Don't Ignore Infertility: but don't ignore the power of ignoring!

It is National Infertility Awareness week.  This year, Resolve's theme is "Don't Ignore", reminding us all to pay attention to infertility, its interpersonal ramifications, and its legal and financial issues. I hope that as more people become aware of the issues surrounding infertility, there will be an increase in sensitivity, legal protection, and funding for treatment.


I think the theme of awareness is an extremely important one.  However, I also believe that there are times in which, in order to best cope with your infertility, you may benefit from a little judicious, purposeful ignoring.   I have come to the conclusion that there are certain interpersonal problems and experiences that are better left neglected.  Intervention only makes them worse, and only makes us more miserable than necessary.  As Ruth Bader Ginsberg wisely said during her speech at my graduation ceremony, "Sometimes, it pays to be a little deaf."

For instance, if someone who is not particularly emotionally close to you makes a hurtful or insensitive comment about your infertility, sometimes the best thing might be to just pretend they never said it at all.  Let's say Great-Aunt Mabel gets on your case for not having children yet, observing that after all, you aren't getting any younger.  You could try to correct her--but since she's 97 years old, she's not likely to alter her behavior.  You could allow the hurt of her words to seep inside, stirring up all the painful issues of which you are struggling.  Or you could pretend, as Ruth Bader Ginsberg might suggest, that you just didn't hear that comment at all, and completely change the subject.  After all, Aunt Mabel clearly doesn't have a good understanding of the situation, and she isn't a source of emotional support.  Her opinion is not valid in this situation, and it will not be of any help to you. 

The two rules of thumb I use in these situations are 1) Is the person close to you and typically a source of emotional support? and 2) is this person able to hear and make good use of constructive feedback?  If the answer to both of these questions is no, then thinking about or responding to what they say is often a waste of your energy.

Another example occurs when after you and your partner have carefully considered your treatment options and chosen a path, only to have others, usually less-informed (and in any case, not you) opine about what you should, or shouldn't do.  If considering their opinion isn't going to change the outcome of your decision, then arguing with them about their thoughts on the matter is only going to be detrimental and upsetting to you.
 For example, if you've decided to try IVF, but your always opinionated cousin doesn't understand why you don't "just adopt", there may not be much benefit in responding to or arguing with him.  A blank stare often suffices.


For the most part, the internet has been a blessing to those of us struggling with infertility, allowing us to connect and share information and support.  Unfortunately though, it seems to be another prime source of information and comments best left ignored.  The anonymity of the internet allows people to feel entitled to say things to and about us that they would never have the courage, and many times even the inclination, to say to our faces.  For example, early on in my blog, I wrote a post which contained some of my feelings about the experience of adopting my daughter.  Someone commented that they had featured my blog post on their blog and to click over and check it out.  When I did, I discovered that this person had used my words, which I had thought were filled with love, as evidence that adoption was bad.  Several of her readers commented that I should never have been given a child in adoption, and that I was not a fit parent.   My first response was to get upset and defensive and leave a comment of my own--but I soon realized it wouldn't do any good.  After all, these folks had never met me, and really didn't have any valid information with which to judge my suitability for parenthood.  Any comment that I wrote would be unlikely to change their minds, and an internet fight was not going to be good for my emotional health.  So I decided to leave the situation alone, and it quickly blew over, without any effort on my part. 

Almost any news article about infertility treatment, if one scrolls down to read the comments, seems to invoke a negative, judgmental reaction in some of the commenters.  I've decided to stop reading those comments.  It's impossible to argue with an anonymous, closed-minded, and misinformed person.  I think our energy is better spent going on about our business and working hard to achieve or family building goals.  Instead of fighting with someone who will never be convinced, I think we should focus our efforts on educating and   informing the public as a whole about infertility and infertility treatment.
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Another type of interpersonal situation I think it is pretty safe to ignore are those in which someone with an obvious profit motive is trying to tell you to buy something or try something.  If it seems to good to be true, than I'm afraid it probably is.  I would be wary of any product or professional that guarantees that if you do X, Y, or Z, then you will get pregnant. 

Of course, there are a lot of things about infertility treatment that you should never ignore--your bodily sensations, and your feelings about and reactions to important people in your lives.  We should also never ignore the medical facts surrounding our diagnosis, and need to learn about and carefully watch over our treatment.  By letting go of the stuff that people say that really doesn't matter, we can have more energy to devote to attending to the things that do--and thus help ensure we create the most positive outcome for ourselves.

For more information about Resolve, infertility and National Infertility Awareness Week, please visit:

• http://www.resolve.org/infertility101  (Basic understanding of the disease of infertility.)
• http://www.resolve.org/national-infertility-awareness-week/about.html (About NIAW)

Sex, infertility treatment, and the real purpose of sex

It's no secret that experiencing infertility can be hard on your sex life.  In fact, I don't think I've ever heard a client tell me that their sex life had improved once they realized infertility was an issue. Typically, the scenario goes as follows:  at first, there is great excitement as a couple begins to try to have a baby.  However, if things don't work out relatively quickly, anxiety sets in, and sex becomes a more scheduled and anxiety-fraught affair. By the time infertility treatment begins in earnest, sex has become associated with feelings of failure and unhappiness, and couples sometimes struggle with maintaining a healthy sex life.

Many times, I've had clients tell me that they feel that because they are infertile, that sex has lost some of its meaning for them.  After all, sex exists for the purposes of reproduction, and if having it can't achieve it's purpose, they experience feelings of loss and failure.

Although this reaction is understandable and predictable, it seems to have more to do with cultural values about sex rather than the realities of the situation.  Although I'm no evolutionary biologist, I would argue that reproduction is only one of the purposes of sex, and perhaps not even its most important purpose.  This is because for human beings, a sexual encounter rarely produces a child.  Even in the case of the Duggars, only 20 or so of their instances of their intimate moments resulted in a pregnancy.  In contrast, many other species only engage in sexual behavior when reproductive potential is at its highest--cats, for example, who only participate in sexual behavior when the female cat is ovulating. 

For humans, then, sex plays another very important role--sexual behavior leads to affiliation.  A couple's sexual intimacy keeps them close to each other.  This had several evolutionary advantages.  Historically,  human beings have survived better when they lived in group.  Their offspring tended to survive more often with more adults available to protect and care for them.  Thus, sex really isn't merely about reproduction.

In the history of Western culture, sometimes the reproductive aspects of sexual behavior have been emphasized over its affiliative aspects.  In recent times, societies' values about sexuality have changed.  Interestingly, from a psychological perspective, when it comes to infertility, we often take a more reductionistic view, focusing only on the parts with which we struggle.

Thus, if you are finding that your sex life isn't what it used to be since infertility, keep in mind that for human beings, sexual behavior isn't primarily about reproduction.  Rather, for us, sex is primarily about forming and maintaining an important relationship.  Even if you are infertile, you can still be successful at feeling close with your partner.  In the end, the survival of the species may depend more on that than on reproduction per se.

Is reproduction a virtue? Attribution theory and infertility

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

Getting "the donor egg talk"

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

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

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

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

1.  Give it time to sink in.

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

2.  Watch out for denial.

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

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

3.  Be kind to yourself.

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

Not quite free to be you and me: Infertility treatment and the recogntion of our limitations

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.

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.

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.