wrong reasons or capriciously destroyed or mistreated. The irony here, I think, is that no one values the sanctity of human life more than those who are infertile. People going through the physical, emotional, and financial hardships of IVF value their embryos, and the children they might possibly create, above anything else in the world.
But Mr. Gingrich is not alone in his misperceptions of and mistrust in infertility treatment. A day after his announcement, I found myself explaining to a group of other mothers at a preschool fundraiser that the Octomom was not the norm in infertility treatment. One woman thought that in IVF, the patient was forced to transfer back all the embryos that had been produced in their cycle, and thus higher-order multiple births were the norm. A long discussion of embryo cryopreservation and medical ethics ensued. The mothers seem surprised to learn that the Octomom's doctor was investigated on ethics charges, that most reproductive endocrinologists try to avoid multiple births, and the field is moving towards single embryo transfer. All they knew about IVF came from sensationalist headlines describing the exception to the rule.
These views are often furthered by inaccurate portrayals of infertility treatment and IVF in movies and on television. I am often stunned by the countless examples of medical inaccuracy of television shows when it comes to reproductive issues. For instance, the show Private Practice, which frequently features themes of infertility and infertility treatment, has on multiple occasions depicted infertility treatment incorrectly. My favorite instance involved a doctor using a microscope in the room with a patient to fertilize an just-retrieved egg, only to immediately transfer it back and pronounce her successfully pregnant, much to the joy of all in the room. Anyone who has ever actually done IVF knows its just not that simple! It amazes me that television shows wouldn't hire a consultant to make sure they were getting their facts straight.
In addition to getting the facts wrong, television shows and the movies often portray infertility treatment in a more sinister light, pulling from the extreme situations in the news that get all the attention. Thus, the general public tends to develop a skewed sense of infertility treatment. For instance, a recent episode of CSI Miami focused on the murder of a sperm donor who fathered over 100 children, all of whom became suspects in the criminal investigation. Although there have been cases where one sperm donor has produced a high number of offspring, I suspect again this is much more the exception than the norm. However, if this is the major exposure that most people have to the idea of sperm donation, they will tend to look at it in a more negative light. I suppose stories about wholesome people with a medical struggle doing the best they can to have a family just don't get the ratings.
My concern about the negative portrayals of infertility treatment in politics and the media is that it perpetuates the already preexisting stigma surrounding infertility. For individuals undergoing infertility treatment, it is exhausting and demoralizing to continually have to fight stereotypes of their treatment. The effort involved in managing the reactions of others colors every social interaction involving treatment and infertility, and takes a lot of energy. When, as in infertility treatment, energy is in short supply, it seems a shame to have to use it to protect ourselves from judgements of others based on misinformation. Even though I've been around infertility for a long time, and have many opportunities to process my feelings regarding it, it still felt burdensome to set the preschool moms straight about the Octomom situation.
In addition, suggestions like Mr. Gingrich's that some secret evil is going on in infertility clinics can cause individuals in treatment to question themselves unnecessarily--although they can't see how they are doing something wrong. Almost all of the clients I work with have carefully considered, without any prompting from me, how their infertility treatment plan fits in with their sense of morality and ethics. IVF isn't the kind of thing that people enter into lightly. Thus, when someone in a prominent public position intimates that what they are doing is suspect, without specific information to back it up, they spend a lot of energy and time questioning themselves. If they are already feeling shame about being infertile, they may be especially sensitive about such suggestions. This adds to the pain of an already difficult situation, and is, as far as I can tell, completely unnecessary.
But Mr. Gingrich is not alone in his misperceptions of and mistrust in infertility treatment. A day after his announcement, I found myself explaining to a group of other mothers at a preschool fundraiser that the Octomom was not the norm in infertility treatment. One woman thought that in IVF, the patient was forced to transfer back all the embryos that had been produced in their cycle, and thus higher-order multiple births were the norm. A long discussion of embryo cryopreservation and medical ethics ensued. The mothers seem surprised to learn that the Octomom's doctor was investigated on ethics charges, that most reproductive endocrinologists try to avoid multiple births, and the field is moving towards single embryo transfer. All they knew about IVF came from sensationalist headlines describing the exception to the rule.
These views are often furthered by inaccurate portrayals of infertility treatment and IVF in movies and on television. I am often stunned by the countless examples of medical inaccuracy of television shows when it comes to reproductive issues. For instance, the show Private Practice, which frequently features themes of infertility and infertility treatment, has on multiple occasions depicted infertility treatment incorrectly. My favorite instance involved a doctor using a microscope in the room with a patient to fertilize an just-retrieved egg, only to immediately transfer it back and pronounce her successfully pregnant, much to the joy of all in the room. Anyone who has ever actually done IVF knows its just not that simple! It amazes me that television shows wouldn't hire a consultant to make sure they were getting their facts straight.
In addition to getting the facts wrong, television shows and the movies often portray infertility treatment in a more sinister light, pulling from the extreme situations in the news that get all the attention. Thus, the general public tends to develop a skewed sense of infertility treatment. For instance, a recent episode of CSI Miami focused on the murder of a sperm donor who fathered over 100 children, all of whom became suspects in the criminal investigation. Although there have been cases where one sperm donor has produced a high number of offspring, I suspect again this is much more the exception than the norm. However, if this is the major exposure that most people have to the idea of sperm donation, they will tend to look at it in a more negative light. I suppose stories about wholesome people with a medical struggle doing the best they can to have a family just don't get the ratings.
My concern about the negative portrayals of infertility treatment in politics and the media is that it perpetuates the already preexisting stigma surrounding infertility. For individuals undergoing infertility treatment, it is exhausting and demoralizing to continually have to fight stereotypes of their treatment. The effort involved in managing the reactions of others colors every social interaction involving treatment and infertility, and takes a lot of energy. When, as in infertility treatment, energy is in short supply, it seems a shame to have to use it to protect ourselves from judgements of others based on misinformation. Even though I've been around infertility for a long time, and have many opportunities to process my feelings regarding it, it still felt burdensome to set the preschool moms straight about the Octomom situation.
In addition, suggestions like Mr. Gingrich's that some secret evil is going on in infertility clinics can cause individuals in treatment to question themselves unnecessarily--although they can't see how they are doing something wrong. Almost all of the clients I work with have carefully considered, without any prompting from me, how their infertility treatment plan fits in with their sense of morality and ethics. IVF isn't the kind of thing that people enter into lightly. Thus, when someone in a prominent public position intimates that what they are doing is suspect, without specific information to back it up, they spend a lot of energy and time questioning themselves. If they are already feeling shame about being infertile, they may be especially sensitive about such suggestions. This adds to the pain of an already difficult situation, and is, as far as I can tell, completely unnecessary.
Thursday, January 26, 2012
Relational Infertility: When partners don't agree
I am part of an email listserv for the Mental Health Professional Group of the American Society for Reproductive Medine, in which mental health professionals discuss psychological issues surrounding infertility. This week there was a fascinating discussion of what do when there is in impasse in couple therapy, in which one member of the couple wants to pursue having a child, but the other member does not. Perhaps there is a disagreement about what method of family building to use--one person is against using donor gametes, or adoption. Other times, the conflict centers around whether or not to have a child, or another child, at all. On the listserv, there were different suggestions about how to be helpful in this situation, but all the clinicians agreed that these are usually very difficult and painful situations for the couple involved.
I have come to realize that there are actually many different types of infertility. Of course, there is your garden-variety medical infertility, which in some ways, though emotionally painful, is a bit more clear cut. There is also situational infertility, in which an individual or couple cannot pursue having a family because of their circumstances, for example, if a family member develops a serious illness, or a financial crisis occurs. But when the members of a couple seriously disagree about if and how to have a child, then relational infertility occurs. This type of infertility often coexists with medical and situational infertility.
In many ways, relational infertility can be the most painful type of infertility of all. With medical or situational infertility, the causes are usually out of anyone's control. But when the family-building impasse is caused by a choice, the feeling is that things could be different--if only the other person would change their mind. In a couple, such a conflict can be very difficult on a relationship. Both partners have to face the dilemma of either having some serious regrets and resentments for the road not traveled, or conversely ending an important relationship. This is because it is often very hard to create a compromise in these situations--you can't have or not have a baby half-way.
One of the things that struck me about the discussion on the listserv is that my colleagues, like myself, didn't have any easy answers for dealing with such a dilemma. I suspect that this is because there simply isn't one. Having, or not having, children is one of the most important life decisions a person can make. At times, the importance of these desires can override the desire for being in the relationship.
However, if you find yourself in this type of conflict with your partner, there are some steps you can take to try to resolve the situation. The most important thing you can do is try to listen to your partner very carefully. Even if you don't agree with their perspective, it is important to try and understand it. Try to put yourself in your partner's shoes and see things from their point of view. If you can develop empathy for what your partner is feeling, you may be able to become less rigid in your own position, and a solution may be possible.
In cases of relational infertility, it is also important to consider whether or not other underlying issues and conflicts you are experiencing as a couple are coloring your feelings regarding having a family. For instance, if there are problems with emotional closeness and support in the relationship, one of the partners may be more hesitant to add on the additional work and stress of having a child. Certainly, if one of the partners is already having doubts about continuing the relationship, he or she may not want to make the additional commitment of having a child together.
In addition, at times an individual's psychological issues can contribute to an relational infertility impasse. For example, one couple with whom I worked was locked in conflict about whether to continue fertility treatments--the wife wanted to stop, whereas the husband desperately wanted to continue to try for a baby. Over time, it became clear that the wife had deep-seated doubts about her own ability to parent successfully. These doubts were rooted in her experiences growing up with her own parents. As she became more aware of these issues, and her husband developed a greater understanding and empathy for her feelings, the couple was better able to decide together what their future would hold.
With relational infertility, the stakes are very high. I think it must be very hard to be the person who kept a partner from his or her dream of having a child. Conversely, it must also be extremely difficult to feel that one's partner is resentful about parenting, or not fully committed to a child. Ending a relationship of long-standing can also be extremely painful. Thus, if you find yourself in this situation, think carefully before you act or make your final decision. Seeking couples therapy with a therapist knowledgeable about infertility would be very helpful in negotiating such an important and life-changing decision.
I have come to realize that there are actually many different types of infertility. Of course, there is your garden-variety medical infertility, which in some ways, though emotionally painful, is a bit more clear cut. There is also situational infertility, in which an individual or couple cannot pursue having a family because of their circumstances, for example, if a family member develops a serious illness, or a financial crisis occurs. But when the members of a couple seriously disagree about if and how to have a child, then relational infertility occurs. This type of infertility often coexists with medical and situational infertility.
In many ways, relational infertility can be the most painful type of infertility of all. With medical or situational infertility, the causes are usually out of anyone's control. But when the family-building impasse is caused by a choice, the feeling is that things could be different--if only the other person would change their mind. In a couple, such a conflict can be very difficult on a relationship. Both partners have to face the dilemma of either having some serious regrets and resentments for the road not traveled, or conversely ending an important relationship. This is because it is often very hard to create a compromise in these situations--you can't have or not have a baby half-way.
One of the things that struck me about the discussion on the listserv is that my colleagues, like myself, didn't have any easy answers for dealing with such a dilemma. I suspect that this is because there simply isn't one. Having, or not having, children is one of the most important life decisions a person can make. At times, the importance of these desires can override the desire for being in the relationship.
However, if you find yourself in this type of conflict with your partner, there are some steps you can take to try to resolve the situation. The most important thing you can do is try to listen to your partner very carefully. Even if you don't agree with their perspective, it is important to try and understand it. Try to put yourself in your partner's shoes and see things from their point of view. If you can develop empathy for what your partner is feeling, you may be able to become less rigid in your own position, and a solution may be possible.
In cases of relational infertility, it is also important to consider whether or not other underlying issues and conflicts you are experiencing as a couple are coloring your feelings regarding having a family. For instance, if there are problems with emotional closeness and support in the relationship, one of the partners may be more hesitant to add on the additional work and stress of having a child. Certainly, if one of the partners is already having doubts about continuing the relationship, he or she may not want to make the additional commitment of having a child together.
In addition, at times an individual's psychological issues can contribute to an relational infertility impasse. For example, one couple with whom I worked was locked in conflict about whether to continue fertility treatments--the wife wanted to stop, whereas the husband desperately wanted to continue to try for a baby. Over time, it became clear that the wife had deep-seated doubts about her own ability to parent successfully. These doubts were rooted in her experiences growing up with her own parents. As she became more aware of these issues, and her husband developed a greater understanding and empathy for her feelings, the couple was better able to decide together what their future would hold.
With relational infertility, the stakes are very high. I think it must be very hard to be the person who kept a partner from his or her dream of having a child. Conversely, it must also be extremely difficult to feel that one's partner is resentful about parenting, or not fully committed to a child. Ending a relationship of long-standing can also be extremely painful. Thus, if you find yourself in this situation, think carefully before you act or make your final decision. Seeking couples therapy with a therapist knowledgeable about infertility would be very helpful in negotiating such an important and life-changing decision.
Friday, January 13, 2012
Infertility treatment and the "Type A" personality
I can only imagine what must be like to be able to get pregnant and have children easily, without much effort. The analogy that comes to mind is the ease with which I taught myself to read, at age three. Watching public television along with my older brother, I learned the letters, their sounds, and how to put them together very quickly. I had my own library card by the time I was in preschool. Reading never felt like work--it was just something I did, and I took it for granted that I could read whatever I wanted. I had no idea that this was an exceptional experience, so I couldn't understand, and was probably insensitive to, other children to whom reading didn't come quite so easily.
Of course, while reading was my strength, other academic struggles presented themselves. My poor visual-spatial skills have created constant fodder for jokes for my friends and family. Math, physics, and chemistry did not come naturally. However, I was still able to achieve good grades in these subjects in school by working hard and pushing myself.
Society seemed to support my view that hard work was the only necessary ingredient for success. After all, I learned that watching public television too. In high school, I once remarked to my social studies teacher that a person could do whatever they wanted to in life as long as they worked hard enough. A wise man, he sighed, took off his glasses, and told me that was completely untrue. I argued with him, but he simply insisted--a person cannot do whatever they want just by working hard, as different people have different abilities, and there is also the involvement of luck. At the time, I felt he was being negative and discouraging, and I did not believe him.
Well, I believe him now.
Like almost everyone, I assumed that when I wanted to get pregnant, it would happen according to my schedule and my timeframe. I couldn't fathom that it might not happen when I wanted it to, much less at all--and if so, there might be very little I could do about it.
In the early stages of infertility treatment, I clung to my approach of working hard in order to achieve my goal. When treatment started going badly, I resolved to fight harder, to do more, and to keep pushing myself. I felt that if I just tried hard enough, I would get pregnant.
When it finally began to dawn on me that no matter how hard I tried, I couldn't overcome certain biological problems, it caused a great deal of emotional turmoil. Not only was I very upset about my infertility; my entire world-view had been shattered.
I know that my story is far from unique because I hear it from my clients every day. In so many cases, infertility is the first real life stumbling block that cannot be overcome by hard work. Like me, my clients also must grapple with their grief and anger about infertility in the midst of developing a new approach to solving problems.
If you are reading this blog, chances are that you are also a hard-working, high-achieving sort of person yourself. If you too are struggling with the fact that your typical life strategies aren't working with your infertility treatment, know that you are definitely not alone.
It's important to realize that however hard you work at your infertility treatment, it will not be the deciding factor in whether or not is successful--that ultimately, success is left in the hands of biology, chance, and perhaps fate. By acknowledging this, you can let yourself off the hook a bit, and see that your don't need to work as hard as you have, perhaps exhausting or depleting yourself in the process.
On the other hand, it's important not to stop working hard altogether. Although hard work cannot ensure that treatment is successful, it can give you the best opportunity you can have to get pregnant. By making sure you understand your diagnosis and treatment options, and by following your treatment protocols to the letter, you can at least ensure that you've given treatment the best try possible. That's important later on--you don't want to feel that you have regrets that you could have done more.
In the end, it's like so many things--a balancing act. We must work hard enough to make sure we get the best treatment possible, but then we have to acknowledge that there is a limit to what our hard work can achieve. Once we've done everything we can do to further treatment, then we should rest, and try to focus on other areas of our life. This, of course, is easier said than done. But by recognizing that hard work alone doesn't cure infertility (or many other problems, for that matter) we can have more energy to devote to other aspects of our lives, thus making infertility treatment more bearable.
Of course, while reading was my strength, other academic struggles presented themselves. My poor visual-spatial skills have created constant fodder for jokes for my friends and family. Math, physics, and chemistry did not come naturally. However, I was still able to achieve good grades in these subjects in school by working hard and pushing myself.
Society seemed to support my view that hard work was the only necessary ingredient for success. After all, I learned that watching public television too. In high school, I once remarked to my social studies teacher that a person could do whatever they wanted to in life as long as they worked hard enough. A wise man, he sighed, took off his glasses, and told me that was completely untrue. I argued with him, but he simply insisted--a person cannot do whatever they want just by working hard, as different people have different abilities, and there is also the involvement of luck. At the time, I felt he was being negative and discouraging, and I did not believe him.
Well, I believe him now.
Like almost everyone, I assumed that when I wanted to get pregnant, it would happen according to my schedule and my timeframe. I couldn't fathom that it might not happen when I wanted it to, much less at all--and if so, there might be very little I could do about it.
In the early stages of infertility treatment, I clung to my approach of working hard in order to achieve my goal. When treatment started going badly, I resolved to fight harder, to do more, and to keep pushing myself. I felt that if I just tried hard enough, I would get pregnant.
When it finally began to dawn on me that no matter how hard I tried, I couldn't overcome certain biological problems, it caused a great deal of emotional turmoil. Not only was I very upset about my infertility; my entire world-view had been shattered.
I know that my story is far from unique because I hear it from my clients every day. In so many cases, infertility is the first real life stumbling block that cannot be overcome by hard work. Like me, my clients also must grapple with their grief and anger about infertility in the midst of developing a new approach to solving problems.
If you are reading this blog, chances are that you are also a hard-working, high-achieving sort of person yourself. If you too are struggling with the fact that your typical life strategies aren't working with your infertility treatment, know that you are definitely not alone.
It's important to realize that however hard you work at your infertility treatment, it will not be the deciding factor in whether or not is successful--that ultimately, success is left in the hands of biology, chance, and perhaps fate. By acknowledging this, you can let yourself off the hook a bit, and see that your don't need to work as hard as you have, perhaps exhausting or depleting yourself in the process.
On the other hand, it's important not to stop working hard altogether. Although hard work cannot ensure that treatment is successful, it can give you the best opportunity you can have to get pregnant. By making sure you understand your diagnosis and treatment options, and by following your treatment protocols to the letter, you can at least ensure that you've given treatment the best try possible. That's important later on--you don't want to feel that you have regrets that you could have done more.
In the end, it's like so many things--a balancing act. We must work hard enough to make sure we get the best treatment possible, but then we have to acknowledge that there is a limit to what our hard work can achieve. Once we've done everything we can do to further treatment, then we should rest, and try to focus on other areas of our life. This, of course, is easier said than done. But by recognizing that hard work alone doesn't cure infertility (or many other problems, for that matter) we can have more energy to devote to other aspects of our lives, thus making infertility treatment more bearable.
Friday, January 6, 2012
Not-normal is the new normal: Infertility in perspective
I apologize for not posting as much as I would have liked to in the past several weeks. I've been in a sleep-deprived haze, and had difficulty even thinking in coherent sentences--much less writing them. Things are better now, thankfully, as I am back at work again.
During my break, I've had another opportunity to think about my own infertility and what it has meant in my life. For me, the bottom line is this--infertility was a real deviation from the "normal" life I had envisioned for myself. Like everyone who experiences infertility, I was forced to give up my dreams and expectations about how I would have a family. This was difficult and painful in and of itself, but on top of this, I had to work extremely hard in infertility treatment and in our adoption. After all, nobody makes you get IVF, or adopt--it is a choice, and you must make the process happen. As we all know, these processes are difficult, time-consuming, and sometimes heartbreaking.
Even after I had children, I still struggled with not feeling "normal", and a bit envious of others who were able to take the typical path to parenthood. My adopted daughter, fine now, initially had some health issues that took quite a bit of time to resolve. In my pregnancies, my body, ever uncooperative in the reproductive arena, continued with its contrary ways. However, as time has passed, although I still don't feel "normal", I'm around enough parents, kids, and families to realize that pretty much every one of them has some sort of issue or problem that makes them "not-normal" also. I mention this because when I was undergoing infertility treatment, it was so painful for me to be around babies, kids, and their hangers-on that I didn't get close enough to see the details of the situation. I imagined that everyone else was having a perfect life--certainly a better life than me. Many of my clients have echoed similar sentiments.
Once I started to let go of my expectations of "normalcy", everything started to seem clearer. It was, emotionally speaking, a much less complicated task to just do what I needed to do in my particular situation to have a family. I guess if I had to do it all over again, I wish I would have let go of these worries about being normal much earlier in the process than I did. I think I could have saved myself a lot of anguish, and had more energy left for the formidable tasks that were at hand.
If you also find yourself feeling bad because your situation is not "normal", I hope you can learn from my mistakes, and try to move past this worry, because I don't really believe there is a "normal" way to have a family. There are just different ways to have a family, and they all have the potential to be wonderful and problematic, all at the same time. Try to keep in mind that the fertile world has its share of problems too, and that although you must take a different path, it is not a lesser one.
Also, I'd like to wish everyone the best of luck with all of their adventures in the New Year. If you have any questions, or suggestions of topics you'd like me to address, I'd love to hear them! Please don't hesitate to comment or send me an e-mail at lisarouff@gmail.com.
During my break, I've had another opportunity to think about my own infertility and what it has meant in my life. For me, the bottom line is this--infertility was a real deviation from the "normal" life I had envisioned for myself. Like everyone who experiences infertility, I was forced to give up my dreams and expectations about how I would have a family. This was difficult and painful in and of itself, but on top of this, I had to work extremely hard in infertility treatment and in our adoption. After all, nobody makes you get IVF, or adopt--it is a choice, and you must make the process happen. As we all know, these processes are difficult, time-consuming, and sometimes heartbreaking.
Even after I had children, I still struggled with not feeling "normal", and a bit envious of others who were able to take the typical path to parenthood. My adopted daughter, fine now, initially had some health issues that took quite a bit of time to resolve. In my pregnancies, my body, ever uncooperative in the reproductive arena, continued with its contrary ways. However, as time has passed, although I still don't feel "normal", I'm around enough parents, kids, and families to realize that pretty much every one of them has some sort of issue or problem that makes them "not-normal" also. I mention this because when I was undergoing infertility treatment, it was so painful for me to be around babies, kids, and their hangers-on that I didn't get close enough to see the details of the situation. I imagined that everyone else was having a perfect life--certainly a better life than me. Many of my clients have echoed similar sentiments.
Once I started to let go of my expectations of "normalcy", everything started to seem clearer. It was, emotionally speaking, a much less complicated task to just do what I needed to do in my particular situation to have a family. I guess if I had to do it all over again, I wish I would have let go of these worries about being normal much earlier in the process than I did. I think I could have saved myself a lot of anguish, and had more energy left for the formidable tasks that were at hand.
If you also find yourself feeling bad because your situation is not "normal", I hope you can learn from my mistakes, and try to move past this worry, because I don't really believe there is a "normal" way to have a family. There are just different ways to have a family, and they all have the potential to be wonderful and problematic, all at the same time. Try to keep in mind that the fertile world has its share of problems too, and that although you must take a different path, it is not a lesser one.
Also, I'd like to wish everyone the best of luck with all of their adventures in the New Year. If you have any questions, or suggestions of topics you'd like me to address, I'd love to hear them! Please don't hesitate to comment or send me an e-mail at lisarouff@gmail.com.
Monday, November 21, 2011
Infertility and the myth of the reparative experience
A common theme in psychotherapy is the wish for a reparative experience, or an experience that in some way, makes up for a prior bad experience. Unfortunately, as much as reparative experiences seem like a good idea, the quest for them is actually the cause of much human misery--for in many situations, repair is impossible. For example, if a woman grew up with a parent who was distant and uninvolved, she may find herself romantically attracted to men who are similarly distant and uninvolved. She is motivated by the unconscious idea that if she could just get this man to love her and pay attention to her, it would somehow make up for the fact that her father did not. Of course, we all know how this story goes. Too often, the new romantic interest is psychologically incapable of being emotionally close, and thus the cycle continues. Further, once the woman realizes that she has been, yet again, rejected. she is retraumatized. She then becomes even more invested in the struggle to get a distant and uninvolved man to change.
The same dynamics that can make the struggle for a reparative experience so compelling in terms of relationships also hold true for infertility. In trying to overcome our infertility, we are sometimes not just building a family; we are also attempting to somehow repair the emotional damage done by infertility. I often hear patients tell me that if only they could get pregnant, everything in their life would be fine. And yet, although things are usually indeed better, pregnancy and parenting bring about their own set of stresses and problems.
My own recent experiences have been a case in point. As I have mentioned in prior posts, I was recently pregnant and had a baby boy in October--the result of a final cycle with our one remaining frozen embryo. Throughout the pregnancy, I found myself worried that I would have to have another C-section. I wanted to have a vaginal delivery for a variety of medical reasons, but also because I wanted to feel like I was "normal" in the reproductive sense, at least for once in my life. When it became clear that a C-section was again inevitable, I briefly became depressed. I realized that I too was longing for a reparative experience. Instead, I was forced to accept that my reproductive system was yet again not functioning normally. Since this was definitely my last cycle and my last baby, my chances for a reparative experience were at an end.
However, regardless of the nature of my delivery, nothing can really fix the emotional scars from my experiences with infertility. Despite the fact that I wish it were otherwise, I must accept that for me, having a baby is like driving a very old car from New York to California. The car can only goes 20 miles per hour, and if you don't want it to explode, you have to pull over and add oil to the engine every five miles. Sure, you will eventually get to California...but it will take you a lot longer to get there, cost more money, and you are going to be pretty darn tired once you arrive. And trust me, although that experience is not easy, I know I am lucky to have a car at all.
In the end, we must learn to accept our losses. If we don't, we will find our energy depleted by our efforts to fix what can't be repaired. Even when we are able to overcome our infertility and have a family, we are still likely to have negative feelings about our infertility experience. The good news is that if we can devote our energies to other, more fruitful, endeavors, instead of trying in vain to undo our painful experiences, we can have a much richer, rewarding life. This weekend, I ran into an acquaintance who recently completed her first marathon, which to me seems a very impressive task. At first I thought to myself that I'd never be able to run a marathon, but then I realized that in terms of my infertility, I've been running my own type of marathon for the last decade or so. I think that running an actual marathon, although difficult, may be easier than infertility treatment. Now that I've dealt more deeply with my feelings of loss and sadness regarding my infertility, perhaps I'll have more energy to run my current "marathon"--parenting an infant, preschooler, and tween on very little sleep! And when things settle down, maybe I'll be inspired to run my own kind of marathon, although I doubt it will be the actual kind.
For all of us struggling with infertility, it is important to take a moment to consider if we are on a quest for a reparative experience, even in a subtle fashion. By dealing more directly with our feelings of loss, we may be able to free up energy we can use to create our families, or enrich our lives and relationships in other ways.
The same dynamics that can make the struggle for a reparative experience so compelling in terms of relationships also hold true for infertility. In trying to overcome our infertility, we are sometimes not just building a family; we are also attempting to somehow repair the emotional damage done by infertility. I often hear patients tell me that if only they could get pregnant, everything in their life would be fine. And yet, although things are usually indeed better, pregnancy and parenting bring about their own set of stresses and problems.
My own recent experiences have been a case in point. As I have mentioned in prior posts, I was recently pregnant and had a baby boy in October--the result of a final cycle with our one remaining frozen embryo. Throughout the pregnancy, I found myself worried that I would have to have another C-section. I wanted to have a vaginal delivery for a variety of medical reasons, but also because I wanted to feel like I was "normal" in the reproductive sense, at least for once in my life. When it became clear that a C-section was again inevitable, I briefly became depressed. I realized that I too was longing for a reparative experience. Instead, I was forced to accept that my reproductive system was yet again not functioning normally. Since this was definitely my last cycle and my last baby, my chances for a reparative experience were at an end.
However, regardless of the nature of my delivery, nothing can really fix the emotional scars from my experiences with infertility. Despite the fact that I wish it were otherwise, I must accept that for me, having a baby is like driving a very old car from New York to California. The car can only goes 20 miles per hour, and if you don't want it to explode, you have to pull over and add oil to the engine every five miles. Sure, you will eventually get to California...but it will take you a lot longer to get there, cost more money, and you are going to be pretty darn tired once you arrive. And trust me, although that experience is not easy, I know I am lucky to have a car at all.
In the end, we must learn to accept our losses. If we don't, we will find our energy depleted by our efforts to fix what can't be repaired. Even when we are able to overcome our infertility and have a family, we are still likely to have negative feelings about our infertility experience. The good news is that if we can devote our energies to other, more fruitful, endeavors, instead of trying in vain to undo our painful experiences, we can have a much richer, rewarding life. This weekend, I ran into an acquaintance who recently completed her first marathon, which to me seems a very impressive task. At first I thought to myself that I'd never be able to run a marathon, but then I realized that in terms of my infertility, I've been running my own type of marathon for the last decade or so. I think that running an actual marathon, although difficult, may be easier than infertility treatment. Now that I've dealt more deeply with my feelings of loss and sadness regarding my infertility, perhaps I'll have more energy to run my current "marathon"--parenting an infant, preschooler, and tween on very little sleep! And when things settle down, maybe I'll be inspired to run my own kind of marathon, although I doubt it will be the actual kind.
For all of us struggling with infertility, it is important to take a moment to consider if we are on a quest for a reparative experience, even in a subtle fashion. By dealing more directly with our feelings of loss, we may be able to free up energy we can use to create our families, or enrich our lives and relationships in other ways.
Tuesday, October 11, 2011
My top ten tips for dealing with infertility
I've been in the infertility world, both personally and professionally, for a long time now. Over this time, I have witnessed some strategies for dealing with infertility which seemed to consistently move things in a positive direction. I thought it might be useful to summarize these strategies for those who may be just embarking on their infertility journey, or who are ensconced in the middle of their struggle.
Of course, like most retrospectively formed lists of advice, this is more of a "do what I say, not what I do" type of exercise! My hope is that by sharing these strategies, I can help someone avoid some of the pitfalls I experienced. After all, we all don't always have to learn everything the hard way!
1. Take the outlook that infertility isn't personal. It is a medical condition, plain and simple.
It eludes me how a much controversy exists about whether or not infertility should be considered a medical problem. I guess I can understand why an insurance company executive would wish to avoid this truth. However, I am continually flabbergasted by how many people seem to believe that there is some moral judgement involved. If you are of reproductive age and you can't conceive a child, then it is obvious that something physical is wrong!
2. Realize that yes, this happened to you, and that it is totally unfair. However, if you spend too much time thinking about this, it might drive you a little crazy.
Infertility almost always comes as a bit of a shock, and it is natural to feel cheated when others can conceive easily. It is one of life's mysteries as to why this happens. My best advice is just to try and accept this as a mystery--trying to figure out why unfair things happen usually isn't successful, and it just makes us feel bad.
3. Don't always try to be positive.
Many people feel that if they don't always maintain a positive attitude, they will somehow be inviting bad energy, luck, or events into their lives. However, this simply isn't a realistic expectation. Some situations, by their nature, are just hard, sad, and painful. I feel it is more important to allow yourself the freedom to feel whatever emotions you are having. If you work to express them in a productive way, your feelings will lessen in intensity, and you will be able to move forward.
4. Educate yourself as much as possible about your diagnosis, prognosis, and treatment options.
Although it can be complicated and time-consuming, it is very helpful to know as much as you can about the medical conditions with which you are struggling. This is very helpful in terms of making treatment decisions. In addition, this knowledge can also help you gain a better emotional understanding of your situation, and can also provide emotional closure should you need to move on to other family building options.
5. Don't expect anyone else to care about your infertility problems as much as you and your partner do.
Your medical treatment team, although they may be dedicated to your case, has a lot of other patients and issues with which to cope. You cannot rely on them to be on top of every detail of your treatment--you have to do this for yourself. Also, remember that even though your friends and family care about what is happening to you, they have their own lives and issues. Sometimes, you may need to remind them about what is happening or what help you may need from them.
6. Learn from your painful experiences and mistakes.
Infertility is complicated, and there will be times when you may make the wrong decision, or end up having regrets. This is inevitable. The important thing is to not be afraid to use these experiences to change your problem solving strategies--whether that means changing doctors, clinics, treatment modalities, or going down a different path of family building altogether.
7. Be as proactive as possible.
Infertility is a major life crisis, and the task of having children is one of the most important things you will ever do. Thus, you must do whatever you believe will give you the best chance of success--even if it's hard, inconvenient, or expensive.
8. Recognize that some people are going to say stupid or hurtful things--no matter what.
I wish this statement wasn't true, but the fact remains that many people harbor misconceptions about infertility, or are insensitive to other people's feelings. It is a small comfort, but the fact is that people will say stupid and hurtful things about any number of subjects, not just infertility alone
.
9. Try to identify who you can get support from, and focus on those relationships.
Sometimes it is surprising to discover who among your friends and family you can count on, and who you can't. Don't feel guilty about not sharing information or being as close as you were to people who, for whatever reasons, cannot be helpful during this phase of your life. You are in a crisis, and you need to focus your energy on those relationships which can provide you with support and understanding.
10. Remember to take the long view.
An important factor to consider when making decisions about infertility treatment is that you are trying to keep yourself from having major regrets later in life. Try to think about how you might feel about your decision ten, twenty, and thirty years into the future, after the window for making these decisions has long past. This perspective may prompt you to do things that are harder in the short-term in order to prevent long-term regrets. Although this is difficult, you can be confident that your future self will appreciate your hard work and sacrifice!
1. Take the outlook that infertility isn't personal. It is a medical condition, plain and simple.
It eludes me how a much controversy exists about whether or not infertility should be considered a medical problem. I guess I can understand why an insurance company executive would wish to avoid this truth. However, I am continually flabbergasted by how many people seem to believe that there is some moral judgement involved. If you are of reproductive age and you can't conceive a child, then it is obvious that something physical is wrong!
2. Realize that yes, this happened to you, and that it is totally unfair. However, if you spend too much time thinking about this, it might drive you a little crazy.
Infertility almost always comes as a bit of a shock, and it is natural to feel cheated when others can conceive easily. It is one of life's mysteries as to why this happens. My best advice is just to try and accept this as a mystery--trying to figure out why unfair things happen usually isn't successful, and it just makes us feel bad.
3. Don't always try to be positive.
Many people feel that if they don't always maintain a positive attitude, they will somehow be inviting bad energy, luck, or events into their lives. However, this simply isn't a realistic expectation. Some situations, by their nature, are just hard, sad, and painful. I feel it is more important to allow yourself the freedom to feel whatever emotions you are having. If you work to express them in a productive way, your feelings will lessen in intensity, and you will be able to move forward.
4. Educate yourself as much as possible about your diagnosis, prognosis, and treatment options.
Although it can be complicated and time-consuming, it is very helpful to know as much as you can about the medical conditions with which you are struggling. This is very helpful in terms of making treatment decisions. In addition, this knowledge can also help you gain a better emotional understanding of your situation, and can also provide emotional closure should you need to move on to other family building options.
5. Don't expect anyone else to care about your infertility problems as much as you and your partner do.
Your medical treatment team, although they may be dedicated to your case, has a lot of other patients and issues with which to cope. You cannot rely on them to be on top of every detail of your treatment--you have to do this for yourself. Also, remember that even though your friends and family care about what is happening to you, they have their own lives and issues. Sometimes, you may need to remind them about what is happening or what help you may need from them.
6. Learn from your painful experiences and mistakes.
Infertility is complicated, and there will be times when you may make the wrong decision, or end up having regrets. This is inevitable. The important thing is to not be afraid to use these experiences to change your problem solving strategies--whether that means changing doctors, clinics, treatment modalities, or going down a different path of family building altogether.
7. Be as proactive as possible.
Infertility is a major life crisis, and the task of having children is one of the most important things you will ever do. Thus, you must do whatever you believe will give you the best chance of success--even if it's hard, inconvenient, or expensive.
8. Recognize that some people are going to say stupid or hurtful things--no matter what.
I wish this statement wasn't true, but the fact remains that many people harbor misconceptions about infertility, or are insensitive to other people's feelings. It is a small comfort, but the fact is that people will say stupid and hurtful things about any number of subjects, not just infertility alone
.
9. Try to identify who you can get support from, and focus on those relationships.
Sometimes it is surprising to discover who among your friends and family you can count on, and who you can't. Don't feel guilty about not sharing information or being as close as you were to people who, for whatever reasons, cannot be helpful during this phase of your life. You are in a crisis, and you need to focus your energy on those relationships which can provide you with support and understanding.
10. Remember to take the long view.
An important factor to consider when making decisions about infertility treatment is that you are trying to keep yourself from having major regrets later in life. Try to think about how you might feel about your decision ten, twenty, and thirty years into the future, after the window for making these decisions has long past. This perspective may prompt you to do things that are harder in the short-term in order to prevent long-term regrets. Although this is difficult, you can be confident that your future self will appreciate your hard work and sacrifice!
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