....but I thought it was time to share.
As many of you know Cory and I have been trying have children
for the past year and a half. We have a fertility specialist we are working
with who is great! She feels strongly that my diagnosis is endometriosis, based
on family history and physical symptoms. This wasn’t a shock to me! Cory and I
are undergoing some of the first treatments for infertility that are pretty
basic. Not anything like IVF yet. The success rate for the treatment we are
undergoing is about 7.6% for three months. The success rate for a normal couple
to conceive is 20- 20.5% each month without any treatment . Our success rate
for pregnancy without any treatment would be closer to 1.3 to 4.0% per month
(not to say that miracles can’t happen).
Cory and I are just on the beginning on this road and are not
sure how much we want to share with family and friends yet. It has more to do
with how personal these treatments are and how emotionally invested we are.
Think about it as if you frequently miscarried, you would not want tell anyone
you were pregnant for a while because of having to tell them that you
miscarried and then having to relive the experience over and over again. Just
know that the treatments might be taxing on us emotionally and to me physically
(and might make me a little crazy, at least crazier than I am). We also are
going to be making tough decisions concerning my working options, and more
fertility treatments down the road depending on our response (IVF vs. adoption).
We are still hopeful that things will work out without these solutions, but we
know that that is a possibility and we will just have to decide when we get there.
Either way, it the decisions will be made with lots of prayer, fasting and
time.
We also wanted to say how much we appreciate everyone’s
support so far. We appreciate knowing that we are in your thoughts and prayers.
I cannot say how much we feel loved in that way. We were also touched to be
remembered on Mother’s day this year. We truly feel that everyone has been
helping us in the best way they can.
I could be awkward trying to figure out ways to help someone
with infertility, especially if you have never experienced it and if the couple
does not want to share too many specifics. Cory and I have found a some helpful
information to share with those interested.
Fact Sheet Series
RESOLVE: The National
Infertility Association
www.resolve.org
INFERTILITY AND STRESS
by
Alice D. Domar, PhD
One
of the many challenges of infertility is hearing the assumptions family and
friends make about the relationship between stress and infertility. Wouldn’t it
be nice if what you heard on a daily basis was “I am sorry that you have to go
through infertility treatment. What can I do to support you?” or “I know it
must be painful for you that your best friend is pregnant. Should I go buy her
a shower gift for you?” Instead, you more often hear comments such as, “You are
obsessed with this baby thing. If you would just stop thinking about it all the
time, it would happen.” or “If you weren’t so fat/thin, if you would only
exercise/stop exercising, if you would only do things differently from what you
are doing, you would get pregnant”. And of course, the all-time favorite, “If
you just adopt, you’ll get pregnant.” There does seem to be a universal
assumption that infertility is caused by stress. There is also a universal
tendency to underestimate the stress that is caused by infertility. The goal of
this article is to educate you about the stress and infertility connection both
for your own knowledge as well as to give you information for your “well-meaning”
family and friends.
How Stressful is Infertility?
In
a word: very. Research has shown that women with infertility have the same
levels of anxiety and depression as do women with cancer, heart disease and
HIV+ status. While this may surprise some, it actually makes sense. Procreation
is the strongest instinct in the animal kingdom. You are facing genetic and
social pressure to have a baby. You are likely surrounded by friends, family, neighbors,
co-workers and a society who conceive easily. Infertility can be very lonely. Infertility
can have an impact on literally every area of your life. It can, and usually
does, affect the relationship between you and your partner. I have never seen
partners respond to infertility in the same way. In most circumstances, the
female expresses more distress regarding their infertility, wants to talk about
it more often and is ready to move on more quickly (see a doctor, consider high-tech
treatment, move onto adoption, etc.) than her male partner.
Infertility can
have an impact on one’s relationships with family
and friends. In all likelihood, siblings and friends are getting pregnant. Many
of my patients don’t want to go home for holidays because the sight of pregnant
siblings is so difficult. They may have difficulty receiving support from their
parents who may not understand enough about infertility, may not agree about
treatment choices or may be distracted by their own life issues. If your
friends are successfully building their families, you may begin to avoid them,
thus losing social support during your life crisis. Infertility can also impact
one’s job. You may be hesitant or
unable to travel for work due to your treatments, you may be late for work due
to early morning appointments, and you may need more flexibility for
last-minute treatments such as intrauterine inseminations (IUI’s), etc. In addition,
many of my patients have found that while they can avoid pregnant friends,
relatives, and neighbors, they are unable to avoid pregnant co-workers, which
can
make
the work environment intolerable. Infertility can also cause a great deal of
financial stress. This can translate to the need to work, causing all of the
stresses just mentioned to be more magnified.
Finally,
infertility can lead to a religious or spiritual crisis. Many patients tell me
that this is the first time that God hasn’t answered their prayers. They wonder
if they are being punished for previous behaviors or if God thinks they will
not be a good parent. In addition, certain religions forbid or discourage some
forms of infertility treatment. Thus, when you add up all the
previously-mentioned factors,
it does make sense that infertility can cause a huge amount of stress. To top
it off, it is one of the few diseases where the patient is blamed for her
condition, e.g. “If you would just relax, you would get pregnant.” Can you
imagine the response if you said something similar to a cancer patient? You
would be considered cold, unfeeling and certainly uneducated. But what is the truth
about the stress/infertility connection?
Does Stress Cause Infertility?
The
answer is, we don’t know. It certainly isn’t a consistent relationship. For
example, rape and concentration camp victims conceive. This defeats the theory
that stress causes infertility and supports the likelihood that some women are
more reproductively sensitive to stress than others. In general, it is highly
unlikely that stress independently causes infertility. There has been some
research on whether or not anxiety or depression contributes to infertility.
This research has shown that women with a history of depression are twice as
likely to subsequently experience infertility as women who do not have such a
history. Another study showed that depressed women have abnormal production of luteinizing
hormone, which is necessary for reproduction.
A European study found that
anxious women took longer to conceive and were more likely to miscarry thannwomen
with lower levels of anxiety. The best and most thorough research to date has
been
on
the relationship between female distress and in vitro fertilization (IVF)
success rates. There have been 14 published studies that have looked at
distress levels in women prior, or at the beginning of, an IVF cycle. These
studies have been conducted worldwide. Ten of the studies showed that distress
levels are indeed associated with decreased pregnancy rates. The more anxiety or
depression the women expressed before undergoing IVF, the less likely they were
to get pregnant. In several of
the studies, the results were dramatic; for example, in one study, the most
depressed women experienced half the pregnancy rates as compared to the least
depressed women. Two of the 14 studies had small sample sizes and the results
showed trends, i.e. there was a tendency for the distressed women to have lower
pregnancy rates but the results fell just short of statistical significance. Two
of the studies found no relationship between distress and pregnancy rates. On a
whole however, the majority of the research does support the theory that
distress is associated with diminished IVF success rates. It is logical then,
for IVF success, and the increased possibilities in
all infertility situations, to practice stress reduction techniques.
Also
some ideas from RESOLVE:
For Family Members:
- Acknowledge infertility as a medical and emotional
crisis with a wide variety of losses, disappointments and 'costs':
physical, financial, social, marital. Do not attempt to deny or minimize
involuntary childlessness either by avoiding the topic or offering empty
platitudes like, "Everything will be fine" or "Just
relax". Avoid offering unsolicited advice and never interfere by
taking sides, blaming, or imposing rigid expectations or limitations.
- Be sensitive to the pain, stress, and emotional
pressure of childlessness or the inability to expand one's family as
desired. If it is difficult to know what to say, tell the couple rather
than saying nothing. Ask them what you might say or do that would be
helpful. Try to frequently convey care and compassion and do not 'forget'
the couple over time as the months and years of the infertility struggle
drag on. Be cognizant that some junctures in the journey may be more
difficult than others such as after a miscarriage, failed in vitro
fertilization cycle, or surgery that fails to produce the hoped for
results. Remembering the couple with a card, phone call, donation in their
names, flowers, or some other kind gesture can make the journey less
difficult.
- Be supportive. Do not assume you know what supportive
means to your loved one but, instead, ask how you can be supportive: what
would they find most helpful and useful? If you are able, consider ways in
which you can assist emotionally (listening during a 'good cry') and
functionally (offering financial assistance). Offer to simply listen and
be ready to listen when called upon.
- Emphasize the importance and value of the couple (and
each partner) in the family. Encourage and welcome their involvement as a
couple or individually in family events and activities. Once it occurs,
infertility becomes a part of the family's history; how a family adapts
and copes with the events and stress will be forever part of the family's
past. Like any stressor, infertility can strain family functioning or
improve it. Families need to be sensitive about the needs of the infertile
couple, particularly around child centered family gatherings. It is
important that they understand the infertile couple's decision not to come
may be important.
- Always keep the lines of communications open. Stress
the importance of honesty, candor, tact, and diplomacy in family
interactions. It is not a good idea to hide pregnancies 'out of kindness' or
not invite the infertile couple to child-centered family events; or keep
secrets out of fear of upsetting the couple. Always think about how things
are told as much as what is being told: tact, kindness, and privacy can go
a long way to soften the blow of difficult news. Open communication also
means being able to express concern if there is evidence of significant
emotional distress. When expressing concern always offer suggestions for
help, such as seeking support and counseling through RESOLVE or an infertility
counselor.
- Respect the boundaries the infertile couple sets
regarding their infertility. Some couples prefer a high level of privacy
about infertility. Other choose a more open approach. When in doubt, ask
the couple their preference.
Infertility Etiquette
Chances are, you know someone who is
struggling with infertility. More than seven million people of childbearing age
in the United States experience infertility. Yet, as a society, we are woefully
uninformed about how to best provide emotional support for our loved ones
during this painful time.
Infertility is, indeed, a very
painful struggle. The pain is similar to the grief over losing a loved one, but
it is unique because it is a recurring grief. When a loved one dies, he isn't
coming back. There is no hope that he will come back from the dead. You must
work through the stages of grief, accept that you will never see this person
again, and move on with your life.
The grief of infertility is not so
cut and dry. Infertile people grieve the loss of the baby that they may never
know. They grieve the loss of that baby who would have had mommy's nose and
daddy's eyes. But, each month, there is the hope that maybe that baby will be
conceived after all. No matter how hard they try to prepare themselves for bad
news, they still hope that this month will be different. Then, the bad news
comes again, and the grief washes over the infertile couple anew. This process
happens month after month, year after year. It is like having a deep cut that
keeps getting opened right when it starts to heal.
As the couple moves into infertility
treatments, the pain increases while the bank account depletes. The tests are
invasive and embarrassing to both parties. And for all of this discomfort, you
pay a lot of money.
A couple will eventually resolve the
infertility problem in one of three ways:
- They will eventually conceive a baby.
- They will stop the infertility treatments and choose to
live without children.
- They will find an alternative way to parent, such as by
adopting a child or becoming a foster parent.
Reaching a resolution can take
years, so your infertile loved ones need your emotional support during this
journey. Most people don't know what to say, so they wind up saying the wrong
thing, which only makes the journey so much harder for their loved ones.
Knowing what not to say is half of the battle to providing support.
Don't Tell Them to Relax
Everyone knows someone who had
trouble conceiving but then finally became pregnant once she
"relaxed." Couples who are able to conceive after a few months of
"relaxing" are not infertile. By definition, a couple is not
diagnosed as "infertile" until they have tried unsuccessfully to
become pregnant for a full year. In fact, most infertility specialists will not
treat a couple for infertility until they have tried to become pregnant for a
year. This year weeds out the people who aren't infertile but just need to
"relax." Those that remain are truly infertile.
Comments such as "just
relax" or "try going on a cruise" create even more stress for
the infertile couple, particularly the woman. The woman feels like she is doing
something wrong when, in fact, there is a good chance that there is a physical
problem preventing her from becoming pregnant.
These comments can also reach the
point of absurdity. As a couple, my husband and I underwent two surgeries,
numerous inseminations, hormone treatments, and four years of poking and
prodding by doctors. Yet, people still continued to say things like, "If
you just relaxed on a cruise . . ." Infertility is a diagnosable medical
problem that must be treated by a doctor, and even with treatment, many couples
will NEVER successfully conceive a child. Relaxation itself does not cure
medical infertility.
Don't Minimize the Problem
Failure to conceive a baby is a very
painful journey. Infertile couples are surrounded by families with children.
These couples watch their friends give birth to two or three children, and they
watch those children grow while the couple goes home to the silence of an empty
house. These couples see all of the joy that a child brings into someone's
life, and they feel the emptiness of not being able to experience the same joy.
Comments like, "Just enjoy being
able to sleep late . . . .travel . . etc.," do not offer comfort. Instead,
these comments make infertile people feel like you are minimizing their pain.
You wouldn't tell somebody whose parent just died to be thankful that he no
longer has to buy Father's Day or Mother's Day cards. Losing that one
obligation doesn't even begin to compensate for the incredible loss of losing a
parent. In the same vein, being able to sleep late or travel does not provide
comfort to somebody who desperately wants a child.
Don't Say There Are Worse Things
That Could Happen
Along the same lines, don't tell
your friend that there are worse things that she could be going through. Who is
the final authority on what is the "worst" thing that could happen to
someone? Is it going through a divorce? Watching a loved one die? Getting
raped? Losing a job?
Different people react to different
life experiences in different ways. To someone who has trained his whole life
for the Olympics, the "worst" thing might be experiencing an injury
the week before the event. To someone who has walked away from her career to
become a stay-at-home wife for 40 years, watching her husband leave her for a
younger woman might be the "worst" thing. And, to a woman whose sole
goal in life has been to love and nurture a child, infertility may indeed be
the "worst" thing that could happen.
People wouldn't dream of telling
someone whose parent just died, "It could be worse: both of your parents
could be dead." Such a comment would be considered cruel rather than
comforting. In the same vein, don't tell your friend that she could be going
through worse things than infertility.
Don't Say They Aren't Meant to Be
Parents
One of the cruelest things anyone
ever said to me is, "Maybe God doesn't intend for you to be a
mother." How incredibly insensitive to imply that I would be such a bad
mother that God felt the need to divinely sterilize me. If God were in the
business of divinely sterilizing women, don't you think he would prevent the pregnancies
that end in abortions? Or wouldn't he sterilize the women who wind up
neglecting and abusing their children? Even if you aren't religious, the
"maybe it's not meant to be" comments are not comforting. Infertility
is a medical condition, not a punishment from God or Mother Nature.
Don't Ask Why They Aren't Trying IVF
In vitro fertilization (IVF) is a
method in which the woman harvests multiple eggs, which are then combined with
the man's sperm in a petri dish. This is the method that can produce multiple
births. People frequently ask, "Why don't you just try IVF?" in the
same casual tone they would use to ask, "Why don't you try shopping at
another store?"
Don't Complain About Your Pregnancy
This message is for pregnant
women-Just being around you is painful for your infertile friends. Seeing your
belly grow is a constant reminder of what your infertile friend cannot have.
Unless an infertile women plans to spend her life in a cave, she has to find a
way to interact with pregnant women. However, there are things you can do as
her friend to make it easier.
The number one rule is DON'T
COMPLAIN ABOUT YOUR PREGNANCY. I understand from my friends that, when you are
pregnant, your hormones are going crazy and you experience a lot of discomfort,
such as queasiness, stretch marks, and fatigue. You have every right to vent
about the discomforts to any one else in your life, but don't put your
infertile friend in the position of comforting you.
Your infertile friend would give
anything to experience the discomforts you are enduring because those
discomforts come from a baby growing inside of you. When I heard a pregnant
woman complain about morning sickness, I would think, "I'd gladly throw up
for nine straight months if it meant I could have a baby." When a pregnant
woman would complain about her weight gain, I would think, "I would cut
off my arm if I could be in your shoes."
I managed to go to baby showers and
hospitals to welcome my friends' new babies, but it was hard. Without
exception, it was hard. Stay sensitive to your infertile friend's emotions, and
give her the leeway that she needs to be happy for you while she cries for
herself. If she can't bring herself to hold your new baby, give her time. She
isn't rejecting you or your new baby; she is just trying to work her way
through her pain to show sincere joy for you. The fact that she is willing to
endure such pain in order to celebrate your new baby with you speaks volumes
about how much your friendship means to her.
Don't Treat Them Like They Are
Ignorant
For some reason, some people seem to
think that infertility causes a person to become unrealistic about the
responsibilities of parenthood. I don't follow the logic, but several people
told me that I wouldn't ache for a baby so much if I appreciated how much
responsibility was involved in parenting.
Let's face it-no one can fully
appreciate the responsibilities involved in parenting until they are,
themselves, parents. That is true whether you successfully conceived after one
month or after 10 years. The length of time you spend waiting for that baby
does not factor in to your appreciation of responsibility. If anything, people
who have been trying to become pregnant longer have had more time to think
about those responsibilities. They have also probably been around lots of
babies as their friends started their families.
Perhaps part of what fuels this
perception is that infertile couples have a longer time to "dream"
about what being a parent will be like. Like every other couple, we have our
fantasies-my child will sleep through the night, would never have a tantrum in
public, and will always eat his vegetables. Let us have our fantasies. Those
fantasies are some of the few parent-to-be perks that we have-let us have them.
You can give us your knowing looks when we discover the truth later.
Don't Gossip About Your Friend's
Condition
Infertility treatments are very
private and embarrassing, which is why many couples choose to undergo these
treatments in secret. Men especially are very sensitive to letting people know
about infertility testing, such as sperm counts. Gossiping about infertility is
not usually done in a malicious manner. The gossipers are usually well-meaning
people who are only trying to find out more about infertility so they can help
their loved ones.
Regardless of why you are sharing
this information with someone else, it hurts and embarrasses your friend to
find out that Madge the bank teller knows what your husband's sperm count is
and when your next period is expected. Infertility is something that should be
kept as private as your friend wants to keep it. Respect your friend's privacy,
and don't share any information that your friend hasn't authorized.
Don't Push Adoption (Yet)
Adoption is a wonderful way for
infertile people to become parents. (As an adoptive parent, I can fully vouch
for this!!) However, the couple needs to work through many issues before they
will be ready to make an adoption decision. Before they can make the decision
to love a "stranger's baby," they must first grieve the loss of that
baby with Daddy's eyes and Mommy's nose. Adoption social workers recognize the
importance of the grieving process. When my husband and I went for our initial
adoption interview, we expected the first question to be, "Why do you want
to adopt a baby?" Instead, the question was, "Have you grieved the
loss of your biological child yet?" Our social worker emphasized how
important it is to shut one door before you open another.
You do, indeed, need to grieve this
loss before you are ready to start the adoption process. The adoption process
is very long and expensive, and it is not an easy road. So, the couple needs to
be very sure that they can let go of the hope of a biological child and that
they can love an adopted baby. This takes time, and some couples are never able
to reach this point. If your friend cannot love a baby that isn't her
"own," then adoption isn't the right decision for her, and it is certainly
not what is best for the baby.
Mentioning adoption in passing can
be a comfort to some couples. (The only words that ever offered me comfort were
from my sister, who said, "Whether through pregnancy or adoption, you will
be a mother one day.") However, "pushing" the issue can
frustrate your friend. So, mention the idea in passing if it seems appropriate,
and then drop it. When your friend is ready to talk about adoption, she will
raise the issue herself.
So, what can you say to your
infertile friends? Unless you say "I am giving you this baby," there
is nothing you can say that will erase their pain. So, take that pressure off
of yourself. It isn't your job to erase their pain, but there is a lot you can
do to lesson the load. Here are a few ideas.
Let Them Know That You Care
The best thing you can do is let
your infertile friends know that you care. Send them cards. Let them cry on
your shoulder. If they are religious, let them know you are praying for them.
Offer the same support you would offer a friend who has lost a loved one. Just
knowing they can count on you to be there for them lightens the load and lets
them know that they aren't going through this alone.
Remember Them on Mother's Day
With all of the activity on Mother's
Day, people tend to forget about women who cannot become mothers. Mother's Day
is an incredibly painful time for infertile women. You cannot get away from
it-There are ads on the TV, posters at the stores, church sermons devoted to
celebrating motherhood, and all of the plans for celebrating with your own
mother and mother-in-law.
Mother's Day is an important
celebration and one that I relish now that I am a mother. However, it was very
painful while I was waiting for my baby. Remember your infertile friends on
Mother's Day, and send them a card to let them know you are thinking of them.
They will appreciate knowing that you haven't "forgotten" them.
Support Their Decision to Stop
Treatments
No couple can endure infertility
treatments forever. At some point, they will stop. This is an agonizing
decision to make, and it involves even more grief. Even if the couple chooses
to adopt a baby, they must still first grieve the loss of that baby who would
have had mommy's nose and daddy's eyes.
Once the couple has made the
decision to stop treatments, support their decision. Don't encourage them to
try again, and don't discourage them from adopting, if that is their choice.
Once the couple has reached resolution (whether to live without children, adopt
a child, or become foster parents), they can finally put that chapter of their
lives behind them. Don't try to open that chapter again.
One Final thought...
Please don't try to talk to us about our treatments in large gatherings or at the dinner table! You would not want to talk about your latest colonoscopy during dinner, would you? We don't mind talking in more private settings, but please, not in front of groups (even if they are family)!
