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.   

I originally wrote this blog post for Pregnancy After Loss Support.  I wrote it on October 15, 2015, Pregnancy and Infant Loss Remembrance Day, in honor of my clients, their partners, their families and friends, and always—always—the memory of their babies.  The presence of their absence is with us every day, but particularly on October 15. 

“She would be five years old now,” said my client wistfully, looking out the window.  “When I see a child of the same age, an imaginary movie plays in my head of what she would be doing.  What would she be like?  Would she be learning to ride a bicycle? Would she have a special blankie? Who would her friends be?  Who would I be as her mother?”

After the birth of a baby born still, time stops.  For a long time.  Devastation results.  It’s not just the death of a beloved, deeply wanted child but also the death of a dreamed of future.

And there are the unintended insults from others who forget about or gloss over a baby’s passing.  And questions about the next child.  Well, it might be a good thing to have another child.  Sure.

At some point.

If you are not terrified.

And if you have hope.

And if you are healthy.

And if you and your partner agree.

And if you don’t have fertility problems.

Or you have not had one or more previous pregnancy losses.

But there’s a problem with other’s hurrying you along.

The baby you can’t forget is the baby others can’t remember.

“The English language lacks the words to mourn an absence. For the loss of a parent, grandparent, spouse, child or friend, we have all manner of words and phrases, some helpful some not. Still we are conditioned to say something, even if it is only “I’m sorry for your loss.” But for an absence, for someone who was never there at all, we are wordless to capture that particular emptiness. For those who deeply want children and are denied them, those missing babies hover like silent ephemeral shadows over their lives. Who can describe the feel of a tiny hand that is never held?”

 — Laura Bush, Spoken from the Heart

We don’t replace children with new children.  They are all beloved, whether they are in front of you or in the front of your “heartmind”.

This is the essence of what Pauline Boss, University of Minnesota Family Social Science professor emeritus and one of my doctoral professors, calls ambiguous loss.  The baby is not physically here but psychologically present.  We may not be able to reach out and hold the baby but she or he is very much here in mind and heart.  Miscarriage and stillbirth are a type of disenfranchised grief.  Too often, what people don’t see, they don’t acknowledge or attach to.  “Unfortunately, in the United States, the size of the coffin, the size of the grief.  If there is no coffin, there’s nothing to grieve,” said Sharon Covington, MSW, LCSW-C at Shady Grove Fertility Center.

It can be tricky to navigate the absence of their presence.  Living here in the Midwest, the first question out of a new person’s mouth is “How many children do you have?”  Some of my beautiful patients name all of the children, those who are living and those who are living in the heartmind, with the brief version of pregnancy loss and perhaps the long journey to pregnancy.  Others shrug and hope that they don’t cry.

You are grieving the child you never knew.

Except you did know a lot about that child, in a way that no one else on this planet has done.  You saw that child in your mind and you attached.  The presence of their absence.  You invested in your dreams for yourself and that child and your family. Loss is both now and future.

But you can heal.  The experience of having a stillborn or a miscarried child is real and it stays with you.  With time, therapy, prayer, compassion for yourself, and other experiences, including some experiences that I don’t have words for, things can change.

I heard a story from a beautiful bereaved mother who was taking a walk on a still warm fall day.  She described a stunning back-lit tree with yellow leaves that was losing its leaves in that very moment.  She said it was like a gentle shower of leaves. She heard a voice in her mind that said, “I’m okay and you are going to be okay.”  She felt a sense of almost instant peace.  She knew in that moment that that was her deceased baby son.  She had no doubt about that and I didn’t either.  Her son was present for her in a way that is filled with love.  She is a bereaved mother.  She is a forever mother. And she will be okay.  And you will be okay, too.

You have started fertility treatment with great hopes. You hope to conceive on the first attempt of whatever type of treatment you begin. Unfortunately, that is not always the case. Fertility treatment can become an obsession that can challenge your health and emotional well-being. Knowing your limits can help you to feel more in control of your treatment options and schedule. Yes, there are choices to make along the way, even if they feel like forced choices. Here are 8 suggestions for when you choose to continue or to stop infertility treatment.

1) Make some decisions up front—It is important to know what you and your partner can and cannot do about treatment options. Some of this will be determined by finances. It is unwise to pursue treatment to the point of bankrupting yourself and your future. A baby at any cost can be harmful to you in the long run. Negotiate what makes sense to you and your partner. It is common that one partner is willing to pursue many options but the other partner is less comfortable. Sometimes treatment options bring moral or religious concerns. Discuss such concerns with your partner and your clergy, if necessary, to know how far you wish to pursue treatment. There is a caveat to early decision-making: the finish line often moves. For example, inseminations do not work and you find yourself open to using IVF or donors eggs. Start over and renegotiate with your partner.

2) Set a timeline for family building—Trying to have your first child or adding to your family can take years. Know how long you wish to pursue a parenting plan and by which means (i.e., inseminations, IVF, donor eggs or sperm, surrogacy, adoption). I hear often from my clients that they will continue with treatment until their birthday, a 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 in life for all of us. Put some time limits around your efforts.

3) Measure your level of hope—Having some level of hope is huge in making decisions about fertility treatment. You still have gas in the can. You feel resilient. You and your partner have enough energy for another try or for trying something different to build your family. You are both on the same page. If you can muster the finances to keep going—without wrecking your financial life, your sense of yourself, or your relationship—keep going. If hope is waning or out of gas, consider other options or stopping.

4) Accurately assess your chance of success—If your doctor is willing to keep going and there is a reasonable chance of bringing home a baby, keep going. However, if you have done many, many cycles of treatment and hormone levels show poor prognosis, we must take that into account. Hope is good. Denial is not.

5) Are you giving it your best shot—You don’t want to have regrets. In fact, avoiding regret is one of the strongest factors in undergoing treatment. Often people have a strong need to have the chance to try some sort of fertility treatment, even if test results aren’t too good. What’s interesting is what the range of “trying” means. For some, this may mean three cycles of timed intercourse with Clomid. For others, this may mean going from inseminations, to multiple IVF cycles, to donor eggs, or adoption. You have to balance the need to try with the need to be realistic. You have to be real about what can you afford. You have to be real about the effect of “trying” on your mood and your relationship. Is this just a bump in the road or one too many potholes that you can’t recover from? Give it your best shot, whatever you choose to do.

6) Are you 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. It is also just fine to say that you don’t want any more medications at all.

7) Have you have lost the reason that you are trying to building a family—You may feel that you have to keep going because you started and the project is not complete. Many people continue treatment for fear of disappointing their families or their partner. With secondary infertility, people will continue beyond a breaking point because of guilt that there will not be a sibling for the living child. Staying with it because of fear of disappointing others, guilt, or shame are not reasons to continue fertility treatment. Losing yourself is a problem in and of itself.

8) If you are feeling traumatized and running out of energy—You are really, really tired. Of EVERYTHING. You feel defeated. Your spirit is deflated. If you cannot stand driving near the fertility clinic, cannot take one more injection, you feel beat up, or that 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. It is 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. Your partner’s got no more gas in the can. This is a time to pack up and find peace over time.

Pay attention and trust your intuition about when to continue and when to stop infertility treatment.

Sometimes the answer comes to you in an unexpected way. 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 “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.”

There are choices to be made. You can make them. Perspective matters. You can be reactionary and say, “Dammit, I want to stop right now!” You can. And then what? If you stop, what does that look and feel like? Grief? Bitterness? Relief? Acceptance? Do what you can to say that you fought the good fight and that you have done everything you could to get what you want and need. Then give yourself time to find closure. Closure takes however long it takes. There is no set amount of time to heal. Finding acceptance and peace is a choice. You will know when you are there. And truly, you will be okay at some point. I promise.

How did you decide to continue or stop infertility treatment?

It’s Father’s Day and many men will be celebrated.  How about the fathers of a stillborn baby or after a miscarriage?  In my office, I tell many a man, “You are still a father after pregnancy loss.”  It doesn’t matter that others have not met the baby or didn’t know that you and your partner (or a gestational surrogate) had a miscarriage. You are still a father after a stillbirth or miscarriage.  I see you. I know.

The Star Legacy Foundation and Face2FaceTwin Cities ‪‎stillbirth support groups have merged. Groups start tomorrow, 6/9/15, at Partners in Healing of Minneapolis.  All groups are free and are offered on Tuesday evenings.  Support group facilitators are Joann O’Leary, PhD, MPH, and Debbie Fischer.

Pregnancy After Loss Support Group – Losing your baby was the most awful experience of your life. Now, facing a subsequent pregnancy is filled with hope but also great anxiety and concern. Learn to nourish your pregnancy while honoring your grief. Talk with professionals who can support you through this journey; meet other expectant Mothers who are on your path but also those who have been through pregnancies subsequent to their own losses.This group meets weekly on each Tuesday of the month from 5:30 pm to 6:45 pm at Partners In Healing, 10505 Wayzata Boulevard, #200 Minnetonka, MN 55305. Enter on the west side of the building.

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…