The art of being infertile in the internet age: When not to pay attention, and why

Last week there seems to have been a little bit of a kerfuffle about Dolce and Gabbana's expressed opinions on children born via IVF and on non-traditional families.  I'm only hazily aware of what they said, and I think I'm going to keep it that way, for the sake of my own mental health.  This is an acquired skill, ignoring comments made by anyone from important celebrities to random strangers.  I have a long history of being what my parents called "overly sensitive"-- being hurt by what others have said, and consequently of nursing a grudge.   Naturally, this made the experience of being infertile and an adoptive parent more painful than it might have been otherwise.  If I've learned one thing through my infertility, it's that people feel comfortable sharing their thoughts and opinions, even if they are uninformed, unwelcome, and painful to hear.  

What I realize as a result of these experiences is that I was putting too much value in the thoughts and opinions of others. I think this resulted from my own insecurity about myself.  I frequently have walked around thinking, "That doesn't make sense....I must be stupid because I can't understand why so-and-so said that!"  However, as a result of hearing so many stupid opinions and comments, I came to see that on certain topics. I should privilege my own thoughts and opinions.  Now, I feel that if someone is an expert in an infertility-related field, or has a lot of life experience with infertility, I will seriously consider what they might have to say, even if it differs from my own initial thoughts.  If they don't have that experience, their thoughts and opinions are most likely irrelevant to me.  This is why I don't care if Dolce and Gabbana might feel that two of my children are "synthetic".  They haven't experienced the same things as me, and it isn't their area of expertise.  So they don't get to have an opinion on it that I value!  

I do try to be fair about things.  So please don't take any fashion advice from me.  I don't know anything about it.  Seriously, my fashion goals are to be able to wear my pajamas to work and to find only marginally ugly shoes that will fit my clunky custom orthotics.  Any clients of mine who might be reading this will back me up on this one.   Dolce and Gabbana are your go-to folks on that subject. 

It used to be that we just had to worry about the uninformed opinions of those we might run into in daily life.  Now, with the internet, we are bombarded with the opinions of everyone, whether they be famous or anonymous.  And it seems that the more outrageous they are, the more they will be promoted, so that we will click on them and generate advertising revenue for someone.  If I see something that looks especially controversial, I try not to click on it.  I don't want to encourage that sort of behavior, and I certainly don't want anyone to profit on it.  

Ruth Bader Ginsburg spoke at my graduation commencement.  She said something that I have increasingly come to see the value of as time has passed.  In referring to marriage, she said, "Sometimes it pays to be a little deaf!"  I think this is true not only in relationships, but increasingly true for the world in general.  Ignoring things can go a long way in terms of saving us some anguish.

Consider the source before you roil yourself into a fit of self-righteous outrage!

I  hope you all have a great week and welcome your opinions and experiences in the comments section or at lisarouff@gmail.com.

Thoughts on "older" motherhood: delayed parenthood after infertility

One things that many women who experience infertility find is that their entry into parenting is delayed...often by several years.  Such was the case with me.  Despite all my efforts to the contrary, I have found myself in the older mother camp, having my last child at age 42.  (With lots of help, of course.  Let's be real here.)  My parents and grandparents both had their children in their early twenties, so it's kind of mind boggling to me that I can remember when my grandmother had her forty-fifth birthday!

People have lots of opinions on what age someone should be when they have a child, and particularly about entering into parenthood in the forth decade and beyond.  I can't tell you the number of times I have heard women tell me that they never wanted to be "old parents".   I hear them often express a fear that it will not be fair to the child to have older parents, and that it somehow isn't "right" or "natural" to have a baby later in life.  And yet, like me, they find themselves in that very situation.

The impact of having older parents on a child is an important issue.  Like so many things in life, there are no clearcut answers about the effect having older parents may have on a child.  It is true that the child may have less time with their parents, although there is never a guarantee of longevity no matter when a person begins to parent.  On the other hand, older parents are usually more financially stable and emotionally ready to take on the exhaustive and difficult task of parenting.  I think the main thing is to recognize that there are really no ideal situations for children.  Every child will receive blessings and face challenges based on their circumstances.  The most important thing is to try to help a child cope with and work around the limitations of their situation.  For example, if you are worried that your child will be alone later in life, you could make the effort now to ensure that there will be other supportive adults available to them.

As for the actual experience of parenting after forty, I would say that I have noticed I have felt out of sync with my peers.  Some of my high school classmates have grandchildren the same age as my youngest child! As their children are older, they are getting back into the swing of adult life--focusing more on careers, and having a more active social life.  Meanwhile, I'm still sleep deprived and changing diapers.  Sometimes I feel a bit envious of their relative freedom, but then again, I still have a lot more of my parenting journey to anticipate.  Many of my friends have noted some envy of me, as they miss the baby stage and the cute entertainment small children can sometimes provide.  Perhaps in the end it all balances out?

 I also have noticed that many of the parents of my children's friends are quite a bit younger than I am, and that we don't perhaps have as much in common.  The older parents I know tend to congregate towards one another with a sense of relief, perhaps feeling that another older parent will better understand their experiences.  But I think this may be our own insecurity, as I've never had a younger parent say or do anything that would indicate criticism or a lack of acceptance.

For me, I think the most challenging part has been the physically grueling nature of parenting a young child.  My husband and I both agree that the sleep deprivation after our youngest child was born was devastating, more so than with our oldest daughter a decade earlier.  I think we were so sleep deprived that we couldn't even realize that we needed help.   Thus, I highly recommend night nurses, grandparents, friends, or anyone you can get to help you at night.  You can fake a lot of things over forty, but dealing with lack of sleep isn't one of them!  

As for the rest of the physical demands, I've had to make sure that I exercise consistently in order to be able to keep up with my children.  I think that base level of fitness keeps me feeling and acting younger, which I need because my son is at a stage where he enjoys running away and hiding...and I need to keep up with him.   Exercising also helps me feel like I am doing something to increase my chances of living a long life, so I will be around for all of my children's milestones.  I also see my doctors for my annual checkups religiously, try to eat a balanced diet, and do whatever else I can to reduce my risk factors for early morbidity.  Although we cannot see what the future holds for us, trying to live a healthy lifestyle reduces some of my anxiety around leaving my children too soon.

I haven't yet had the experience of being mistaken for my child's grandmother, mostly because I keep a hairstylist in business trying to get all my grey hairs hidden from sight, but I feel that may be coming soon.  I don't suppose there is much any of us can do about that one.  After all, throughout my journey to parenthood, I have endured many tactless comments, and I guess it only makes sense that it would continue.

For many more thoughts on parenting after forty, I recommend this blog A Child after Forty, which has lots of great stories and resources.

Thanks for reading!  I welcome any comments or suggestions for future posts.  Feel free to comment below or email me at lisarouff@gmail.com.

Anonymous egg donor selection: a few tips

 Choosing an anonymous egg donor can seem like a very daunting task.  Usually, people don't arrive at choosing an egg donor without having experienced some emotional turmoil already, so they are already likely be stressed and upset.  Thus, when faced with the job of selecting maternal genetic material for their family, many people understandably become overwhelmed!  I've been fortunate to work with many couples and individuals who have gone through this process, and the amazing thing is that they all seem to find donors that they connected with and felt good about--so I think that although it can be quite intimidating at first, it usually has a positive outcome!

Here are few tips about choosing an egg donor.


--Don't try to replace yourself.

Some women begin the process of choosing an egg donor with a very specific list of qualities they would like in their donor, only to find that very few women can match all of these criteria.  Often, this stems from a wish to "replace" the woman with a copy of herself.  It is very difficult to mourn the loss of a genetic connection to a child, and perhaps the fantasy of a nearly identical donor seems like it might soften the blow.  This type of defensive strategy can be problematic for a couple of reasons.  First, it can make it very difficult, if not impossible, to find an available egg donor.  Secondly, even if such a donor exists and is available, it may delay a woman's grieving process about her reproductive misfortune.  In my experience, there is really no way to avoid dealing with such feelings of loss, and I think it's probably better to do that at the front end of the egg donation process rather than after a pregnancy is achieved or children are born.

--There is an illusion of choice.

Looking through an egg donor database for the first time can be an overwhelming, overstimulating experience.  It can appear as though there are hundreds or even thousands of possibilities.  However, that is somewhat of an illusion.  In many egg donation databases, women have applied to be egg donors but have not been screened medically or psychologically.  Thus, a certain percentage of them will be eliminated as possible donors because they won't pass one of these screenings.  In addition, potential donors are usually listed on databases months or even years after they apply to be an egg donor.  Thus, by the time they are selected, their life circumstances may be very different and they may no longer be available to be egg donors.  Further, they may be available to be egg donors in general, but not for the specific time window, or clinic location that you require.  By the time unavailable donors are eliminated, the selection pool becomes much smaller (and perhaps more manageable).

--No matter which donor you choose, epigenetics and random chance may be big factors in the characteristics of your children.

Just as their really aren't any genetic guarantees in a typical baby-making situation, random chance plays a role in the egg donation process as well.  Selecting a donor with specific characteristics doesn't give any guarantee that your child or children will also have those characteristics.  Further, science is just beginning to understand the role epigenetics plays in turning on or off different traits.  It is theorized that different uterine environments turn on or off different genetic traits present in the DNA.  A fetus with identical DNA that develops in one woman's uterus may end up being in some way different than if he or she developed in another woman's uterus.  At this point, we don't fully understand the extent of the uterine environment's influence on genetic traits.


--Find a donor with whom you feel some sort of connection.

Given all the unpredictability in the situation, both in terms of donor availability and genetic factors, my best advice is to find a donor with whom you feel some sort of emotional connection.  Perhaps she excels at the same sport that you do, or her favorite book is the same as yours.  Ideally, she should be someone that you feel you would like if you actually met her, and about whom you have very positive feelings.  After all, you are going to be having thoughts and feelings about your donor for the rest of your life, as a parent and in regards to your own infertility.  It helps to feel positively about her from the beginning.

--Don't forget the pragmatic issues!

I think one of the main criteria on which to evaluate a potential egg donor is on her ability to follow through with the many demands of the process.  For an egg donor to successfully complete a cycle, she must be able to be consistently on-time to appointments, be able to follow complicated instructions, be able to inject herself with the correct medications at the correct times, and be alert to any medical problems or side effects she might experience.  To do all of this, she needs to be responsible, organized and consistent.  When looking at a donor profile, look for evidence of the donor candidate's level of organization, follow-through, and responsibility.  For instance, if she has a consistent work history, or was able to complete a higher education degree or a vocational training program, chances are she has utilized these skills in her life.  If a written statement is included in the profile, you might be able to glean further evidence of her level of responsibility and her understanding of how important her role in the process is to intended parents.

Finally, perhaps it goes without saying, but I do find myself saying it to clients quite a bit anyway:   proven donors may have a better chance of ensuring a successful cycle.  Not only do proven donors have an established history of fertility, they are also more experienced with the  appointments and injections.  They know what the process entails, and may be less likely to drop out of a cycle.  However, the most important thing is to feel positively about the donor, and that might be a more important variable than prior experience.  Every donor has to have a first cycle!

At the end of the day, there's always a risk that things aren't going to go well, no matter what donor you might pick.  However, if you try to find a responsible, available donor with whom you feel some sort of commonality or connection, you've pretty much covered your bases in terms of the variables you can control.

Thanks for reading, and please let me know if you have other tips for choosing an egg donor.  Suggestions and comments are always welcome!

"Just relax"...again? Does a reduction in anxiety levels increase pregnancy rates? Summary of a new meta-analysis

As a former infertility patient, and as now as a psychologist working in the area of reproductive mental health, the oft-repeated statement, "Just relax, and it will happen (referring to pregnancy)" has always made me cringe.  It has always seemed overly simplistic and somewhat pejorative--as if the woman's feelings were somehow preventing her from conceiving.

Thus, I did a double-cringe when I first read the abstract for the following article:

 Frederiksen, Farver-Vestergaard, Gronhoj Skovgard, Ingerslev, and Zacharaie (2015) Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis--- which can be found here.

In this study, the authors conducted a meta-analysis of 39 different studies.  The studies looked at the effect of psychosocial interventions on mental-health symptom reduction and clinical pregnancy rates in research subjects undergoing infertility treatment.  A meta-analysis uses other clinical studies found in the literature as its source of data.  Studies were only included in this meta-analysis  if they studied infertile participants, presented data regarding some sort of psychosocial intervention program (such as cognitive-behavior therapy, group therapy, etc.), measured outcome variables such as stress, distress and pregnancy outcome, both before and after the psychosocial intervention occurred, and used a quantitative research method.  The data for the 39 studies were analyzed for a number of variables.  Interestingly, they found that women who had received any type of psychosocial intervention were twice as likely to become pregnant than women who had not received psychosocial treatment.  Although they found that the psychosocial interventions were effective at decreasing both symptoms of anxiety and depression, only a reduction in anxiety levels was significantly correlated with an increased pregnancy rate.

On the face of it, this is a quite dramatic finding.  The authors theorized that increased anxiety levels could have a negative effect on the uterine environment, and could thus negatively impact pregnancy rates.  However, they also reported a number of limitations to their study that might also explain their results.  For instance, there was no distinction made as to type of infertility diagnosis or type of infertility treatment received among the different studies.  Obviously, the level of severity of the infertility diagnoses involved among the different studies would have a large impact on pregnancy rates, as would the types of medical treatments offered.  Secondly, the authors of the meta-analysis had no access to the pregnancy outcomes for women who dropped out of the studies.  Without this information, it is hard to obtain a complete picture of what really happened.  In addition, the authors had to contend with "publication bias"--meaning that usually only studies with statistically significant results are likely to be published.  Although information that disproves a hypothesis might be just as important from a scientific perspective, it often is not considered as desirable for publication, leading to the "drawer effect"--it gets left in a desk drawer and never sees the light of day again.  For this reason, looking merely at published research can give a skewed perspective on an issue.  The authors did attempt to find unpublished studies to include in their meta-analysis, but as you can imagine, this is a difficult task.  Thus, the results of their meta-analysis might be skewed in a positive direction towards the positive effects of psychosocial  intervention.

As a mental health clinician, I would love to believe that the psychosocial interventions I offer would double the pregnancy rates among my clients.  Not only would it be great for business, but I would love it if I could have that kind of positive impact on helping people solve such a difficult problem.  However, I have my doubts.  To me, I think the key problem with this study is its inability to distinguish between the types of infertility diagnoses among research subjects.  Imagine Patient A, who has a mild but correctible type of infertility diagnosis.  She receives the appropriate medical care along with a psychosocial intervention.  The psychosocial intervention helps her to better cope with her situation, but as she learns more about her diagnosis and her medical treatment commences, she feels less anxious because she is justifiably optimistic about her prognosis.  And as things go according to plan, she becomes pregnant, and there is a nice, happy ending.  Now imagine Patient B.  Patient B has an unexplained infertility diagnosis with some indications of a larger, more serious problem (let's say her AMH and FSH levels are borderline, for example).  Patient B might not get assigned a psychosocial intervention treatment due to luck of the draw.    As her infertility treatment progresses, it doesn't go well, with failed cycles, and her prognosis looks poor.  Naturally, she's not going to get pregnant during the study, because she has an underlying medical problem which prevents it, and she's also going to understandably get more anxious and distressed as she realizes what her situation truly entails.  But we can be pretty sure that her anxiety isn't at the root of her problems getting pregnant.  As you can see from these two examples, diagnosis and situation makes all the difference--but the study isn't able to pick that up.

Thus, I don't think this study really can tell us with any certainty that decreased anxiety levels are associated with increased pregnancy rates.  I believe that psychosocial interventions, such as therapy, relaxation training, or support groups can be helpful during infertility treatment, in that they can provide support and coping tools during a difficult time.  I think that is an incredibly valuable thing in and of itself.  But I don't think that the data support the idea that a psychosocial intervention is going to increase pregnancy rates.

I also think we can all still be justified in getting annoyed the next time someone tells us to "just relax".

Thank you as always for reading, and I look forward to any comments and questions you may have!

Hello Again!

Back to blogging after a long absence!

I don't know exactly where all the time went between my last post and this one!  Actually, to be honest, I do know.  Things got really busy with clinical practice, and at the same time, things became somewhat challenging personally as well.   For a long time, the act or writing seemed to require more emotional energy than I had to spare.  And of course, there is the classic snowball effect.  The longer you let something go, the more difficult it is to get back to it.  So the months turned into years...and here we are.

Although I'd stopped writing about infertility and it's discontents, I certainly haven't stopped thinking about it, and there are so many times that I've had moments that I wanted to share in this blog.  But to begin with, I want to relate this clinical vignette that recently occurred, which I feel best exemplifies my experiences in the meantime:

I was having a session with a client who does not have a history of infertility.   What she does have is a long history of anxiety.  She has lived her life constantly afraid; afraid of natural disasters, afraid of storms, afraid of criminals, afraid of car accidents, afraid of an airplane crashing on her head, etc., etc.  We were discussing the recent changes in her situation, which of course have her feeling unsafe, when it occurred to me: she has the fantasy that there will be a time in which none of these threats exist, in which she will feel safe.  Thus, she keeps trying to do whatever she can to make this possible.

Being the killjoy that I am, I waited for a pause, and then stated that I thought that there had never been a time in human history when things were safe, or went well.  In fact, right now might just be the safest time, ever.  And she was right, it wasn't too safe--but that perhaps complete safety was impossible.

After a pause, she asked me, "So what you are basically saying is, life is unsafe and it sucks.  And there's nothing I can do about it."  I replied, "Yes, that is what I am basically saying.  And I'm also saying that you probably need to get used to it like that, because it's not going to change."

My client, who was gracious enough to have another session with me after this display of my charm, told me that although she found my words quite upsetting, she also found them liberating.  With the possibility of achieving a safe world off the table, she had more energy to put into enjoying her unsafe world.

I think the same principle holds true for dealing with infertility; for so many of us, the loss of the fantasy of the easily-conceived baby and the the easy, adorable pregnancy is one of the most painful aspects of infertility.  Only by allowing that fantasy to diminish in intensity can we experience any amount of relief.  If there is one thing that infertility reveals to us, it's that our world isn't perfect, and it's never going to be.   

I hope to be writing more regularly in the future, and as always, appreciate your comments, thoughts, and suggestions.

Tales from the other side: setting realistic expectations of life after infertility

When I was struggling with infertility, having a child was almost like finding the "holy grail".  I was convinced that if I could just start my family, all of my problems would be solved.  I must add that most of this expectation was held unconsciously; regardless, boy was it ever wrong!  I am fortunate to be the mother of three (at this moment) reasonably healthy children, but I can't say I have ever approached the nirvana of a relatively problem-free existence.

I know from my clinical experience in working with individuals and couples struggling with infertilty that I am not alone in this belief.  Perhaps it's one of those working fictions that we need to keep us going during difficult times.  If we really recognized that difficult times don't really end, but just lead to difficult-in-a-different way times, we might just curl up in a ball and call it a day.  However, the usefulness of this fiction often dissipates after the infertility struggle is, at least overtly, over.  Often, I see people struggle with the expectation that once their child or children arrive, they should be over-the-moon happy all of the time.  When they don't always feel this way, they worry that they are not grateful enough, or that after they have endured, they are somehow not "doing it right".  Of course, it is their expectation that is inaccurate...most likely, their feelings are completely normal and expectable give their current situation,

In order to create a more realistic picture of life after infertilty, I will describe some of the more common experiences I have witnessed in the lives of others as well as my own life.

1.  Pregnancy after infertility is often filled with anxiety.

Instead of shouting with joy from the rooftops, many newly pregnant infertility patients are riddled with anxiety and fear.  This is usually quite the opposite of what they expected.  They live anxiously from beta to beta and ultrasound to ultrasound.  Every early pregnancy symptom is examined and reexamined.  As the pregnancy progresses, the anxiety dissipates somewhat, but it never totally goes away.

2.  Childbirth and breastfeeding can be difficult and can add to the already negative feelings you may have about your body.

For many infertile women, childbirth and breastfeeding seem like an opportunity to finally be and feel "normal".  That's great if everything works out the way you hoped.  Unfortunately, many women with infertilty are at at higher risk for difficult childbirth and breastfeeding troubles.  For some women, having an unexpected c section or milk production issues can feel like another body "failure", adding to their still painful feelings about their infertility.

3.  Your child isn't going to be perfect, and you aren't going to be the perfect parent, no matter how hard you try.

Of course, this is true of any child and any parent.  However, many parents who have a history of infertility have lingering, unconscious expectations that because they have been so committed to building their family, they need to be perfect parents.  When they fail at the impossible, they can be too hard on themselves.  Sometimes, they may unconsciously  blame themselves or their infertility for whatever difficulties their child might be having, even though chances are, it's completely unrelated.

These are just a few experiences I have noted, and I would love to hear about the experiences and observations of others, so please leave a comment!

Also, even though the parenting experience isn't a perfect one as we may have envisioned, it can be very rewarding--perhaps more so if we free ourselves of unrealistic expectations.

Thanks so much for reading, and as always, I look forward to your comments and questions!

More decisions; medical decisions, emotions, and infertility treatment

I often think that if I ever were to write a book on psychological issues, it would be on how individuals make decisions about their medical care.  I find it fascinating and sometimes frightening how much emotional issues can affect and impair the ability to make good health care decisions.  Unfortunately, I have seen this lead to very sad and perhaps avoidable negative outcomes,  in the area of infertility and in other types of illness as well.

In this post I will discuss some emotional issues that commonly interfere with the ability to make sound medical decisions.  The first, and perhaps most serious problem is an overuse of the denial defense.  We have all heard stories in which a person notices some significant medical change, like a lump, and copes with their anxiety about it by using denial.  They do not seek medical treatment and often don't alert loved ones about the problem until it is too late.  My own father-in-law, a dear, wonderful, and educated man, ignored the warning signs of his colon cancer for years.  When the family finally became aware of and responded to the problem, it was too late, and he died a few weeks after his diagnosis.

In the infertility world, this can occur when individuals fail to seek treatment even though they meet the criteria for infertility.  They often trust that it will "just happen when the time is right".  Meanwhile, the clock is ticking, and if there are ovarian reserve issues at play, time may be running out.  I sometimes see women in their late 30's or early 40's remain convinced of their ability to conceive naturally with their own eggs, despite much objective evidence to the contrary.  Perhaps in some of these cases there is an underlying ambivalence about having a baby, but regardless inaction at this crucial time may ensure that they lose whatever opportunity of using their own eggs that remains.

Another type of emotional issue that can impair medical decision making is feelings about the doctor-patient relationship (or transference as we psychodynamically trained therapists like to call it).  Feelings of loyalty to a doctor may make it difficult for some people to seek a second opinion.  They may have idealized their doctor and be unable to recognize or admit that their doctor has missed something or made a mistake.  Alternately,  they may find it difficult to trust others, especially medical professionals, and therefore are unable to provide a complete symptom picture, leading to under diagnosis or misdiagnosis, which then unfortunately only increases their mistrust.  Even if they do receive the correct diagnosis, their feelings of mistrust prevent them from following treatment recommendations, which can have tragic effects.

As you can see, making sound medical decisions requires the ability to deal with your feelings directly, and to be able to acknowledge anxiety-producing situations.  It also involves the ability to trust and value the opinion of others, but not so much so that you cannot examine these opinions critically.  These emotional abilities are not always easy to obtain.  In an emotionally charged situation such as infertility treatment, it is even harder to apply these skills.  Thus, it is important, when you are making treatment decisions, to take a moment and think about whether you are using denial, or if your emotions about your doctor could be interfering with your ability to critically examine their recommendations.

As always, thank you for reading, and please feel free to contact me with any questions, comments or suggestions you may have!

Infertility, pregnancy, and self-esteem

I was picking up my daughter at a class the other day, when I overheard one of the other mothers talking to the school director.  "Did my daughter tell you our news?" she asked excitedly.  It turned out that this woman was unexpectedly pregnant, after undergoing infertility treatment to conceive her children.  Her face was all aglow, and she went on and on about how she was finally normal, finally experiencing a miracle.  To her credit, the school director told her, "Well, I think all your children are miracles," but that really didn't even slow her down.

I left feeling uneasy, and frankly, a little irritated by what I had overheard.  I was also irritated at myself--shouldn't I be as happy for this woman as she was for herself?  After all, she was experiencing the holy grail of infertility treatment--the spontaneous pregnancy.  As I further considered my reaction, I realized that what was really bothering me was this woman's assertion that now, and only now that she had achieved a pregnancy without treatment, that she was normal.  That now, she could feel good about herself.

The more I work in the field of infertliity, the more I am able to see how much we, as a society, tie the concept of fertility in with our sense of self-esteem.  If a woman can be pregnant and successfully deliver a baby, she's normal and good; if she can't, she's something else--at best someone to feel sorry for, and at worst someone who God/the universe is trying to tell that she doesn't really deserve to be a mother anyway.

The pain that this societal assumption causes is immense.  Further galling, anyone who thinks rationally for any amount of time about this assumption will realize it is patently and ridiculously untrue.  Of course we all know supremely fertile women who are failing miserably at parenting; and we all know (and might well be) supremely infertile women who will make amazing parents once their infertility crisis is resolved.

I guess this is why I felt so annoyed with the woman at my daughter's class-a feeling of "et tu, Brute?"  After all, she is one of us--and yet she still bought into the fertility=normal/good equation hook, line, and sinker.

After a long and protracted battle with infertility and my body in my quest to have children, I have come to realize that I can't let my infertility define how I feel about myself.  It was all beyond my control anyhow, and even if it wasn't, I can't feel worse about myself because of it.  In the same light, I can't feel like I'm a better, normal/good person because today my lungs are functioning well.  That's out of my control too.  Instead, I must judge myself on how I respond to my circumstances, and how I treat others in my life. 

I hope if you are struggling with infertility, you try to do the same; remember that fertility, or infertility is not the measure of a person.  Our efforts, our choices, and our treatment of others are much more valid criteria for self-assessment.

The light at the end of the tunnel: aging out of expectations of fertility

When I was in the throes of infertility treatment, I remember often reading and hearing that infertility was just a life phase, and that over time, it would resolve itself one way or the other. Life would go back to normal. Of course, this was intended to give me hope, and strength, but instead of finding it comforting, it just made me want to throw up.  I could already see then, as I can confirm now, that there was no way I was ever going to be the same person after going through all of that pain and disappointment.

In that way, it seems that infertility never ends--even when the struggle is over, our perspectives and relationships have changed.  However, I can say that one of the silver linings of getting older is that now no one is expecting me to be able to have babies anymore!  As I approach my mid-forties, I no longer am asked whether or not I am going to have children, or have more children.  People just assume that it's all done with, and because of my age, I am not very likely to become pregnant--and here is the important part--JUST LIKE EVERY OTHER WOMAN MY AGE.  Yes, I've found myself back in the "normal" group again.  It took a decade or two for everyone else to catch up with me, but now we are all in the same boat.

I can't tell you what a sweet relief I have found this to be.  It almost takes the sting out of my encroaching wrinkles and grey hairs--almost.  Now that the book is closed and the dust is settled, it occurs to me that most women my age had their children quite some time ago, and that they haven't defined themselves by their ability, or inability, to get pregnant for quite some time.  They have left all that behind and have moved on to other aspects of their lives.  Perhaps that's one of the problems with infertility--it can imprison us in the "reproductive phase" of our lives for extended periods of time, but without the easy ability to complete the phase successfully.

Thus, although the emotional changes infertility causes never fully leave us (nor, in my opinion, should they) it does seem that society's expectation that we go forth and multiply does, thankfully, come to an end.  As for me, I notice the difference in myself when I am social situations with people I don't know very well.  For years, every time I met someone new, I had been unconsciously bracing myself for the questions about babies and pregnancy, whether they actually arose or not.  Now I can observe myself feeling much calmer and lighter in these situations, knowing that the questions just aren't going to come up.  Although that's not a complete end to the "infertility" phase of my life, it certainly feels much better, and it isn't as much of a constant presence in my mind.

The Infertility Therapist gets cranky, part III: a study of dubious usefulness

Perhaps I'm just in a cranky mood, but I was shocked to open my January 2013 issue of Fertility and Sterility and discover an article entitled, "Attractiveness of women with rectovaginal endometriosis: a case control study" (Vercellini, Buggio, Somigliana, Barbara, Vigano, and Fedele).  I first thought that surely the article couldn't be about what I thought was about, but a closer examination revealed that I was correct.  The authors spent considerable time and effort to compare women with different types of endometriosis--rectovaginal, ovarian and peritoneal, along with women with other gynecological conditions--on the variables of BMI, breast size, waist to hip ratio, and age of first coitius.   They were also evaluated for attractiveness by a panel of four judges.  According to the findings of the study, it turns out that women with rectovaginal endometriosis are considered to be significantly hotter than the women with the other conditions.  So ladies, if that's you, you have my congratulations.

Can someone out there in the blogosphere please enlighten me as to 1) why this study was conducted in the first place and 2) why it was accepted for publication in a major scientific journal?  The study authors argue that different types of gynecological disorders might be due to different genetic phenotypes, which would cause women to have different types of appearances.  But is that really going to be helpful to science?  Are doctors really going to start diagnosing the type of gynecological disorders a patient has based on how attractive they seem or when they lost their virginity?  Especially when we can already diagnose these disorders using things that seem a bit more reliable, like ultrasound images, DNA testing, or surgical reports.

Endometriosis is a complicated disorder that causes a great deal of pain and suffering.  Heck, I even have it myself (although not, as you may have guessed, the kind that makes a girl look appealing to a panel of four trained judges).  Isn't there a better way to work on finding a treatment and a cure?  In my opinion, infertility patients deserve better than an objectifying and demeaning study like this one, which seems to serve no one's interests.

The fantasy of closure in infertility treatment

By the time a person enters into infertility treatment, they have already experienced a significant loss in terms of their expectations of having a family.  They have had to come to grips with the fact that they could not start their family the "normal" way, without medical intervention. However, for some infertility patients, this is just the beginning of a journey that involves numerous losses, disappointments, and other twists and turns. Every once in a while, the reality of the situation is revealed quickly and definitively; for most, however, the real nature of the problem only becomes clearer in slow motion--one failed treatment at a time.  To me, it's like freefalling down through space on an elevator, but agonizingly slowly, but without any idea of where the bottom floor is.

This is one reason that infertility wreaks such havoc with our emotional life.  While it's going on, it can feel like a constant stream of torture, filled with the worst kind of suspense.  Hope alternates with fear and despair, and of course, there is no definitive ending that can be reliably predicted. Time seems to slow down to a standstill. When looking at others' lives, I can see that these things do come to an end, and usually happily so; but while I was myself living in the midst of it, I had no confidence that those days would ever be done.  I try to share this with my clients, that their struggle will most likely end, and happily so too; and while I am always thanked for my reassurance, I think I am very rarely believed.

Although many problems do tend to resolve themselves over time, infertility is not usually one of them.  To overcome it, you have to actively address the problem, and this is even more difficult when you don't know exactly what the problem is.  Many times, we never really get true clarity, and are forced to guess, making finding a solution difficult.  We usually don't have unlimited time, money, or treatment options.  Plus, as described above, we are usually in an emotionally upset and fatigued state when we must make these incredibly important decisions.

Thus, many of us find ourselves in situations where we cannot know what the best course of action would be--and yet we must, in spite of this, act anyway.  As my grandfather used to say, "You pays your money and you takes your choice!"  Whether it ends up to be a good or bad choice is many times also impossible to determine.  You may have embarked on exactly the right course of treatment for yourself, and it could still fail, just due to bad luck that time around.  Or not.  Too often, there is just no way to know.

All of these observations lead me to the conclusion that that because of the many unknowable variables inherent in infertility treatment, true closure is frequently impossible to obtain.  I have heard many clients long for this closure, understandably feeling that this would help them get over their trauma and losses, and move on with their lives.  However, the frequent impossibility of obtaining closure is yet another one of the traumas and losses those struggling with infertility may have to experience. Thus, sometimes we have to give up our quest for explanations, diagnoses, and certainty, because otherwise we will become even more exhausted and depleted.

The good news is that learning to live with this kind of ambiguity is a skill, and it can be learned.  It's not only helpful with dealing with infertility; life is full of situations that present little clarity, logic or fairness.  The key to to getting over something without clear closure is to accept that you are always going to have some sad and angry feelings about the situation.  Over time, these feelings will dim in intensity, and they will not unduly interfere with your life.  Too often in our culture, I think we feel a pressure not to experience our negative emotions.  If we aren't "happy" all of the time, then there is something wrong with us.  However, I think this is a fairly American and western concept, and an unrealistic one at that, given the trials and travails that can life can offer.  Once we accept that sad and angry feelings are a normal response, and a normal part of life, we don't feel as intense of a need to quell them with explanations and understanding. 

The aftermath: The effects of infertility once the dust settles

I often hear from clients in the midst of a battle with infertility that they can't wait for their children to come so they can "just put this thing behind" them.  I suppose some people, perhaps who are more skilled at this denial than myself, may be able to do so--but the majority of us find that our infertility is something that we simply can't leave behind.  Even if our infertility is eventually resolved in a manner we feel good about, it still has long-reaching effects in our lives.

As an experiment, this week I tried to keep track of the different ways my own personal infertility came up even though our family is (finally!) complete.  Here's what I discovered:

1.  Having to tell the nurse at our pediatrician's office (again) that I don't know my adopted daughter's birth family's medical history.
2.  Fending off questions from a neighbor about whether I had used infertility treatments and/or donor eggs in the procurement of our youngest child, who is one year old, due to my elderly age.
3.  Having to justify to the school principal and school administration officials why my middle daughter should be "grandfathered" in and not have to lottery in to gain admission to her older sister's school, as they are "too far" apart in age.  Luckily, the school officials didn't really want to deal with my argument that because of my medical problems, I couldn't control the age spacing of my children, and they agreed to let her in the school.
4.  Listening with incredulity to the story of a woman who managed to get pregnant twice while faithfully taking birth control pills.

To me, I think that's a pretty typical week.  Even if I wanted to "put it behind" me, the world has a way of bringing it right back around to the forefront.

I don't think my experiences in this regard are atypical, either.  I am frequently struck by women telling me, that despite the many traumas they may have experienced, their infertility is the problems that still continues to haunt them.

Thus, although wanting to put infertility into the past is an understandable wish, it may not be a realistic expectation.  My personal recommendation is that it may be better off to expect that infertility will continue to be an issue, although hopefully in a less urgent and intense manner.  That way, when you get the insensitive questions or difficult situations, at least you won't be surprised, disappointed, or filled with self-blame.

"Fertility envy", infertility and friendships

I came across this article about "fertility envy", written from the perspective of a woman without fertility issues who felt hurt and isolated when her closest friends distanced themselves during her pregnancy.   The author describes feeling disappointed and dismayed when her friends, who had not yet disclosed their infertility struggles, did not react with excitement to her pregnancy announcement.  As her pregnancy progressed, she felt increasingly isolated and unable to talk about her pregnancy and preparations for her children.  Instead, she felt burdened by having to spend time talking about her friends' infertility treatments.  In the end, she found herself spending more time with her friends who already had children or who were not interested in having children, and grew apart from her friends with infertility.

For me, the article stirred up a myriad of feelings.  On the one hand, I guess I couldn't help experiencing a little bit of "fertility envy" myself--after all, the author had no problems conceiving and carrying  beautiful twin girls.  Is it fair of her to be upset that her infertile friends, because of their own pain, couldn't be as excited about her pregnancy as she was?  On the other hand, though, it was an interesting perspective,  and one that as a therapist specializing in infertility, I don't often hear.  I suspect that many friends of mine may have felt similarly during their own pregnancies, but I don't think they would have ever felt comfortable admitting it to me.

I believe that disruptions in friendship and family relationships are one of the most painful aspects of infertility.  It seems that they are incredibly common and perhaps unavoidable.  However, what I find makes a pregnancy a "fatal blow" to a relationship is a preexisting problem in the relationship prior to the pregnancy.  Once a pregnancy occurs, the issue surfaces, and because emotions are so high, the issue is usually unable to be resolved.  For instance, in the article mentioned above, the author only learned upon disclosure of her own pregnancy that her friend had been struggling to conceive for three years.  To me, the fact that her allegedly closest friend did not feel comfortable sharing this with her prior to her pregnancy announcement was a sign that her friend was already having mixed feelings about the relationship.  It is also interesting that the author turned out to have several friends undergoing infertility treatment at the same time, none of whom shared this with her.  Rather than bemoaning the fact that her friends weren't available to her, she might be better served questioning why people she felt close to didn't feel comfortable opening up to her.  In a sense, what she really discovered is that her former friendships weren't really all that close anyway, and thus they were unable to withstand the emotional pressure of her pregnancy.

Much has been written about the difficulties that individuals struggling with infertility have when their friends and family members become pregnant.  I agree that this is often very difficult, but I think much of the difficulty comes from the attitude and expectations of the pregnant persons involved.  The pregnant person's reactions usually fall in one of two camps: either their is complete insensitivity to the feelings of the infertile person, or their is a high level of guilt and oversensitivity, which can then become burdensome for the infertile person to manage. 

Last year I had a relatively unique experience in this regard when I became pregnant (as a result of a frozen transfer from a prior IVF) somewhat unexpectedly, in the midst of working with several clients struggling with their own infertility.  I must say I was repeatedly impressed with how well my clients handled my pregnancy.  Perhaps knowing my long history of infertility, I got a "pass", but I think it had more to do with my willingness to understand and tolerate the fact that they would have negative feelings about my pregnancy, and that I didn't expect them to be excited for me.  In my own personal life, when I was embroiled in IVF, I found that I was able to tolerate, and to some extent enjoy the pregnancies of friends who understood that I was going to have my own feelings about it.  It helped that they listened to my feelings when I brought them up, but didn't force me to talk about it when I didn't.

As for the author's feelings of pregnancy isolation, I find this hard to believe.  It seems that our culture worships pregnancy and its related rituals and material goods, so it seems nearly impossible to me that she couldn't have found other women (other than the old lady in the checkout line) that would have been excited to share in her experiences with her.

I am curious to hear what your experiences with pregnant friends or family members and "infertility envy" have been.  Where there responses or attitudes that you found helpful, or that were less than ideal?

As always, thank you for reading, and please feel free to contact me with any questions or suggestions!

IVF causes stress, but stress doesn't cause infertility: I knew it!

I've said  it before, and I'll say it again:  unless you are extremely and chronically emotionally distressed (and I mean extremely so), it isn't the root cause of your infertility.  I have long maintained that your ovaries do not care about your unconscious, unresolved conflicts or your relationship with your mother.  Your uterus is not swayed by either profound wishes to become a parent, or ambivalent feelings about changing poopy diapers at 3 am.  If this were true, the human race would have become extinct long ago.  We can hardly say that we live in the most stressful time in history--as long as humans have been alive, they have experienced feelings of stress.

Now, however, I can say these assertions with a little more confidence, thanks to some new research.  A study published in the journal Fertility and Sterility (found here) found no relationship between levels of stress women experienced before IVF and their treatment outcome.  As you might expect, they did find a relationship between treatment failure and a higher number of IVF cycles and higher levels of emotional distress.  The study's authors concluded:

IVF failure predicts subsequent psychological distress, but pre-IVF psychological distress does not predict IVF failure. Instead of focusing efforts on psychological interventions specifically aimed at improving the chance of pregnancy, these findings suggest that attention be paid to helping patients prepare for and cope with treatment and treatment failure (Pasch, et al, 2012).

As a clinician who works with individuals and couples experiencing infertility, I wholeheartedly agree with this conclusion.  To many times, clients come to me with a deep-seated worry that they are the architects of their own misery, and that their desires to have a child have caused their fertility problems.  Of course, it doesn't help that many people hold this mistaken belief, and are constantly telling them to just relax and stop trying.  

I'm afraid my own field of psychology is partially to blame for the theory that emotional conflict causes infertility.  I remember when I first started realizing I had an infertility problem, I did a search in the psychology literature on infertility.  I discovered a case report of an infertile woman, who was allegedly cured of her infertility once she finally worked through her unconscious conflicts about motherhood.  I was upset upon reading this--although I didn't feel I was excessively conflicted about becoming a mother, could my unconscious be keeping me from getting pregnant?  

 

Luckily for me, a few moments later I had to get back to work, to perform a diagnostic evaluation on a woman who was suffering from mental illness and drug dependence and who had several children, none of whom were in her custody.  She was rife with conflict, conscious and unconscious, about motherhood, and yet her reproductive organs appeared to be working just fine.  That experience, combined with my knowledge about the giant endometrioma that had set up camp on my ovary, allowed me to shake off some of these worries.  I knew somehow that feelings of conflict or mild upset couldn't be interfering with fertility--that just couldn't be right.

Too often, when we don't understand a medical, physiological problem, we tell patients that it is caused by a psychological factor.  For example, until we realized that ulcers were caused by a bacterial infection, we blamed stress and emotional distress for their development.  I predict that the more we come to understand the different underlying cause of infertility, the psychological explanation will fall by the wayside.  Until then, it is important to remember that although there is no conclusive evidence that stress causes infertility, there is a great deal of evidence to indicate that infertility causes stress, anxiety, and depression.  Thus, as the study's authors conclude, our focus should be on treating these "side effects" of infertility, not on subtly blaming infertile individuals for having these feelings in the first place.

 

Infertility treatment and the disaster plan: or, another defense of negative thinking

I remember  the moment like it was yesterday; the moment I decided to quit infertility treatment (although, glutton for punishment that I am, I would return two more times).  Another IVF had failed, and the diagnostic explanations as to why were becoming increasingly sinister.  I had a break at work and was agitated, so much so that I couldn't sit still.  I paced back and forth in my office, back and forth, wondering what to do next.  Giving up treatment felt like such a loss, an admission that I couldn't make a baby, and  yet, staying in treatment felt completely hopeless.  I had no confidence anymore in my  body.  I felt so much loss and frustration that things had worked out this way.  And just at the moment when I felt these things most intensely, I felt some sort of shift in myself, a new voice in my head, and I found myself telling myself that although I couldn't get pregnant, I couldn't be unhappy all of the time anymore.  I had to spend my time doing something that I had some hope of being good at, and I felt that I could be a good parent to an adopted child, someone who needed a family just as much as I needed to be a mother.

That was the moment when everything changed for me, and resulted in us joining our eldest daughter five months later. It's all very dramatic sounding, isn't it?  But the truth is that this moment was actually the product of many moments before that, moments that allowed me to reach the clarity of this decision.  Those prior moments were spent constructing my disaster plan, a plan that I could implement if things didn't work out with my first plan of infertility treatment. 

When I recommend that clients create a disaster plan for themselves, I am sometimes not met with enthusiasm.   The truth is that for a therapist, I am actually not that "comforting" of a person to be around.  My way of reassuring myself  has always been to imagine and plan for the worst case scenario.  If I have a concrete plan for surviving that situation, I feel calmer, and I'm more able to focus on the situation at hand.   More than once, I have had  clients react negatively to this line of thinking, for they didn't find considering the worst-case scenario to be comforting at  all, but rather extremely anxiety-provoking.  At these times I am usually asked why I am bringing negativity into the situation.  Wouldn't it be better if I just focused on a positive outcome?

Perhaps it would be better to just focus on a positive outcome, but I know myself well enough to know that I'm not capable of pulling that off.  But more than that, I think that there is great utility in a disaster plan. Having a concrete plan of what you would do if things go badly not only gives you a plan of action, it also aids in decision making and helps you emotionally prepare for the event that things don't your way.

For instance, for me, when I was going through treatment and things were looking increasingly bleak, I started researching all of my options, and in detail.  I learned about surrogacy, and I learned about adoption.  As I considered these options and gained more knowledge, I began to realize how I felt about myself in either of these situations.  In so doing, I decided to focus more on adoption, and then began learning about the different options in the adoption world.  I sent off for information from adoption agencies, signed up for listservs, read message boards, and tried to become literate--fast--in the adoption world.  Some of my family and friends thought I had gone off the deep end.  My IVF treatment was still proceeding, and we didn't know how that would end.  But I felt compelled to keep up with researching and planning.  Pretty soon, my husband and I had decided on a detailed specific plan of action that we would take regarding adoption, including the agencies we would use, if our last treatment failed.

Thus, when I was pacing back in forth in my office that day, I already had a detailed, concrete picture in my mind of what I needed to do should we decide to adopt.  And I think the importance of that detailed picture cannot be overemphasized.  It's basically impossible to feel clarity about an undefined, abstract option.  Everything is so hazy and undefined--how can you possibly know how you really would feel about it?  Having a detailed plan that you can visualize and implement immediately if necessary helps you make a better, more realistic decision.

In addition, the emotional clarity I felt in that moment in my office was the result of gradually working through my feelings about adoption as I read, researched, and talked to others about it.  Instead of jumping in all at once, I had time to imagine myself in various situations.   When the decision was finally at hand, the shock value had gone out of the equation, and I could just focus on what was best for my husband and myself.

Another benefit of the pre-prepared disaster plan; I didn't have to figure all this stuff out when I was terribly upset, when my cognitive functioning is not at its best.  I  just had to plug away at the steps I had already outlined.  This allowed me to keep going, and not lose time while I processed my feelings regarding ending infertility treatment.
 
Of course, some disasters cannot be planned for, and the best-made plans may not pan out in actuality.  But if you are in the midst of infertility treatment and things are not looking very positive for the outcome, I would encourage you to give serious thought and time to developing an alternate plan of action.  You might decide to try a different type of treatment, get a second opinion, or go to a different clinic.  You might consider third-party reproduction as an option, or decide that adoption is a path you might take.  Once you decide on a direction, learn as much as you can about that direction as possible, so that if you should need to go that way, you've already got a very detailed map to follow.

Although I did end up using my disaster plan, I am happy to report that in doing so, I soon realized that my new path was anything but a disaster.  Although there were many challenges along the way, they were ones I  could handle.  The paper chase of adoption was a breeze compared to infertility treatment.  For example, though couldn't get my body to cooperate in IVF, it turned out I could assemble our homestudy documents with alacrity, and wade through bureaucratic red tape with efficiency.  In so many ways, adopting our daughter was an amazing experience that I will always cherish, even though it began as my disaster plan.

On loss and miscarriage after infertility

Today, of course, is the tenth anniversary of the terrible events which occurred on September 11, 2001. For all of us, it is impossible to avoid thinking about where we were when we heard about the attacks. But for me, I also can't help remember what I was that day--which was pregnant, for the first time.


I was driving through Chicago gridlock to get my second hcg level drawn when I heard the news that planes were crashing into the World Trade Center. It was following my first IVF, which was a disaster all around, and worthy of a blog post in its own right. I was shocked and horrified all day long as the events unfolded. In addition, I was quite anxious and worried, waiting to hear "the number" from the IVF clinic. When it more than doubled, I was ecstatic, and yet I felt terribly guilty, feeling happy when so much tragedy had occurred.


But my happiness and excitement was short-lived. A few weeks later, my first ultrasound revealed a sac but no heartbeat. After a torturous week of waiting, another ultrasound confirmed my suspicions--I was having a miscarriage. I remember before the ultrasound appointment, I looked online at all the different stages of fetal development, and I had a feeling that my pregnancy would never progress in that way. I remember the way my husband, unable to reach my hand, grabbed my foot when the ultrasound technician told us there was not going to be a baby. I remember crying so hard in my RE's office that he escorted me out the back door of his office, I think less for my own comfort than his fear that I would scare the other patients in the waiting room.


The next afternoon I was scheduled for a D & C. I took a walk in the morning, thinking this was the last thing my "baby" and I would do together. At the hospital, things went worse. As I was waiting to go into surgery, crying the whole time, I heard the patient in the next cubicle, crying herself, only for a different reason--she had just found out she was pregnant, and therefore unable to have her surgery.


After the D & C, my hcg levels would not drop. Every week, I was back at the RE's office for more blood draws. During one of them, one of the nurses (and she was not, unfortunately, one of those great nurses we all know and love) questioned me as to whether or not she should put "pregnant" as my diagnosis--technically I was pregnant, but we all knew the situation. As do so many women who suffer a miscarriage, I desperately wanted to cycle again and get pregnant as soon as possible--but my body was not cooperating. Another ultrasound revealed that fetal matter had been left in my uterus during my D & C, so I had to have another one two months later. All in all, it was not a pleasant experience.


When the chromosomal test results came in from the D & C, the nurse was reluctant to tell me the sex of the fetus, but relented after I pressed her repeatedly--it was a boy, and the chromosomal tests came back normal, leaving the cause of the miscarriage, like so many, a mystery.


Although it has been ten years since these events occurred, I can still feel the sting of them. I am often asked by clients when the pain resulting from miscarriage and loss goes away. My best guess is that it doesn't really ever leave us, although the intensity of the feelings does lessen over time.


I have often thought about writing a blog entry about coping with loss and miscarriage after infertility, but the same thing has always stopped me: I don't have any words of wisdom about this subject. To me, every miscarriage or loss just seems really, really sad. There doesn't seem to be any way to avoid that. Although it is a relatively common experience among women, infertile or no, it still seems a very personal and cutting loss. The best I can offer is to listen to and sit with all the sad feelings that come up, and to pass the Kleenex when needed. A friend of mine, after struggling with infertility, lost her baby to a chromosomal disorder at 32 weeks, and with her, it seemed like she was grieving in some sort of emotional ditch. All I could do is crawl down into the ditch with her, listen, hold her hand, and try to bear witness to her incredible sadness.


The other odd thing about recovering from a miscarriage or loss is that life goes on, and so do we. As I watched my adopted daughter today, participating in a balloon release to commemorate 9/11, I reflected that if I hadn't miscarried my first pregnancy, it was unlikely that she would be here, in this town, on this football field, releasing balloons. I could not have loved her more than at that moment, and yet I still felt sad about the little one that never was to be. So many of my clients have reported a similar mix of happiness and grief, all jumbled together. I don't think there is any way of avoiding those feelings either.


To me, it is even more surprising that on this ten year anniversary of my first confirmed pregnancy, I find myself pregnant again, with a boy, who will hopefully be born healthy and happy in a few weeks. Like all mothers and mothers-to-be, I just hope that my children and I can make it through this day together, and for all
of the days that follow.

Our emotional relationship with embryos created in IVF: some thoughts

I have been having a problem lately keeping the pet fish in our tank alive. Despite my best efforts at following all of the rules (feeding properly, changing the water often, etc), watching the fish closely, and medicating them if necessary, I have somehow become the fish equivalent of the Grim Reaper. All of this has been upsetting, but also has felt eerily familiar. When I noticed the latest victim floating at the top of the tank at 4 am today, it occurred to me that this is because this is very similar to how I have felt about the many embryos my husband and I created through our IVFs--despite all my best efforts, I couldn't seem to keep most of those alive either.

In some ways, the argument about when life begins seems like a nonstarter to me. I know all too well that an embryo is not necessarily a person. True, it contains the potential to become a person--perhaps, if all the conditions are right. But I also know that an embryo can break your heart. When people bemoan the thousands of embryos that are frozen in storage at IVF clinics around the world, it shows me that they haven't spent enough time hanging around with embryos. I know that many of those embryos would never have a chance of becoming a baby in the first place.

It is a interesting side effect of our modern age that we can now develop an emotional relationship (albeit a probably one-sided one) with embryos. During an IVF cycle, it is very easy to develop fantasies about the embryos we create. Looking at their pictures, we can imagine them growing into our beloved children. We pin all of our hopes on them. It seems to be almost a universal psychological aspect of IVF, especially in the first couple of cycles. A friend of mine, during her first IVF, created 24 embryos. She celebrated, sure she would get pregnant with that kind of haul. "It's enough for a baseball team!", she exclaimed, as we popped the champagne. She didn't get pregnant, though, and none of those embryos survived to Day 5. She didn't get pregnant in any of her ensuing IVFs, either. Not to worry, she and her husband adopted two incredibly smart, lovely girls, and are completely happy with their family, as they should be.

As for me, my first IVF was not so fruitful. I had 4 embryos that had any serious chance of success. I remember planting four plants in my garden to commemorate them. The plants later died. One of the embryos got me pregnant, only to miscarry at 7 weeks. To honor him (chromosomal testing revealed it was a boy), I planted a shrub in my garden, only it didn't take root. The next spring, I kept waiting for it to start to grow again, to no avail. I think I finally gave up in July. I planted St. John's Wort in the same spot instead--for its antidepressant properties if nothing else.
It did just fine.

Such experiences, along with the experiences I witness among my clients, make me wonder if getting emotionally attached to embryos is at all wise. However, the same experiences also make me wonder if getting attached to embryos is somehow unavoidable. Even the most veteran, jaded IVF patient seems to harbor secret, unspoken fantasies about his or her embryos, although they are long past the point of celebrating them or commemorating them in a garden. What makes this so hard is that although not all embryos are going to turn into babies, some indeed do--and it's hard to definitively tell which ones are capable of doing that at the outset. In contrast to my first IVF cycle, my last cycle was with our one last, remaining, frozen embryo, created four years ago. We cycled to complete our infertility story, but without expectation that it would result in a baby. Now, at 33 weeks pregnant, it appears this embryo had other plans, and we are hoping for a good outcome in October. But to be honest, I never would have guessed it was possible.

If you are undergoing IVF, I would caution you to try to remember that an embryo is a possibility, not a promise, of a child. However, if you find yourself having lots of feelings and fantasies about your embryos, I think that's probably par for the course. The important thing is to acknowledge how you feel and give yourself permission to process these feelings, no matter what happens in your cycle.