I just wanted to share this article I came across, thanks to Dawn Davenport at Creatingafamly.org, which is a wonderful resource.
Here is the link to the article: Adoption, Destiny, and Magical Thinking
Happy reading!
Saturday, August 18, 2012
Monday, July 30, 2012
The other side of the river: reflections on a first IVF cycle
Geographical landmarks are a funny thing--sometimes being in the same place as you were when something memorable happened can bring you right back to those feelings, as if no time had ever passed. I was reminded of this last night, when I found myself across the Chicago River from the sidewalk where I paced back and forth eleven years ago during my first and perhaps most traumatic IVF cycle. The feelings I experienced then flooded me again, overwhelming me for a moment.
I always tell my clients that the first IVF cycle is usually the worst, because invariably our expectations entering into the cycle are very high. We have pulled out all the stops and gone for the big guns. How could it not work? For many, the first IVF does indeed work--but for the rest of us, the disappointment of treatment failure is compounded with shock that treatment failed in the first place. In addition, everything is all a new experience, and our anxiety is usually higher when we don't know what to expect.
My first IVF was an emotional roller coaster ride that was one of the most intense experiences of my life. It started out badly, when on a Saturday morning right after I started Lupron shots my RE called to tell me that our first cycle would be cancelled. I had learned a month earlier that I was a carrier of Tay-Sachs disease, genetic disorder that is usually fatal. This was not too surprising to me because I am of Ashkenazi Jewish descent. However, the cycle was cancelled because my husband had also tested positive as a Tay-Sachs carrier. This was extremely suprising to us, because he is of Southeast Asian descent and Tay-Sachs is not common in this population. "Don't worry," my RE told me, "We can do PGD next cycle to find the embryos where you don't contribute your Tay-Sachs! I've got it all set up for you, and we can do it next month!" And thus, we entered the world of preimplantation genetic testing, then in its' infancy. We would be doing a polar body biopsy, meaning that they would only be able to test the maternal genetic contribution to the embryos.
A few days later, I found myself at the genetics lab, where a nervous doctor who clearly didn't usually do procedures on actual human beings gave me a shot of lidocane, and then without waiting for it to take effect, took a sort of hole punch and removed a large divet of flesh from my arm. My pain tolerance is pretty high, but I can still remember how excruciating that was. I endured it because I desperately wanted things to work. I have a huge scar on my arm to this day to remind me of this misadventure.
My sample was sent off to determine the exact genetic mutation I carried so that they could identify it during the PGD. I began to prepare for the IVF cycle again, starting BCP and Lupron. Meanwhile, my husband and I kept scratching our heads, wondering how he could possibly be a Tay-Sachs carrier. It just seemed so improbable. Of course, head scratching quickly turned into obsessive internet searching. After a few weeks of research, we found one lab in Philadelphia that ran a test for a "pseudodeficiency allele" for Tay-Sachs; apparently some people carry a mutation that causes their blood to react with the solution in the collection test tube, producing a false positive on the Tay-Sachs test. We took our research to the genetic counselor, who had never heard of the allele or test but agreed to test my husband anyway. It would take weeks to get the results.
I began the stimulation process of the cycle with very disappointing results. I remember one nurse yelling at me, telling me I needed to have ten follicles on each side. "You are 32 years old; you should be doing better than this!" I began to experience a feeling of panic and dread. When it came time for retrieval, they got 8 eggs, but at day 3, only four were viable embryos. Two were of good quality. Unfortunately, the genetic testing showed that the two good embryos were the ones that carried my Tay-Sachs gene. My husband's pseudodeficiency allele test wasn't back yet. At this point, we had nothing to transfer. I was filled with shock and despair. I was downtown that day, and unable to concentrate on my work, I went for a walk along the Chicago River. I felt hopeless. I couldn't believe that after everything, my cycle ended without anything to put back. I remember thinking, "This is the end of the line." I cried for a while, and then walked back to work to complete the rest of my day.
I was wrong, though. It wasn't the end of the line. On the afternoon of day 5, we got a call from the clinic. My husband's results were back--he tested positive for the pseudodeficiency allele, which meant he wasn't a Tay-Sachs carrier after all. We raced to the clinic to transfer the two affected embryos, which were still alive and doing well. Nine days later, I got a positive pregnancy test. It looked like my luck had changed again. My betas were strong, and I had lots of early pregancy symptoms. Unfortunately, there was no heartbeat at 6 and 7 weeks, and I ended up having to get a D & C. I was devastated all over again, filled once more with shock and despair.
All of those feelings came rushing back to me last night, as I stood across the river. For a moment, I was back in that time again, but my daughter excitedly squeezed my hand and I came back to the present. We were in the process of boarding a architectural boat cruise organized by the American Girl store. It was a beautiful summer night, and there were happy girls and their dolls everywhere. I was struck by what a difference it made to be on this side of the river. When my first IVF was taking place, my adopted daughter was just a few months away from being conceived in a faraway land. That long ago terrible day on the river wasn't the end of the line; it was the beginning of a journey that would span continents and years that eventually would give me so much for which to be grateful.
As we toured the city, I basked in the glow of the city lights and in the world of dolls and childhood imagination. I always tell people that infertility is a phase, and although the pain never goes away completely, you can have a wonderful and happy life in spite of, or perhaps because of, the experience of infertility. I say this because it is true; and if I can survive infertility and find some measure of happiness, then I know you can too. If you are reading this and you are having a hard time right now, please remember that one day, you too will be on the other side of the river. I hope that your crossing will be smooth, and happen very soon!
I always tell my clients that the first IVF cycle is usually the worst, because invariably our expectations entering into the cycle are very high. We have pulled out all the stops and gone for the big guns. How could it not work? For many, the first IVF does indeed work--but for the rest of us, the disappointment of treatment failure is compounded with shock that treatment failed in the first place. In addition, everything is all a new experience, and our anxiety is usually higher when we don't know what to expect.
My first IVF was an emotional roller coaster ride that was one of the most intense experiences of my life. It started out badly, when on a Saturday morning right after I started Lupron shots my RE called to tell me that our first cycle would be cancelled. I had learned a month earlier that I was a carrier of Tay-Sachs disease, genetic disorder that is usually fatal. This was not too surprising to me because I am of Ashkenazi Jewish descent. However, the cycle was cancelled because my husband had also tested positive as a Tay-Sachs carrier. This was extremely suprising to us, because he is of Southeast Asian descent and Tay-Sachs is not common in this population. "Don't worry," my RE told me, "We can do PGD next cycle to find the embryos where you don't contribute your Tay-Sachs! I've got it all set up for you, and we can do it next month!" And thus, we entered the world of preimplantation genetic testing, then in its' infancy. We would be doing a polar body biopsy, meaning that they would only be able to test the maternal genetic contribution to the embryos.
A few days later, I found myself at the genetics lab, where a nervous doctor who clearly didn't usually do procedures on actual human beings gave me a shot of lidocane, and then without waiting for it to take effect, took a sort of hole punch and removed a large divet of flesh from my arm. My pain tolerance is pretty high, but I can still remember how excruciating that was. I endured it because I desperately wanted things to work. I have a huge scar on my arm to this day to remind me of this misadventure.
My sample was sent off to determine the exact genetic mutation I carried so that they could identify it during the PGD. I began to prepare for the IVF cycle again, starting BCP and Lupron. Meanwhile, my husband and I kept scratching our heads, wondering how he could possibly be a Tay-Sachs carrier. It just seemed so improbable. Of course, head scratching quickly turned into obsessive internet searching. After a few weeks of research, we found one lab in Philadelphia that ran a test for a "pseudodeficiency allele" for Tay-Sachs; apparently some people carry a mutation that causes their blood to react with the solution in the collection test tube, producing a false positive on the Tay-Sachs test. We took our research to the genetic counselor, who had never heard of the allele or test but agreed to test my husband anyway. It would take weeks to get the results.
I began the stimulation process of the cycle with very disappointing results. I remember one nurse yelling at me, telling me I needed to have ten follicles on each side. "You are 32 years old; you should be doing better than this!" I began to experience a feeling of panic and dread. When it came time for retrieval, they got 8 eggs, but at day 3, only four were viable embryos. Two were of good quality. Unfortunately, the genetic testing showed that the two good embryos were the ones that carried my Tay-Sachs gene. My husband's pseudodeficiency allele test wasn't back yet. At this point, we had nothing to transfer. I was filled with shock and despair. I was downtown that day, and unable to concentrate on my work, I went for a walk along the Chicago River. I felt hopeless. I couldn't believe that after everything, my cycle ended without anything to put back. I remember thinking, "This is the end of the line." I cried for a while, and then walked back to work to complete the rest of my day.
I was wrong, though. It wasn't the end of the line. On the afternoon of day 5, we got a call from the clinic. My husband's results were back--he tested positive for the pseudodeficiency allele, which meant he wasn't a Tay-Sachs carrier after all. We raced to the clinic to transfer the two affected embryos, which were still alive and doing well. Nine days later, I got a positive pregnancy test. It looked like my luck had changed again. My betas were strong, and I had lots of early pregancy symptoms. Unfortunately, there was no heartbeat at 6 and 7 weeks, and I ended up having to get a D & C. I was devastated all over again, filled once more with shock and despair.
All of those feelings came rushing back to me last night, as I stood across the river. For a moment, I was back in that time again, but my daughter excitedly squeezed my hand and I came back to the present. We were in the process of boarding a architectural boat cruise organized by the American Girl store. It was a beautiful summer night, and there were happy girls and their dolls everywhere. I was struck by what a difference it made to be on this side of the river. When my first IVF was taking place, my adopted daughter was just a few months away from being conceived in a faraway land. That long ago terrible day on the river wasn't the end of the line; it was the beginning of a journey that would span continents and years that eventually would give me so much for which to be grateful.
As we toured the city, I basked in the glow of the city lights and in the world of dolls and childhood imagination. I always tell people that infertility is a phase, and although the pain never goes away completely, you can have a wonderful and happy life in spite of, or perhaps because of, the experience of infertility. I say this because it is true; and if I can survive infertility and find some measure of happiness, then I know you can too. If you are reading this and you are having a hard time right now, please remember that one day, you too will be on the other side of the river. I hope that your crossing will be smooth, and happen very soon!
Thursday, July 26, 2012
The RE's waiting room: a world unto itself?
During my eleven on-and-off years as an infertility patient, I logged an impressive number of hours in the waiting room of various infertility clinics, and I have a confession to make: although I appeared to be calmly reading a magazine and minding my own business, I really wasn't. Instead, I was watching, listening, and observing everything that went on with the staff of the clinic and the other clients. And boy, did I see and hear a lot of interesting things! Of course many of the things were what you would expect; couples arguing, other clients in various stages of happiness or distress, and the occasional awkward meeting of two acquaintances, both obviously wanting to keep their treatment private, who were now forced to interact. As interesting as those events were to a nosy nelly like myself, for me the most fascinating occurrences were the subtle looks and interactions between patients.
For instance, when I first began infertility treatment, I was in my very early thirties, and at the time, I looked much younger than my age (unfortunately, I do not have this problem anymore). On numerous occasions, if a woman in her late 30's or 40's was in the waiting room with me, she would surreptitiously give me the once over, and then start looking really annoyed. Once, a fellow patient started asking me questions about where I was from and if I went to school, and if I lived with my parents, which all seemed very strange, until it hit me--she thought I was an egg donor! The irony of that situation is that despite my relative youth, my underachieving ovaries were what had me sitting in that waiting room in the first place. These looks and questions were a little upsetting to me--I kept thinking, "Here we all are in a difficult situation, and we are still making assumptions and being competitive? Is no place sacred?"
One another occasion, I was in the waiting room during an IVF cycle, and there were a bunch of women who obviously knew each other and lived close to each other. It was as if my RE had offered a discount to their city block. Apparently they all lived near the RE too, and they were having boastful conversations for about how many times they had run into Dr. X at the Starbucks, the gym, the grocery store, jockeying for position about who knew him the best. For his part, I heard Dr. X tell the nurses that this was obviously a waiting room full of his patients, as opposed to the patients of his partners, because his patients were clearly the most friendly and attractive. Again, I found myself being irritated and annoyed.
As for me, I spent a lot of the time in the waiting room feeling like the most infertile person in the world. In my darker days, as someone would walk in, I would find myself thinking that she would get pregnant before me. My clinic had us sign in with chart numbers that were sequential, and thus I could see that I always had the lowest number--hence I had been going there the longest.
I'm curious to know about the waiting room experiences of others. What was your most intresting experience or observation? And do you have any suggestions about how clinics could make their waiting rooms more comfortable?
Thank you so much for reading for your comments, and if you ever have a question or suggestion, don't hesitate to email me at lisarouff@gmail.com.
For instance, when I first began infertility treatment, I was in my very early thirties, and at the time, I looked much younger than my age (unfortunately, I do not have this problem anymore). On numerous occasions, if a woman in her late 30's or 40's was in the waiting room with me, she would surreptitiously give me the once over, and then start looking really annoyed. Once, a fellow patient started asking me questions about where I was from and if I went to school, and if I lived with my parents, which all seemed very strange, until it hit me--she thought I was an egg donor! The irony of that situation is that despite my relative youth, my underachieving ovaries were what had me sitting in that waiting room in the first place. These looks and questions were a little upsetting to me--I kept thinking, "Here we all are in a difficult situation, and we are still making assumptions and being competitive? Is no place sacred?"
One another occasion, I was in the waiting room during an IVF cycle, and there were a bunch of women who obviously knew each other and lived close to each other. It was as if my RE had offered a discount to their city block. Apparently they all lived near the RE too, and they were having boastful conversations for about how many times they had run into Dr. X at the Starbucks, the gym, the grocery store, jockeying for position about who knew him the best. For his part, I heard Dr. X tell the nurses that this was obviously a waiting room full of his patients, as opposed to the patients of his partners, because his patients were clearly the most friendly and attractive. Again, I found myself being irritated and annoyed.
As for me, I spent a lot of the time in the waiting room feeling like the most infertile person in the world. In my darker days, as someone would walk in, I would find myself thinking that she would get pregnant before me. My clinic had us sign in with chart numbers that were sequential, and thus I could see that I always had the lowest number--hence I had been going there the longest.
I'm curious to know about the waiting room experiences of others. What was your most intresting experience or observation? And do you have any suggestions about how clinics could make their waiting rooms more comfortable?
Thank you so much for reading for your comments, and if you ever have a question or suggestion, don't hesitate to email me at lisarouff@gmail.com.
Thursday, July 12, 2012
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:
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.
Wednesday, June 20, 2012
Infertility treatment and the Type A Personality, Part 2: feelings of failure
In an earlier post, I discussed some of the issues that can occur when a person with a "type A" personality style experiences infertility. In this blog post, I would like to focus on one particular aspect of that experience; namely, the emotional experience of treatment failure.
Failure is endemic to infertility and infertility treatment, as the failure to produce a viable pregnancy starts the whole process.
By the time a person with Type A personality typically gets diagnosed with infertility, they have already been deluged with feelings of failure. Failure to get or stay pregnant is distressing to everyone, no matter their personality style. However, it seems to be particularly stressful for those of us who are more on the type A side of things. To me, this is best expressed by this equation:
Type A personality + treatment failure = uncomfortable recognition of lack of control.
One of the biggest motivations for being type A, e.g., worried about the details, anxious about potential obstacles, is that it can provide a faux sense of control. Someone with a more laid-back approach to things may have a basic belief that although things are out of their control, they will work out well in the end. This is not so for people with The A personality style. Simply put, they do not feel lucky. Not only do they not feel lucky with infertility, they do not feel lucky in any aspects of their lives. The underlying assumption is that the world is not a safe place.
It's pretty uncomfortable walking around being anxious and worried about the future all of the time. Thus, if you have this basic belief, you will need to develop a psychological strategy for minimizing these feelings. That's where a type A personality style, with its emphasis on working hard to manage all the details, can come in very handy. You can get so busy organizing, planning and working that you can put your feelings of anxiety about the world out of consciousness.
The Type A strategy of managing anxiety is usually adaptive in most situations. However, in a situation like infertility treatment, where success or failure usually rest on several factors beyond anyone's control, it all falls apart. A treatment failure isn't just a profound disappointment; it is also an example of the person's worst fear come true. It is a concrete reminder that no matter how hard they might try, bad things happen--and thus, the world is not safe.
Add in some fertility drugs tweaking the emotions, financial stress, and a few insensitive comments from friends and family, and you've got a recipe for the perfect storm in terms of creating an emotional meltdown. Sound familiar? I know I myself have been in that play several times before.
Although it is painful and unsettling to realize that we feel unlucky and unsafe, there are some advantages to doing so. In reality, your situation is no better or worse off than it was before. The primary loss is actually the fantasy that you had some sort of omnipotent control in the first place. By letting go of this fantasy, you may be able to paradoxically relax a bit more--if it's not all in your power, it can't be all your fault, right? Also, by acknowledging that your fear that you are always unlucky of that the world is always unsafe, you can also realize the ways in which your fears aren't accurate. In reality, a person can't always be unlucky, and not every situation is unsafe. This can allow you to respond more specifically and helpfully to the threats of a given situation, saving your energy for the things that matter most.
By the time a person with Type A personality typically gets diagnosed with infertility, they have already been deluged with feelings of failure. Failure to get or stay pregnant is distressing to everyone, no matter their personality style. However, it seems to be particularly stressful for those of us who are more on the type A side of things. To me, this is best expressed by this equation:
Type A personality + treatment failure = uncomfortable recognition of lack of control.
One of the biggest motivations for being type A, e.g., worried about the details, anxious about potential obstacles, is that it can provide a faux sense of control. Someone with a more laid-back approach to things may have a basic belief that although things are out of their control, they will work out well in the end. This is not so for people with The A personality style. Simply put, they do not feel lucky. Not only do they not feel lucky with infertility, they do not feel lucky in any aspects of their lives. The underlying assumption is that the world is not a safe place.
It's pretty uncomfortable walking around being anxious and worried about the future all of the time. Thus, if you have this basic belief, you will need to develop a psychological strategy for minimizing these feelings. That's where a type A personality style, with its emphasis on working hard to manage all the details, can come in very handy. You can get so busy organizing, planning and working that you can put your feelings of anxiety about the world out of consciousness.
The Type A strategy of managing anxiety is usually adaptive in most situations. However, in a situation like infertility treatment, where success or failure usually rest on several factors beyond anyone's control, it all falls apart. A treatment failure isn't just a profound disappointment; it is also an example of the person's worst fear come true. It is a concrete reminder that no matter how hard they might try, bad things happen--and thus, the world is not safe.
Add in some fertility drugs tweaking the emotions, financial stress, and a few insensitive comments from friends and family, and you've got a recipe for the perfect storm in terms of creating an emotional meltdown. Sound familiar? I know I myself have been in that play several times before.
Although it is painful and unsettling to realize that we feel unlucky and unsafe, there are some advantages to doing so. In reality, your situation is no better or worse off than it was before. The primary loss is actually the fantasy that you had some sort of omnipotent control in the first place. By letting go of this fantasy, you may be able to paradoxically relax a bit more--if it's not all in your power, it can't be all your fault, right? Also, by acknowledging that your fear that you are always unlucky of that the world is always unsafe, you can also realize the ways in which your fears aren't accurate. In reality, a person can't always be unlucky, and not every situation is unsafe. This can allow you to respond more specifically and helpfully to the threats of a given situation, saving your energy for the things that matter most.
Friday, June 8, 2012
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.
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.
Thursday, May 10, 2012
Get over it....
As a therapist, there isn't a workday that goes by without hearing the question, "Why can't I just get over it?" The short answer, of course, is that if it was that easy to get over whatever it was, you wouldn't be here talking to me about it in the first place--you'd be working or laughing doing your laundry or drinking a coffee or taking a nap. Psychotherapy, like infertility treatment, usually isn't anyone's first choice.
The reason people often go to a therapist in the first place is with the idea that psychotherapy may help them "get over" something, which indeed it may, although not in the way they might initially expect. In our culture, o there seems to be an expectation that to get over something, you shouldn't have negative feelings about anymore--your sadness, anger, hurt, despair will all become things of the past.
If that were the usual course of events, that would put me out of a job. And believe me, I would be fine with that. Instead, I find myself trying to find way to gently explain that perhaps "getting over it", in terms of no longer having negative feelings, is an unrealistic goal, for that there are some things in life that just can't be gotten over so easily.
Infertility is almost always one of those things that can't be gotten over so easily. No matter what the outcome, the struggle of infertility almost always changes a person in fundamental ways. The losses endured are often profound and unchangeable. They have due dates, anniversaries, and countless other reminders. Other people are reproducing everywhere you look. In the thick of my infertility treatment, the number of pregnant women I would see on a daily basis was breathtaking. I sincerely wished the continuation of the human race would just stop for a few minutes, to let me catch my breath, but that wish, like so many others, never came true.
I suppose that is one of the many things I have never "gotten over" about infertility. And although I have children now, I don't think I will ever lose touch with how bad that felt. Thinking about those moments of my life still makes me feel sad, angry, and alone. When I am around people who didn't have the same struggles I did, I still sometimes feel alienated and shake my head, marveling that children could arrive in their lives with such little fuss. I don't see how that's ever going to change.
What has changed, however, is my expectation that I am ever going to feel differently. I have come to accept that there are certain memories and issues that are going to upset me no matter what, and that they probably will continue to do so for the rest of my life.
This is no small thing. For by recognizing that you can't escape certain negative feelings, you can find freedom in other ways. First of all, you don't have to feel badly about yourself because you haven't "gotten over it" yet. And secondly, there is something about accepting how you feel that makes those feelings less intense and more bearable over time. Once you start processing your feelings, they may not go away; but they may not affect your ability to enjoy the rest of your life.
My rule is that if you keep telling yourself you need to just "get over" something, it is likely that you may be up against an impossible task. Instead, take some time to explore and process the feelings you think you should just be getting over. You may be surprised that even though you aren't over it, you still feel better anyway.
The reason people often go to a therapist in the first place is with the idea that psychotherapy may help them "get over" something, which indeed it may, although not in the way they might initially expect. In our culture, o there seems to be an expectation that to get over something, you shouldn't have negative feelings about anymore--your sadness, anger, hurt, despair will all become things of the past.
If that were the usual course of events, that would put me out of a job. And believe me, I would be fine with that. Instead, I find myself trying to find way to gently explain that perhaps "getting over it", in terms of no longer having negative feelings, is an unrealistic goal, for that there are some things in life that just can't be gotten over so easily.
Infertility is almost always one of those things that can't be gotten over so easily. No matter what the outcome, the struggle of infertility almost always changes a person in fundamental ways. The losses endured are often profound and unchangeable. They have due dates, anniversaries, and countless other reminders. Other people are reproducing everywhere you look. In the thick of my infertility treatment, the number of pregnant women I would see on a daily basis was breathtaking. I sincerely wished the continuation of the human race would just stop for a few minutes, to let me catch my breath, but that wish, like so many others, never came true.
I suppose that is one of the many things I have never "gotten over" about infertility. And although I have children now, I don't think I will ever lose touch with how bad that felt. Thinking about those moments of my life still makes me feel sad, angry, and alone. When I am around people who didn't have the same struggles I did, I still sometimes feel alienated and shake my head, marveling that children could arrive in their lives with such little fuss. I don't see how that's ever going to change.
What has changed, however, is my expectation that I am ever going to feel differently. I have come to accept that there are certain memories and issues that are going to upset me no matter what, and that they probably will continue to do so for the rest of my life.
This is no small thing. For by recognizing that you can't escape certain negative feelings, you can find freedom in other ways. First of all, you don't have to feel badly about yourself because you haven't "gotten over it" yet. And secondly, there is something about accepting how you feel that makes those feelings less intense and more bearable over time. Once you start processing your feelings, they may not go away; but they may not affect your ability to enjoy the rest of your life.
My rule is that if you keep telling yourself you need to just "get over" something, it is likely that you may be up against an impossible task. Instead, take some time to explore and process the feelings you think you should just be getting over. You may be surprised that even though you aren't over it, you still feel better anyway.
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