For the infertility "veterans"--psychological implications of long-term infertility treatment

Infertility treatment, whatever it's duration, is stressful and often difficult. For the majority of people, however, it's of relatively short duration--within a year or two, a pregnancy is achieved or a diagnosis is clarified, leading to a different path.

On the other hand, there is significant subset of infertility patients for whom treatment spans many years, sometimes even more than a decade, before any sort of resolution occurs. Perhaps this occurs because there is no clear diagnostic picture, or because they have tried multiple, time-consuming ways to build their family without success. Sometimes, life circumstances require them to take longer breaks from treatment. Whatever the case, being in infertility treatment for a prolonged period of time can definitely take its toll on a person.

Bitterness is often the main worry of the veteran infertility patient. After so many disappointments, it can feel hard to be hopeful for the future. Watching friends, family, and coworkers create their own families with less effort and stress makes them feel chronically isolated. Despite their best efforts, these feelings may seep into other aspects of their lives and relationships.

Further, one of the hardest parts of infertility "veteran" status is that after years of trying and failing, an individual can start to feel alienated even from the infertility community itself. I have had more than one client in this situation discuss how they feel they are left behind by all of their infertility friends who go on to have treatment success. Unbelievably, he or she begins to feel envious of other infertility patients. It can start to seem that all the other patients in the waiting room have a better chance of success. When listening to the emotional experiences of "newbies", or those just entering infertility experience, the "veteran" often feels irritated and impatient. The mix of hopefulness along with the anxiety that is so common in the beginning stages of infertility treatment is often painful to hear--the veteran remembers all too well how he or she used to feel hopeful as well, only to end up with multiple painful disappointments. Usually, the veteran infertility patient feels ashamed or guilty about feeling envious, impatient, and irritated with other people, because he or she really wants to be helpful and share his or her hard-won expertise. It is often difficult to recognize that in addition to our altruistic impulses, we also experience negative emotions such as envy and anger. Sometimes, this dilemma can have a further negative impact on the veteran's self-esteem, on top of the damage done by years of protracted infertility.

On the positive side, veteran infertility patients have almost always learned from their prior experiences, and are extremely wise and educated participants in their treatment. They have a clearer idea of what they expect from their doctors and clinics, and they usually make excellent treatment decisions. In addition, they know from experience they are resilient, and that they are survivors. They can be empathic to others who are suffering from a variety of life crises, because they have themselves been in crisis for years. They understand how complex emotions and relationships can be. I believe that when veteran infertility patients do become parents, they are extremely well prepared for the stresses involved in raising a child.

If you find yourself in the "veteran" camp, know that you aren't there all by yourself. For instance, I'm right there with you--with an eleven year infertility treatment history (or as I jokingly call it, an "infertility lifestyle"). It's important for infertility veterans to recognize all the knowledge and strength they have gained from their experiences. Learning things the hard way is probably the most effective form of education, and being an expert has its advantages.

Also, I think the most important thing infertility veterans need to do is to keep trying to achieve their goals, in whatever way they feel will be most successful for them. The temptation to give up is strong, especially when faced with the possibility of future disappointments. However, the risk of profound future regret is real. Thus, endurance, and lots of it, is vital to this process. In order to maintain their ability to keep going, infertility veterans must take special care of themselves to ensure that they do not become emotionally and physically depleted. Being in a chronic state of crisis is exhausting, and it requires good emotional support to not become overwhelmed. Further, pacing is key here--a person can't be full-steam ahead in infertility treatment all the time! Making time for pleasurable personal interests--hobbies, friends, travel, etc., can be really helpful.

Finally, I sincerely hope that if you are an infertility veteran, your infertility career will be over soon, and you will soon have the family you for which you have worked so hard! I would love to hear about your own experiences and perspectives! As always, please let me know if you have any questions, comments, or suggestions for further topics.

When infertility happens to good people: bad luck or somehow "meant to be?"

How many times have we heard the cliche that "everything happens for a reason"? On the face of it, it is a very tempting thing to believe, especially if it involves a good outcome. Of course, we were meant to be at the party where we met our partner, or to happen to run into that old friend who told us about that latest job opportunity. It seems many people believe that much of what happens to us isn't due to chance, but is somehow preordained. This usually provides a measure of comfort; life is not a random series of events, and it usually involves some benevolent spiritual force that is looking out for us, and has our best interests at heart.

It all works well...until something bad happens. Then the once-comforting belief now raises a bunch of unsettling questions. If the bad event was meant to happen for a reason, what was it? For instance, why do natural disasters happen, or do little children suffer painful and horrible illnesses? The answers are often not immediately apparent.

When experiencing infertility, the idea that it may have happened for some higher purpose can be troubling. I cannot count the number of times I have heard clients struggle with this issue, and they always seem to come up with the same answer: for some mysterious reasons, they are not meant to be parents. This worry usually only increases the painfulness of their situations. They cannot help but reflect that the situation seems so unfair. There are so many examples of people who are clearly problematic parents but who seem to have limitless fertility. They search their life for hidden sins or exaggerate the importance of minor flaws, all in the service of discovering the "reason" their infertility has happened to them. Eventually, they come up with quite complicated, convoluted theories about their alleged unfitness to parent, almost all of which appear, to me at least, to be patently untrue.

In addition, those struggling with infertility often must also contend with the comments others make about how "when it's meant to happen it will", or how they should just relax and trust God or fate or whoever or whatever is supposedly in charge of these things. These comments often add to their worries about themselves as potentially unfit parents. Further, they now are concerned that the feelings of sadness, impatience, and anger they feel aren't normal--shouldn't they just "relax and let it happen"?

Although I would never claim to have the answers as to whether or not things happen for a reason, I do know this: I have myself been infertile for a long time, and I have talked to many people who have also struggled with infertility, as well as people who have suffered many other types of terrible losses. I myself have never been able to piece together a convincing reason that all of these bad things happened, either in the individual cases, or collectively. Rather, I think that it is more likely that there is a lot of random chance at play. Out of 100 couples, 8 of them will experience infertility for separate and different reasons. I happened to be in the part of the population that is infertile, for various medical reasons, some currently diagnosable and some not. If you are dealing with infertility right now, I think the same is probably true in your case. I doubt it has much to do with your personality, your goodness as a human being, or your fitness to be a parent.

The downside to not believing that everything happens for a reason is that it is, from an an emotional perspective, scarier to live in a world where events are affected by random chance. After all, that means that all bets are off; anything could and might happen, even if it is not particularly likely. On the other hand, it does save us from creating explanations of difficult or tragic events that cause us to feel terrible about ourselves, and that seem unlikely to be true. Plus, it makes us appreciate our good fortune when it occurs--it isn't just "meant to be". It is the result of some good luck and our hard work combined. This can help build self-esteem. Further, we can be more empathetic with others who have experienced misfortune as well, for we understand what it feels like to end up on the wrong side of random chance.