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. I’ll tell you mine later this week.

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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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On this New Year’s Day 2015, I raise my glass to you and to new beginnings.  My new year started at heated vinyasa yoga with a reading from one of my favorite books, Journey to the Heart by Melody Beattie.  (You can find it in the book section of my website).  It speaks to all that is in front of us–hurts from the past,  reassessment, and possibilities going forward.  It is about honoring the beginning.  I had to share it with you.

Let this year be the year that you resolve your infertility.  Let this year be the year that you have a healthy, happy baby in your arms.  Let this year be the year that you find love.  Let this year be the year that you find safety from an abusive relationship.  Honoring the beginning…

Honor the Beginning

 by Melody Beattie

Beginnings can be delicate or explosive. They can start almost invisibly or arrive with a big bang. Beginnings hold the promise of new lessons to be learned, new territory to be explored, and old lessons to be recalled, practiced, and appreciated. Beginnings hold ambiguity, promise, fear, and hope.

Don’t let the lessons, the experiences of the past, dampen your enthusiasm for beginnings. Just because it’s been hard doesn’t mean that it will always be that difficult. Don’t let the heartbreaks of the past cause you to become cynical, close you off to life’s magic and promise. Open yourself wide to all that the universe has to say.

Let yourself begin anew. Pack your bags. Choose carefully what you bring, because packing is an important ritual. Take along some humility and the lessons of the past. Toss in some curiosity and excitement about what you haven’t yet learned. Say your good-byes to those you are leaving behind. Don’t worry who you will meet or where you will go. The way has been prepared. The people you are to meet will be expecting you. A new journey has begun. Let it be magical. Let it unfold.

All parts of the journey are sacred and holy.

Take time now to honor the beginning.

Let me know how your beginnings go…

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You have started fertility testing or treatment with a doctor who you know and trust. Or, so it seems. Perhaps, you are starting to realize that your doctor or clinic is not a good fit for you and you feel uncomfortable every time you walk through the door. Or maybe you have an intuition that your doctor does not have the level of expertise you originally thought was being offered.  Did you know you have the right to go to another clinic and that a good doctor will not be offended if you decide to make a change?  Here are some reasons why you might be better off changing providers:

•    Your OB/GYN Does Not Seem To Specialize In Infertility (Even If Their Business Card Claims That They Do)

OB/GYN’s are terrific at caring for pregnant women and delivering babies. They are not always so great at treating infertility.  I hear many complaints from clients because their doctor has offered ineffective, low-level treatment for so long that it has wasted time and money, prevented more effective treatment from occurring and possibly even put their health at risk. If you are 35 or older, it makes sense to start infertility treatment with a medical professional, such as a reproductive endocrinologist, who has received training in reproductive medicine and infertility. If you do not conceive after three to four months of oral medication use, or three to five intra-uterine inseminations with your OB/GYN, get a second opinion with a reproductive endocrinologist at a fertility clinic. You do not have to ask your current doctor for permission or for a referral to do so.

•    You Feel Like A Number At Your Clinic

This is a very common complaint at fertility clinics. You might need more one-on-one time with your doctor than is being offered to you, or you may not feel that your care is being individualized enough to suit your specific needs. The American Fertility Association’s Professional Network, online patient groups and the SART are all sources of referral and recommendation for doctors and clinics with whom you may feel better suited. You may or may not decide to pursue treatment with another clinic or doctor, but you certainly have the right to do so. Self-advocacy can help your treatment efforts feel much more comfortable.

•    Another Clinic Offers More Options

Some clinics offer a larger variety of fertility treatment options than others, such as PGD or frozen donor egg cycles. Another example is that some clinics are offering time-lapse embryo incubators that offer better predictors for success in pregnancy. You might simply prefer to work with a female or male doctor. Work with the clinic that best fits your needs, not just the clinic that is closest to your house. Do your research, then trust your intuition about which clinic or doctor is the right one for you.

•    Traveling May Yield A Better Option

It is becoming more common for people to travel to the clinic that best suits their needs.  For example, if you have had recurrent pregnancy losses, traveling to a fertility clinic that has been doing research in that area may cost some money and time but give you your best option to have a full-term pregnancy.  However, traveling just for the sake of traveling may not be your best option. Consider the costs in time and money and what you will be “buying” for the extra effort.  Traveling to a less expensive clinic may not be better, nor is cost necessarily a reason to make a change.

•    You Have Been Traumatized By Something Or Someone At Your Clinic

Going through infertility treatment takes a lot out of you on even the best of days. On the worst of days, there has been no heartbeat on the ultrasound, or someone has not been empathetic enough to help you with your already bruised feelings.  It is not uncommon for people to have symptoms of anxiety, depression, and even PTSD during infertility treatment. If that is you or anything at all has made you feel uncomfortable, you do not have to go back there, period.  Starting over with another clinic may help you to reset the treatment experience and increase your level of hope.

•    You Just Don’t Like Your Clinic And Don’t Want To Continue There

We all get different signals when we interact with health care professionals and organizations. The culture of your clinic can make a difference in the experience. If you feel welcomed warmly when you step up to the reception desk and truly heard by your empathetic doctor, this may be a factor in your continuing treatment at that clinic. On the other hand, if that one nurse bugs you every time you have an interaction with her or your doctor seems rushed and doesn’t take the time to answer your questions, you have the right to seek treatment elsewhere.  Before you choose to make a change, remember that your emotions may be too raw to make a good decision. It is always helpful for both partners to attend appointments if you are in a couple, to get the best possible information about the doctors’ or nurses’ attitudes as well as the data being offered. Ultimately, what you want is a knowledgeable doctor and clinic that can help you to have a child. Sometimes it is okay to put up with someone’s attitude or presentation to get the best possible medical care.

If you opt to change doctors, keep in mind that your medical records, including sonogram films and reports, are your property. Requesting these may be stressful for you and if so, you can ask the next physician you decide to work with to get your records for you. You also may need to make arrangements to have eggs, embryos or other types of samples moved along with you. Your new physician and their staff will be able to help you with that change as well.

Changing doctors is not personal.  It is about advocating for yourself and your needs.  The bottom line is that you have the right to work with any clinic or any doctor that is the best one for you. Take your time and make your decisions wisely.  I trust your intuition.  I hope that you will, too.

Dr. Deborah Simmons is a marriage and family therapist at Partners in Healing of Minneapolis, specializing in infertility.

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