Mother’s Day is so difficult when infertility, miscarriage, or stillbirth are part of your life. When you are not sure that you can go on, just open your heart to possibility.  Even bleeding hearts are open…

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There is a general assumption that pregnancy will happen in the first month of trying to conceive. That actually is not the case. I know that this comes as a surprise to many. Under the best possible circumstances, people conceive 15 to 20% of the time in any given cycle, assuming that everything is healthy and working.  I was really shocked the first time I heard this statistic. When you are not conceiving easily or it’s taking time, it is crucial that you become your own advocate. There are many decisions to make along the way when you suspect that you have an infertility problem or when you are already in treatment. Here are 5 crucial infertility decisions for you and/or your partner to make that can make the road a little smoother.

1) If Your Intuition Is Pinging, Trust It.
Your intuition is pinging as you try to conceive but things are not going according to plan.  This may come as a sense or a whisper in your mind. It doesn’t always come with words that you can explain or that others can understand. So you check it out with others. Your OB/GYN, your partner, your friends, and others may tell you not to worry, that you have time, that you are young, that you just need to believe or relax or be positive, or that you are trying too hard. I am from a family with a lot of doctors. I like doctors. I am not a physician and I trust their training. However, I trust my intuition just as much as I trust their training. Please trust yours. For example, you know that there is a difference between menstrual cramps and excruciating pain when you get your period.  You are the only one who is living in your body. Intuition is an important type of data. Pay attention. Trust it.

2) Don’t Wait to Go to a Doctor.
Many people live in a place of denial about their fertility. The idea of having a fertility problem can be frightening. It can be difficult to get your mind around it. I understand. Here’s the problem: denial makes problems worse. A lot worse. Denial wastes time that you won’t be able to get back later. I understand that going to a doctor can make a potential problem feel very real and very scary. Make a phone call anyway. If your partner is the optimist and you are more of a realist or pessimist, make an appointment with a doctor. Just do it. Make the phone call. Get some blood and semen testing. It is good to have data, even if you do not like the results. If you are near 40, run to the infertility clinic. If you are in your 20s and you are having trouble conceiving, run to a clinic as well. The decisions we do not make intentionally are the ones that become what I call “non-decision decisions”. Those lead to a lot of internal regret later on.

3) Go to the OB/GYN AND the Infertility Specialist. Get a Second Opinion.
People usually think about going to an OB/GYN when there is the possibility of infertility.  OB/GYN’s take care of “female problems”, right? Well the answer is yes and no. OB/GYN’s are terrific at caring for you when you are pregnant. However, most just dabble in infertility treatment. People will usually start with an OB/GYN because of insurance coverage. That’s fine. It is a good place for an initial conversation. However, going to the OB/GYN can also be affected by your own sense of denial. Denial can become an unintended self-fulfilling prophecy. Let me put it to you this way: if you are having a heart attack, a family practice doctor can probably take care of you. However, you would be better to go to a cardiologist, don’t you think? Unfortunately, people stay too long at the OB/GYN’s office, wasting crucial time that could have been spent better at the infertility clinic. Get a second opinion with an infertility specialist. It is not personal. Your OB/GYN will not be offended; if he or she is offended, you might consider finding a different doctor. This is about your journey, getting to the root of the problem and finding an appropriate solution that will get you pregnant and bring home a baby.

4) Be Flexible About Trying Different Infertility Treatment Options.
It is not uncommon that someone will go through different levels of infertility treatment. You start with Clomid or Letrozole, both oral medication. That doesn’t work so you add intrauterine inseminations (IUIs). That doesn’t work so you drop oral medication and you at injectable ovarian stimulation medication to the IUIs. That doesn’t work so you do in vitro fertilization (IVF). That doesn’t work so you consider donor eggs, donor sperm, donor embryos, working with a gestational carrier (i.e., a surrogate), or choosing to adopt. The many different starts and stops of family building are painful.  They create the hope/uncertainty/devastation roller coaster. Unfortunately, this can be part of this very difficult journey. Fortunately, there are a number of choices. You do not have to like anything about this process. That is a fact. But here is the truth—the people who are the most flexible about trying different family building options are the ones who end up being parents.

5) Know When to Keep Going, When to Rest, and When to Stop.
Family building can feel like a never ending treadmill.  Sometimes you can keep up with it.  Sometimes you just feel like you are running and running but not getting anywhere.  Sometimes you can hardly hang on.  You don’t have to power through this, even though you wanted be a parent years ago. Take your time to think things through.  Plan the journey whenever you can.  Decide the best doctor or clinic.  Decide when you want to start something new.  Decide when it is time to take a break.  I know that taking a break can feel like a defeat or that you are losing time, but it is not.  It is time to regroup and recharge.  People going through chemotherapy take a break in between treatments to catch their breath.  Do the same with infertility treatment.  You can also decide when it is time to stop.  This is not giving up.  This is when you get to stop banging your head against a wall that is not yielding.  Stepping back from the process may be painful or it may be a relief.  Again, it allows you to catch your breath, observe, and gain some perspective on where you have been.

There are many other decisions to make along the way.  I’ll be writing about that as well.  For now, know that you have some control over decisions on this journey.  Use your wise mind and your intuition to find the best path at any given time.

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RESOLVE, the National Infertility Association, sponsors National Infertility Awareness Week, April 19-25, 2015.  The theme for this year is “You Are Not Alone”. One in eight couples in the United States has a problem with their fertility. One in eight. In a typical week, 75% of the women and couples that I see have a problem with infertility or pregnancy loss. Got Infertility?  You Are Not Alone.  Did you know that women going through infertility treatment and women going through cancer treatment have similar levels of depression? Infertility is that difficult an experience.

There are some wonderful ways to talk about the infertility journey, be it your own or someone you love, and feel support from around the US. Start by adding a ‪Resolve‬‬ Twibbon to your Facebook and Twitter posts. Please ask your family and friends to do the same. You Are Not Alone! Tell your story.

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Feeling stressed as you start the work week? Try this:  breathe a quick reset.  Here we go:  first empty the air from your lungs, slowly and steadily.  Next inhale through your nose, also slowly and steadily.  In your next exhales, put a slight constriction in the back of your throat.  If you exhale with your mouth open, you will sound like Darth Vader. If you exhale with your mouth closed, you will hear the sound of ocean waves!  This textured breath and sound soothe the mind and body with ease, and quickly!  Many of my clients experience almost instant relaxation of mind and body.  You might find it to be instant brain bleach.  You can breathe your quick reset with your eyes open or closed. Enjoy and let your every breath be victorious.  Have a great week everybody!

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You may be starting fertility treatment with great hopes. You hope to conceive on the first attempt of whatever type of treatment you started. Unfortunately, that is not always the case. Or you may be well into a relationship with your doctors, nurses, and clinic. Fertility treatment can become an obsession that can challenge your health, emotional well-being, energy, relationships, and finances.  Deciding your fertility treatment options and limits can help you to feel more in control of your treatment options, your schedule, and your life. Here are some suggestions for deciding when to proceed with treatment and when to step away.

Make some decisions up front
It is important to know what you and your partner can or will not do about particular treatment options.  Negotiate what makes sense to you and your partner.  Some people will stop after one round of inseminations and some will stop after ten IVF cycles. It is common that one partner is willing to pursue many options but the other partner is less comfortable. Express every fear and thought you have out loud.  It is the unspoken stuff that gets you in trouble later.

Some of your choices will be determined by finances.  Will you go as far as IVF (in-vitro fertilization)? Will you consider donor eggs, donor sperm, or donor embryos?  It is unwise to pursue treatment to the point of bankrupting yourself and your future, or harming your health.  A baby at any cost will be harmful to you and your relationship in the long run. Sometimes fertility treatment options bring moral or religious concerns. Discuss your concerns with your partner and a religious leader, if necessary, to know how far you wish to pursue treatment.  There is a caveat to early decision-making:  often the finish line moves.  For example, IVF does not work and you find yourself open to using donor eggs. Restart your negotiations with your partner.  You don’t need to know exactly where your line is right now.  It will come to you in some way, maybe in a way that surprises you.

Set a timeline for family building
Trying to have a child or adding to your family can take months or years. Know how long you wish to pursue family building and by which means (i.e., medication with timed intercourse, inseminations, IVF, donor eggs or sperm, surrogacy, or adoption).  I hear often from my clients that they will continue with treatment until their birthday, the New Year or another chosen date, or an anniversary of their first treatment attempt.  Age can be an important issue when pursuing fertility treatment or adoption.  I often hear “I don’t want to get my Social Security card when my child graduates from high school.” Know that time is passing for all of us. Put some time limits around your efforts.

Feeling traumatized and running out of energy
It is not unusual that one of my beautiful clients will say something like, ““I miss my happiness” or “I’ve lost who I am.”  If you are tired of your life being on hold, cannot stand driving near the fertility clinic, cannot take one more injection, you feel beat up, or feel you have lost yourself and the life you used to know, these may be signs that you feel traumatized and are running out of energy to continue with your family building efforts. Consider how many more disappointments you can take.  If you have had one or more miscarriages, hope for a good outcome can wane.  Determine how much hope you still have. Get some therapy for yourself and your partner.  It is also a-okay just to say “I’m done.”  You may notice a lot of unexpected relief. The idea of never going back to the clinic may have great appeal.

Feeling worn out by medication and injections
Hormones are difficult for many women. You may have gained weight or feel uncomfortable lumps on your rump from intramuscular injections. Your mood may have gone to new and uncomfortable places while on these medications. It is fine to tell your doctor that you no longer want a particular medication. Clomid is notorious for making women feel jacked up in perpetual PMS.  It is also just fine to say out loud that you don’t want any more medications at all.

Trust your intuition
It is very important to pay attention to your intuition about continuing or ending your family building efforts. You may not trust your body but you can trust your intuition.  If you can keep going and shift to more of the same or different treatment, I support you wholeheartedly.  If that is not the case, though, listen to what it is going on inside.  A client told me a story about the day that she unexpectedly ended her fertility treatment efforts. She stepped up to the receptionist desk and spoke warmly with the receptionist whom she had known for several years. When the very large chart was placed on the desk, it made a loud “Whummp!” sound.  That sound was symbolic of years of trying and “That was it,“ said my client. “I was done and I was relieved to know that I was done.”  You do not need to stay with more and more treatment because you fear disappointing your partner or your families. But please think it through.  Don’t be reactionary with a “Dammit, I want to stop right now.”  You can.  And then what?

People continue fertility treatment long beyond their breaking point because they want to avoid regrets.   If you have done everything that you can do, let yourself find some peace.  Know that you have fought the good fight and you have done everything that you could do to get what you want and need.  Perspective matters.  If you stop, what does that look and feel like?  Grief, relief, acceptance, and reevaluation of life without children can be okay. Think and feel your way to the right decisions for you.

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