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.

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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

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.

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.

Now.

Here in Minnesota and across the United States.

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

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.