Dealing with infertility and its treatment is challenging.  With it comes choices.  That’s the good thing.

And the hard thing. It means that you are responsible for making choices.

I know that these choices are forced choices. You feel forced into doing things you never thought you would have to do. Or things that you don’t want to do.

If things were working reproductively, we wouldn’t be having this conversation.

It’s not that you don’t have choices.  You do.

It’s that you don’t like the choices you have.

You don’t have a choice about your fertility and its challenges.  You DO have a choice about what to do about it.

When you don’t have a choice, make a choice.

There will not be a perfect, right choice.  But there will be one or more choices you can live with.  Here are 5 choices you DO have about infertility.

Choosing not to freak out. It helps to keep your wits about you.
When faced with an infertility diagnosis, people go through a variety of emotions:  shock; disbelief; denial; embarrassment; fear; sadness; anger; panic; failure; and shame, among many more.  The same thing can happen when something you try doesn’t work.  You absolutely have the right to feel whatever you feel whenever you feel it.   That makes you NORMAL.  Don’t let anyone tell you to buck up or be grateful for what you have. That “advice” isn’t empathy.  What is im­portant is to keep your thinking cap on, however you can, whenever you can.  You might be scared or pissed off at yourself, your partner, God, or the world.  Use your head to figure out what to do about it.  Don’t just get mad at infertility—get even with it.  Figure out a plan you can live with.

Treating the fertility problem. Or not.
To treat or not to treat.  This is the question. Whether ’tis Nobler in the mind to suffer…  You get my point.  There are good fertility clinics and acupuncturists out there. Lots of them.  You can try some dietary changes and see if they can “reset” your fertility.  You can choose to treat the problem now. Or you can wait. Or not treat it at all.  Figure out how much time you have to consider your options.  Consult with the right doctor to get the data you need.  Talk and maybe negotiate with your partner.  Most important, check in with yourself about what plan makes sense and feels right to you. Make a choice.  Move forward.

Choosing the level of treatment.  Not everyone jumps straight to IVF.
Sometimes the problem you are struggling with can be treated with low-tech options, like ovulation predictor kits or oral medication. Because you may have insurance coverage for inseminations and medication, it might make sense to give that intermediate step a try for a short while.  But for some problems, like a fallopian tube blockage or poor sperm quality or no sperm at all, I’m sorry to say it but you will need a higher level of treatment.  Some people like to go step-wise with their treatment, adding on treatments as needed.  Pacing yourself is fine.  Others want to get this journey over with.  Which one are you?  Be realistic.  Make a short-term and a longer-term plan.  Be strategic.

Picking the time to do treatment. Just don’t wait too long.
Some of you have been trying to conceive for longer than you ever thought possible.  Hope, finances, and some level of denial can make people wait even longer to get started on treatment.  I have been with so many people who wish they could have started treatment sooner.  You get to pick the timing of when you start treatment with one caveat: If you are nearing 40, don’t wait.  Go.  Run to the fertility clinic, NOT your OB/GYN. OB/GYN’s are awesome at pregnancies and delivering babies, not fertility challenges.  You also get to pick the timing of when you take a break or trying something different.  I really don’t want you to have heartbreaking regret about wasting precious time.

Choosing to be open to different options. Your partner needs to do that.
One of the challenges of life is that choices can be limited.  Again, you may not like your choices.  Not at all.  Not one bit. If you are absolutely closed to adoption or donor sperm, that is your right BUT you may be limiting your partner’s opportunities, too.  Think about fairness.  She or he may grow some mighty resentments toward you if you won’t even explore possible choices.   It has been a certainty in my practice that when people take the time to learn more about adoption, IVF, donor eggs, or donor sperm, and challenge their negative assumptions, they become more open to the possibilities of building a family in a different way.   Data and facts are always better than assumptions!

These are 5 choices you DO have about infertility.  What’s most important is to make a choice.  Get unstuck.  Something can work.  Something different can work.  Life moves forward.  You can move forward, too.

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People sometimes wonder why others turn to gestational surrogacy as a way of building a family.  I am happy to add my two cents and expertise to this important topic because I work daily with Intended Parents and Gestational Surrogates.  These are lovely, loving people.  Here’s why gestational surrogacy is a blessing and here to stay.

For heterosexual Intended Parents, meaning people who wish to be first-time parents or add to their family, there is a long list of medical problems that can lead people to surrogacy including:

  • Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH), a congenital condition that results in a woman’s uterus and vagina being absent or underdeveloped
  • Cancer survivor, which can restrict use of hormones or have resulted in the removal of ovaries or the uterus
  • Multiple miscarriages
  • Bipolar disorder, schizophrenia, or other mental health condition that, if untreated, could be dangerous during pregnancy
  • Blood clotting disorders
  • Unexplained infertility
  • Previous birth trauma (hemorrhage, uterine rupture)
  • Too many C-sections
  • Heart complications
  • History of premature delivery, sometimes resulting in the death of a baby
  • Diabetes

Gay Intended Parents want to be parents, too.  They want to be represented genetically.  Just like straight Intended Parents.

Surrogates, also called gestational carriers, want to meet the need.  And the need is growing day by day.  They are not “surrogate mothers.”  Surrogates are mothers to their own children, not to the child or children they carry.  They are quite articulate about that.  They will tell you every time that the child they are carrying “It’s not my baby. I’m just carrying the baby.  They are the parents.”

They believe it.  I believe them.

Do you?  I hope so.


Helping people to build their families is a blessing.

Here’s the thing that people who are anti-surrogacy need to understand. Surrogacy makes sense to Intended Parents and their families and friends. Surrogacy makes sense to gestational carriers, their partners, their children, their families and friends.  They all see this as a blessing.  If you are a religious person, you might even say that all babies come from God and this is one way that God can help to bring a baby into the world. To ease hurt and suffering.  To bring joy.  Gestational surrogacy works and is a blessing.

Ending or restricting gestational surrogacy would be like stopping a moving train with your hand. People would get hurt.  Badly.  But it will keep going.

What we need to do is to ensure that Intended Parents and Gestational Surrogates are safe in the process.

Legislation is needed to protect Surrogates and Intended Parents.


Here in Minnesota and across the United States.


Because gestational surrogacy is a blessing that’s here to stay.



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Infertility takes over your life.  How can you get to the clinic before your big presentation today? Is today ovulation day?  Did you do your injection at the right time in the right dosage?  Will your spouse be home from the work trip in time to give a semen sample? How many BBB’s (Big Bellies and Babies) are you going to see at the grocery today?  How many blogs can you read today about infertility?  How sick of infertility are you?

Infertility takes over your mind, too.  It is very hard not to think about.  I bet you know what day of the cycle you are on.  I remember how confused and angry I was every month when I wasn’t ovulating but my doctor kept pooh-poohing my concerns and my intuition.  I could not stop thinking about it, only to be told that I was obsessing, not to worry, and to relax.

I know what you are going through.  I am sorry that you hurt and you are scared that the hurt won’t ever end.

Until that moment when the pregnancy test is positive.

No way!

Could this be happening?

Do another few tests at home.  They are still positive!  What does this mean?! Everybody says that you should feel happy about a positive result, right?

Not when you have been trying for months or years.

When you have been in the infertility trenches and you are now pregnant, you are in what I call a

Prove It Pregnancy

Yes, that’s right.  A Prove It Pregnancy.  Yeah, yeah, other people stay pregnant and have babies. Could that be possible?

Infertility tells you, “Hold on there, honey. This can’t possibly work out well.”  It’s the Too Good To Be True Factor.  But this could be real.  Truly.  Really.

When you get pregnant after months—or years—of undergoing fertility treatment, there is shock, disbelief, and excitement.  Shhhhhh!  Don’t jinx it!  That first ultrasound can scare the jeepers out of you.  But it might be real.  You may not really believe it until the next ultrasound.  Maybe not.  Maybe later.  Am I pregnant?  Prove it.

Transferring your care from the fertility clinic to an OB/GYN or midwife care can be disorienting and even frightening.  This means that your pregnancy is continuing, despite your fear.  Can this really be happening?  Yes.  I know that you may have had a close relationship with the fertility clinic doctors and nurses.  You can learn to trust a clinic that can help you deliver a baby.

Really?!  Yes.  It is possible.

And there may come a time when you consider investing in the pregnancy and a baby, but fear still may remain.  Superstition is normal in a Prove It Pregnancy.  Others want to invest in baby stuff.  No. Thanks.  Maybe. Later.  It is okay to put things off.

As one gentleman recently said to me, “I may think about investing in the pregnancy when we get to 26 or 27 weeks.  When it seems real.”  And a woman I know thought it might be okay to peek at Pinterest.  Sure.  For just a moment.  And honestly, it may not seem real until a baby is warm and squawking in your arms.  That’s okay.


It’s a Prove It Pregnancy.   



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Some things suck when you have infertility.  It is really hard to go along and get along with others’ requests and demands for attendance at events.  You might have enjoyed spending time with others in the past but now certain things can feel like a hot poker in your eye.  Isolating from the world is too much but being selective about what you want to do—or not—can bring you a sense of control.  Over something, anyway. I am happy today to offer you permission to say, “No.” Or “Nope.” Or “I don’t want to.”  Without any explanations.  Here are four things to avoid during infertility treatment:

  • Baby showers—I know that you know this one already. Baby showers are not happy and silly when you are aching for a child yourself.  #justsayno
  • Family gatherings with children—You know that someone is going to ask you to hold the new baby. Or talk about how cute children are and ask you when you are going to have children yourself.  I know that families can be tricky and demanding.  It is okay to beg off with vague excuses about not feeling well.  #throwingup
  • Anyone who tells you to relax, it will happen, or why don’t you just adopt—Sometimes this one comes out of left field or even from a trusted person. You are there for some chips and dip and a know-it-all has lots of advice for you.  You have permissionNobutton to let that person know that you are not having that conversation.  Then it’s okay to walk away.  #stopit
  • The baby section at stores—Well, duh. I hope that you will spend plenty of time in the baby section later but it’s just too much right now.  Thank goodness for the Internet.  If you need a gift for someone, go to the Web.  Or let your partner do the ordering. #noway

This is a short list.  There are many others.  Please share what has helped you.  Be as snarky as you feel the need to be.  What other types of things and people should others avoid?



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The holiday lights are shining and Christmas carols drift through the air.  Everyone seems so happy. But it’s Christmas and you are at the infertility clinic.  Not so happy.  Maybe not so happy at all.

Infertility and its treatment can be confusing and particularly difficult at holiday time.  The fact that another year has passed without a pregnancy or another child can be very disheartening.  When the dreaded phone call about the latest unsuccessful treatment cycles comes at holiday time, feelings can feel even bigger and worse than usual.  Seeing others’s happiness may bring resentment or despair.  Even the simple act of shopping for gifts for others can be a trial.

Many families have many expectations about holiday traditions and rituals.  You get to exchange gifts with loved ones.  ‘Tis the season, put a smile on your face!  In the past, you might have loved the holiday traditions.  Maybe not this year.  This is even harder when there are children in the family but not in your house.  And Christmas tends to focus on children’s excitement and happiness.

Many of my patients feel overwhelmed by mandatory attendance at holiday events.  Not only is physical presence mandatory but emotional presence seems to be required as well. It is at holiday time that my patients come to me in tears.

“I don’t want to ruin the holidays for my family.  But I’m resentful and I feel left out because I don’t have children.  I don’t have it in me to pretend to be happy when my heart is breaking.”  


At the annual Midwest Resolve conference in the fall of 2014 in Minneapolis in, I gave a talk on depression, anxiety and infertility.  There was a lot of discussion among participants about how to handle the holidays.  You know what happened?  The fifty people in the room all said that they wanted to take a trip to somewhere, anywhere during the holidays. You can consider doing the same. Something different can help your relationship.  And it sure as heck can help you.

And what if you just don’t feel that you can attend holiday events but your partner feels just fine?  It is important to negotiate with your partner about what you can and cannot do.  Maybe you limit the amount of time spent at events.  Maybe you stay in a hotel. Maybe you have a secret signal between you and your partner that says, “Time out” or “Gotta go!” Maybe you spend a lot of time in the bathroom; people don’t follow you in there.  If you decline to attend, be as honest as you can with your family and your in-laws about why you are staying home this year.  Tell them that grieving people aren’t the best party goers and that your doctor gave you permission to take care of yourself.  Here’s an important tip for now and other times of the year:



If you can go to holiday events and you can enjoy something about them, by all means go.  Sometimes acting like things are okay makes it so.   It offers the opportunity to be a part of a treasured group. Maybe it would be feel good to do something that has brought you joy and peace in the past.  You could get the support you have needed. You could teach others about the infertility journey.  Maybe you can take some time off from infertility for an hour or two and just be yourself.

You don’t have much control about infertility.  You do have control over what you do with your time.  You can do what you want–or need–to do during the holidays.  However you do it, use this season as a time to recharge and heal a little.  You and your partner might come up with a new ritual that is just for the two of you.  It is important and even necessary to put yourself first sometimes.  You are always number one to me.


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