I read an article recently entitled “­Mother who spent £20,000 on FOUR rounds of IVF says she was made to feel ‘selfish’ because she already had a child – and reveals her battle to conceive felt like a ‘shameful secret.’ (www.DailyMail.com, March 30, 2017).  Note the “FOUR”, as if that’s SOOOO much.  It’s not.  Most of my patients do whatever they need to do to build their family.  If a doctor told them to stand on their heads and cluck like a chicken, they would do it.  And they are often judged negatively for it.

Secondary infertility is the red-headed stepchild of the reproductive world. Secondary infertility gets no love at all.  It is confusing and maddening.  This is an ache.  Yearning. There is nothing logical about wanting a child or children.  We just want it.  The pain and obsessiveness of the chase is very similar to primary infertility with one big difference: people are fresh out of empathy for you.  Even people who are trying to make their first child don’t quite understand your distress.

I’m learning to live without you now

But I miss you sometimes

The more I know, the less I understand

All the things I thought I knew, I’m learning again…

“The Heart of the Matter”

By Don Henley

Let’s say your first child was conceived in the bed with some pleasure or in a doctor’s office.  Great! That went well enough.  Let’s repeat a successful process.  Wait. Things aren’t working.  Time is passing.  Things are getting more confusing.  It can be a crushing blow when attempts at the second child go flat.  There is a sense of panic because you are trying to make sense of something that makes no sense.

WHAT THE HECK IS GOING ON HERE!?

Inseminations worked before.  Why aren’t they working now?

IVF worked for us.  Why can’t we get good embryos again?

Nobody ever told me that I might not be able to get pregnant again!

Why am I having miscarriage after miscarriage?

When did my AMH (Anti-Mullerian Hormone) level plummeting?

Unfortunately, there are seldom answers to these important questions.  Urgency and anxiety grow in the absence of data and certainty.

This is when the questions and “helpful” comments start from others.  Let’s list them, shall we?

• What’s your problem? At least you have a child.
• You’ve got what you wanted. Why can’t you just be grateful that you have a child?
• Aren’t I enough? (This one seems to be is a specialty of the male species.  She loves you a lot but she needs something more.  Read my earlier blog post “No Fellas, She Needs a Child, Too.”)
• Maybe it’s meant to be. Move on. Get over it.
• It’s not the end of the world if you have one child.
• This is God’s way of saying (________).
• Why would you spend money to have another child? (Hint to the helpers: why wouldn’t you?)

Exhausting, all this “helpful” advice.

I understand your pain.

I wish other people did, as well.

It is hard to explain to your child that he or she may or may not get the sibling they ask for.  You are trying.  So hard.  It’s not your fault.  You are a good person.

Your very real medical problem is being dismissed by others who cannot understand that your family is not yet complete.  Ask yourself how many children you have wanted.  I’ll bet that the number comes to you right away.  I don’t know of any research that explains that instant number that everyone seems to know.  I know that you are setting the table for another person.  You have invited them but they are not here yet.  And they may not be coming after all.

This is when empathy from others would go a long way.   It’s National Infertility Awareness Week from April 23-29, 2017.  If you have the energy, teach the people around you about your pain.  Because it’s real. I’m doing my best to do the same.

Please hang in there.  Hold on to the dream, if there are different paths to take that might make the dream come true.  And if you are at the end of the journey, your grief is real and true.  Your tears speak to what might have been, and who you are now.  Give yourself the time and grace to heal. Because you will.  And new dreams will form…

#ListenUp #NIAW

Infertility turns your life on its head. This is especially true of people who label themselves as planners or control freaks. Unfortunately, there seem to be a lot of control freaks and planners in the world of infertility treatment.

I really am not sure why this is so. There is nothing about the world that we can control, really. We can’t control the weather but maybe we can control the type of clothing that we put on. We can maybe control the type of food we put in our mouths. We can control how fast or slow we drive. You can control which clinic you work with. But when it comes to the big stuff, like a medical problem like infertility, we cannot control it at all. We can only control our approach to it.

Infertility treatment is physically, emotionally, socially, and financially challenging, as you well know. One of my patients called infertility, “controlled chaos. It is a lot of juggling.” All of the required medical appointments wreck your work life. The timing of an IUI or IVF cycle wreck your personal life. So what you do? You try to control other things. You go to the gym to work off the anxiety and try to control your body, because the hormones you are adding weight to your adorable body. You go to acupuncture and maybe take herbs. You quit caffeine and alcohol. You figure out how to eat “right” or perfectly.  I have wondered if planners take on the strict regimens of infertility treatment as a good thing or not so good thing. After all, it is something that can actually be planned. Another patient said, “Infertility feels like one too many things. It is so much to take track of.  Which times to take medicines. Which doses. Which days to be at the clinic.”

Control freaks are trying to control anything and everything, as a way to tamp down anxiety. In my experience this is the case prior to a diagnosis of infertility. The codes words “I am a worrier” are often my clue that I am working with someone who calls themselves a planner. Often this goes back to childhood. It is code for anxiety. The uncertainty of infertility sets up all kinds of “what if’s” that are beyond our control.  What if I get pregnant just in time for the family cruise to South America? What if I lose the baby? What if my boss doesn’t appreciate my working less? What if I drink too much coffee? What if I never get pregnant? And then there are always the coulda/woulda/shoulda’s.  Control freaks look for something—or someone—to control.  But control is a myth.  You can make as many plans as you want. Life has a way of happening right under our nose.

I feel for you. I really do. Humans look for answers and certainty. Medical problems like infertility offer question marks and uncertainty. I have learned over the course of my life that I don’t know nothin’ about nothin’ and that flowing works better than controlling or planning.  What I know, in truth, is that the only thing we can control is ourselves. Yeah, that sucks but it’s real.

Let me share something with you that is very helpful during anxious times. Break down time into 15 minute blocks. Most of us can control our lives in 15 minute blocks. When you get to the end of that time block, start the next 15 minute block.

You can plan, perhaps, for the next 30 minutes or hour or day, but don’t get too far out ahead of yourself, because anxiety is waiting to say hello and kick you in the behind. Meditation can help, too, but I think that moving meditation maybe works better for somebody who is anxious. Walking slowly, and I mean slowly, while you just observe your thoughts or physical sensations without judgment can be very helpful. Step by step.  Just like life.  Another way of moving meditation can just be to sway slowly back and forth and just letting things be.

So be aware of what you can actually can and cannot control.  Make plans as long as you know that plans are just a thing, not something that may come to pass. I’ll tell you personally that when you let go of the need to control your world, things ease up. It may seem counterintuitive but it’s true. And the 15 minute time block idea may change your world for the better…

#NAIW #ListenUp

I have noticed that fertility clinics are not chatty places.  I also hear many of my patients talking about why they don’t talk about infertility with others.  Why is that?

I think it’s infertility shame.

Maybe you already know what I’m talking about. Suffering in silence. Keeping your head down. Not telling other people in your life about the fertility struggles you are having because you are embarrassed. Feeling that there is something wrong with you. Learning through others’ stupid comments that it’s not worth trying to talk about it.  Infertility shame tells you that you are a failure because getting and staying pregnant are not happening in the way that you were promised.  That you are different. You are living in a bait and switch world.  We have all been told that you get pregnant any and every time you have intercourse.  Well, that story happens for some people, I suppose.  But if that was true of everybody all the time, the Earth would be groaning with the weight of trillions of people.

I’ve been there.

I never understood my reproductive “stuff” because doctors told me that everything was normal. Before I really even understood what intuition was, I knew that my reproductive stuff was NOT working correctly. Getting a period and bleeding for weeks and then nothing; repeat. Terrible cramps. Menstrual migraines.  You get the picture. It didn’t make any sense at all. And then…I tried to get pregnant.

My husband and I were told to use a basal body temperature thermometer and chart my cycle. Let’s cut to the chase, shall we: there was no obvious ovulation. Ovulation kits were expensive and the 14^th day of my cycle was as crazy as any other day. I detested BBT thermometers. I remember my ritual with my husband of cursing them and throwing them in the garbage. By some miracle we were able to get pregnant, even with wonky ovaries.  And then… I tried to stay pregnant.

What I found out ultimately was that the bottom segment of my uterus doesn’t work when it has too much baby in it. My uterus was not meant to be pregnant, not really. Aha, maybe that was what my intuition was about!  I felt like a failure for not having a body that would make things easy and for putting a baby at risk unintentionally. It took me some therapy and some compassion for myself to learn that my wacko uterus and wonky ovaries were beyond my control. I have learned that my uterus may have been “defective”, but I sure as hell am not.

And you are not defective or a failure either. You have some intuition about your body, too. Something isn’t working, or maybe something isn’t working for your partner. That is nothing to be ashamed of. It is beyond your control. It is something to work on, or work through, or work with. That may be with a fertility clinic or an adoption agency.

Shame is personal. It’s the shitty things we tell ourselves about ourselves. You sure wouldn’t say shitty things about your neighbor’s body, right? For other people you have a sense of conscience and compassion. You are kind and empathetic (hopefully) and you offer to listen.

Here’s the thing: for you to listen, somebody has to speak. Now let’s turn that around so that you can start to beat down your infertility shame.

For other people to listen, you’ve gotta talk.  You’ve gotta let it out into the sunshine. Shame is the shadow in our lives. You have to talk back to your infertility shame and beat it by letting it out. Sometimes that is talking with family or friends or colleagues at work. Unfortunately, that may or may not end up being a good idea, depending on the often dumb responses from other people from other people. Going to a Resolve meeting near you or online can be a lifesaver. Facebook groups, Twitter, Instagram, and Pinterest are great places to talk with other people, too.

www.bigstockphoto.com

You are not alone! One in eight couples in the United States struggle with infertility. In Canada, it is one in six couples.

It’s time to work with your Self. Please stop saying shitty things about yourself and your body. Stop apologizing, or explaining, or justifying the fact that you are struggling with infertility. This is a physical, medical problem, just like cancer or thyroid disease. You did not bring this on. With help and compassion, you may be able to beat it.

So listen up. The best way to beat infertility shame is to do it together. You and your Self.  You and me. You and Resolve. During this National Infertility Awareness Week, April 23-29, 2017, let’s work together.

Let’s. Beat. Infertility. Shame. Together.  #NIAW #ListenUp

Listen up!  It’s National Infertility Awareness Week, a week that is so important in my life and the lives of my beautiful patients.  This year’s theme, “Listen Up!” is a call to action for a multitude of interested parties:

• For people struggling with infertility, it is a call to do what must be done, to treat infertility sooner rather than later. Avoid regrets by taking action.  It is also imperative to talk openly about the physical, emotional, and financial difficulties that come with crappiness of infertility. Together, we can beat infertility shame! #ListenUp
• For couples struggling with infertility, get on the same page about what to do. This may mean getting to a specially-trained therapist who understands the emotional rollercoaster and medical issues of infertility.  You can find me and other therapists through the American Society for Reproductive Medicine.   Or you can talk with me in the office or online on videoconference.  Your relationship will be strengthened by working together.  #ListenUp
• For people who love someone with infertility, it is a call to action to learn and listen with a full heart, not to offer quick fixes or religious advice. Ask your friend or family member how they are.  Hug them when they cry. Drive your loved one to an appointment.  #ListenUp
• For OB/GYNs, it is a call to action to refer patients to fertility clinics quickly, especially if they are close to or older than 40. When your patients get pregnant with the appropriate fertility treatment, they will come back to you, with a grateful heart. #ListenUp
• For fertility doctors and OB/GYN’s, it is a call to action to refer your patients to Resolve and to specially-trained therapists before they are crying in your office. Thinking about your patients in a holistic way will buy you a lot of brownie points with your patients. #ListenUp
• For insurance companies, it is a call to action to change the ways in which you disenfranchise your subscribers from receiving the MEDICAL treatment they need and deserve. It’s 2017.  Infertility is not a desirable treatment, it is an illness process requiring medical treatment.  Here’s the truth: Fertility treatment doesn’t cost you that much. It is worth gold to your subscribers.  #ListenUp
• For legislators, it is a call to action to recognize that reproduction and parenting happen in many ways. Enact laws to recognize and support gestational surrogacy and to update parentage laws that recognize parenting through gestational surrogacy.  #ListenUp

We humans do best when we have a purpose and take action.  Listen Up!  It’s National Infertility Awareness Week.  #NIAW

An infertility diagnosis and the process of treatment can hijack your life.  One of my beautiful clients told me, “It feels like a being on a fast moving train without brakes, going toward an unknown destination and you can’t get off.”  Another told me, “It’s like a bad dream you can’t wake up from.”  Here’s what I wish people understood about infertility. It hijacks your life, similar to the possibility of a cancer diagnosis. Both spin your head around and can shake you to your core.  Are they exactly the same?  Of course not.  But there are similarities.  Here are 7 ways infertility hijacks your life:

1. Your plans for your life are now different. Most of us grow up with the idea that we will meet the right partner, plan our pregnancies, and enjoy our lives.  *screeeeech* Um, no.  The plans have changed against your will. Your life is now controlled by your menstrual cycle and a clinic.  For the gentlemen among us, you never planned to “produce a sample” with others’ knowledge, did you? I think not.
2. You lose control. Of your body. Of your work schedule.  Of your money.  Of your time. Of the way that things are just supposed to be.  Most of us don’t like something or someone else controlling us.  The many requirements of a treatment cycle control many parts of one’s days for weeks at a time.  Be here.  Do that.  Be here again.  Do this other thing.  Do it some more. For people who describe themselves as planners and self-described control freaks, infertility throws a wrench into the very way that you think.  *cue anxiety*
3. Your dreams of the future are altered. Your biggest worries used to be what month you would get pregnant in and where you would do yoga.  You wanted to space your three children 2½ years apart. You were already thinking about the Disney vacation.  You have had a vision of two children at your table.  Now you are grateful to be able to have one child. Or get pregnant at all.  (No, I’m not telling you to be grateful for what you have but somebody will, unfortunately).
4. Your life is on hold. It’s hard to make plans.  Your extended family is planning the dream vacation next summer.  Wait a minute, you might be doing an embryo transfer or waiting for your first ultrasound at that time.  And, of course, others will pressure you in a variety of ways. Why can’t you come to the party? Can’t you put off you insemination? Why are you always so preoccupied?  It is very difficult not to think about something, isn’t it?
5. Your finances have been hijacked. You might have been planning to buy a home, or a car, or plan for your retirement.   Now you may be forced into debt in a way that you have never considered. You must now think intentionally about money and its uses.  Why do you have to pay for a child when the weird neighbors
   pop out kids like popcorn?
6. Sex is no longer about fun or closeness. It’s a J-O-B.  Something to do on command, at the right time, on the right day.  Many of my clients have said something like this: “Have sex?  Why would we do that just for fun?  Our job is to show up at the clinic and punch the time clock.
7. The way you usually take care of your body has to change.  It is an unfortunate truth that fertility drugs often cause weight gain.  That might be okay if you could exercise but now you can’t exercise when and how you want to.  For many people exercise is how they manage anxiety and keep in shape.  Are you a runner or a triathlete?  Nope, you can walk though.  Like that feels the same.

Soooo, what to do?  

Know that this time in your life will be worth it, somehow. You will do whatever you decide to do and know that you have no regrets.  Maybe you will end up with the children you have dreamed of.  Maybe you will find you inner resilience and find out that you are a pretty tough–and great–person. Maybe your relationship will become even stronger than you could have ever imagined. Maybe you will become even deeper and more empathetic than you are now.  We figure out later, at some point in the future, how we have changed.  Fight back.  Be mad at infertility, not at yourself.  You will get through this.  Somehow.  Some way.  Remember you are not alone.  I am in it with you all the way along the journey.  (And please share this blog post with people who don’t get it!) 

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.