Unsung Lullabies [8. Vollig Neu B ed.] 9780312313890, 0312313896

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Must reading

for the

thousands

oi

people

struggling with the pain of infertility." —Chris tiane Northrup, M.D.

Janet Jaffe, Ph.D. Martha Ourieff Diamond, Ph.D David J. Diamond, Ph.D.

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"Drs.

Jaflfe

and they

and Diamond have

relate

how

also suffered

own

their

from longing

experiences have shaped

and professionally and have helped them address

and other couples with the emotional aspects of I

'nsung Lullabies

may

some peace of mind

find

to have a child,

them personally concerns

their patients'

infertility.

.*„

.

Readers of

as they start the healing

book on

process of their sorrows and wounds-*s thfy read this excellent

coping with longing for a child."

—

^^wJlflSjjjj-j

Lori L. Arnold,

BRj\HCb4

M.D., F.A.C.O.G., Boiro*e?M*d

Reproductive Endocrinologist and

"As an ob/gyn nurse practitioner, diagnoses and treatment.

.

.

I

see couples in

The combined

.

all

phases of

it

will

this

infertility

personal and clinical experi-

ence of the authors makes this a truly valuable resource.

mend

Infertility

thorough, thoughtful book to couples in

I

would recom-

my practice,

knowing

be a great source of comfort and information."

—Lisa A.

"As an adoption attorney, sung Lullabies has given

this

book

to

CRNP, MSN,

see couples at the very

I

me

exhausted as they face their

recommend

Clarke,

insight into last

any and

all

who

CA

end of the road. Un-

why couples

hope of becoming

San Diego,

are so emotionally

parents. ...

have experienced

I

highly

infertility as

well as to professionals in the field."

—Susan Romer, Ph.D., Attorney-at-Law, Law Adams and Romer, San "

Unsung Lullabies

for fect

women and

is

an insightful,

Offices of

Francisco,

CA

sensitive, useful, easy-to-read resource

their partners experiencing infertility. It strikes the per-

balance between realism and hope as well as a balance between

women's needs and men's. Too often men matter. Reading this selves in their

own

book

voices

will help

should read

are overlooked in the

—and women—

whole

express them-

and help the struggling couple through the

moils they endure. Everyone infertility

men

this

who knows someone who

is

tur-

experiencing

book."

—

Gail R. Shapiro, Ed.M., president of

Womankind

Educational and Resource Center, Wayland,

MA

"

Unsung Lullabies

is

an excellent read. The authors do a wonderful job

capturing the complex emotions and issues involved with

way

infertility in a feel

ter

the

way

reading

the patient can relate to.

I

finally

do, and so will anyone going through

I

many

technical

and

scientific infertility

who

it

all

aspects of

understand

why

I

reads this. Af-

books, this was such a

refreshing change."

—

Kristy Echelberger, president of

RESOLVE,

CA

San Diego,

"I

highly

recommend Unsung Lullabies

ficult infertility path. is

valuable. ...

years of

No

to

anyone traveling down the

matter where one

So many times

my infertility struggle

is

this process feels so lonely. this

is

the

first

—Linda Huston,

book of

must-read for

month

after

all

(both

month

when

news they

—David

it

the twelve

RESOLVE, Ohio

many

couples

challenged with

men and women!) who

for the

Of

kind."

its

president of

"This book gives language to the experiences of so unite, disintegrate, or just drift apart

dif-

currently in this journey,

who

infertility.

A

have ever waited around

are desperately

hoping

to hear."

When Good Men

B. Wexler, Ph.D., author of

Behave Badly: Change Your Behavior, Change Your Relationship and executive director of the Relationship Training Institute

"Janet,

Martha, and David share perspectives that can enrich our per-

we struggle we can survive

sonal and spiritual lives as

to weather the storms of infertility.

They bring hope

the roller-coaster ride of emotions

from the

first

that

diagnosis through to deciding

when enough

getting off the treatment merry-go-round to find peace

joy again, even

if

parenthood

may no

—Sandra K.

enough and

longer be an option."

Dill,

AM,

Australia Infertility International

is

and eventually

executive director of

Network and

Consumer Support

ACCESS

director of iCSi,

for Infertility

Network

Understanding and Coping with Infertility

Unsung Lullabies Janet Jaffe, Ph.D.

Martha Ourieff Diamond, Ph.D David

J.

Diamond, Ph.D.

* St.

Martin's Griffin

New

York

unsung

lullabies. Copyright

Ph.D., and David America.

J.

©

2005 by Janet

Diamond, Ph.D.

Jaffe,

Ph.D., Martha Ourieff Diamond,

All rights reserved. Printed in the

United States of

No part of this book may be used or reproduced in any manner whatsoever without

written permission except in the case of brief quotations

embodied

views. For information, address St. Martin's Press, 175 Fifth Avenue,

in critical articles or re-

New York,

N.Y. 10010.

www.stmartins.com

Library of Congress Cataloging-in-Publication Data

Jaffe, Janet,

Ph. D.

Unsung

lullabies

:

understanding and coping with

Ourieff Diamond, and David p.

J.

infertility

/

Janet Jaffe,

Martha

Diamond,

cm.

Includes bibliographical references

(p.

265) and index

(p.

269).

ISBN 0-312-31389-6

EAN 1. I.

978-0312-31389-0

Infertility

— Psychological

Diamond, Martha

Ourieff.

II.

aspects. 2. Childlessness

Diamond, David J., Ph. D.

— Psychological

aspects.

III. Title.

RC889.J33 2005 616.6'92'0019— dc22

2004063282

First Edition:

10

9

8

7

6

June 2005

5

4

3

2

1

This book

is

dedicated to our families,

past, present,

andfuture.

Contents

Acknowledgments Introduction: The Wish to

Part

ix

Become a Parent

I:

Reproductive Trauma: What Happens Things One: This Isn't

Supposed to Be

Part

Four:

How Can

Five.-

If

I

The

It

Hurt

Losses of Infertility if I

Everyone Else Can Six:

II:

Why Does

Be an Adult

Men Have

3

22

Two: Your Reproductive Story

Three:

When

Go Wrong?

How It Was

The Pain of Hope:

xi

So Bad? 47

Don't Become a Parent?

Do This, Why Can't

Feelings

Too

Seven: Relationships Under Fire

111

132

I?

87

67

Contents

viii

Part

III:

Grieving and Coping

Eight:

Grieving for the Pregnancy or the Baby

Never Was

153

Nine: Dealing with the

World

that

Part

179

IV:

Rewriting Your Reproductive Story

Ten: Eleven.-

Knowing When

to Stop

Trying

A New Ending, a New Beginning: Reproductive Story

209

Rewriting Your

229

Twelve: Parenting After Infertility: Singing Your Lullabies at Last

244

Epilogue

262

Resources

265

Index

269

Acknowledgments

There are many people we would

like to

thank

journey: our literary agent, Betsy Amster,

prodded

us,

as

we complete

who

has guided us,

and kept us company throughout every

stage of this

book; Jane Rosenman, for her early support of the book; Dellon, our editor,

who

this

Hope

picked up the torch and has steered us

through the process with wisdom and assurance; Robin Michaelson, for her boundless enthusiasm,

and

for

what we thought we could do; Laura editing of the proposal;

pushing us always beyond Bellotti, for

and Ann Harris, who has been a wonderful

mentor from the very beginning. Also, we'd lies

and friends

love, support,

patients,

their

so

who

own

much.

—

her perceptive

you know who you

and good meals.

Finally,

are

like to

—

we'd

thank our fami-

for their

like to

unwavering

thank our

many

have shared with us the sad and happy chapters of

reproductive stories, and from

whom we

have learned

The Wish to

Introduction:

Become

When you

a Parent

decide to have a child, the wish to be a parent be-

comes almost primal. You decide

to stop using contracep-

lovemaking, and imagine that conception will take place

tion, start

in a mystical, romantic sort

that you've always

What you

of way. You begin to

dreamed of singing

—

don't wish for

to

hum

the lullabies

your baby.

or even imagine

—

is

that this won't

happen. That instead of making love you might be having timed sex

on

a doctor's orders, giving yourself injections, providing

sperm samples. What's supposed high-tech pursuit. Even

might have be what

it

fertility

if

to

be natural has

now become

a

you knew or vaguely worried that you

problems, you never imagined that this would

took to try to make a baby.

Each of us has

a story, a

dream of what

a parent.

Although everyone's story

dream

to

come

But

if

you

is

it

will

unique,

be

we

like to all

become

expect our

true.

are brave

unfortunately, that not

enough

to pick

all stories

up

this

book, you know,

go that way. We, the authors,

Introduction: The Wish to

xii

know

this too,

we

technology

assisted reproductive

perienced the struggle of

we had hoped.

In

didn't think we'd have to utilize

either. Yet all three

infertility; infertility

of us have ex-

has affected each of

and profound ways.

us in unique

know,

all

too vividly, about feeling envious of pregnant

ashamed of our

couples and then feeling

numb,

feeling

a Parent

because our stories did not go as

our dreams to become parents

We

Become

angry, out of control,

jealousy.

lost.

We know about

We know

the nagging

worry that our spouse would stop loving us because we couldn't

We know

have a baby.

the feeling that we've done something

wrong, that somehow we are being punished. ness

and loneliness

Who

we?

are

—and

Martha of

we

First

are

a married couple

Janet, married to Jules.

who founded

Psychology in San Diego. because

without any support

—

We are also

it's

that's

what happened

women and men,

colleagues, a trio

through

to us.

help peoinfertility

And we work

counseling them on

when

how

to

go

as

their stories don't

they hoped, whether they are coping with birth,

and

the Center for Reproductive

like to struggle

deal with the emotional upheaval

premature

— David

We joined together seeking to

we know what

with hundreds of

the crazi-

infertility brings.

clinical psychologists

ple,

We know

infertility,

miscarriage,

postpartum adjustment, or other reproductive

trauma.

Unsung Lullabies grows out of our personal tility,

which have shaped who we have become personally

professionally,

and from

is

whom we

our pain, and our solutions have,

tions. In these pages,

as well as

listening to the heart-wrenching stories

the individuals and couples with

pain

struggles with infer-

we hope

we

of

have worked. Their

hope, been their solu-

that you, too, will find insight

and

Introduction: The Wish to

why

understanding as to

Become

full

which

labyrinth of feelings

—

hear your unsung lullabies

We

believe that once

meaning behind the

psychological

infertility creates,

you

those innermost thoughts and feelings

from the deepest

insistently,

falling apart.

We

from the

ples

storm

hope that these

stories

— and go on

yourself,

to

of others

make

be able to

will

about your longing for a baby that well up, softly

more

xiii

being unable to have a baby can cause an

ongoing current of emotional repercussions.

you comprehend the

a Parent

at first,

then

—without

parts of your being

insights,

combined with exam-

help you to weather the

will

the wisest reproductive decisions for

your partner, and your family.

Who We Are Before

we go any

experiences.

further,

we'd

like to share

While our diagnoses

differed

some of our personal

and we underwent

ferent aspects of the assisted reproductive technology

we did

cess,

live

dif-

(ART) pro-

through similar emotional pain and trauma.

And

those underlying emotional similarities in our experiences far out-

weigh the differences in our For each of

us, the

specific individual trials.

way things went was

what we had envisioned and hoped. Here

painfully different from are our stories:

Janet

As

a

young

girl, I

the Ballerina" played

did

I

love the music,

loved to dance for hours and hours as "Tina

on our I

living room's record player.

loved Tina's story: she travels to Paris to see

when

the

classes.

But

the ballet and saves the day by dancing the lead role

prima ballerina I

is

Not only

injured.

took ballet to be

like

Tina.

And

I

loved

my dance

— Introduction: The

xiv

Wish to Become

a Parent

my turn came to pirouette across the room. Would I shine and get noticed for my dazzling grace and I

became very nervous when

also

form

Tina?

like

What would happen

Fast-forward several decades.

and not ready yet

chimed was

I

early thirties,

was

I

dance

was

I

but could

designing the baby's

I

was our turn really

becoming

my first miscarriage,

I

do

it." I tried. I

room

It

right

again

this?

and have

a

I

had

felt

baby and

worried about "being" a

I

"becoming" a parent.

a parent didn't go smoothly. After

was told by various medical

well as family and friends, to "go

about

room

anticipation

to try

didn't expect to have problems say,

clock

was surprised and overwhelmed.

I

start

The same nervous

class returned. It

Needless to

ca-

my arms.

also scared.

thrilled,

parent;

mid-

When my biological

pictured myself dancing around the living

time with a baby in

But in

my

parenthood.

for

could do to not

all I

away! this

in

I

my

married Jules in

and we postponed having a baby, both busy with our

twenties, reers

I

if I failed?

really tried.

on vacation,

professionals, as

relax, don't

think

We did go on vacation and I lay on good time, trying my best not to

the beach, pretending to have a

think about

it.

Easier said than done.

My second miscarriage occurred five months later. bathroom constantly

when

pregnant; firmed.

I

I

to

started spotting,

my

go to the I

was

deepest fears were con-

was devastated.

As each month and each unsuccessful

more and more despondent. Everyone nant, or

I'd

check for blood during the ten weeks

it

cycle passed,

else

I

had nothing

to say.

unsure of myself. Unlike the young dancer in

became

me was

around

seemed that way. Conversations with other

evitably turned to babies;

I

I

preg-

women

felt lost

command

in-

and

of her

I

Introduction: The Wish to

bodv,

my body

Having

xv

a Parent

was no longer responding the way

baby was out of

a

Become

wanted

I

it

to.

my control.

After five years of continued trying, meeting with eight different doctors, having test after infertility surgical procedures,

I

had

my

test,

drug treatments, and

third miscarriage.

My husband and

doctor, although upset by the miscarriage, were weirdly elated

was able

to get pregnant, they cheered!

share in their excitement, however, and

I

—

could not and did not

felt

only doom. Lying on

the gurney that time there was no anxious anticipation waiting for

my

turn.

knew

I

the routine

too well.

all

have a baby, and the physical pain pared to

I

was

as if

I felt

feeling

I

would never

was nothing com-

my heartache.

Martha

When

I

was growing up, our family spent summer vacations

camping.

I

loved searching for the right campsite, hiking through

meadows, and roasting marshmallows around the those times

I

remember

ways knew that

when ible

I

When

I

bill

I al-

family one day, and that

chose to do would have to be compat-

I

mom.

work

we had

When we

realized that he felt the

children.

I

could then cut

That was our grand

decided to begin trying,

of health.

I

stopped taking the

same way,

I

We agreed that I would finish my

for a while so

I

went

to

down

to part-

plan.

my doctor and got

had always taken good care of myself. The

doctor even remarked that I

my own

family was in our future.

time once

a clean

would want

met Dave, and

doctorate and

During

feeling such a strong sense of family.

grew up, whatever

with being a

knew a

I

fire.

Pill

I

had a

great build for carrying a baby!

and waited the

requisite three

months.

I

Wish to Become

Introduction: The

xvi

was

ready.

Sometimes

found myself window-shopping

I

backpacks and off -road

strollers as

Only nothing happened.

And when

Pill.

lasted six weeks,

And

finally did,

my

and more

shots.

period after going off

menstrual cycles sometimes

told us that

How

We

months and

to be true

could this be happening? wasn't

ther

away from the family campsite

It just

wasn't

and

fair.

Dave

fair for

either.

were

I

our de-

to

was never supposed

step,

I

felt

further

had always dreamed

awake

each

allergic to

different things at night,

to be

and

fur-

of.

touched

we were both

Sometimes we could help each other

struggling with our infertility.

and sometimes we couldn't.

I

years of tak-

diagnostic sur-

and only added

Although

different images kept us

tempted to forge a

It

With each

way.

tests,

even coped with diagnostic

Dave and

this

It

my

ten.

— one doctor —which turned out not

spair.

never got

I

temperature every morning, painful

errors

other

I

sometimes

gery, shots, shots,

us,

baby

daydreamed about when our

so our infertility journey began:

my

ing

I

for

family would go camping.

new

the

a Parent

It

trail in this

was a shared loneliness

as

we

at-

uncharted wilderness.

Dave I've

garage

my dad, I have a and since working alongside my father when I

always been a full

was young,

of

tools,

my

fix-it

kind of guy. Like

favorite Saturdays

have been spent tinkering with

the car and working on projects around the house. things,

and

I

like

making

always had visions of building the perfect tree house,

my kids hammering away next when my kids would be old enough with

I

to

me.

to use

I

even worried about

power

tools.

But that

Introduction: The Wish to

was before the

infertility,

Become

a Parent

xvii

before our project of building a family

began to change.

When we was

to take care

me

things were going.

side, it

for her.

too struck

ment had by

it,

The

home when my

much and

I

was

me how

friend Steve asked

appreciated his question, because the treat-

I

time become a major focus of our

this

main job

realization that the situation

was worried about our current treatment

I

my

thought

I

of Martha; she was going through so

needed to be strong hard for

through

started going

first

lives,

cycle

and

in-

and whether

would work. However, not wanting

Steve

I

was getting

the nurse said

more

wife

I

how

concerned

to be a pro at the shots,

.

launched into a story of a friend of a friend

IVF

a successful

was,

I

told

my

thought of

I

then turned serious. "Don't

might upset her

it

I

and joked that while

should imagine poking an orange,

as a peach. Steve laughed,

Martha, because

tell

to reveal

he told me,

."

.

as

he

who had gone through

treatment, only to lose the baby late in the preg-

nancy. Steve didn't notice as

such tragic story

first

what

hit

me

would upset I

her."

that

moment,

Steve's story as ple,

of

was

What I

drew

in a tense breath. It

had heard, nor would

I

the hardest

was shocked, and

At

I

Steve's opening:

"Don't

the hell did he imagine

I

realized that

I

felt

it

tell

last.

But

Martha,

would do

to

it

me?

every bit as upset by

he worried Martha would be.

What

be the

was angry.

including myself, assumed that just the

infertility.

it

was neither the

about the man?

What

I

wondered why peo-

woman

felt

about me?

didn't occur to Steve to tread lightly with me;

it

was

I

as if

the pain

guess

it

my feel-

Introduction: The

xviii

ings were invisible. After

all,

Wish to Become a Parent

we were both

be anxious and worried too.

I'd

only was plex

I

not invisible, but

and deeply

Just like

So

ers.

tering

I

—

infertility

profound.

I felt

of

manly because

to being a parent.

I

of our baby. As a kid,

I

I

years, as the three

of us

having

not

could not

for Reproductive

about our experiences, we realized

doctors had been great; others had

"fix" this

how much we had

filled

will

be okay" attitude

was dismissive of our

sive

and wanted so much money that we retreated

Other doctors seemed aggres-

suffering.

in helplessness.

Friends and family wanted to help, but they didn't

and

realized

as couples,

how much we had

and how alone we had

When we were going through port for

what we

hurt the

way

not, that

it

really

did,

needed

and

a

suffered as individuals

there

that end, in

was so

little

deep understanding of

sup-

why

it

whether we had a baby or

survive this living hell.

part of our mission to provide the help that

To

know how. As

felt.

a reassurance,

we would somehow

all

infertility,

—

common

We agreed that some

that

we

in

notes

us with false hopes and a

condescending "there, there dear, everything

talked,

problem.

down and compared

sat

was

children

Psychology

despite the differences in each of our stories.

we

Not

my two much-younger brothadded to my own pain in encoun-

prospect

the

The Center Over the

was.

take care of

to do. This

less

I

my own feelings were every bit as com-

had so looked forward

my mother

knew what

didn't think

even scared. But

a father, to take care

couldn't wait to be

had helped

I

He

my wife's.

felt as

Martha,

Or

guys.

It

has been

we

so sorely needed.

1996 we established the Center

for Reproductive

Introduction: The Wish to

Psychology to help others

who

suffer

productive traumas. Unique in

its

from

a Parent

xix

and other

infertility

re-

focus, the center offers counsel-

who

ing to individuals and couples

Become

are experiencing infertility,

miscarriage, premature birth, multiple

and complicated

We

well as postpartum adjustment problems.

births, as

also help people

grapple with the complicated decisions regarding the use of donor

technology, surrogacy, and adoption.

We

also serve as a resource

toral students researching

ductive issues for both

and educational

many

center, with doc-

psychological aspects of repro-

men and women.

Research

at the center

is

leading to a deeper understanding of the psychological impact of infertility

and other reproductive

crises.

We lecture

internationally, at hospitals, doctors' offices,

nationally

and

and professional con-

ferences to increase the sensitivity of the medical

community

to

the depth of the trauma that infertility patients are experiencing.

We speak to nurses, will listen

midwives, and book clubs;

Why We Have Written Not only do we

we

lecture wherever

clients, their spouses, their doctors,

of

talk to

whoever

about the importance of understanding the meaning of

this experience for individuals, couples,

our

we

clients' stories

over the years

isolation, the feelings

—

and extended

this

can,

Book

we

also listen

and our own

hearts.

—

to our

Hearing

the painful emotions and sense

of shame and self-doubt

that we, ourselves, wrestled with,

family.

made

us

—

want

all

the feelings

to provide

you

with the help we didn't have. Sadly, the to the

number of

American Society

infertile

for

couples

is

staggering. According

Reproductive Medicine,

infertility af-

— Become

Introduction: The Wish to

xx

women and

American

fects 6.1 million

a Parent

their partners

mately one in ten of the reproductive-age population.

more people

are utilizing

—

approxi-

More and

ART every year.

Reproductive technology

is

both a

gift

and

On

a burden.

the

one hand, with the incredible advances in reproductive medicine,

would not otherwise

couples have opportunities they

same technology, however, that people have never

creates painful

had

have.

The

and complicated choices

to face before.

Unsung

Lullabies helps

couples understand and sort through these difficult dilemmas.

We you

hope that the

feel less alone. (Please

case studies.)

You

often feels like

we

I,

important

est layers

you recognize

feelings

—but

of our identities

and

this

way, although

how

as such. Infertility involves

it

as

human is

beings,

and may

trigger a

confusing, complex, and difficult

We explore what happens when

are derailed

trauma, and

infertility as a

the experience also taps into the deep-

sense of loss and trauma that to navigate.

clients' confi-

Unsung Lullabies

to

that

is

share will help

it.

why we define

it

we

identifying details in our

one hurting

explain

many painful

how you

clients that

note that to protect our

are not the only

Roadmap In part

of our

we have changed names and

dentiality

it

stories

things go so

by the medical interventions used

treat infertility as well as the

emotional side

wrong

to diagnose

effects.

We

also

introduce the concept of your "reproductive story," your vision of

what

it

will

be

like

fuels the intense

In part debilitated

II,

we

when you become

emotional issues explore

by your

why

a parent. This inner narrative

at the heart

all this

of

infertility.

"hurts so bad."

diagnosis; your sense of self

You may

feel

may be crum-

Become

Introduction: The Wish to

By recognizing and acknowledging

bling.

causes

ity

— from

of feeling

life is in

control

—you can

many

the

the loss of feeling healthy

gain

a Parent

losses infertil-

and normal

some

xxi

to the loss

control over the

overwhelming pain and confusion you may be experiencing.

We

also focus in

how

depth on

ships with your partner

and your family, with suggestions on how

We

to cope with these changes.

men

that

deal with this loss

Too

the couple.

men

yet

ways

also discuss the particular

and trauma,

often the pain

are just as

your relation-

infertility derails

men

as well as

experience

isn't

its

impact on

acknowledged,

prone to intense feelings about

infertility as

women. In part

how best

III,

to

we

talk about the necessary steps

cope with an

infertility-insensitive world.

acknowledge and handle the tremendous get your period each fails?

and

month

You've invested so

loss

you

much

feel

when you

personally, emotionally, physically,

financially, yet the outside

world doesn't recognize your feel so vulnerable.

meaning remarks can "zap" you; we suggest how

We

How do you

or an in vitro fertilization (IVF) cycle

Being in the world can be tricky when you

trying situations.

of grieving and

also discuss

how

loss.

Well-

to handle those

to cope with holidays, ex-

tended family, and the strain on friendships.

how you

rewrite your reproductive story

you proceed through treatment.

We cover the decision of know-

In part IV, as

ing

when

we

discuss

to stop trying,

and how

to

make

decisions regarding

donor technology, surrogacy, adoption, and remaining

We've also included a chapter on parenting after infertility

trauma can

persist

childfree.

infertility, since

even after the birth or adoption of a

baby.

Writing Unsung Lullabies,

as heartbreaking as

it

has been at

xxii

Introduction: The Wish to

Become

times for us, has also contributed to our

own

a Parent

healing.

contributes to yours as well, even though at times tionally difficult for

you

to read.

We

realize

we

it

We

may

when you understand why

emotional havoc that

infertility

wreaks

time healing your sorrow and wounds.

this hurts so

—

you

will

it

be emo-

are bringing

painful feelings and emotions at a vulnerable time, but believe that

hope

we

up

firmly

—

bad

the

have an easier

PART

I

Reproductive Trauma: What Happens

When Things Go Wrong?

One This Isn't

How Was It

Supposed

to

Be

For couples experiencing infertility, wanting a baby The

unlike any other.

intensity of

your longing

is

a craving

is

matched

only by the complexity of the emotional and medical maze you

must ity,

navigate.

When unexpectedly faced with the sting of infertil-

would-be parents experience an unacknowledged trauma that

leaves

them

feeling not only frustrated

and angry, but

sad, fright-

ened, confused, guilty, overwhelmed, and out of control.

You may

feel as

though you

caught up in a swirl of

posed to

We,

be,

wondered

and these

this too, as

us. "It's so

Emily, a thirty-six-year-old teacher. circles

under her

getting pregnant else

is

—

eyes. "I never

I've

this

how

as you're it

was sup-

happening to me?

we were going through

are the first questions that

and men we work with ask

dark

your mind,

difficult feelings. This isn't

you think. And you wonder, why

the authors,

fertility,

are losing

many of

the

hard to talk about

Makeup

thought

I

in-

women

this," said

couldn't erase the

would have problems

always been as regular as a clock. Everyone

seems to have no trouble. So what's wrong with me?

UNSUNG LULLABIES

4

"It's also

we're going to have kids and like myself.

when

embarrassing," she continued. "Everybody asks

I

such

feel like

I

never

know what

to say.

don't feel

I

a loser."

Emily and her husband Jack, a thirty-nine-year-old lawyer, have been trying for three years to conceive. Six months ago, their in vitro fertilization (IVF) attempt failed;

whether to try another

many

she cried. "I'm so tired of being

me

with hormones that make

said they could help out, but

loss.

doesn't

if it

And

if

it

work

of

infertility

about

is

your

I

and

may

its

tests,

poked and prodded and

my

again?

I

know

don't

if

I

may

sleep, or

And

what do we do?"

be experiencing the emotional turbulence

mind

races as

Or you may feel vague and

you may

feel like

cry at the drop of a hat; you

worry that you

parents

can take another

all

you think

distracted,

and

may

not

have trouble concentrating or remembering things. You be able to

filled

don't want to take their money.

treatment. Your

infertility.

but nothing has worked,"

feel awful. Financially,

doesn't work, then

You, like Emily,

they need to decide

cycle.

"We've been through so

what

now

first

are going crazy.

sleeping

may

You may

You obsess about what your body

is

all

of the time. You

explode

easily.

You may

feel like a failure.

doing

now

or the next step

your doctor recommends. Faced with complicated decisions, often involving costly medical procedures, you lack of clear-cut solutions. ful the next.

You

from excitement

— only

you're on

it,

the

feel as if

to

pointment

You

may get

are devastated

frustrated

by the

one moment, hope-

— careening

you're on a roller coaster

gloom, wishful thinking to devastating disap-

this ride isn't at all thrilling; rather, the longer

more you

about to go soaring off

its

feel as if

tracks.

your carload of emotions

is

How

This Isn't

You

It

Was Supposed you

these things because

feel all

is

one of the most painful

Clearly this

is

not

how you thought

What Often unrecognized is

5

are going through a reproas

and when you had

crises that

couples confront.

ductive trauma. Being unable to have a

hoped

Be

to

it

baby

would

be.

Reproductive Trauma?

Is

as such, infertility truly

is

A trauma

a trauma.

any event or feeling that goes beyond the range of usual

experience and both.

It

is

overwhelming

either physically, emotionally, or

typically involves a threat to

of a loved one.

It

may be

human

your physical integrity or that

the result of a single devastating event or

a series of events that gradually build

up and overwhelm you. As

part of the mind's attempt to master the catastrophic overload, the

events

may be

re-experienced in flashbacks, which can be triggered

by anything reminiscent of the original eral hypersensitivity

cally

feels

Sometimes a gen-

of

the experience of infertility a trauma?

infertility,

it,

traumatized

The

diagno-

and the medical interventions often needed

to

represent a threat to our physical integrity, our sense of be-

ing healthy and whole.

our physical selves

is

trauma because

it

One

of the most fundamental aspects of

our reproductive capability.

not function properly,

self, it

A

paradoxi-

anxious, depressed, and has difficulty concentrating.

What makes

treat

events.

irritability occurs, alternating

with a sense of numbness and withdrawal.

person

sis

and

we doubt

everything

attacks both the physical

When

else.

Infertility

relationships,

and

it

shifts

is

a

and emotional sense of

presents us with multiple, complicated losses,

most important

that does

it

affects

our

our sense of belonging

in the world.

When

you

are diagnosed with infertility, the

world

as

you

pre-

UNSUNG LULLABIES

6

knew

viously

—

ney

crumbles.

it

No

matter where you are in your jour-

way"

trying the "old-fashioned

no

to

whether you

avail,

have just been diagnosed, are using drugs to produce more eggs,

undergoing surgery adjust to this crisis

dreams.

—your outlook on everything changes and what

The trauma of

Moreover,

you

after

month,

is

such that what you had taken

who must

another menstrual

doesn't work, or an intervention

return to battle again and

must be

—month

failed intervention,

How

do you

effect

you have

thing will go well." vice

is

that

negative. It

trauma

The implied message

may seem

—

after

needs to be dealt with

may

hear,

in this

feelings

infertility.

let

As you and

"Keep

and you

a stiff

relax, every-

well-meaning ad-

and not dwell on the

wouldn't

as

this

it

be better to forget

kind of trauma

you go through

it.

is

all

the

ongoing and

Talking about

Giving voice to your feelings gives you some

help you

that

counterintuitive to rehash the details of all,

bad things and move on? But

trauma of

all

the treatment,

all

like infertility?

a positive attitude

you should hide your

your experience

of

of

its toll.

get through a

lip" or "If

are consequently re-

react to the cumulative effect

your partner go through treatment, you upper

canceled. Infertile cou-

—and

you have undergone. The snowballing the trying, takes

procedure

the

month. Not only do you react to one

after

you

when, month

losses

occurs,

cycle

ples constantly re-experience their loss

all

your future and your

an accumulation of traumatic

face

traumatized

for

you

lost.

is

like a soldier

again,

means

infertility

and expected

for granted

it

as

relief

it

helps.

from the

Like an old-fashioned pressure cooker,

it

can

off steam by airing your worries, your distress, your

sadness, your fears. If

you can

talk

about what you are going

How

This Isn't

through, with someone ing and safe, able to

you

move

Was Supposed

It

who

is

to

Be

not judgmental, but

7

understand-

is

more control over the trauma and be

will gain

forward.

The Emotional and Medical Roller Coaster "Not

a

day goes by when

I

don't think about getting pregnant,"

said Kate, a thirty-five-year-old

know

for four years. "I

I

museum

dwell on

it

curator trying to conceive

too much, but

I

can't control

my thoughts.

After

symptoms.

my breasts get tender I calculate my due date.

If

ovulate,

I

help myself, even though

When my period Not only did from high activity

to

it

it

gets even worse.

start

during the month

continued, "Then

I

—wondering

also

if

too much, but

serve this?' All

I

I

month, going

she were to blame. She

have exercised as vigorously as

monitor every move sess

PMS.

begin to worry, and second-guess, and doubt

Maybe

vitamins?

can't

ruminated about her

I

did?

much by carrying that heavy load of groceries? Did

my

I

comes, I'm crushed."

Kate's emotions yo-yo through each

I

looking for

has always turned out to be

low and back again, but she

myself. Should

I

I

can't stop thinking, is

I

do too

forget to take

shouldn't have had that glass of wine.

make, every month, every day.

I

want

I

Did

a baby;

is

'What have

that too

much

I

I

know done

I

I

ob-

to de-

to ask?"

Being preoccupied with pregnancy and consumed with wondering whether or not you are

somehow to blame

is

typical

of

this

kind

of traumatic experience. There are emotional highs and lows inherent in infertility trauma. Yet friends and family members, even

your doctors,

Traumatic

may

not understand

as well are the

treat infertility,

which

how

upsetting

all this is

to you.

medical procedures to diagnose and

are physically

and emotionally demanding,

UNSUNG LULLABIES

8

invasive,

And

and painful.

may

the results

than answers, causing even further

bring more questions

distress.

Having waited out the prescribed year of trying on

own,

their

wedding and event planner, and her

Marissa, a thirty-two-year-old

husband Ken, a thirty-eight-year-old veterinarian, consulted a spean

cialist for

infertility

workup. The doctor recommended that

Marissa undergo a hysterosalpingogram procedure.

"The doctor stood on one and

the other,

I

room, the technician on

side of the

lay there feeling helpless.

They

chatted about the

Lakers while they were injecting the dye into me," she said. "The technician yelled: 'The right one to find

do

something wrong. But

to not start bawling

on the

I

was devastated.

wrong

—shocked

—

Marissa.

torted her perception, as if the

it

bad news

dis-

in her ears.

Not

to her; the

news were echoing

—

should, but what she wanted most

much more

a

—

baby

having trouble concentrating on work.

be planning these happy parties," she asked, "when

so miserable? It doesn't

the brides she

"They

come

all

or two, and

Ken

I

is

sense."

she ex-

felt

that

carefree

—

I

"How am

can

feeling

She became envious of

worked with and what she perceived

as their naivete.

as if all they

wish for will

imagine them barefoot and pregnant in the next year it

makes me so

also felt jolted

and dogs

make any

seem so young and

true.

way

unattainable.

Now she was I

could

surprising that the

isn't

only did she discover her body wasn't functioning the

pected

all I

was something

that there

It

announcement sounded so loud

tech's

was

It

table."

Finding out her tube was blocked physically

They seemed happy

blocked!'

is

a part of

jealous."

by the news. "Spaying and neutering

my

practice,"

he

said. "I

never gave

it

a

cats

mo-

How

This Isn't

ment's thought before, but

what Marissa and it,

but

1

I

now

Every time your period medical

every time

are going through.

Going through

cant.

Was Supposed

It

all this is

do one,

I

wish

I

9

I

think about

could laugh about

really taking a toll."

every time you have another

arrives,

test or consultation,

I

Be

to

you must again face the

loss

of your

dreams.

The Stakes Are High While

assisted reproductive technology

dream come

true,

it

can also subject

(ART) provides hope

infertile

for a

couples to even more

emotional pain, more physical discomfort, and

stress

—

in other

words, more trauma.

By you

the time

you get

to your doctor's office to discuss infertility,

are already feeling vulnerable after experiencing several losses.

In chapter 3

a parent,

velopment.

with the

you may

how

these accumulated losses affect your

when you

decide to be-

a shift in your identity

and adult de-

discuss in chapter 4,

you undergo

When becoming pregnant fails to happen, you're faced

loss

to conceive

discuss

As we

self-esteem.

come

we

of doing

it

the "normal" way. Because

and have not been

feel

successful,

it's

you have

understandable that

depleted and desperate.

Shifting Gears:

The trauma of

infertility

is

From "Normal"

to Patient

not confined just to the medical proce-

dures you must endure, but reaches into the core of

and how you identify normal person to

yourself.

The

infertility patient

shift in identity is

you

who you

are

from healthy,

one of the most disorienting

and painful changes you might ever have

When

tried

to

are diagnosed with infertility,

make.

you

are inducted into

UNSUNG LULLABIES

10

a club that

you never dreamed you would be forced

Can't Have a Baby Club." "But this

isn't

ways been so healthy!" Although the be-pregnant person to

you

me!" people

from healthy, about- to-

shift

may happen

infertility patient

you

Emily,

like a

who

in her sense

thing about

of

is

it

self

felt

when

she was

felt like I

I

first

was

diagnosed. "As

wrong. This wasn't the doctor's

news

hearing. Instead of a

warm, kind doctor

baby was on the way,

numbers and

facts. It

was

I

as if

had I

I

later, it still feels

it is

sense of

from the

self, it

can be

telling

me

the

had been beamed

tests

is

I

was supto be

happy news

me

into a parallel

how

it

should be."

and procedures, is

try to

remem-

not functioning prop-

so inherently intertwined with your

difficult to parcel

out that part of yourself

rest.

Where Do Belong? I

but

I

Don't

I've

Been Pregnant,

Have a Baby

the authors, have found through our

our

office

a scientist coldly quoting

only apart of your body that

But since reproduction

sitting

unreal to her.

As you plough through the ber that

was

I

was supposed

universe where everything was the opposite of

Three years

re-

in the Twilight Zone. Every-

this wasn't the

that a

end

considering her second IVF, described this shift

posed to be in and

as

gradually as

ton of bricks.

in the doctor's office

We,

cry, "I've al-

try to conceive over "the required year of trying," the

sult hits

erly.

to join: the "I

clients', that

trauma and pregnancy underneath

it all is

own

experience, as well

within the club there are subgroups. Infertility loss take

on many shapes and forms, but

the pain of loss. For example, if

pregnant, but not carry to term, does that

mean you

you can

get

are infertile?

How

This Isn't

As Charlene

me

that because

infertile. I

cringed

I

But

Be

to

11

I

had four miscarriages,

I

still

have no baby.

never

I

My doctor

have never carried a pregnancy to term

was considered primary pregnant.

Was Supposed

"Even though

said,

thought of myself as told

It

infertility,

when he

even though

said that.

I

was able

I

it

to get

don't want to believe

it's

true.

women who

Similarly,

have a child and then are unable to con-

They may

ceive again are labeled with secondary infertility. this diagnosis

others),

because they don't see themselves as

and yet the

baby, but

secondary

somehow

basis

a

infertility,

ity patient"

may

of their trauma

baby

is

the ego blow

is

the same.

do

They want

from "normal" to

shift

a

"infertil-

— —

dissonant with their self-concept

they are already parents

all,

infertile (nor

out of their reach. For couples with

making the

feel so

is

resist

who

have proved their

after

fertility

that

enormous.

Starting Treatment

When

an

starting

infertility

Clomid

doctor suggests you consider

or other ovulation-enhancing drugs to intra-

IVF

uterine inseminations (IUIs) to an questions.

What

ical

is

best,

cycle

how

drugs are necessary,

them, which procedure

many

ART— from

will

how much

times should you try? There are

—

you'll have

many

your body react to

will

it

many more

cost,

and how

practical

med-

questions that you can ask and your doctor can answer.

But these procedures also doctor can't answer. doesn't work,

what

and what does

How

raise

this say

Starting treatment

we

will

are the odds,

emotional questions that your get through this,

what

will this

do

what

if it

to our marriage,

about me?

makes many

feel "like a

tinderbox about to

UNSUNG LULLABIES

12

ignite," as

The

Rochelle said, about to take

uncertainty of the situation

many

made

Clomid

Rochelle, as

and added

others, feel out of control,

for the first time. it

does for so

to her reproductive

trauma.

may

Yet your partner

that your anxiety will hurt your

feel

chances. Ross, Rochelle's husband, needed to stay optimistic and positive.

A successful pharmaceutical salesman, he was knowledge-

able about drugs

don't understand

many women do

and comfortable interacting with

why

on edge about taking Clomid. So

she's so

these days.

keeps thinking negatively,

I

just

it's all

wish she wasn't so tense.

bound

up with an alcoholic mother and learned tions.

doctors. "I

to go wrong." Ross to cover

grew

up painful emo-

His need to be upbeat and deny Rochelle's feelings was

own

he protected himself from his lessness.

As we

ferently.

with

Recognizing

partner handles

anxiety and feelings of help-

it

infertility

how you

is

that each person copes dif-

deal with the

trauma and how your

can help prevent the two of you from misunder-

standing each other. Accurately gauging each other's needs

during

Hanging

how

discuss in chapter 7, regarding couples, part of the

difficulty in dealing

cial

If she

is

cru-

this sensitive time.

in

Midair:

Deciding what to do

The Anxiety is

stressful

of

Undergoing Treatments

enough. Then

there's the stress

of

undergoing treatments, which are both physically and emotionally taxing.

make

it

The

anxiety of whether or not this will

through a procedure

that tensions between It's

—can

exacerbate

you and your partner

completely understandable that this

is

—

work

stress.

if

you even

You may

find

are at an all-time high.

so.

Roberta and Scott, both in their mid-thirties, were having a

ter-

How

This Isn't

rible

time in their

IVF

first

It

Was Supposed

to

Be

13

arms were black and

cycle. Roberta's

blue from having her blood drawn so frequently. She winced every

time Scott gave her an injection; feeling awful, his hands shook

more, making matters even worse. Not only did the shots hurt, Roberta's swollen ovaries hurt her too.

The

daily doctor visits for

ultrasounds were time consuming, drastically cutting into her

workday. Scott was also agitated about producing a

worrying: what

When

and nurses think? tell

do

if I can't

I

this

sperm sample.

on demand? What

finally got in there

it

"I

will the

kept

doctor

went okay. Let me

you, there's nothing quite like a hospital bathroom to inspire

romance!"

He

me

I

realize

hope

I

For

wasn't the only guy

won't have to do

many men,

ducing a sample sults.

"The well-worn

smiled.

it

lessness

is

who had

to

do

this,

but

I

sure

again."

the relief of getting through the anxiety of pro-

is

quickly replaced by the worries about the re-

— your sperm count —can send you

Hearing any bad news

your motility

made

'literature' in there

that

is

low or that

into a tailspin of help-

not the best

and self-doubt.

Other than making the decision to take the hormones and shots, infertile couples

go.

Your

fertility cycle,

your future

have no control over

your reproductive system, and to an extent,

as parents are all in the

most intimate of

acts

hands of other people. The

between the two of you, once confined to

the privacy of your bedroom, ile

how the procedure will

is

manipulated by strangers in a

ster-

hospital environment.

Tammy, who months, cried thing so

fast,"

has been trying to get pregnant for eighteen

after her first insemination.

"The doctor did

she said. "I had wanted to at least hold

every-

my

hus-

UNSUNG LULLABIES

14

band's hand or something as the sperm was injected, but there was

no time.

And

was so impersonal. Whose baby

It

since

ment process larly

you is

can't

predict what

with an IVF cycle) can be a potential

you don't stimulate

poor, or

So much uncertainty can

ful.

thing

is

already.

is

anyway?" next, the treat-

It

loss since

may be

leave

Tammy

it

can

fail at

that the egg quality

well, or implantation

you with the

about to spin recklessly out of control

As

this

happen

emotionally draining. Indeed, each step (particu-

any number of places along the way. is

will

is

not success-

feeling that every-

—

if it

hasn't

done so

described, "I feel like a fragile porcelain tea-

cup, teetering precariously on the edge of the table."

Our Doctor Our Last Hope The

loss

of control you experience with

creases your

infertility

treatment in-

dependence on your doctors, which can further

weaken your self-esteem and sense of your own competence. As noted, Ross was

far

more

trusting of his infertility doctor

than was his wife Rochelle. For Ross, their doctor stood high on a pedestal. His view of their doctor as all-knowing provided

with

relief

and

a sense of hope.

ings about the very person

who

"How

is

can

we have

him

negative feel-

holding the key to our dreams?"

he asked. As with his alcoholic mother, he wanted to believe that all

was

well.

He

felt

responsible then, as now, for keeping the

emo-

tional ship afloat.

many there

But for

—he was

her doctor

are

a sensitive

invested in helping her felt

mixed

make

Tara

felt

very attached to

and caring man who was genuinely a

frustrated at her need to rely

Tara didn't think her doctor

feelings.

baby

—but

at the

on him. After

same time, she

a failed procedure,

really understood.

"He seemed

so

— This Isn't

when he

aloof

It

Was Supposed

called with the results

he had to deal with.

without him,

How

I

—

like

I

Be

15

just

another case

to

was

can't afford to get angry with him, because

I

don't have a chance," Tara said.

understand was that her physician was

What

Tara didn't

having his

likely

own

feel-

ings of loss about the unsuccessful cycle. Infertility doctors

and business. Most

ism, science,

want you

to get pregnant as

their expertise,

you may look to

can be a complicated mix of

remember

you may

to

them

as

much

idealize

having

artistry, altru-

are devoted professionals as

you do. Since you depend on

your doctor and his/her

all

who

the answers, but

it is

staff

important

that they are just people too.

These medical procedures may be routine

for

your physician,

but they are not for you. Infertility treatments are

stressful, physi-

and emotionally. Your doctor

cally

is

concentrating on the physical

components of your treatment, not necessarily the psychological Although you might want your

ones.

tention to

all

may

you

feeling disappointed

at-

be beyond the scope of his/her expertise. This can leave

—than

—

and even more diminished

less

impor-

before.

okay to be angry with your doctors. They may make mis-

It is

takes

doctor to pay

aspects of your care, including your emotional needs,

that

tant

infertility

and may not be

as sensitive as

you would

like.

Tammy's com-

plaint that her doctor did her insemination too fast

wanted

to hold her husband's

your vision of

how things

hand

—

should go

is

—

she had

a perfect example of

may differ from your

how

doctor's

focus on the medical procedure. If there are specific things you

know you want them.

Tammy

ward,

when

I

or need let

from your doctor,

her doctor

finally

know

calmed down,

it's

reasonable to ask for

she was disappointed. "AfterI

gave

him

a hard time," she

.

UNSUNG LULLABIES

16

said. "I teased

off to.

We

mind him

him and asked

he had a hot date he was rushing

if

we did an

agreed that next time to include

my husband;

insemination, I'd re-

he was fine with that."

Because you are obliged to place so

much hope

in

your doctor,

your anger or ambivalence toward him/her can be very disconcertBut don't be afraid to discuss your feelings with your doctor

ing.

or

staff.

you

You can

feel

let

them know

rushed or misunderstood.

tions and, if

you disagree with them, or

if

It's

perfectly

you don't understand, ask them

to get a second or even third opinion;

you

emotional commitment to

you decide whatever

ing for you their

to consult with

facility

again.

It's

else. It

also valid

making an

will not fall apart if

can help to remember,

to use, that the medical staff

their

is

work-

paycheck and you are also one of

You

referral sources.

your

to say nothing of

Your doctor

someone

you decide

—you provide

main

this.

okay to ask ques-

are, after all,

enormous investment of time and money,

if

and

are a valuable customer,

should be treated as such.

The Procedures: The You

get your period.

if

A new

Two Weeks

cycle begins. "I

you wonder how many eggs you

think, as

or

First

they will be any good. You

feel

ovulation gets closer, your nerves

you

ART

taking drugs for an

start

testing for ovulation,

easy to

it's

till

Ovulation

am my

will

.

.

ovaries,"

produce

you

this time,

hopeful once again. But as frayed.

Whether

procedure or wait to

start self-

become more

become hyperaware of what's

happening in your body. You wait for your temperature to go up.

You run cus.

to the

And,

if

bathroom

you

to

are taking

as the stimulation

check

if there's a

change in your mu-

may

feel physically well,

meds, you

not

makes you bloated and uncomfortable or

gives

This Isn't

you

How

Was Supposed

It

headache and may even make you

a

when you There

feel

good enough But

It feels

I

eggs?

Here

mean,

this

so out of

charge,

I

is

it

can also be

Lynn

exciting to watch,"

control.

you

of frequent doctor

also the pressure

is

developing can be fascinating, is

Be

said.

visits to

how your

"But what

feel

I

is

riding

on

more and more

can't

I

is

it.

in

this

enjoyable, loving obligatory.

your doctor's

With

And

as

that

Time

it's

that time.

What

be going in for

artificial

IUI, there

is

have been inseminated.

is

should be an partner

feels

insemination or

bloated belly and partner in hand, you're off to

What

used to be a

woman's body, now

takes place using ultrasound, needles, test tubes,

What makes

as

each cycle passes, you

office for yet another procedure.

fertilization

may feel

one single function of your

process that "magically" happened within a

With an

It

moment between you and your

Or you may

retrieval.

in the result.

desperate.

You're ovulating, you're nervous,

painful

make

detached, like someone else

feel

you become even more invested

cycle,

It's

of

don't

if I

my body and yet this is happening to

body, of which you have no control.

cess

follicles are

go again, worrying about stuff

my control.

your entire future

egg

monitor

stressful.

And more worried about whether or not it will work.

may

are pregnant

and yet so invested."

With each

if

17

are not.

your progress. While the ultrasounds to see

"It

to

and

petri dishes.

no guessing; you know exactly when you

And

with IVF, you can see the entire pro-

and watch the embryos grow.

the medical treatment of infertility so emotionally

that technology provides

you with an opportunity

to at-

UNSUNG LULLABIES

18

You not only watch on

tach in concrete ways to your baby-to-be.

ultrasound as your eggs develop,

your "baby" when

you

if

only eight

you

see

ical

and emotional attachment that you

ART procedure means of

loss at

IVF

you

you can

and attachment may happen

try not to attach

takes over

and

is

—

IVF

for fear

is

that

Adam, both

Judi and

of a

loss

—

much more

The

was

as

people

if

the procedure

is

not

traumatic.

many

summer break

to

unsuccessful attempts

when

ten eggs of

good

next day they found out of those ten,

mature and seven had

three days later, three were

much

the process of attachment

teachers, devoted their

for the first time. After so

quality were retrieved. eight were

fails.

and be more intense

earlier

with other procedures, they were thrilled

tor

an enormous sense

evidence of an embryo. As

very powerful. Therefore,

successful, the loss

psycholog-

each step of an

feel at

also suffer

The

cycle,

to witness the previously unseen processes of

because of the visible

trying

that

cells old.

any point along the way when the procedure

allows

biology,

it is

doing an IVF

are

good

fertilized.

to go.

At

By

the time of transfer

their transfer, their doc-

optimistic, proclaiming as he gave Judi a digital

photo of

They were

delighted

the embryos, "There's your future family!"

with their doctor's enthusiasm.

How Can

Waiting:

Time

takes

on an

whether you have utilized

you

ART.

Move So Fast?

entirely different quality

tried

making

a

during

infertility,

baby the old-fashioned way or

Indeed, the two weeks you must wait to find out

are pregnant

filled

a Glacier

move

at a glacial pace.

if

The two-week wait can be

with a mixture of hope, anxiety, anticipation, and fear

—

all

magnified by each passing day. As you wait out your cycle, you

This Isn't

may even have Phyllis,

who

Was Supposed

it

I

about

surance, Judi

it's

it

it.

are pregnant.

that if

my

period

—

wanted

I

to sleep

you don't think

may

positively,

even suggest that you try not

It

feel

"normal" or not think about

can help to stay busy, but

to anticipate

—and

know

that

it is

also

and be on edge about the outcome.

A doctor's suggestion to not think about we, as therapists

go

"just

normally" after their IVF embryo transfer. But

not impossible, to

during the wait.

you

all

you might

and Adam's doctor suggested they should

difficult, if

"I felt

In an undoubtedly well-meaning attempt at reas-

live life

natural for

19

was pregnant."

hurt your success. Your doctor

home and

Be

make you think you

got closer to

thought

You may worry

to think

to

took Clomid for the second month, remarked,

really

I

It

sensations that

so exhausted as the time.

How

it

runs counter to what

infertility patients ourselves

—have found

again and again. As with most traumatic experiences, giving voice to your feelings, especially those that are negative or painful, frees

you from them

far

more

effectively

than denying them. If you can

speak about your emotions, you can proceed with a

mind and If

much

clearer

relaxed body.

you have delayed childbearing, the experience of time

ing can be even more difficult.

The doctor may look

pass-

at his or her

schedule and casually say, "Oh, we'll start in two months," not realizing that

two months can

feel like forever.

The hope

that time

can be extended indefinitely as you pursue a career or other activity is

dashed when you

realize that the clock

is

running out and

every week, every month, and every year becomes longer

trivial

no

to wait two weeks, to say nothing of two months.

Infertility patients

slows

critical. It is

know all

down during some

too well, however, that even as time

phases of treatment, at others, things

UNSUNG LULLABIES

20

move tion,

altogether too

fast.

You go

to

what you think

a consulta-

is

and the doctor suggests that you could be inseminated that

you

day, or wants

whelming, yet

if

to begin medication

you

You

other opportunity.

when

And

angry.

support

if

worry that

also

recommendation

a

may

weeks

decline,

tomorrow.

if

you don't

then where would you be

feel over-

you have an-

pass before

made, the doctor

is

can

It

act immediately

will disapprove, or be

—you must have

the doctor's

you are even to hope you'll get pregnant.

Finding Out

As you wait

for the

tor's office for a

wracking. So

pregnancy

many women

taken pregnancy

tests

—whether you

kit

I

just sat

Adam go.

when

nant.

day

—

I

—

it

I

feels as if

call. I

to be.

"Adam and

call.

didn't

know what it

rang,

ment!

I

I

feel like

So often,

I

on

both stayed

do with myself.

couldn't pick

was so sure that

.

it

I

it

was

a

up.

no

was preg-

.

had been pregnant, even someone has

this

life is

."

Judi continued to cry. "The doctor said

pregnant, but

I

to

I

could see on his face that

eggs looked so good, though.

had

your entire

or the other.

she got the

just waiting.

an agoniz-

your at-home preg-

to see if

by the phone, but then when

took the phone

The

two minutes

It's

few hours to hear from your

are waiting a

know one way

Judi sobbed all

bathroom

describe endless trips to the

has turned positive

hold until you

home

the anticipation can be nerve-

before the two weeks are up.

doctor's office or even

nancy

test,

go to your doc-

arrive or

whether they are bleeding. Others confess they have

to check

ing time

day your period might

is

I

if it

wasn't technically

was

just for a

mo-

died."

a loss that goes unrecognized. Until recently,

This Isn't

there

was not even

How

name

a

It

for

Was Supposed such a

to

Be

We know,

loss.

however, that

this "pre-carriage," or "pre-implantation miscarriage,"

even

it fails, it is

Getting

treatment you are losses are real.

infertility

in, is

Even

if

the

Your reactions and

pected and unavoidable. essential that

The

next step

plore the these

is

—your baby—who has

many

Through

is

died,

first

still

step in getting through

feelings not only

To

make

it.

Your

for successful

if that

treatment

sense, but are ex-

defuse the intensity of your emotions, talk about

understanding why.

reasons

no matter what stage of

be grief stricken

you explore and is

it

a trauma,

you know that your odds

treatment are low, you will

it's

baby

a

a "preg-

medical pregnancy was never established.

if a

Acknowledging that

fails.

can be emo-

During ART, you have experienced

tionally devastating.

nant moment." If

21

why

The

infertility

is

them. following chapters ex-

a trauma.

The

first

of

that infertility does not merely represent a recent failed

pregnancy, but a whole lifetime of dreams, hopes, and plans that

have gone horribly awry.

Two

Your Reproductive Story My mother was a teacher,

and ever since I was

what I would be

too.

summers off and

basically the

teacher, just like

I figured

my mom,

it

same schedule

just as I

now for five years and still no

I always knew

little,

that's

was the perfect job for a mom, having

baby.

as

my

had planned,

—Cheryl,

kids.

So here I am, a

only we've been trying

infertile five years

Did you plan how many kids you'd have? Imagine what names would be? Decide whether you'd work? Even

maternity leave return to

names it's

yet,

we

all

have an idea of "how

if

have a baby,

it

may be

eager plans and innocent hopes

home

or after

you hadn't decided on

it's

supposed to be" when

our turn to get pregnant and have a baby.

difficult to

stay at

their

Now that it's been so

excruciating to think about your

when you

first

started

on your

journey to parenthood.

What

Is

Your Reproductive Story?

Your reproductive story

is

an unconscious narrative that begins in

childhood and runs through your adulthood.

how you

think your

life as

It is

a parent will unfold.

your story of

You begin

"writ-

Your Reproductive Story

ing" your reproductive story to be modified

and "rewritten"

story isn't unfolding as infertility

you become an

as

you hoped

it

and

are a child,

would

continues

it

That your

adult.

explains, in part,

why

so emotionally painful.

is

Each of us has of

when you

23

unique reproductive

a

can be specific

this narrative

—

as

story.

The

conscious parts

noted above, you

may

already

have picked names or decorated the nursery in your mind. Sometimes there pictures

may dow

—

no

is

narrative; instead,

we

that

we have

a picture

—

or series of

don't even put into words. For example, you

picture yourself watching your kids through the kitchen winas

they play together in the backyard, imagine yourself

throwing a baseball to your daughter or son, see yourself sewing

Halloween costumes, or hear yourself singing a lullaby your arms. Such images are

falling asleep in

snapshots without captions as clearly as

and ideas

—but they

also

like silent videos, or

are imprinted in our

have a subtler prologue, which consists of our

tice this aspect felt

an infant

minds

any camera could capture. These conscious images

actions with our parents since

always

to

we were

inter-

very young. You might no-

of your reproductive story in the way you have

comfortable around groups of children, in your doubts

about whether you'd ever grow up sufficiently to take care of

them, or in your image of yourself

as a

nurturing person.

When your reproductive story goes as planned no hitches on the path that

it

exists.

to

parenthood

—

—when

you're not usually aware

—when

Only when something goes wrong

miscarriage, or other reproductive crises force

productive story

—

can you recognize

traordinarily painful to

its

you

impact.

examine your ideas and

parenthood right now, when you

there are

feel so far

infertility,

to edit It

may

your

re-

feel ex-

feelings

about

from becoming a par-

UNSUNG LULLABIES

24

ent.

But we've found, both personally and professionally, that

when you examine

are experiencing infertility,

this story

and pay

you begin

and

to understand

functions in your

life,

to

its

how

conscious,

uniquely written story

this

be better prepared to deal with the

you'll

the reproductive story means,

importantly,

its

subtler prologue.

earlier,

now

unexpected and traumatic narrative you are

What

and

crucial to excavate

careful attention to both

readily accessible chapters,

When

it's

what happens when

how

living through.

develops, and most

it

the reproductive story doesn't

unfold as you originally envisioned, are crucial elements of infertility

The

trauma.

hood and

dreams of parent-

clash between your lifelong

the daily nightmare of infertility

in part,

is,

what makes

infertility so devastating.

How As a

first

it

Was Supposed

be

we

step to uncovering the reproductive story,

clients to share

with us the story of "how

We want our clients

to

move

it

ask our

was supposed to

this story into the

than the background, of their

Some

to

be."

foreground, rather

lives.

clients find their stories readily

forthcoming.

They have

thought about having children for a long time and have a vision of

how

their story will unfold. "I always

called Laura,

who

used to play house for hours and stuffed animals.

help

me make

wanted

to be a parent," re-

has been trying to have a baby for over a year. "I

would rock and feed

I

all

my

My mom even got me a little cradle and she would

clothes for

my 'babies.' "

Carly, a systems analyst for a

would become

a parent

planned to have

kids. It

computer

when and

firm,

as she wished.

assumed she "I've always

was something that was a given," she

said.

Your Reproductive Story

"Bur

was not going

I

do

to

too young to have kids

They were

nineteen.

guing about money.

still

I

would I

way my

the

— my I

parents did.

up under that kind of

I

knew

I

thought

I

was doing

all

ar-

that

I

I

knew

So

that's

stress.

wait, find the right guy, be financially secure.

did.

father,

and they were always

was ten they divorced.

my kids

They were

my

mother was eighteen;

kids themselves,

When

wasn't going to bring

what

it

25

the right things, but I'm

still

not pregnant."

For others, the reproductive story

isn't as clear.

Jordan grew up

thinking she did not want children. She loved to travel and devel-

oped a successful career thirties,

back,

I

as a travel agent.

she changed her mind.

"On

But when she reached her

an airplane

few years

trip a

read a magazine article that asked you to imagine yourself

at eighty years old. Well, here

I

was, a world traveler, and

I

pic-

tured myself as a grandma, baking cookies, reading stories, taking

my grandkids

on

came surging up.

And now

that

I

trips! All It hit

the feelings

me

can't have them,

I

I

women

—

it

is

often easier to

for

my own

—

I

elicit

we've heard so

—men have

many poignant ones

think that males don't

reproductive stories from

It's

dream of being mommies. One

are ex-

a mistake to

about parenthood

do. Little boys fantasize about being daddies, just as girls

and

reproductive stories too, and

over the years.

feel as strongly

kids!

ever."

Stories too

traditionally they play with dolls, baby-sit,

pected to be the nurturer

grandma

wanted

want them more than

Men Have Reproductive Although

had

ton of bricks

like a

little

as females

much

as little

boy we know, Nathan,

loved to learn things from his father, as he told us proudly, "I can teach

my kids

the same

way when I'm

a dad."

UNSUNG LULLABIES

26

Sometimes boys

reveal their fantasies less directly.

and defend

light saber to fight off aliens

protect

and nurture, and

may

Boys

is

his planet

focus their interest on trucks, sports, or other activities

play reflects is

way to

a boy's

is

a foundation of his reproductive story.

that they identify with as part of being a

father

Wielding a

his

how

man, but

as such, their

they envision themselves as fathers. Since a boy's

primary male

model, he will identify with his dad,

role

not just as a man, but also as a father.

Adult

men

have shared with us

how

they thought about future

parenthood when they were children. Kevin, struggling with

remembered the

for the past three years,

tility

younger brother.

proud

"I

was

to be a big brother.

by patting him

Now

I

would help

to sleep. It used to

he got older, we fought a him."

when Alec was

six

but

lot,

I

my mom

worry

was

—and

Alec has a baby

Dean was number

built-in

"My wife comes It

was

"We right

Once

Kevin doesn't, and he

feels

child.

four out of six kids, so his family's size

his reproductive story.

ways had a

he'd cry.

him

always watching out for

robbed of the opportunity to take care of another

shaped

was so

I

take care of

me when

still

of his

arrival

born, and

infer-

He

loved chaotic family dinners,

al-

team to play with, and never had to be alone.

from a pretty

just a given that

large family too

we would have

have a nice house, but

it

feels

lots

—

she's

one of

five.

of kids," he remarked.

awfully big and painfully empty

now."

Derek

recalled building

was seven years

old.

model airplanes with

his

dad when he

"My dad and I would spend hours

in the base-

ment building models. Sometimes we'd follow the plans but other times

we would come up with

kind of customize

it."

He

wistfully

exactly,

—we'd

a different idea

remarked that he hoped to

Your Reproductive Story

27

have a son someday to share this kind of experience.

With

infertil-

he was unable to produce his most precious, one-of-a-kind

ity,

model.

How Your Whether

we

still

or not

Reproductive Story Develops

we have

whether or not we want a

when you choose

not the case. Even

if

we

to get pregnant.

don't have children,

parents' role

When

modeling and various cultural influences material gets pieced together,

all this

reproductive story, which In the next sections

stand and

tell

we

is

it

And

re-

this

chil-

our

also play a

comprises our

an underpinning of our adult

explore these influences so you

your reproductive story to

But

we once were

dren, learning from and identifying with our parents.

role.

child,

have a reproductive story. You might think that your

productive story begins is

a child,

identity.

may

under-

its fullest.

The Story Begins "Let's play dress up," suggests four-year-old

friend

Tommy.

married

—

and have

"I get to

no, first

lots

and

"Okay," says

be the

we have

lots

to

mommy.

go to

But

college,

Sarah to her best

first

then

we have we

to get

get married

of babies."

Tommy.

"I get to

be the dad. Bye! I'm off to

work now!" Scenes like these are played out in nursery schools, kindergartens,

and play yards everywhere,

as

young children begin the

process of thinking about future parenthood.

centered on a

new baby

brother or

sister,

that they help to take care of, stories

and

Whether

they're

or a favorite doll or a pet fantasies

about being the

mommy or the daddy pour out of children without much prompt-

UNSUNG LULLABIES

28

ing.

Rocking

dolls to sleep,

reprimanding a pet when

mommy,

having a "family" of trucks with a truck, pretending to be a

sword

to

save the kingdom from

experiences

As

younger

make up

the

first

we watch our

kids,

what they do

dragons

evil

—

parents with fascination, wanting to to

make

their sense

Our and

—

who

the reproductive story

they are and

who

reproductive story weaves

his kid eat broccoli,

is

mom

or

they want to be.

its

way through our childhood

sitting in a tree, k-i-s-s-i-n-g. First

then comes marriage, then comes

every stage of our childhood.

Mary with

a

baby

And when

comes

carriage!"

are revealed at

our preschoolers, Sarah

busy playing house, they are beginning to develop

their future parental identities.

or

—

being encoded into

Such anticipatory thoughts about future parenthood

are

or dad

thousand ways. Remember the childhood

"Mary and Johnny

and Tommy,

A

shrieks that she will always trust her kids. In ei-

into adulthood in a

ditty:

love,

of

do

do what they do.

ther case, whether children are trying to be like just the opposite

wielding a

these childhood

chapters of our reproductive story.

ten-year-old will insist that he will never girl

daddy, and baby

sibling's teacher,

—and sometimes vowing not

while a teenage

he's naughty,

when Tommy scolds

his

When

Sarah snuggles her baby doll

teddy bear, they are each playing

at be-

ing a parent.

Your Parents' Part

in

Creating Your Reproductive Story

Your experience of being parented

is

another crucial component

contributing to your reproductive story. Your memories and perceptions of your relationship with your

own

nalized as

you grow up, and help you

example,

your parents were

if

warm and

parents

become

inter-

to define yourself. For

nurturing, you will likely

Your Reproductive Story

grow up

to be a

you may

tant,

try to

warm and

29

nurturing adult. If they were more dis-

either be distant yourself or choose consciously to

be closer to others, including your children.

Your notions and a mirroring of

about parenthood essentially begin as

feelings

what you experience

as a child,

and

mirroring

this

continues to develop into stories, fantasies, wishes, and plans that

Andy, age twenty-seven, recalled

you carry

into adulthood.

his father

comforted him when he had chickenpox

"My dad would come and cozy and made baby,

I'll

do

me

and read

also identify

to

me

feel a lot better.

that a lot too,"

Not only do we

we

in

I

know

that

father or

warm

It felt

when

I

have a

Andy said.

identify with our parents as potential parents,

with

how

they chose to structure their

becomes an important piece of our reproductive

too,

age seven.

at

every night.

how

mother was always

at

work and

rarely

lives.

This,

story. If

our

home, or one of

our parents stayed at home, our ideas about work and family will

What we saw

be affected accordingly. can't help but color our

own

choices in

and hobbies, and our personal "I

remember when

shop out

I

in the garage.

was a

He was

work and

watching

my

I'll

interests

dad

in his

work-

infertility for three

thought to myself even then, 'Someday when I'm a dad,

be the one to

fix all

the stuff.' I've learned

—

things, but the infertility, I'm sad to say

When

our

always tinkering and fixing things

around the house," said Paul, struggling with years. "I

love,

of relating to others.

style

kid,

our parents do (or not do)

infertility derails

choices (good or bad),

mented that

it

beyond

to fix

most

my abilities."

our plans to incorporate our parents'

we can

into treatment because she

it's

how

felt

feel quite unsettled.

her

life

was

Melissa came

off track.

had always been very important

to her to

She com-

do things

UNSUNG LULLABIES

30

on

work and

off to

that

many

fall

behind. She slowly realized

how

of her expectations were based on

her parents

"My parents went straight through college and then got mar-

lived.

ried, just like

want

a year

abroad. But she opted not to so she could

live

graduate with her class and not

Jake and me.

We

they did.

work

college.

wanted

I

always planned to have our years; that's

We

well for them.

middle name," she

In talking about her

life,

Her

we had

boy

first,

because

I

my

planned to name him Ethan,

I

said.

Melissa revealed that she and Jake had five years.

Overwhelmed

own

internal timetable or her parents' ex-

had been so successful

would

fail

shape your reproductive story.

Of course,

was

in her eyes that she

by following a different course.

Things that were missing or painful

are perfect.

just as

off balance because she wasn't pro-

parents

terrified that she

do things

felt terribly

gressing according to her

ample.

didn't

child after

first

to have a

been trying to have a baby for more than with anxiety, she

to

I

my folks did and it seemed

what

wanted

liked having a big brother. brother's

guess that's the real reason

I

from

to take time off

been married for four to

had considered taking

time. In college, for instance, she

We

all

in

your

know

no one would want

own childhood no

that

also

one's parents

to mirror or pass

on

ex-

treme cases of family dysfunction. Seeing parents fighting, witnessing alcoholism or drug abuse, or experiencing emotional, physical, or sexual abuse are not

every family, there are to avoid.

Maybe our

what we want

less

for

our

own

children. But in

extreme behaviors that we

parents nagged us a

lot,

may still want

leaving us feeling un-

worthy or underappreciated. Perhaps they neglected

to

enough time with us or

These

things

we

didn't like

to listen to

what we had

and don't want to

repeat.

to say.

spend are

So we may decide

— Your Reproductive Story

we want

rhar

heal old

The

to

wounds

do things

differently with

or provide something that

lessons Carly learned

her choices.

From an

our

we

own

children, to

didn't have.

from observing her parents shaped

early age, she

knew

from those of her parents,

ferent choices

31

she wanted to in her

make

dif-

approach to both

marriage and parenting. Carly never imagined she would have productive problems; sified

by her

now

her despair in facing infertility

is

re-

inten-

have the chance to "do

fear that she will never

it

right."

Many of only

we

us

who had

are able to

do

to heal the old hurts

enough.

And often

you have counted

it

similarly troubling childhoods feel that if

our way with our

own

and wounds, maybe not

this

is

what happens.

so long

way

we will be

able

perfectly, but well

On the other hand, when

on having children, and the circum-

stance of infertility interferes with your plan,

ognize any other

kids,

it is

difficult to rec-

to "fix" the past.

The Role Other Family Members Play Your reproductive story

is

further enhanced

with extended family and by the experiences, ries

we

by your stories,

interaction

and memo-

handed down or shared between family members. Sometimes feel that

we have

to

measure up to

how our

the roles of mother and father; sometimes

but in either case these legacies

become woven

—and

relatives

we hope

to

enacted

do

the perceptions of

better,

them

into the fabric of our reproductive stories.

Susan, trying for nine years to have a child, observed family influenced her ideas of

fertility.

"My

over on the boat at the turn of the century.

how

her

grandparents came

They brought

five kids

and then had four more. They were so poor that the baby had

to

UNSUNG LULLABIES

32

sleep in a dresser drawer, but their hardships did not stop

them

kids," she said. "I have forty-three first cousins

from

from having

that side of the family, plus three brothers, too. Fertility just didn't

came

to me."

Susan

seem

now

all

of

whom

have kids

—

to be an issue in this family

until

it

the black sheep of the family.

feels like

Likewise, Joanne, infertile for six years, said, "I had always been told that

used to

all

the

women

be so proud of

When

in

my family were

you incorporate the

pleased

lore.

may

it

also

want

Not only does

I

to give

and grandparents

gift

will

be

of grandchil-

your own reproductive

dreams and

story,

but

own

reproduc-

feelings about

becoming

allows your parents to write the chapters of their

tive stories that contain their

into

family traditions.

your parents the

this further

you

tells

be hoping to continue the

that your parents

when you emulate beloved

You may dren.

You hope

your family

stories

your own reproductive plans, you family

'built to carry babies.'

that."

grandparents. Fred, a retired restaurant manager

who

has two

married daughters but no grandchildren, regretted not spending

more time with

his children

when

busy working and making a

they were growing up. "I was so

living;

daughters are wonderful people, but ther.

I

missed out on so much.

I

don't think

I

was the best

I'm looking forward to having grandchildren so

another chance at

I

fa-

can have

it."

Part of the pain of infertility parents' reproductive stories. yourself. But, sadly,

somehow

My

is

You

your parents

that

it

won't

let

you

fail

feel as if

may

themselves

you

fulfill

them

your

as well as

feel that

they are

responsible for your inability to get pregnant. For exam-

ple, in the

1950s and 1960s doctors often prescribed

ethylstilbestrol),

a

synthetic

hormone,

to

DES

(di-

prevent miscarriage.

Your Reproductive Story

women whose

However,

DES

mothers took

33

have had considerable

reproductive tract damage, and more than the average share of

problems

with

births, as well as infertility.

course,

now

is

banned.)

became

own

a factor in their

irony,

of

daughters' reproduc-

trauma.

It is

get pregnant, tility

—

you

their ability to

and

have you

own

make your

your parents'

—which can make your

infertility

You may

to yourself.

that

own. As you struggle to

are constantly faced with

even worse. Your

ents

DES

not only circumstances like the use of

parents' reproductive lives evident in your

feel

The

that these mothers were trying to prevent miscarriage,

is

yet their efforts tive

(DES

premature

pregnancies,

ectopic

miscarriages,

fer-

infertility

can be puzzling to your par-

"How

question:

have problems having children

own

when

could we possibly

their reproductive story

un-

folded so smoothly?"

Or, as sixty-two-year-old Doris pondered, stand

why my

so easy having

daughter

my own

happened.

is

children.

can't imagine

it

want

to be a grandparent so

and

don't under-

having trouble getting pregnant.

then

I

"I really

much.

talk about their grandkids,

I

decided

just

I

why

this

is

it

very

Although Doris was dealing with the

was

was time and

happening to

When my friends

feel

It

her.

I

get together

left out."

loss

of a part of her own

reproductive story, remarks like hers can be very hurtful to those

of us going through

infertility.

(How

to

cope with your parents

and other family members while dealing with these multiple of feelings and tant

now

is

loss will

be covered in chapter

9.)

What

is

layers

impor-

to recognize that your parents have an ongoing repro-

ductive story of their own, which continues to play a significant role in the

way your

reproductive story

is

written.

UNSUNG LULLABIES

34

How Culture

Influences Your Reproductive Story

Historical Influences

Pregnancy and childbirth have been central to our cultural experience since the beginning of

human

the earliest hunters and gatherers,

it

history.

From

was a man's job

the days of to go off to

"work," to protect and provide food and shelter for the family. In part,

because of the physical demands of pregnancy and breast-

feeding,

hearth,

The atives

it

became the woman's job

which included caring

for the

of

to take care

home and

young.

gender-role differences that derived from biological imper-

were thereafter woven into the very fabric of

flected in the history

of

art, religion,

society,

and

re-

and mythology around the

world. Although stay-at-home dads are becoming more accepted

nowadays, the cultural stereotype that raise the children still lingers.

this scenario.

home

still

Indeed,

men go

to

work and women

Even our preschoolers played out

many women who work

outside of the

find that the lion's share of child rearing

If the cultural expectation

is

that

women

should

falls

to them.

raise

ture children,

how

woman when

she discovers that she can't get pregnant?

and nur-

does our society's prevailing ideology affect a

How will

others perceive her? Historically, childless

women

abnormal. The Old Testament Elkanah's two wives.

Hannah

about her

infertility,

wife's constant ridiculing

tells

the story of

tried for years to

Elkanah's other wife had given bitter

were stigmatized

him many

as barren

and

Hannah, one of

have a child, while

heirs.

Hannah was

very

which was exacerbated by the second of her for not having children. Dis-

Your Reproductive Story

turbed by her

Hannah went

infertility,

(where usually only

bab>y

35

to the temple to pray for a

men went

to

make

sacrifices)

and

poured her heart out to the Lord. Indeed, Hannah changed the nature of prayer forever after, for she was the

God

to

woman In the

can

and humiliation of

infertility,

and how

isolated

modern world,

women may

childlessness

women

still

considered aberrant.

is still

today choose to remain childless,

be seen

as

nonconformist, unfeminine, or

threatening to the continuity and well-being of our culture.

women

by choice, they may

are childless not

face the

How does our culture regard a man if he family for whom he can provide, thereby

about men?

unable to create a

demonstrating his manhood? People manly, immature or his

selfish.

motherhood may be

may assume

for

of England,

who

and went through

it

line are as

has for

much

a part of his iden-

fulfill his societal role

many

wives trying to produce a male heir.

well as infertility. In a sense, the

has

the VIII

reproductive difficulties

his wives suffered miscarriages, stillbirths,

Henry

gay or un-

women. Consider Henry

struggled with six

is

women.

Indeed, a man's sense of pressure to altered history just as

he

Yet a man's longing to be a father and

wish to continue his family

tity as

just like

Hannah.

And what is

When

same judg-

ments by society and often experience tremendous shame, the biblical

il-

feel.

Although many more these

to pray directly

with prayers from a grieving heart. This biblical story

lustrates the pain

a

first

He and

and infant deaths

as

Church of England was born of

the VIII's reproductive trauma, since he broke from the

Catholic Church to give himself the option of divorce

when

his

— UNSUNG LULLABIES

36

first

to

many failed

wife, after

produce only one

was beheaded

pregnancies and infant deaths, was able

live child, a girl.

had

after she

The

beautiful

Anne Boleyn

a daughter instead of a son.

Popular Culture Popular culture also influences velops.

Knows

Best, or

how

as a kid.

Old

reruns of Leave

it to

Beaver,

The Brady Bunch, for example, present

ized pictures of family

image of

reproductive story de-

the families you saw on television shows or

Think about

movies that you watched Father

how your

life

—

pictures that

may

a family should be. Likewise, the

such as Cheaper by the Dozen

—

all

ideal-

have shaped your

books you read

contribute to your internalized

reproductive story. Even movies can sneak in and influence you.

"My

favorite

nette. "I

knew

movie

as a kid

was The Sound of Music,"

wanted to be part of that family.

exactly

what

to

do and

say; she

Julie

said

An-

Andrews always

took care of those kids so

well."

But cultural influences don't just come from the cent events also shape your story.

Media

velope on age limits for parenthood

stories that

make

may

More

re-

push the en-

headlines, adding to

our sense that childbearing should be timeless. has on your reproductive story? You

past.

The impact

believe

on some

this level

that your biological clock will tick longer than normal. (Easy to

say until you're faced with age-related infertility.) In addition, the

popularity of birth-control

pills,

introduced to the public in the

1960s, and the era of sexual freedom that ensued, influenced the

reproductive stories of most

The

Pill

nancy

added

until

to our sense

we were

ready.

women

of childbearing age today.

of control, allowing us to avoid preg-

The unspoken message?

If you're in

Your Reproductive Story

when

control or

37

you can be

not to get pregnant,

in control of get-

ting pregnant.

These cultural messages

—whether

subtle or blatant

—rhave

considerable impact on our lives and on our reproductive stories,

even though we

may

not be aware of their influence until infertil-

ity hits.

Current Medical Technology and Your Reproductive Story

The medical treatment of

infertility

in recent years. Procedures that

now have been

years ago

has progressed at light speed

may

refined to a

have been ineffective a few

much

higher degree, present-

ing the infertile couple with an overwhelming array of choices and decisions.

What mean

for

your reproductive story?

extend your reproductive years.

— pregnancies pausal

First,

We

it

it

have

"change-of-life babies"

women, but

the line.

many

does the availability of so

—

high-tech options

suggests that all

you can

heard of surprise

that occur in perimeno-

used to be that menopause was the end of

Now it's possible

(though

still

rare, difficult,

woman

ways a good idea medically) for a

past

and not

menopause

al-

to get

pregnant and bear a child.

Technology

also affects

your story in terms of the sheer number

of options that are available you'll be investing in each

—and

the time, money, and emotion

one you choose. Having so many op-

tions can be bewildering yet enticing; there's cally there state that

hope where

had been none. Some advertisements

you can have a baby, and

offer a

for

IVF

in order to get one.

clinics

"money-back guarantee."

However, these ads promising a baby don't necessarily

what you must do

histori-

The

tell

you

disclaimers are never in

UNSUNG LULLABIES

38

bold type. Such hope-filled messages play on your emotions and

draw you

in.

When

there

is

yet another option,

As Tina, who has spent

can never say no.

need to know that

a baby, remarked: "I possible, otherwise

will live

I

with

odds on various procedures, and there's

glamorous, or pretty.

an enormous

chapter 10,

we

enough

is

Telling

have

have tried everything

Our

doctor has given us

don't think we'll quit as long as

when

assault,

have your

loss to

is

make

it's

exhausting,

efforts

is

it's

not easy,

risky.

And

end without a baby. In

choices about the future of your re-

to continue with treatments or

traumatized,

way

perience into one's is

an

It's

that infertility treatment

Your Reproductive Story

not feeling that

when

to say

intended, you

—and unable

story

it is

—A Step toward Healing very difficult to imagine ever

or being able to incorporate the traumatic ex-

As with other traumas, the

life.

marked by

Given that your as

I

you

feel like

enough.

a person

trauma

knows

help you

productive story:

When

can

five years trying to

even a small chance of getting pregnant."

Yet Tina, like you,

it's

I

regret.

it

infertility

the feeling of being trapped.

lifelong plan

may

feel

to see

of becoming a parent

isn't

going

stuck in your tragic reproductive

any way

out.

To

feel better,

it's

crucial

that

you understand how your reproductive story functions

your

life.

Your reproductive story needs to be able to

tell

told.

their story, they develop a better

infertility hurts as

much

as

it

When

our

in

clients are

understanding of

why

does. Telling your uniquely written

reproductive story allows you to put infertility into the broader

Your Reproductive Story

context of your

life.

It is

not just the loss of pregnancy and birth

that infertile couples suffer;

hopes

for the future.

39

When

it is

also the loss

of their dreams and

couples share their reproductive stories

with each other, they gain insight into their past, their goals for the future,

and what parenthood means

to each

Your reproductive story may be readily only gain insight into

its

many

of them.

accessible, or

facets over time.

you may

The more you

think about the things that have influenced your story, the more

you remember about your own childhood, adolescence, and adult

life,

the

more depth

it

will take on.

We've discussed many of

make your unique reproductive

the ingredients that

earlier

your

story:

parents are likely the biggest influence, but also consider the other cultural

and medical

factors that

we have

As you ponder your reproductive

noted.

story, please reflect

on your

thoughts and feelings about wanting to be a parent. Here are some questions to help draw your story out:

•

Did you have story,

a favorite doll or stuffed animal?

TV

movie, or

show?

How

A

favorite

did they shape your

re-

productive story? •

When many

do you remember

first

wanting children?

How

did you think you would have? Did you want to

have a family by a certain age? Did you pick out names? •

What were some

of your favorite things to do with your

parents? Your grandparents? •

What was your

least favorite

memory of

childhood?

does this influence your feelings about having your children?

How own

UNSUNG LULLABIES

40

What do you want

•

origin

your

own

family of

and the relationships you had with your parents and

siblings?

What

don't you want to repeat?

How is your story different or the same as your partner's?

•

Remember as

to re-create about

you

that your reproductive story

is

as personal

and unique

are.

The

Infertility

Diary

Writing Your Story

As you

reflect

on your past and remember

your reproductive memories.

We

story,

it's

a

stories that influence

wonderful idea to write down these

suggest keeping an

"infertility diary,"

where you

can write about your reproductive story and record the they

details as

arise.

Here you can record childhood memories, both happy and

You can dren,

write about

how you would

and how that may be

different

like to raise

your own

from how you were

sad. chil-

raised.

Writing about these memories and dreams make them more tangible

—and your

your partner.

story

It

may become

clearer so

it's

easier to share

with

can be eye opening to discover where your repro-

ductive stories are similar and where they differ.

Some

couples choose to share one diary or you

may

choose to

keep separate ones. Whatever you choose, remember helpful to share

partner in

what you discover with each

on what you have written

better understand

what each other

the diary can be an activity

strengthening your bond.

—and is

it

can be

other, to let

vice versa

—

so

your

you both

grappling with. Writing in

you decide to do together

—

further

— Your Reproductive Story

[f

you

are pursuing this journey of

41

becoming

a parent

on your

own, you may choose to share your story with someone close to you. Whatever your circumstance, you discuss your reproductive story with

may

find

members of

it

beneficial to

a support

group

and talking about your story with others

or in therapy. Writing

will help alleviate the isolation

you may be experiencing.

Dournaling Your Feelings

You can ings.

also use

Journaling

is

your

diary to vent a myriad of feel-

infertility

a wonderful

and something you can do

way

to get things off

privately.

We

your chest

encourage you to track

your feelings of anger, sadness, anxiety, or depression feelings

and

to spill over into every area of

how

infertility

tern of responses and

Daphne

your

life. It

and family

are likely

becomes much more ap-

—with your

—when you can

see a pat-

started keeping her infertility diary after a year of try-

did this release a

lot

it

going on that

ary to refer to

made

helpful to write things down.

of frustration,

fluctuated depending on it

it all

I

so

become

much more

at her diary entries,

more

Daphne

I

took

could talk to Sean about

it

it.

a big blur.

Not only

how my mood there

was so

Having

my di-

understandable." noticed that whenever she

likely to argue

"This was more than just the normal

And

could also see

what was happening. And

started to

got her period, she was

was angry.

how your emotions

reactions.

ing to conceive. "I found

Looking

learn

can affect your relationships

partner, friends, co-workers,

much

as well as

of hopefulness, excitement, and happiness. You can follow

events of each day or week,

parent

—

with her husband.

PMS crankiness," she said.

"I

out on Sean." Seeing the pattern, she "I let

him know

it

was not about him."

UNSUNG LULLABIES

42

What

it

was

Recognizing

really

about was, once again, she was not pregnant.

helped

this

Daphne modulate and

control her

emo-

and Sean, now understanding what fueled her anger, was

tions,

able to be

more compassionate when her period came.

Tracking Your Medical Procedures

A third use for your infertility diary

is

to use

it

to keep track of

your numerous medical consultations and procedures.

down

tremely useful to write

dures, your reactions before

doctor

may

doctor here. ting,

ex-

is

one place the dates of your proce-

in

and afterward, and any advice the

have given you. You can also

And when

It

questions for your

list

a consult or procedure

especially upset-

is

your diary can provide a constructive means to release your

pent-up emotions during these particularly stressful times.

Having

all this

of control, when

information in one place helps give you a sense

it

feels like all

other control

menstrual cycle, sexual relations

— of your body, your

—has been taken

away.

Your Story, Your Self Your reproductive wordless images,

story,

is

a

whether

and when

all

without your ever

It

grows and evolves

goes well,

really

as a series

coming

a parent. Sometimes,

as

self,

it is

it.

of

a cor-

you grow and

simply unfolds as you wish

when you

a conscious story

when

it

becoming aware of

become

disequilibrium

form or

fundamental part of your sense of

nerstone of your identity. evolve,

in narrative

In fact,

it

may

it

to,

only

experience an obstacle to be-

the pain

you

feel

—

the sense of

faced with reproductive difficulties

—

that

brings your reproductive story into focus.

Looking back

to the beginnings of

your reproductive story can

Your Reproductive Story

help you figure out where you are

now

43

your thoughts

in terms of

about becoming a parent. You can clearly see that your hopes and expectations for parenthood are deeply ingrained.

your core

the glue

When

intact.

fails

to hold,

your story

fails

your very sense of

to

go

self

is

As you go through

infertility treatment,

many feelings,

and

great

we

low, read,

that

and notice how treatment. tled

challenges,

discuss these experiences

we hope

it

you

as if

are in

your

Try

life.

when

threatened.

you

are faced with a

In the chapters that to handle them.

fol-

As you

about your reproductive story

story,

your reproductive story

intervention.

and how

story will always be yours

now you

as expected,

feel

changes and evolves as you progress through

You may feel

of your

losses.

and how

will think

away with each new

lost part

are part of

of the psychic glue that allows you to

identity, part

whole and

They

and

You

being whit-

will learn to grieve each

to rewrite

will always

is

it

along the way. Your

be a part of you. Right

one of the most important and painful chapters of

to

remember

that

it is

a

work

in progress.

PART

II

The Pain of Hope:

Why Does

It

Hurt

So Bad?

Three

The Losses of

We

are

all

put together, so to speak,

jigsaw puzzle.

When

the puzzle

our psyches are in one piece and

few pieces are missing, we selves; the picture

intact.

Infertility

may

we

many

pieces of a feel

whole;

ourselves. If a

but otherwise ourself are

still

fairly

pieces of the puzzle are missing or

damaged, the meaning of the picture

and not

we

good about

feel a bit off,

of the puzzle and our sense of

But when too

many

complete,

is

feel

like so

is

and we

lost

feel

confused

ourselves.

too

many

puzzle pieces are missing. Like the

puzzle that loses shape

when

too

With

infertility,

many

causes our sense of self to fragment.

pieces are lost, infertility

Our

sense of

comes undermined and weakened; rather than whole,

we

feel

who we

are be-

vulnerable and scattered, wounded, depleted, and

confused, like we're running on empty. This helps explain

when someone children?"

One

and

feeling solid

innocently asks us,

we crumble with

"When

are

you going

why

to have

grief.

of the problems with

infertility loss

is

that although

we

— UNSUNG LULLABIES

48

know something on what

is

is

terribly

causing so

much

wrong, we can't always place a finger pain and sadness. Obviously

have a baby, but the impact of

infertility

goes

shakes our very foundation. In this chapter, ing puzzle pieces such

•

you

feel

friends,

isn't

from "healthy person"

it

to

and normal

the loss of feeling healthy shifts

at large

— of your body, your

doing what you want

on

feel like a misfit

your family, or in society

the loss of being in control

—you

life

—you

your body

•

focus on the miss-

are missing out

the loss of a sense of belonging

among your

•

deeper and

the loss of the experience of pregnancy and birth

one of the most miraculous events of

•

can't

as:

long for a baby, but you also

•

we

much

we

life

do

—your

identity

to "infertility patient"

—you

the loss of feeling competent

feel as if

you can no

longer achieve what you set out to do •

—what

the loss of sexual intimacy, identity, and privacy

had been the most private and intimate of scrutinized

Some of

by doctors and medical

these losses are obvious,

acts

is

now

staff

and

knowledged and not minimized. Other

it's

vital that

they be ac-

losses are less apparent,

and these too must be uncovered and considered.

What we

own

per-

that identifying our thoughts

and

have found with our

sonal dealings with infertility, feelings about these losses

is

clients, as well as in

—moving what

is

our

lurking in the unspo-

ken and unacknowledged corners of our minds into our conscious awareness, where

it

can be reflected upon and perhaps shared with

— The Losses of

others

—

essential to help us put the pieces

is

49

Infertility

of the puzzle back

to-

gether again.

The Loss The most obvious perience

loss,

infertility,

is

single or simple loss.

Pregnancy and

and the

common

loss

Birth to

loss

that of having a baby. But even this

Not only do we

lack the baby

has unique meaning for each of us.

woman

I

to be me!

I

pregnant it

we long

and know that

it's

am

so envious of

how

— even

want

to feel big

because

I

am

growing

"When

if it's

life

wanted

me

over the place," she sobbed.

all

to help prepare all the

for her.

hard.

I

But seeing

don't think

all

I'll

I

pregsee a

"On

is.

I

uncomfortable

inside me."

baby shower,

astated that she too couldn't celebrate a pregnancy.

happy

we

for,

big and round she

Kristin, after attending her sister-in-law's

were

ex-

not a

is

The shape of

nant women, for example, magnetized Joanne.

want

who

of us

all

denied the physical experience of pregnancy and birth.

also are

This

of

the one

"My

felt

feelings

hand

food and plan the party.

dev-

I

I

really

am

so

the adorable baby outfits she got hit

ever get the chance to have people

do

that for me."

Leanne, trained as a midwife, focused more on the birth process "I've

itself. still

watched natural childbirth a thousand times and

miraculous to me," she

world

is

something

to that point," she

I

long

added

said.

for."

"To

Her

see

my own

it's

child enter the

face darkened. "If

we

ever get

sadly.

Skipping over these losses of pregnancy and birth minimizes their

importance.

We

ask our clients to share with us their

thoughts, feelings, and images about pregnancy and birth, and to spell

out the specific things they long

for.

Greg, Kristin's husband,

UNSUNG LULLABIES

50

described his hope poignantly. "I have always imagined being there at the birth, video camera in hand. era last year

when we thought we would be

should return infertility,

even bought a

I

it,

but that would seem

you have

you can hold on ways dreamed

to give

like

pregnant.

we were

Now I

giving up.

up so much. But you have

some

to something, have

new camfeel

With

to feel like

what you've

part of

I

al-

of."

Talking about the

loss

of pregnancy and birth gives you the op-

—whether

portunity to acknowledge what you personally long for it's

wearing maternity clothes, decorating a baby's room, or cutting

the umbilical cord. Talking about

allows

it

portion of your reproductive story, which

away and only becomes apparent when there What's important to remember here

cess.

losses in this chapter as well

these losses losses first

of

—

is

you

may

a glitch in the pro-

is

—and

that labeling

to uncover this

have been hidden

as

we

discuss other

and understanding

a necessary step in the grief process. Grieving the

is

infertility will

step in the process

be discussed in chapter is

8,

but an important

identifying and acknowledging the

many

losses involved.

Where Do Belong? I

"I

remember

gaged,

I

sat

my mind I

years ago,

friend Jane told

smiling at her, expressing

ran a ticker tape of what's

meet someone

ity

when my

too," said Lydia,

If

we

I

feel

she got en-

congratulations, but in

wrong with me, why couldn't

who was

two years ago. "And now when

friend's pregnancy,

my

me

I

diagnosed with

infertil-

hear the news of another

the same way."

can't have children,

how do we

relate to the rest

family, our friends, indeed, society at large?

Where do we

of our belong,

The Losses of

we

ask ourselves,

if

self threatened, so

we

Infertility

51

Not only

can't have a baby?

is

our sense of

our sense of our place in the community.

is

Abbie, a thirty-two-year-old occupational therapist in a large

on her

rehabilitation hospital, loves her practical impact lives

and her sense of camaraderie with the

watch patients work so hard and again. This kind of

on everyone

here;

work

we

calls for a

staff. "It's

patients'

amazing

to

will their bodies to function

team

effort.

group

are a very tight

—

I

know I can count

professionally as well

as socially."

But Abbie has

felt less

Abbie and her husband past

two

years. Six

connected with her co-workers of

late.

have been trying to have a baby for the

Bill

months ago she conceived, but miscarried

at

eight weeks. She's been despondent ever since, in part because several

co-workers are either pregnant or have babies. "They seem to

be falling like dominos," she cried. "Everyone

and having babies but me! who's next.

It

"It didn't

I

getting pregnant

—with dread—

keep waiting

should be me, but

used to bother

is

me

to hear

it isn't!

—

these people around

all

ting pregnant or having babies. But

now

I

me

get-

find myself wanting to

avoid their company. Gina and Lori are completely engrossed with their babies

—

can't handle rolling over

as they

it

when

should be.

and who's

them

for that

—but

I

get so angry inside.

I

feel

am totally out of the loop. And then

I

feel

do or

say.

starting to crawl.

of the loop;

guilty, like

I'm uncaring or

Last time

was with them

I

don't fault

they talk about poop and spit-up and who's

totally out

my

I

I

selfish. I I

I

don't

just sat there

know what with

this

to

dumb

face trying to be part of their world, but in reality

perately trying to keep

I

smile on

was des-

from crying."

Abbie wanted to be happy

for her friends,

but being around

UNSUNG LULLABIES

52

them was exceedingly had expected of

painful.

They had moved forward,

and she

herself,

felt left

behind.

as she

Not only could

she not have a baby, Abbie couldn't be the supportive and caring

on being.

friend she prided herself

from

herself

wanted

Instead, she

same time longed

them, but at the

and support. Confused by conflicting emotions, she was sad

for herself,

and

and envious of her

bitter

to distance

for their felt

comfort

alone.

friends

—

all

She un-

comfortable, unfamiliar feelings.

Not there ents

fitting in

is

—

feel as

no

with peers cuts to the core and makes us

We

right place for us.

don't

fit

into the

world of par-

the world where children are such a huge focus

though we belong

in the realm

feel as if

— nor do we

of young couples not yet

ready to start a family or those deciding to be childfree. We're in

we

feel

out of step with peers

They

are

moving forward

limbo, and like Abbie,

of childbearing tive stories,

dead-end

age.

alley.

Everyone

may

still

else

are also

in their reproduc-

while ours has taken an unexpected turn

but our invitation

When

who

—

into a

has been invited to a fabulous party,

hasn't arrived

and we don't know why.

faced with not being invited to the "reproductive party,"

feel as if there

is

nothing

we can do

to restore

it

our sense of

belonging.

The Holiday

The

Spirit

—Where has

calendar year, resplendent with

provides

little

all sorts

it

Gone?

of social demands,

respite for infertile couples. Holidays, birthdays,

weddings, baby showers

—any and

all

of these get-togethers can

feel like a minefield. Shelly, a librarian in

scribed her agony of trying to decide

ing in these functions or not.

her mid-thirties, de-

what was worse

—

participat-

The Losses of

found myself welling up with

"I

Halloween. From

for

now

together after another. If

one

is

more than

go,

I

a mess.

me who

It's

But then,

kids.

if

I

is

don't go,

in control.

Going

I

Year's,

it's

I

if

one family

get-

going to be miserable. Some-

no one

will bring

on the

says anything, I'm

don't belong because

still

don't have

I

I'm missing out."

feel as if

in these situations helps

Thanksgiving dinner

to

decorated the library

I

something that

even

thinking

Giving yourself a choice

am

I

likely to say

tears," she said. "Truthfully,

tears as

New

until

53

Infertility

may feel

to a birthday party for a friend's one-year-old

may

you

feel

more

okay, but going

be too

much

to

handle. Choosing which events to attend and which to avoid puts

you back behind the

and

steering wheel

leaves

you

feeling less

helpless.

Of course,

uations;

whether you attend events or not depends on your emo-

tional state

you

If

may feel wrong at

decide,

you

alert their

to regain

feel to go.

another.

And

it's

you

to talk to

it

may feel

it

helps to have

like

what-

some

We advise our clients to have a signal to

We

fine to

also suggest not hosting anything your-

make

can't escape

may

cameo appearance

a

an event

want

to maintain

all

at

someone

your house. You may

at the last

not be appropriate in

will

at

your host beforehand and explain

need to leave early or cancel

when you

feels right at

on something.

lose out

composure.

Although

strategy

What

sit-

partner that they need to leave or escape briefly in order

else's party,

want

ways to handle these

you do opt to attend a social function,

ready escape tools at hand.

self.

clear-cut

and how obligated you

one moment ever

no

there are

minute.

situations.

also

why you might

Of

course, this

There

are times

your privacy and should, but of-

ten people understand and empathize with your dilemma. There

may

be no perfect solution, but

it

does help to

know you

are not

UNSUNG LULLABIES

54

and that you can

helpless in these situations

some degree

exercise

of control.

What we had pening.

Our

thought was a given

and we

to fix the problem.

Erika, like so

What

all

No

your control.

many

—

other infertile people, expressed the irony

many years. "When

—

essential as effective contraception is

ours. After

all, if

is,

it

will

reproductive story.

do

is

that

who

it

I

get pregnant."

is

is

We

doesn't happen for us on the

the second or third, "I

of course,

been ripped

off."

creates the illusion

control a pregnancy

part of our collective

your friend or

sister

or

jokingly, albeit proudly, announces, "All he needs to

look at me, and

when

cliche,

think

also true. Indeed, the

is

be easy to get pregnant

The

it

we can

from happening, we assume the opposite notion that

I

those years of trying not

all

can't help but feel like I've

I

that bodily control

cousin

should; they

how hard you may try,

matter

those years of birth control

to get pregnant

As

not hap-

should have been so easy has become

of diligently using birth control for so about

way they

is

to will their bodies to function again, getting

truly out of

is

—

are often left feeling helpless in our attempts

pregnant doesn't work that way. this

a child

and emotionally challenging. Unlike Abbie's rehab pa-

who seem

tients,

—having

bodies are not functioning the

are failing us

physically

My Body

Lost Control of

I've

we

used to joke with

start to feel

my

often enough," said Lydia.

have heard

first

it

month of

so often, trying, or

damaged and inadequate.

husband that he wasn't looking

"Then

I

temperature and using an ovulation the right time. But that didn't

work

started taking kit to

either,

make

my

sure

at

morning

we did

even though

me

it

at

my period

— The Losses

was

as regular as

my body

—and

could be. I'm just getting more and more

of

loss takes

an enormous

to utilize reproductive technology,

ductive control of your

no longer

cles are

hormones you table,

body

toll.

Then, when you choose

you quite

literally give

to the infertility specialists.

you

are prescribed leave

repro-

Your cy-

and timed. The

feeling tired, bloated,

irri-

and depressed. What had always been a function of your

now

is

controlled

by medications. Your ovula-

tracked by ultrasound and the doctor "orders" you

is

have

at

no baby, the progres-

still

natural; they are medicated

own body rhythms tion

mad

me."

at

After months or years of trying and sive sense

55

of Infertility

when

to

sex.

It is

though you cannot tant to

disconnected from your body. Even

difficult to feel so

remember

will yourself to

that

you

become pregnant,

are in charge

whether you want to pursue a particular treatment to get

you

are under the care of a doctor does not

through

this loss

is

to

although of great import

Going

to the

The Loss Although ize, it

infertility

never

feels

—

is

just

life.

The

mean

—

Doctor Must

Mean

to

or not.

you

One

just because

you cease

to

who you

are.

I'm Sick:

and Normal

much more common

"normal," and also

that

up

reproductive system

one piece of

of Feeling Healthy

is

it is

remind yourself that

be in charge of other parts of your

impor-

of decisions regarding

your medical treatment. You choose your doctor, and

way

it is

than most people

calls into

real-

question people's

overall sense of their physical health.

The

necessity of taking

on the

role

vokes a major disruption in the sense of

of

infertility patient

self.

No

pro-

longer able to see

UNSUNG LULLABIES

56

yourself as healthy, the other alternative

Mary,

who

made

her

recently

is

view yourself

to

as sick.

underwent a laparoscopy, said the experience normal human being and more

feel less like a

like a

case. "I

walked into the hospital wearing

was soon

behind. As

left

the sense that

moved and

I

I

my own clothes.

But that

changed into the hospital gown,

was losing myself with each

article

stuffed into the plastic bag they gave me."

had

I

of clothing

me

I

re-

Mary admit-

ted that she was also nervous about the anesthesia and surgery, but

when feel

the nurse snapped on her hospital bracelet, she could really

her sense of self disappear. "I was reduced to

parts

and had become

just another

As Mary's experience

my reproductive

body on another gurney."

illustrates,

our feelings about ourselves,

our partners, and our relationships change

when we undergo

in-

treatment. Shifting from her previous sense of self as

fertility

Mary now donned

healthy and competent,

woman," which

filled

the label of "infertile

her with shame, like a scarlet "I" attached to

her forehead.

The

loss

of feeling healthy and normal can also reawaken past

worries about our health and our bodies. Dale, a thirty-eight-year-

old

man who

suffers

as a teenager,

from a low sperm count, noted,

we would

Everybody always laughed a

lot,

takes?

I

didn't have

what

it

true." For Dale, the diagnosis

about his adequacy

Becoming

as a

remember

kid each other about 'shooting blanks.'

What

if

"I

of

but inside,

And

then

infertility

I

secretly worried.

it

turned out to be

confirmed old doubts

man.

a patient can be

an enormously disorienting and psy-

chologically uncomfortable event. Again,

it is

critical to

of well-being to be able to separate the piece that

is

your sense

"infertility"

The Losses of

from the

rest

clients, to

remember

that

Although the

loss

parts.

found, are,

if

inability to

people

you

are

feel

your reproductive

of feeling healthy and normal

from the

loss separate

of

rest

who

and involved, and

who you

has struggled with infertility for a year, lost

— not only

I

in having a child, but in the

good

usually can use

them maintain

like the class

their

humor

rather than

good behavior," she

Now, not only

my classroom

is

is

punishment "But

said.

and competent

feel

not working

falling apart."

is

the loss of feeling whole

her classroom experience.

I

interrupting, talking

my body

Distracted by the onslaught of emotions triggered by

lumped together

work-

keeping the kids interested

at

out of control. Everyone

is

back, and squabbling.

Leslie

pro-

is

Competent

of Feeling

place as well. "I used to be so

even

just

have a child often makes otherwise very capable

faith in her abilities

right,

more than

inept at everything. Leslie, a usually upbeat kinder-

garten teacher

to help

encourage you, as we do our

be easier to cope.

Loss

The

We

identity.

you can keep that

will

it

of your

57

Infertility

Her

spilled over

loss

and

intact with

of faith in herself

and tarnished her view of

infertility,

as healthy

herself as a

great teacher.

For

Leslie, as

with so

many of

separate from the rest of her

life

our

an essential component of her feeling

keeping

clients,

was extremely

difficult,

better. In chapter 5

more about how

to compartmentalize, or keep separate,

your emotional

self

from the

keep reminding yourself that not

all

rest

of

infertility

but

who you

"infertility

is

are.

it

we

was talk

one part of

But for now,

only a part of me;

of me." You are competent in other areas of your

life.

it's

UNSUNG LULLABIES

58

Sex Just

Isn't

Sexy Anymore: The Loss

Rick, a thirty-seven-year-old infertility for three years,

man who

through

to spontaneity

prelude to sex?

as a

And

this ritual.

when

are times

has been struggling with

feels

it

infertility loss.

wake up every

like to

obnoxious 'beep, beep, beep' of a thermometer?

to the

What happened music

Sexual Intimacy

spoke of another painful

"Does anyone understand what

morning

of

I

I

I

—and

feel so

and romantic

to soft lights

bad

for

my wife,

having to go

can't believe I'm saying this, but there

don't enjoy having to have sex. Sex just

isn't

sexy

anymore." very hard to

It is

ner and

he thinks:

Am

I

Although the

his

The

when

a

woman

looks at her part-

good shape

to-

boxer shorts to keep everything cooler?

Or

is:

Are those sperm

on duty tonight? Will we be initial efforts to

crease a couple's sex desire.

romantic

she can think of

all

Did he wear

night?

feel

life,

make

infertility

a

in

in the

mood?

baby can improve or

in-

can disrupt sexual activity and

regimentation of sex caused by infertility can interfere

with spontaneity and enjoyment. Waiting until you are in the

mood

does not work. Planning some time for recreational sex with

your partner can help, but tivity

it

also

other than baby-making

The

loss

is

may

is

at

foreign

itself.

we

anymore.

Sex

as

an ac-

and pressured.

Perhaps

a constant reminder of our loss, but

very person

son that

feel

feel strained.

not just about sexual intimacy, but can also extend

into the heart of the relationship

partner

may

we need

the

get angry

most

at this

it's

it is

because our

ironic that the

time turns out to be the per-

and frustrated with, and

can't stand to look

The Losses of

Mark and

59

Infertility

Sheila, a couple in their mid-thirties, started therapy

because Sheila, a very down-to-earth, pragmatic graduate student in chemistry, felt that

something had

was

in his thirties if his sex drive

Now

to be so in love.

even get a good-night tears.

seem "I

to

low

it

feels like

kiss.

And

it.

We used

have to tiptoe around him to

I

I

man

as Mark's.

pulling teeth," she complained. "I don't get

"It's like

with

as

to be the matter with a

so ugly."

feel

Her

eyes welled

wrong because he

"There's got to be something

doesn't

want me anymore."

do want you. There's nothing wrong with you and nothing

wrong with our

relationship," he retorted. "It's just that

much on my mind sity professor,

of pressures publication

these days."

went on

at

to

I

have so

Mark, a newly appointed univer-

grumble about

work," he explained.

"I

coming up, I'm serving on

his career.

have

all

too

far

"There are

lots

these deadlines for

many

committees,

my students are putting a lot of demands on my time right now." He paused and then added, "Having sex with Sheila feels and

like just

but

I

another demand.

am just

I

But Sheila didn't believe ried that their relationship

macy her

and

love her

it.

love our time together,

She doubted

was

more depressed. But

his sincerity

falling apart.

own

and wor-

Their lack of

inti-

attractiveness

and made

in trying to figure out

what was

increased her doubts about her

feel

I

too stressed."

wrong, they had ignored the most important piece of the puzzle: their struggle

with

infertility.

They had been

trying to conceive for

eighteen months.

After identifying that infertility was, in their problems,

it

became

clear that

fact,

Mark was

at the root

of

feeling pressure not

UNSUNG LULLABIES

60

only at work, but also in his ability to perform sexually.

when

admitted: "You know, there are times

have

sex,

He

finally

I'd actually like to

but I'm afraid we'll use up the good sperm,

if

there even

are any."

What Does

Mean

it

The Loss Mark's

an

last

aside,

comment,

was key

self -blame. "This

Sexual

or a

Woman?

Identity

"If there even are any," almost

thrown out

to understanding his underlying insecurity is

my fault!" was

Mark

out the room.

of

Man

be a

to

being

silently

as

and

shouted through-

unconsciously believed that

if Sheila

wasn't

pregnant, he was doing something wrong. His efforts to reassure Sheila that there

was

tion that he

was nothing wrong with her reinforced to blame. "After all,"

to be." Rather than

thrown

in his face

was choosing

make an

month

to avoid the situation altogether.

was the cause of

—not

behavior

sity as well.

just his

by

his

their reproductive

avoidance of

sex,

feel

women

you

less

—and what

of a

man

swer, of course,

is

or

it,

is

his

at the univerat

work was

his manliness.

about the relationship

his or her partner, sexual identity has to

about themselves as sexual beings. Infer-

has a major impact on

and

trauma dictated

but his role

Different from sexual intimacy, which

do with how people

realizing

Although they had

need to prove himself and

between an individual and

his "failure"

and begin any testing, his assump-

His desire for perfection and success

driven, in part,

tility

and have

month, Mark, without

yet to see an infertility specialist tion that he

he explained, "someone has

effort sexually,

after

his convic-

it

means

woman

no, but

how we

it

if

to

you

may

think about ourselves as

men

be masculine or feminine. Are can't have a child?

feel like yes.

The

real an-

The Losses of

Sometimes prove their

may

a

or femininity in other ways.

week, there

Women may

triathlon.

61

in order to counteract these feelings, people try to

virility

increase their sports activities

few times

Infertility

may

—

Men,

for example,

instead of jogging

two miles a

be a sudden desire to train for a

boost themselves by going on a shopping

spree or trying to lose weight. In general, we've noticed that

tend to become more active to counter their loss of

women more These

while

virility,

often retreat into depression.

feelings

of sexual inadequacy

may

lead people into fan-

of having extramarital relationships, which,

tasies

men

if

acted upon,

are obviously destructive for the couple. Carl, a software engineer,

found himself

in a

he worked with. flirtation

dize

my

wonder It

is

quandary because of

his attraction to

have been feeling so unappealing

my co-worker has been wonderful.

with

her and what

"I

it

would be

like,"

other

fantasize about

Carl said. "I don't want to jeopar-

marriage, but in the back of if this

I

someone

lately that this

my mind

woman and I would be

I

able to

can't help but

make

babies."

often difficult for people to admit to these kinds of

thoughts; they feel extremely guilty even though they haven't

acted on their feelings.

mal

We let clients like Carl know that it is

to feel these things,

and very helpful

to talk

about them

nor-

—but

best in individual sessions with a therapist, rather than directly

with their partner or in couples' sessions. Bringing these fantasies out into the open and talking about the feelings with a therapist helps that

you

it

to understand rather than act

may well

on them. Please remember

be the losses connected with

infertility, rather

than

something Wrong with your relationship, that drive the desire

to

look elsewhere.

Having

a child feels like a proof to the world that

you

are a vi-

UNSUNG LULLABIES

62

able sexual being.

a

woman

or a

The

man

the feeling that

It's

regardless

you

dressed. Infertility can

of your

eas

life

truth, however,

life.

Sex,

are just as

much

of whether you have a child or not.

undermine your confidence

that

many

in so

ar-

important to look for the possible

it's

feel insecure.

Nothing Sacred? The Loss of Sexual Privacy

When you decide to yourself

you

are sexually diminished that needs to be ad-

connection whenever you

Is

that

is

up

to even

consult with an infertility specialist, you open

more

strains

on

this

most intimate part of your

which has already caused so much

more labored with medical

interventions.

You

anxiety, feels even

now

are

faced with

giving intimate details of your sexual activity to doctors, nurses,

medical technicians, and hospital personal and private of acts

staff.

What was

now becomes

once the most

clinical data for the

medical staff to analyze. All sense of sexual privacy

is

lost.

The

act

of making a child, which should have taken place in the comfort of your bedroom with the

now fice

of

occurs in the

sterile

lights

dimmed and

music playing,

environment of a hospital or doctor's of-

under the glare of fluorescent

lights

and the clanging sounds

stainless steel instruments.

One way

to get

through

embrace the bizarreness of to cut

this intrusion into

it all.

shocked. She said, that?'

'Why

I

belief.

One

time

a pretty racy sex scene

in heaven's

Anyway, Aaron and

is

to

know my mother-

Maxine began. "She

and proper, and conservative beyond

movie together which had

your privacy

Using humor can be a great way

through the tense moments. "You have to

in-law to really appreciate this,"

a

soft

name do

is

so

prim

we went

to

and she was

they need to show

took her out to dinner

at her favorite

The Losses

and out of the blue she

restaurant the other night

children (she always calls us children!), the for the

woman

to

be on top. That's

one

Mom'

and

I

now;

specialists

how

to get pregnant

down

at

first I

my

she did;

we needed

everybody

else

it is

was angry.

is

said,

We

have

way and

when we

got

wants to help and maybe

just

able to put his mother's

not always easy to do that.

knows everything about your

may need

swers for you as well, you ing a baby

and

dare she butt in that

She

"

dear.'

good laugh."

a

Maxine and Aaron were perspective, but

off.

is

food hoping no

think that she knows more than they do? But later

home, we laughed our heads

'You know,

started squirming

heard her. At

else in the restaurant

been to three

looked

just

way

said,

how we had you, Aaron

"We were dumbfounded. Aaron 'Yeah, right

63

of Infertility

to

comments

When

sex

life,

it

into

feels as if

and has an-

remind yourself that mak-

only one aspect of your sexual relationship. Nothing

can take away the private closeness that you and your partner share.

When

going through

infertility treatment,

cope with the embarrassment and office,

you must

also

know

so

many

details

that their support begins to feel intrusive.

when our

next treatment

duced, and It

of privacy in the doctor's

contend with your family and friends. Some-

times the people close to us

ment

loss

not only must you

if it

worked

can be especially

is

this

scheduled,

about our

treat-

They may

how many

eggs

we

ask pro-

time around.

difficult

because couples often differ in their

comfort level with sharing their situation with others. Karen and Joe had been struggling with infertility for three years but had told

no one. By nature, believe that

Joe,

"we don't

to ourselves." Karen,

an extremely private person, was raised to

air

our dirty laundry.

We keep our problems

on the other hand, came from

a close-knit

UNSUNG LULLABIES

64

family and was desperate to turn to her mother and

good

port, as well as to her

friends.

By

ity secret at Joe's insistence.

sisters for

But she had kept their

came

the time they

sup-

infertil-

in for help,

Karen was not only overwhelmed with accumulated pain, anxiety,

and

stress,

but she was furious with Joe for the control he exerted

over her.

During therapy, but that their

emerged not only that Joe was very

it

was due

infertility

Joe was deeply ashamed.

promise.

He became more

anyone

for each

In chapter 9,

meaning

that their

into

more

to talk about

on how

detail

you need

that

is

to

right or

who

wrong way

is

right or

We

wrong. In

fact,

in the course

The accumulation of

of

all

of

Our Sense

these losses

—

power is

no

moment

to

feeling empty.

The

of Self

those that are obvious as

— can

you

into

infertility treatment.

well as those that are less apparent leave

help our

to handle these situations; the degree of pri-

The Loss

and

of your

there really

vacy needed varies from person to person, and from

moment

essential

is

to be aware, not only

compromise with each other rather than get

struggles about

with

cope with the

needs for privacy, but of your partner's as well.

clients

it

first.

on us by the outside world, but what

to understand here

own

checked with him

we go

pressures imposed

of which

comfortable with her talking to her

and she agreed not

friends,

else unless she

the

private,

motility,

of them, Joe and Karen could find a com-

had

and

low sperm

By understanding

infertility

closest family

to

shatter your sense of self

pieces of the puzzle that

your identity have been scattered, damaged, and ing course of infertility and

its

treatment.

make up

lost in the gruel-

The Losses

Think back donned

gown

upcoming

for her laparoscopy.

surgery, but she

losing a part of her identity

mal.

The

reality

65

Mary, when she removed her own clothing and

to

a hospital

cause of the

of Infertility

—

She

felt

anxious be-

was equally upset about

her sense of self as healthy and nor-

of being in a hospital setting for a diagnostic

test

disallowed denial. She was forced to replace one piece of the puzzle

—

am

I

healthy

Leslie, the

—with another—

kindergarten teacher

class, also lost a

distress

a teacher

am

an

who was

fundamental piece of her

taken pride in her teaching

much

I

from her

losing control over her

infertility that

Having always

identity.

Leslie

ability,

was undermined. Feeling

infertility patient.

was experiencing so

her sense of competence as

competent

less

at

work, com-

bined with not being able to have a baby, created a downward ral

of emotions that

her feeling depressed and inadequate.

left

Likewise, Mark's conflicts about sex line.

He

spi-

made him

feel less

mascu-

struggled with sex not because he lacked desire for his

wife, Sheila, but because his sense of self

was challenged. Since

Mark's idea of manliness was reduced to the act of insemination, then he was not doing his job. Because Sheila was not yet pregnant, he

assumed

it

was

his fault.

any good sperm revealed

man; the shame he self, as

felt

he had defined

When

his

low estimation of

was due

it,

His doubt that he could produce

to this larger sense that his

identity of infertility patient,

forced to define yourself differently.

can rely on

the sense of your

whole

—

puzzle

is

as if

you have

lost

You no longer

you

feel that

are

you

not only self-esteem, but also

own competence. You

someone has kicked the

resting.

whole

was crumbling.

you take on the

yourself;

his abilities as a

are in pieces rather than

table

on which your jigsaw

You become consumed with trying

to regain co-

— UNSUNG LULLABIES

66

you can recognize yourself

hesion, so

only

way

to accomplish this

is

again.

You may

to have a child. That's

feel that

the

what makes

us feel so desperate.

In chapter

5,

traumatized by

we

explore in

infertility.

more depth why our

Understanding

why we

identity

is

so

are shaken to

the core gives us a plan for putting the pieces of the puzzle back to-

gether again, and thus helps us heal.

Acknowledging the Losses The

first

from the multiple

step in healing

acknowledge that they

exist;

losses

of

infertility

is

to

only then can they be mourned. As

we have

suggested throughout this chapter, bringing the losses out

into the

open and talking about them

—with your

partner, a sup-

port group, a therapist, or even talking to yourself or writing in

your

infertility

them.

We

creates

—

diary

is

the best

way of gaining

control over

have found with our clients that hiding from the losses

more problems; trying

Only by recognizing losses

have on us can

which

is

to

deny them causes more

distress.

the powerful impact that these multiple

we

to learn to grieve

take the second step toward healing

them.

Four

How Can Be an Adult

if

I

Don't

I

Dames and five

by.

they never

to

Gretchen began.

he has three, and we

come

to ours.

Whenever we

come here

their stuff here.'

go to them, but

I

it

and holidays

instead?

all

it's

—

makes me angry

their siblings,

With each

together

and

I

close

once a month

to their houses;

them

over, they say,

more convenient

like they're the

have

for us

grown-ups

not."

Out of

outsiders.

all live fairly

easier for us; the kids

James and Gretchen are the only ones

without children; they have wrestled with years.

have

at least

invite

It's

understand that

"I

— —we go

there's a family get-together

don't you

and we're

a Parent?

large families,"

sisters,

their kids' birthdays

all

'Why

come from

brothers and

Whenever

with

all

I

Become

family gathering, they

"Even though neither of us

it

feels that

should be

is

infertility for

feel

over three

more and more

the youngest,

way," Gretchen continued. "It

when we

feels like

like

get

James

sitting at the kids' table."

What Gretchen

describes, as

regressive pull of infertility.

do so many of our

It's

startling to hear

clients,

is

the

accomplished

— UNSUNG LULLABIES

68

and successful men and

women

talk about themselves in child-

like terms: feeling lost, helpless, or stuck.

may

hit

harder

at

when you've had ternity leave,

times

when you

a failed cycle,

when someone

And

these sentiments

feel particularly

when

a

vulnerable

co-worker goes on ma-

asks the dreaded question about

having kids.

You may not be consciously aware of

how I'm we

not an adult yet

if

I

this

underlying "some-

haven't had a child" thought. But

find that the loss of confidence

and autonomy that comes

with adulthood permeates the stories that our clients share

with

us.

Why

does

infertility

makes you

feel like a child?

What

is

it

about the experience that makes successful people in their twenties, thirties,

and

adult world?

What

early forties question their status as adults in the

does

infertility

do

to the deep inner workings

of our psyches to derail us from feeling as though we really do belong at the "grown-up table"?

We know

that growing

Nor does

turn twenty-one. first

job,

up it

isn't

magically completed

suddenly cease when you

move away from home,

or get married.

when you start

your

While our bodies

stop growing during adolescence, our psyches continue to develop

throughout our process,

life

span. Psychological maturation

and adulthood

is

phases, just like childhood

marked by

losses

of

all,

infertility are

developmental

perhaps the most

and may well cause the most

The developmental maturity include:

a lifelong

and adolescence. The milestones of

adulthood that are thwarted by

hidden

specific

is

distress.

processes that underlie true psychological

How Can

Be an Adult

I

own

separating from your

•

if

I

Don't

Become

a Parent?

parents: developing a psycho-

independence from your parents

logical

strengthening your adult identity: gaining confidence in

•

yourself as you increase responsibility in your

share a

with to starting a family of your

life

own

giving to a future generation: fulfilling a need to leave

•

something

for the future

Although there cessfully,

may

be

are

many ways

to achieve these milestones suc-

parenthood can and does play a key

at the

someone asks

role.

That's

why you when

top of your profession, but shrivel up inside

you have

if

worked through

all

kids.

You may

feel as if

infertility

tries to

important to recog-

It's

not only an individual and marital

is

finally

procedure, or worse, laments

you have not given her a grandchild.

nize that infertility

you have

your "stuff" with your mother until she

comfort you following an

is

life

forming intimate relationships: from finding someone to

•

that

69

crisis

—

it

a developmental crisis as well.

So we

are left with the question:

can't be a parent?

how your hope own

how can you

be an adult

if

you

You can begin by uncovering and acknowledging

of becoming a parent

—

parental identity

is

—your

realization of

one way in which we come to

your

see our-

grown.

selves as

Becoming Your Own Person

"When want tor,

I

was

to be

a

little girl,

people would always ask, 'What do you

when you grow

up?'

Sometimes

I

wanted

to be a doc-

sometimes a fireman, sometimes a teacher. But always,

I

UNSUNG LULLABIES

70

wanted thirty.

to be a

And

mom," that's

mom.

here

My mom

am, almost

I

had

forty,

five kids

by the time she was

and not even

close to being a

"To me,

said Sandy, diagnosed with polycystic ovaries.

what being

grown-up was

a

Why does Sandy, though

really all about."

a family-law attorney, feel so unfulfilled, even

an extremely competent and successful

to others she's

adult? First, regardless of your age or circumstances, parenthood entails the passing

ent,

of the generational torch

and someone

else

becoming

pressed,

is

—you

the child. But as

a parent does even

are

now the par-

Sandy so painfully

more than

that. It helps us

consolidate our identities as separate from our parents get to be the ones

making the

rules instead

ex-

—now we

of the child always

fol-

lowing them.

Becoming emotionally and ing into an individual one's parents,

is

who

and matur-

physically independent,

is

psychologically autonomous from

a process that changes

and

throughout

varies

Psychologists refer to this developmental task as separation the process separate

of

ties;

and

by which we become our own person with an

from our

parents. Separation does not

rather, the goal

is

Max, 30, remarked, "Now

we

as father

and boy."

Feeling

like

The

life

I

own

the

a severance

new

identity.

relate to

my

As

dad

are friends, with similar lifestyles, rather than

a Child Again

event of infertility can

said,

your

that I'm married,

the regressive pulls of childhood.

Connie

—

identity

to reconnect to those close to us in

different ways, once you've developed

differently. Like

mean

life.

"Chip and

I

make

us especially vulnerable to

"Whenever we

stay in

my

visit

my

old bedroom.

It

folks,"

hasn't

How Can changed since in charge

—

I

like

ing to have our

Be an Adult

I

home and

left

Become

Don't

I

makes me

it

I'm a kid again.

I

own

now

family, but

your sense of autonomy

ity,

if

used to

may

feel

it's

a Parent?

—

feel little

feel

it

before

precarious.

I'm not

like

we were

With

really bad."

71

Even

if

try-

infertil-

you have

achieved professional goals and have not been dependent on your family for years, you

You may turn

may suddenly

care of

as a

you

insecure and inadequate.

to parents for financial help,

At

sense of providing for yourself.

may come

feel

welcome

for a while.

relief; it

But

can

undermining your

times, your family's support feel

good

you may

at other times,

going backward. Rather than feeling adult and

are

feel childlike,

someone take

to let

feel as if

you

self-reliant,

you

needy, and out of control.

Conflicts about dependency can affect the potential grandparents as well as the infertile couple.

dependent,

may want

may

feel

awkward and unsure of how

first

may

feel like a

burden

Joan, 38, was torn about asking her parents for

IVF

as in-

They

to help.

to help financially with the exorbitant costs of infertility

treatment, but such an offer lief.

Your parents, used to you

cycle.

"When we were remodeling "my

as well as a re-

money

for her

the kitchen in our

They went

to a

kitchen store with us and began talking to the salesman as

if it

house," she said,

were their kitchen! invisible.

It

parents offered to help.

made me

so angry, like

I'm worried the same thing

help us out financially, they will treatment.

And yet,

if

will

I

was a

little

kid and

happen now; that

become overly involved

they don't help out,

we won't be

if

in

they

my

able to af-

ford this." Feeling trapped by the financial costs, Joan was battling the regressive pull of dependency on her parents.

UNSUNG LULLABIES

72

Growing Up

Is

The separation

Hard to Do process

is

especially important to the reproductive

story at three important developmental stages. early childhood, during the toddler first

The

and preschool

first

occurs in

years,

when we

begin to form ideas and expectations about what

a person in our

own

right,

and then make the

The second happens during

outside of our immediate family.

It's

is

in-

adolescence,

when we

The

begin to

to people

third takes place in early

often focused on the transition to parenthood.

important to recognize that the passage through each phase

does not

mean

that separation

is

complete. Just as physical growth

occurs in spurts, so does separation.

marks

to be

from the

more mature attachments

explore our sexuality and form

adulthood, and

transition

means

our parents into the social world of

tense, one-to-one attachments to

school.

it

a readiness to

move on

come more of our own our autonomy,

Moving through one phase

to the next.

Each phase helps us be-

person, and foreshadows the realization of

as well as

our

ability to establish intimate relation-

ships with others as adults.

Yet the helplessness and loss of control that infertility evokes

reawakens feelings from early childhood. less,

what everyone

ing for you.

you

can't

else

You may

do

it

feel the

up

go

as

same

feel

it

not happen-

it

did in childhood

that

when

you envisioned

when your reproduc-

out of reach

you had imagined

thwarted, just as

is

frustration as the toddler

The grown-up world

when you were young may

feels

should be effort-

seemingly can do with ease,

yourself.

tive story doesn't

What

would. Your growing

when your parent

told

you: "No, you're not big enough yet." In turn, the shame and embarrassment that often accompany

How Can

I

when

infertility,

Be an Adult

adolescence,

you

a Parent?

73

intimate details of your feelings and your sexual-

when

the need for sexual and emotional privacy and

independence was paramount.

if

Become

Don't

I

too public, can remind you of similar feelings from your

ity feel all

child but

if

still

will

And

like

an adolescent, no longer a

not part of the world of grown-ups, you

be stuck

may

feel as

at thirteen forever.

Feeling Stuck

The

third phase of the separation process often focuses

transition to parenthood. If infertility

velopmental stage, you

can you

feel like a full

may adult

is

on the

interfering with this de-

be faced with a painful question: if

you

are unable to

become

how

a parent?

There are no easy answers, but we find that when you understand the separation issues you might be struggling with uncon-

and the

sciously,

role that

parenthood can play

as

you mature

into

adulthood, this limbo can be easier to bear.

Becoming Equals Having to-adult,

a child allows

you

to connect with

rather than as child-to-parent.

your parents adult-

Without

infertility or

other reproductive traumas, having a child means you can get to

know your

parents in a different way, as

be a parent yourself. "Once

my own

stood

parents so

I

became

much

you

learn

a parent,

what

I felt

it's

like

I

like to

under-

better," said Claudia, 38.

"My

mother always worried about me. Her constant concern drove crazy;

I

wanted

until

you have

Now

I

But

worry it is

to be left alone.

I

remember her

kids of your own. You'll see.'

just as

more

me

saying, 'Just wait

And

she was right!

much."

difficult to feel identified

with or "equal" to your

UNSUNG LULLABIES

74

parents, if

you

can't be a parent yourself. Again,

sciously be aware of this;

it

was only

Claudia had children

after

What

that she understood the connection.

you may not con-

your awareness of what might be occurring

helps

is

to heighten

internally, so

you can

better cope with the strain.

Cassie described the subtle shift she

mother and

sister

got together.

whenever she and her

felt

"My mother and

sister,

thought

I

was jealous of

my sister. We and

as teenagers. She's three years older,

such cool friends. Back then

thought maybe

it's

At

used to compete a

lot

it's

I

high school she had

was so envious of

her.

And

then

I

my sister needed advice about my niece to my mother. I guess I'm still envious.

because

and she would only But

I

in

has a

don't.

two-year-old, have a connection with each other that first I

who

more than

listen

that. There's this feeling

I

have that they are

both adults and I'm not." Cassie

still

struggles with her feelings about this difference, but

knowing what's going on makes her she's

feel

more

in control

when

with her family. Identifying what's lurking beneath the sur-

face won't

make

the feelings go away, but you'll be better able to

handle what you do

My

feel.

Parents Had Kids.

Competition between

siblings, as

Why Can't

I?

with Cassie and her

sister,

is

readily understandable. Less obvious are the competitive feelings

you may have with your parents

why

—

after

all,

they were able to have

an equal with a parent

in-

volves resolving the natural (and normal) sense of competition

we

children, so

feel

can't you? Feeling like

with them. Consciously or not,

we want

their approval

and

How Can

Be an Adult

I

their admiration,

that

we

if

I

Don't

and often we want

are just as

good

at things as

Again, having a child of your

to

Become

75

show by our achievements

they are

own

a Parent?

—

if

not better.

you achieve

helps

a sense

of

equal footing with your parents. If you struggle with

infertility,

however, you can't quite resolve the competitiveness.

Infertility

prevents you from sharing the

own

of "parent" along with your

title

parents.

The

intergenerational impact of this loss

fecting not only

you but your parents

may

be profound, af-

as well. June, 62, the

mother

of four, was distressed that she and her daughter Amy, 34, were no

Amy

longer close. years. "I

only

had been trying

know

would confide

two

to get pregnant for over

they were trying because at the beginning she

in me,"

June said

sadly.

June was hurt by Amy's growing distance and didn't understand

Amy's need June

said.

to flaunt her material successes. "This isn't like her,"

"She

much more

talks

about

cultured she

portive, she rebuffs

me,

is

like

how much money than me. Even

when

I

infertility

adequate, especially in light of June's

own

made

fertility,

pathize with her daughter. June also recognized her

being a grandparent, and

pening

as

try to be sup-

I'm not good enough for her."

June understood that her daughter's

how

how

she has, and

When

Amy feel

in-

em-

she could

own dreams of

sad she was that this was not hap-

planned. As June got in touch with her

own

grief,

she

understood the depth of her daughter's trauma. She came to see that

Amy's put-downs were Amy's way of competing

other than parenthood.

in

an arena

Amy was struggling to feel like a successful

adult, even at her mother's expense.

The more you can

recognize and understand these normal

feel-

UNSUNG LULLABIES

76

ings of competition, the less distress

you

will feel.

Talking about

your struggles with your parents can also help reduce

this sense

of

competition.

By doing

so,

you may discover more about your

parents' repro-

ductive stories and find out that your parents also experienced re-

productive traumas.

and

infertility are

It is sad,

but true, that events like miscarriages

often not discussed, even within one's

Linda, 34, has a brother fourteen years older.

ily.

own

confided in her mother about her that her

mother had three miscarriages

brother's birth

was

infertility

thrilled

and didn't expect

when

to

own fam-

Only when

she

did Linda learn

in the years after her

become pregnant

Thanks

she finally conceived Linda.

conversation, Linda's mother could support

again.

She

to their

and empathize with

Linda, which she had not expected.

Your parents' experience didn't realize.

When

may

also influence

you

in

ways you

Jason talked with his mother, she revealed

that she experienced several miscarriages before his birth.

when

Jason was three years old, his younger twin brothers were

born prematurely. were born," Jason

"I

mother.

home

I

had

said. "I

of

to stay with

first it

thought maybe

to take care

my brothers my neighbors until my

remember being confused when

grandparents arrived. At

my

Then,

me again.

was okay, even fun, but

my I

I

missed

parents were never going to be

really didn't

understand what was

happening."

As an

adult, Jason

was so

terrified

of having multiples, and go-

ing through what his parents had experienced, that he was unwilling to pursue infertility treatment. Understanding

trauma made him so

him

resistant to

to reconsider using

it.

how his

parents'

medical intervention finally freed

How Can

I

Be an Adult

As you uncover and help to learn more,

to their parents,

a Parent?

your reproductive

about your parents'

if possible,

eases their

it

Become

Don't

I

articulate

of our clients have found

up

if

story,

stories.

own burdens

if

77

it

can

Many

they open

and sometimes they have learned surprising

things about their family history.

Even

a small exchange of infor-

mation can help you see yourself differently

in relation to

your

parents.

Of this."

course,

it's

easy for us to say, "Talk to your parents about

We know how difficult

it

can be to discuss something as pri-

vate as your struggles to have a baby.

omy you sexual

have worked so hard to

You may want

life.

pointment guilty cial

and

at

It

runs counter to the auton-

attain,

and the privacy of your

to protect yourself

from

their disap-

not becoming grandparents, because you already

sad.

Or you may

You may

help from them.

seem pushy or

not

comfortable accepting finan-

feel

also

insensitive in their

feel

worry that your parents may

own

discomfort and sense of

helplessness about your situation.

So consider what's

right for

you

as

you decide whether or not

have these conversations with your parents. If you that

you don't want

to

do

to

feel strongly

so, take that as a sign that

you

aren't

ready to talk yet, so there's no need to force a conversation. If you

do go ahead,

try to anticipate

Always know that

if

for

they might respond.

the conversation takes a negative turn,

can be prepared to end

enough

how you and

it

by simply

stating that

you

you have talked

now, that you appreciate their concern (give them the

benefit of the doubt),

and that you can

talk

more

later.

This gives

everyone time to digest what has transpired and rethink his or her responses.

UNSUNG LULLABIES

78

Reworking Old

Conflicts

Having your own family through

want

conflicts

to raise

parents and if

from your

also gives past.

your children

is

you the opportunity

Making

way

another

become an individual

in

decisions about to separate

your own

child.

work

how you

from your

For example,

right.

your parents were distant or unavailable, you

more nurturing and engaged with your

to

may

plan to be

Not only does

this

allow you to heal old wounds, you can also pass on lessons learned

from your you'll

and not repeat

parents' errors

their mistakes.

(Of course

make some of your own!)

Infertility deprives us

sense of

self,

and

ways better than chapter 2,

to prove

we can be

— our own

who had

parents were

of the chance to repair old damage to our

still

parents. This

from

—and

happened

in

some

to Carly,

from

a troubled relationship with her parents.

teenagers

and troubled family

different

when

Her

she was born, leading to a chaotic

situation. Consequently, she

and her husband,

Vince, waited until they were older and financially secure before trying to start a family. "I thought that said.

my kids

was

way

I

thought

I

I

planned

a family give

you can

on the

also pass

nisced in chapter 2 about

her "babies," said,

remember loving

how

positive.

her mother

"My mom also made

I

want

so well,

you a chance

I

stress,"

so

she

can't have a

to

do

for

to

rework the

As Laura, who remi-

made

doll clothes for

the best oatmeal cookies!

have the recipe and can't wait to bake for I

it

way

would."

Not only does having negative,

fixing things in a

wouldn't grow up with the same kind of

"But now, even though

family the

I

my own

my children

kids.

The

as well."

I

things

How Can

I

Be an Adult

if

I

Don't

Become

How Can You Achieve "Separation"

if

a Parent?

79

You Don't Have a

Baby? seems so unfair

It

development Again,

as

we

an adult. Haven't you already

don't

mean

don't have children.

achieve

their parents;

dren find other satisfying ways to do

to have a child,

are not quite the

adults

who

many

what

and cannot,

same

as

are parents. If

else

—not

it

You have

quite

don't

likely separated

your

your

career,

to

feels as

though you

—

the other

on par with

become

all

a parent, infertility

and accomplishment, no mat-

you have done. as part

of the

infertility

an important step in overcoming them. You only by the fact of

developmental

It

still

others without chil-

sometimes

you want

Recognizing these feelings

this

you

are not adult if

significant ways: in

interrupts your sense of completion ter

much?

children and

many

so.)

too

lost

your friendships, and your finances. But when you

relationships,

want

in

you

to suggest that

(Many people have

autonomy from

from your parents

your

to lose these opportunities to continue

infertility,

feel

experience

is

traumatized not

but also by the delay in completing

task.

can help, though, to think of other ways to accomplish

this

goal, or consider

ways that you've already done

How

else

do

you

and independent from your parents, and

like

an

feel separate

adult in your

own

right?

How

your parents, or proud to be

are

you glad

so.

to be different

similar, that don't

having children? Are there other people in your

from

have to do with

life

who

see

you

as

a competent adult? Ask yourself these kinds of questions, and periodically

remind yourself of the answers.

UNSUNG LULLABIES

80

Consolidating Your Adult Identity:

Who Am As you mature of

who you

together in

are.

if

The

Have a Baby?

Can't

I

you consolidate an

into adulthood,

jigsaw puzzle pieces that

new ways

moving

married,

I

as

you gain new

own home,

into one's

work, or having a child are

all

ways

in

internal sense

make up

the self

Getting

responsibilities.

receiving a promotion at

which the course of adult

development moves forward and strengthens your sense of

When

you decide

to have a baby,

fit

your identity

shifts

self.

from be-

ing the child to being the parent, from being a couple to being a

threesome, from being a husband and wife to being a father and

mother.

And

as

with any

life

transition,

guard to make room for your new lescence

when you

pelvis loosens

and widens

to

let

down your

you did

identity, just as

from child

shifted

you must

to adult. Just as a

make room

in ado-

woman's our psy-

for the fetus, so

chological structures loosen to attach to an infant and take

on

a

parental identity. This often leaves us feeling extra vulnerable and

emotional;

we

are excited, scared, confident,

same time. During

this transition,

selves, internally, just as

we

get to

we need

and nervous

all at

the

know our new

to get to

know a new neighborhood when

we move. If all goes well,

and you conceive

consolidates and progresses into the

as

planned, your psyche

new

—

identity

re-

that of preg-

nant person/couple. You use the time of pregnancy to become gradually accustomed to this change. However, infertility at this point, the

ground

ing through an earthquake.

You

you

are;

you

feel

isn't

feel as if

if

you experience

merely shaky;

it's

like liv-

you no longer know who

confused and unbalanced.

The

psychological

How Can space you

mind

Be an Adult

I

made

anymore

together

—

all

I

Don't

baby

to include a

The

are not being sung.

if

is

Become The

empty.

a Parent?

81

lullabies in

your

seem

pieces of the puzzle don't

because

infertility

makes you

lose sight

the whole picture. Rather than feeling that your identity idating,

you

feel as if

"I'm falling apart

nosed

when

I

try to

make

of

consol-

are floundering.

seams," said Sarah, 29, with undiag-

at the

plans.

constantly doubt myself and

I

know who

don't

is

fit

"I'm not able to concentrate and get frazzled

infertility.

ties. I just

you

to

I

am

my abili-

anymore."

Katherine, 36, also feels at a crossroads.

Two years

ago she quit

her sales rep job, because she wasn't sure she wanted a career that required constant traveling. At exhilarating. "I tion.

I

had so much

first,

the relief of not working was

free time,

it

felt like I

was on vaca-

caught up with old friends and completed house projects

that I'd been trying to get to for a long time.

pregnant quickly and everything would

was sure

I

fall

I

would

get

into place accord-

ingly," she said.

Now she doesn't know what to do after two years of trying.

Re-

turning to work, in her mind, means giving up the idea of having a family. But she doesn't

want

to think

of herself

as a full-time in-

fertility patient.

And Jenny,

a chiropractor,

to put their life

open up nant,

my own

and when

this yet."

on hold

When

I

is

like

many of

I

get

more

who

move forward

tend

want

to

keep waiting to get preg-

frustrated that

Jenny recognized what

over her, she could

clients

as they battle infertility. "I really

practice," she said. "I

don't

our

a

hold her

I

haven't done infertility

to fulfill the important

had

"work"

part of herself.

When

you, like so

many

others, yearn for a label of

"mommy"

UNSUNG LULLABIES

82

you need

or "daddy" that isn't forthcoming,

your longed-for new

overwhelming that your entire adult identity

is

self.

can be so

can take over and color

how you

feel

We

clients to

remember

just

self, is still

is

list

you can

that your

many

one

can bring

piece. It

made up of many

a baby" part. Keeping in

just the

a

helps

feel

Longing for Connection:

dif-

relief

different

mind

your

all

you maintain perspective on

this

strong as a person once again.

My Arms Ache

to

Hold a Baby

growing up means being separate, adulthood can indeed loom

as lonely

and disconnected. The wish to regain a sense of connec-

tion with others

have a family.

is

part of

When we

what motivates us

to

fall

we may

find our partner,

in love

common

ing children are varied and complex, one intimate connection with a partner

is

the wish to

result

make

—

—whether

Creating a family child, using

it

—

a family is

bond you and your partner

in a

of

this

What

bet-

together.

having your

donor technology, or adopting

want-

a family to-

gether and build on the closeness you cherish and love.

joy than to create something

for

and

we've

feel that

found another part of ourselves. While the motivations

ter

about

Being a parent, although a major piece

— not "having — even making —

identity crisis, so

If

our

your identity

to celebrate that

parts

tell

not a single element, but a composite of the

of your adult sense of

of

infertility

ferent aspects of yourself.

parts

this loss

The trauma of

identity.

it

mourn

to

—

own

biological

has the potential to

new way. And whether you

are a

couple or a single parent, having a child sparks another very different intimate connection with another person

with your baby

is

—

the relationship

unlike any relationship you have ever had before.

We long for the joy being a parent can bring.

Corinne described

— How Can this.

"I

watched

climbed into her rest

Be an Adult

I

as

my He

lap.

if

snuggled into her arms and

why my arms

it.

own

There

to love,

and

is

cry.

chapter is

was

like the

miss, that's

I

infertility,

you may

no replacement; the baby you yearn

to nurture,

These deep 8.

it

what

I

feel that

long-

family to such a degree that nothing else can sat-

painfully absent.

is

vice can get rid of this pain.

but

83

ache as they do."

When you are going through ing for your

a Parent?

two-year-old ran to her and

friend's

of the world was shut out. That's what

want, that's

isfy

Become

Don't

I

losses

No

Sometimes there

for, to

magic words of ad-

is

nothing we can do

need to be grieved, which we discuss

—your unsung

Being aware that your longing

part of normal adult development

depth of the despair you

sing to,

may help you

in

lullaby

understand the

feel.

Giving to the Future

Another goal of adult development concerns our wish something of ourselves this the

for future generations. Psychologists call

need for "generativity":

genes, but also our principles

generations to society

come. By

generation. ity,

life's

By doing

knowing

that

we

how we

and

ensure that not only our

values, will be passed along to

giving to the future,

and add meaning

students, absorbing

to leave

so,

to our present lives. lessons,

also give

It's

back to

as if we've

been

and now we can teach the next

we come

will, in

we

some form,

to the next generation can involve

own

mortal-

in others.

Giving

to terms with our live

on

mentoring younger workers in

your job, working on a cure for cancer, or

like Laura, sharing a

well-loved recipe. Clearly, having a child this need.

Our

is

one of the most tangible ways to

fulfill

family line continues, linking the past and future.

UNSUNG LULLABIES

84

As

Alice, 70, said,

"Becoming

a grandparent

was one of the most

my life. It felt as if I had finally come full circle, that I could see into my future. I hadn't been as aware of my own mortality when I had my kids, but now I can see how we pass the torch from one generation to the next. To see my son thrilling experiences

holding his baby Yet

many of

—

I

of

cried."

us feel frustrated like Rosa, a journalist and writer,

infertile for four years

that her to

work

is

do these days seems

knew someone was I

with no clear diagnosis. She no longer

an ideal way to give back. "Everything

was changing

anymore.

anyone

reading an

I

really

want

cares to read

this

mean

the future? For

that

some

you

used to

article

Other couples

and values

skills

the child

is

"But

my child,

just

and you

not just

must continue

believe that raising a child

ways to

their genetic

and imparting

their

wishes to give to the future, even

fulfill

The problem

their generative needs.

to terms with their

arises

story,

when

when

—

your becoming a parent is

if

who remain

wish to

infertility interferes it

feels as if every-

has been thrown off

to leave a biological child for the fu-

are faced with the prospect of being unable to

the other ways

me

couples, having a biological child feels like

course. If your greatest wish ture,

has no meaning for

are unable to leave part of yourself for

with your particular reproductive

—not

it

not genetically connected to them. Those

give to the future.

I

have written."

I

Each person and couple must come

thing

good when

are unable to have a biological child?

fulfills their

childfree find other

feels

attempt

had written, that somehow

I

the only choice possible; they feel they line.

feel so

to give to a child,

is

what

What happens when you Does

I

their life," she said.

What

who

pointless.

I

you express your

generativity

and contribute

do

so,

to the

How Can future

may

Be an Adult

I

feel like pale

Only by understanding

if

Don't

I

Become

what you

substitutions for

can you regain

really

85

long

for.

you

are trying to

own

reproductive

the developmental needs

meet, and facing the losses and changes in your story,

a Parent?

what you

at least partial satisfaction in

are al-

ready doing to give to the future.

Maybe your to

back through your business contributions,

you'll give

or your volunteer work. Margaret decided

artistic creations,

make

and nephews. "A piece of

quilts for her nieces

into every quilt," she said. "It

may even

When fertility

makes me

pass these quilts to their

you

step back, even a

own

me

goes

think they

feel great to

children."

little bit,

from the

and think about how you contribute

struggles of in-

to the world,

you can

discover sources of satisfaction that will be there throughout your life.

So we suggest these three

to offer. That's a

lot!

steps. First, reflect

on what you have

Second, please continue doing these things

while you are undergoing

infertility treatment. Finally,

that these contributions are important sources of life

that will continue regardless of the

How you portant

is

How Can Be I

When we

up

is

what you have

an Adult

If

I

meaning

in

outcome of your next

choose to give to the future

regaining pride in

recognize

Can't

to you.

your

cycle.

What's im-

to offer.

Have a Baby?

consider the complexity of growing up, and what

may

be accomplished psychologically by having a child, we can appreciate

how

deeply

though there

are

we

are touched

many ways

by the trauma of

infertility.

to achieve adult milestones

and

Al-

fulfill

our adult needs for autonomy, growth, intimacy, and continuity, having a baby can be a particularly meaningful one.

Can you be an

adult if

you don't have

a baby?

Of

course, but

UNSUNG LULLABIES

86

when you long that will

we have

fulfill

for a baby,

it is

difficult to

imagine anything

the adult needs covered in this chapter. Indeed, as

seen with so

many

people

we have worked

merous ways that people do accomplish these counted when infertility,

else

infertility

you may have

tasks often get dis-

becomes part of the

felt

tionships with your partner

proud of and

and

friends,

plishments, your home, and your

life.

with, the nu-

picture. Prior to

satisfied

with your

rela-

your professional accom-

But

all this

seems to pale in

the face of infertility.

Getting thrown off course of achieving these developmental milestones by infertility

is

an enormous

loss.

Again,

it is

a loss of

opportunity, and, because the needs are most often unconscious,

and unfold quite naturally when

more loss

how

helpless

life

due

infertility derails these

goals.

goes well,

we may

feel

even

and bewildered by our diminished self-esteem or the

of meaning in our

hood, you

all

will

to infertility.

By becoming aware of

normal and necessary

tasks of adult-

be able to develop other ways of meeting these

You can be conscientious

in setting clear boundaries with

your parents, maintaining close relationships, recognizing your value as a person, and contributing to society. that parenthood does not define adulthood,

By remembering

and that

infertility

does not define you as a person, you will be able to continue your

growth

as a

person throughout this ordeal.

Five

Everyone

If

Else

Can Do

Why Can't

Like

I?

hook coming out of nowhere,

a left

powerful punch right

your

core.

that seems so easy for everyone

else.

at

This,

You

infertility delivers a

are failing at

You may

with your peers, your family, even society

feel

at large.

something

out of synch

You may

feel so

awful that you want to hide in shame.

The ity

loss

of self-esteem and confidence that comes with

infertil-

may

can be truly overwhelming. The negative thoughts you

harbor about yourself hurt

when you

feel

terribly.

knocked down and

"I feel beat up,"

And

it's

hard to

fight

back

depleted.

Marsha began. At

thirty-four,

Marsha has un-

dergone multiple surgeries for endometriosis, yet her prognosis

mains poor. in the ring

"It's

not just the surgeries that

with Mike Tyson.

It's

make me

something

me, but ^//of me."

is

I'm

the daily grind, that ever-present

awareness that I'm different than most other feel like

feel like

re-

wrong with me, not

women.

It

makes me

just the physical part

of

UNSUNG LULLABIES

88

In this chapter that can

we look

at several external

undermine your self-esteem, such

on how easy

•

the media's emphasis

•

our family-oriented culture

•

the narcissistic injury that

•

your personal suffering of the

We

have found with our

of you are.

why

lets

Holding on

it is

silent

what

feeling demoralized

is

to get pregnant

pain of

feel.

negative feelings arise and

to

as:

clients that the

you separate those

internal factors

you experience

about themselves, the better they

where and

and

feelings

infertility

more they understand

Being able to pinpoint

how

they can take hold

from the

rest

of

who you

positive about yourself in the midst of

and defeated

lets

you

get back in the ring

again.

We

The Myths

Live by

Media Myths Bridget, thirty-one years old

time,

was peeved.

"My friends

are

"It

and taking Clomid

seems so easy for everyone

popping out kids

like crazy.

People filled with glowing photos of are they pregnant

it,

it's

else,"

she said.

then you pick up

these celebrities

—not only

and happy, they're stunning! Their bodies are

gorgeous, their hair

name

all

And

for the second

perfect!

is

impeccable, their

They make

it

makeup

is

seem so simple

flawless

—

.

.

.

so what's

you

my

problem?" Celebrity pregnancies plaster the pages of fashion and parenting

magazines, sending the message that everyone can (and should) be seven months pregnant and look dazzling, even in their

forties! It's

Everyone

If

Else

Can Do

This,

Why

Can't

too easy to absorb this media message that pregnancy natural state

my

—and

What you

Why can

to

Of

course, celebrities

few have chosen to

are entitled to their privacy, but only a brave

do we hear

share publicly their struggles to get pregnant. Rarely

anything negative about pregnancy in the media.

we

six

couples

These troubles are not broadcast nearly Instead, the implied message

it.

The

truth

pregnancy pregnant

is

is

don't read

that having a

and

be experiencing

baby

that, indeed,

is

easy. In fact, for

it

is

effortless

comes

some of

as

is

so deeply

predictable

anyone can do

not a sure thing at

woman

will

all.

embedded

pregnant

is

How

the

even become

The myth in

an enormous blow when

us, getting

it.

all.

unpredictable and out of anyone's control.

lective culture that

our colit is

not

the hardest thing

ever tried to do.

Before you experienced ceive,

is

may

as loudly, if at

and whether or not a

that getting pregnant

we have

is

control,

that pregnancy

will go,

We

certainly don't read about infertility,

even though one out of every

and expected, within our

is

of the great lengths that

go to to get pregnant.

about the miscarriages and

Why

everyone do this except me?"

rarely see are the stories

some women have

an easy and

is

"What's wrong with me?

start agonizing,

body not working right?

89

I?

infertility,

you may have had some

practice that

some women

before

trepidation.

will

you even

We

tried to con-

have found in our

worry about gaining too much

weight while pregnant, while others are concerned about miscarrying.

Or

they

feel

thing might be

about

nervous about labor and delivery, or that some-

wrong with

infertility until

stage in our lives.

it

the baby. But people rarely worry

happens.

Not only

are

And when

you not

it

living

does,

up

it

takes center

to the airbrushed

images of becoming the ideal parent, you can't even audition for

UNSUNG LULLABIES

90

the part.

It is

when you

can't live

be

lieve to

not surprising that your self-esteem takes a nosedive

up

own

to your

expectations, or

what you be-

society's expectations.

The Myths of Reproductive Technology Advances tural

myth

from

perfect,

will

in reproductive technology also contribute to the cul-

that pregnancy it

is

in

our control. Although

does give us a sense

—perhaps

years, the

women

less,

under

what

Disease Control.

ART can

are

thirty-five; for older

according to 2001 nationwide

ters for

—

ART

is

far

that

we

has im-

chances of having a "high-tech" baby

from non-donor eggs through IVF for

a false one

be assured of a successful outcome. Although

proved over the

ART

still

women

statistics

A disconnect exists

do and the hope

only about 25 percent the chances are even

compiled by the Cen-

between the

holds for so

it

many of

reality

us.

This

of is

not to say that couples should avoid using assisted technology.

Not

But be wary of the myth that the technological advances

will

at

all.

guarantee you a baby

—

that's

what becomes the

have talked about having a baby for about ten dren was always something

we wanted

time just never seemed right," Nell Patrick was. First he got his

turn and to

work

rarely

I

went back

had time

ter thirty-five, artificial

but

means

it

I

Many women,

never bothered

like Nell, are

it

realized

to have children.

I

—

I

"Having

eventually. I

was

me

and

chil-

But the

in school, or

worked. Then

my MBA. And then

company and

for each other.

do

many.

thirty-eight,

years.

said. "Either

MBA while

to school for

for a start-up

to

trap for so

now

This was true for Nell and Patrick. Both are

it

was

Patrick

my

went

was so time consuming we it

was going

because so

just figured

to be harder af-

many people

we would

use

too."

aware that their biological clock

is

Everyone

If

ticking, bur

can

urilize

Else

Can Do

Why

This,

ART. Sometimes women we work

were

at

twenty- five.

chance of conceiving

The

reality

is

91

I?

pur off having children because they

srill

know

who

with,

menstruating regularly, think that they are as as they

Can't

rhey still

fertile at thirty-five

that at age thirty, your

only 20 percent per month; by age

is

are

forty,

it

drops to only 5 percent per month, according to the American Society for

Reproductive Medicine (ASRM).* Another prevailing be-

lief is that

thanks to

ART we

can get pregnant without too

trouble. That's

what the media

of the

our friends

line

stories

toll

that

state

can someone say

ART

that's usually the

whom ART

ART

too

isn't

enormous

we presume

lengths to realize the

that

of not-so-

cost to our emotions

and pocket-

ART

will is

mentally,

infertile

family,

answer our prayers?

so strong.

dream of having

ductive story in spite of the fact that

Ours

a

It's

We will go to great

baby and

fulfill

our repro-

ART can be so trying—phys-

and economically.

Myths is

a family-centered society.

As we discussed

couples lose a sense of fitting in

and with society

at large.

There

—with

is

in chapter 3,

peers,

Fertility:

A Guide for Patients,

2003.

with their

a tacit cultural expecta-

tion that married couples will have children. Couples

*Age and

The

spite

because our desire to have children

Cultural

trouble?

can take on people's psychological and financial

favorable odds and the

ically,

as of-

never worked.

much

can be astronomically high. So why, in

books, do

punch-

What's not told nearly

tell us.

ten are the stories of the couples for

And how

and

says

much

who

choose

UNSUNG LULLABIES

92

not to have children do not ples, yet

they too can

feel

the same pressures as infertile cou-

feel

out of the loop

expectations. But those of us

who

when

it

comes

to cultural

have not consciously made the

choice to be childfree, but have had the decision forced feel

stuck in limbo

as well as

—

what others expect of

us. All

who

fitting the

mold. Her sense of

Day

passing month, and Mother's

of her personal

failure.

"For me,

ably spend the day in bed.

no way

I

can partake in

Of

of getting married

I

want

it's

my family's

if

you

my husband,

I

but this

to par.

I

—but

as a

mom."

Feel So Bad? societal factors

And

feel

attacked from the

chipping away at your

how you

guilt.

self-

envision yourself and

your future and can cause feelings of worthlessness and

shame and

as the

contribute to the sense

while you

changes

—such

by the media, along with

—can

likely that inside you're Infertility

is

can't have children feel

Day

demands and expectations

esteem as well.

but there

my idea of what a family is.

isn't

cultural

it's

with each

been wondering, what's the point

the perfect pregnancy portrayed

outside,

my mom,

call

myth of

up

hyperaware

traditional get-together."

We've explored above how external

are not

is

the worst," she said. "I invari-

to be able to celebrate Mother's

you

six years,

can't have kids?" she asked. "It's not that

Why Do

that

self.

has become a symbolic marker

course

sorely out of place. "Lately I've

don't love

expect of ourselves

self gets battered

women and men who

Like Valerie,

I

us,

has been married for eight years and has tried nu-

merous medical interventions over the past of not

upon

of these factors contribute

and sense of

to a diminished sense of well-being Valerie,

we

out of step with what

No wonder your self-esteem

plummets.

failure,

Everyone

If

Delores,

who

Else

Can Do

Why

This,

Can't

has been trying for three years, recently received

her invitation to her twenty-year high school reunion. cited

when

I

first

got the notice.

blast," she said.

"But then

show

my face?"

I

possibly

it

went

I

married then, but

now I'm

really

of shame

ages.

critic

when

it

—not

others

—

It's

is it

a

of people weren't even

don't think

I

could stand

my own

it's

feelings

about

it.

What

embarrass-

— I'm my

me

to not having children."

that she

When

was the source of her

she

feelings

she was able to bolster herself by monitorcritic,

and attend her reunion.

that infertility wreaks such havoc with are the psychological

how you

mechanisms

feel

at play?

a better understanding of these internal emotional systems

will help in dealing

with the trauma of

Changes Career

I

my own

comes

and understood

about yourself?

Having

lot

"You know,

ing and "turning off" her internal

Why

was

sure the conversations will be about

say.

me.

that's upsetting

identified

it

How could

bothering Delores, though, had nothing to do

with what others might

own worst

wave.

ex-

everyone say about me?"

What was

ment

like a

was

At her ten-year reunion, very few of her

how many, and what

What will

"I

my ten-year and

to

came over me

high school friends had children. "A

kids,

93

I?

in

infertility.

Your Self

Shifts

When you new and

decided to have a baby, you opened yourself up to a

life-altering situation.

Whether you

are in a traditional

marriage, in a gay or lesbian relationship, or have decided to be-

come

a single parent

—no matter how you

parent means that you are dealing with

and

realities.

arrange

new

it

—becoming

a

psychological issues

UNSUNG LULLABIES

94

As discussed a baby,

you

in chapter 4, as

start to

soon

as

you begin planning

to have

modify the way you think about yourself and

your partner. The twosome of the couple becomes a threesome

your sense of couples

self incorporates parental responsibilities.

literally

need to "make room"

often motivates a couple to

move from

one or change neighborhoods to

good school

a smaller

live closer to

Often

to start a family

home

to a larger

family or to be in a

district.

Making room Monica,

— deciding

as

for a

who worked

baby may

also influence career decisions.

for several years as a hospital nurse, ran the

cardiac intensive care unit before she decided to switch to a job as a school nurse. "Even though prestigious that

I

and stimulating

could

still

I

job,

took a major pay I

When

work, but have a more

new

flexible schedule," she said.

make

I

became

-minivans!" His music career

great,

we were

thing to look forward like

to.

"I

as

was excited

it,"

and

he took on a at

first

—

the

building toward something, had some-

But now,

it's all

a bust."

Hal and Monica, you've been willing

to

make

change and modify your personal ambitions in order to

your stronger desire to have a family.

Had you

children as you had planned, these career shifts right.

musi-

as a

interested in investments

became an avocation

full-time position as an engineer.

reer

it

sense of responsibility. "I can't believe

he chuckled. "Suddenly

Maybe

a less

he and his wife started talking about having a family,

the idea instilled a

money was

and

decided to make this change so

Hal, an engineer by training, was trying to cian.

cut,

But now you are suffering a double

loss:

a ca-

satisfy

been able to have

would have seemed not only

is

your

re-

productive story not unfolding according to plan, you also need to readjust your feelings about the career choices you've

made.

If

You may

Everyone

Else

Can Do

This,

Why

95

I?

your career. Ginny, a

also find that infertility affects

certified public accountant,

Can't

found that the daily ultrasounds nec-

essary to monitor ovulation drastically cut into her workday,

and

she opted to take a leave of absence. "Not only was the treatment too disruptive,

no picnic

I

But staying

just couldn't concentrate.

"With

either," she said.

so

much

can't help but think about getting pregnant off,

time on all

there seems to be an endless parade of

pushed down

my street

during the day.

I

my

the time.

baby

home

is

hands,

I

at

To top

strollers

it

being

just can't win."

Identity Shifts

As we discussed

to the birth of a baby; fore

we become

our parental identity begins prior

in chapter 4,

we become

psychological parents well be-

When

biological ones.

Hal decided not

to pursue

music professionally, he was consciously thinking about financial security,

but underlying that was the unconscious development of

his identity as a father.

to

become

ideal

part of his reproductive story, he

a better provider for his family-to-be

and

live

wanted

up

to his

of what a father should be.

This identity state;

As

shift puts

you may wonder

ful as a parent.

shoes?

if

you

you

You may

Or you may wonder

feel if

in a psychologically vulnerable

be up to the task and be success-

will

unsure: can

you've

made

you

fill

your parents'

the right choices, in ad-

dition to feeling ambivalent about past decisions during this transition.

Did you delay childbearing

to pursue a career?

struggling with age-related infertility?

the decision to start a family and ical

and

when

practical adjustments,

that hoped-for

Now,

Are you now

after finally

coming

to

making the necessary psycholog-

what

baby doesn't

a

blow you

arrive.

are experiencing

— UNSUNG LULLABIES

96

The changes we go through are profound, all

and can

leave people feeling vulnerable even

goes according to plan.

we have about becoming are

all

a parent

normal, occur whether

ture,

At

worth

It's

changes or not, and happen baby.

in preparation for having a family

we

as

this critical juncture,

when

reiterating that the feelings

—both

positive

and negative

are consciously aware of these

soon

as

we think about having

a

our hopes and dreams for the fu-

our feelings about our past, our perceptions about ourselves

and our parents, and our achievement of the ongoing developmental tasks

of adulthood

a vulnerable period,

come

all

we

are at

together.

much

And

because this

greater risk for

such

is

wounds

to our

self-esteem.

Healthy Narcissism If all goes well,

problems, you

and pregnancy and birth move forward without

may sail through

this critical juncture

normal psychological growing pains. tive experience

is

If,

with only the

however, your reproduc-

traumatic, you're in for a psychological beating.

Psychologists use the term narcissistic injury to explain

happens to one's self-esteem when

we undergo narcissism

is

infertility.

often

To

clarify

thought

of

it

suffers a blow, as

and define

a

negatively

dimension, which

is

an

person. Healthy narcissism

is

essential part

of a

does

when

few terms: while

as

excessive

centeredness, grandiosity, and need for admiration, tive

it

what

vital

it

self-

has a posi-

and dynamic

defined as concern for the

self.

Look-

ing inward, understanding your motives and feelings, and paying attention to your needs are

all

crucial in feeling

Solid self-esteem, a belief that

whole and worthy.

you have something

to offer,

and

— Everyone

If

Else

Can Do

all

cope with the

and tribulations of

good about yourself

Can't

97

I?

part of healthy narcissism, helping

self-confidence are trials

Why

This,

life.

you

to

In other words, feeling

not a bad thing.

is

Healthy narcissism develops unconsciously over the course of our

grows from simple events

lives. It

when you

with a smile

hung up

for

refrigerator,

also built

is

drawing praised and

doing well on an exam,

complimented on a new

run, or getting

Healthy narcissism

having others greet you

are small, having a

view on the

home

ting a

like

when you

set a goal

hit-

hairstyle.

and meet

it

or

master a challenging task.

Having

a child

is

another

way

that people enhance their sense

of positive narcissism. The pride people take in their children and their

accomplishments

reflects

saying "a chip off the

when

ol'

pride in themselves. Consider the

block"

—

them

their children resemble

it

how

illustrates

in looks or actions.

parents feel

Even when

a couple has adopted or used donor technology, they are

when

their children take

can serve

hope

their

as a narcissistic extension

mannerisms and of the

self;

in

traits.

A

child

our offspring, we

to see the best of ourselves.

It is

will

on

proud

natural to have expectations and hopes that our children

be similar to us and will be everything we want them to be

Of course,

and more.

it

never turns out exactly that way; children

develop and grow in their tually to separate

parents. It

might be

is

like

from

also

own

ways, and in fact must do so even-

us, just as

normal to

we had

to separate

fantasize about

what our children

long before they are conceived. This

the essence of the reproductive story, and because

about our

children-to-be for so long, they

from our own

is,

in actuality,

we have thought

may become

idealized in

UNSUNG LULLABIES

98

our minds.

The hope

that our children will

fulfill

our longings

a

is

normal part of the wish to have children. It follows,

then, that

by not being able

we

to have a child,

not extend ourselves through our children into the future.

we

denied the fulfillment of watching them grow;

can-

We

are

are denied the

pride and delight of seeing their accomplishments as a reflection

of our sad,

own achievement

as a parent.

A major part of us

is

missing,

and empty.

Having children may further enhance healthy narcissism by lowing people to undo their

own

childhood.

—

If,

or redo

—some of

for example,

that age,

you

will

new

own

remember your experience

to revisit the feelings, but as

brings

the painful events of

you were one of the

picked for the team, you can bet that as your

insight

Infertility denies us the

our bodies, you can think of the

immune

infertility causes a

is

self as

when

it is

having an

injured, but like

immune system.

you, infertility attacks your "self-esteem

system." Instead of feeling sick physically, you feel

tional pain.

A

as

such an intangible concept,

can be hard to imagine what happens

like a virus attacking

wounds by

of damage to your sense of yourself

a whole person. Because the psyche

And

heal old

op-

to the Self

Rather than fueling your healthy narcissism,

it

Being able

to be.

Wounds

narcissistic injury, a feeling

kids

child approaches

viscerally.

own childhood and

becoming the parent we want

last

an adult with an adult's perspective,

and understanding.

portunity to return to our

al-

narcissistic injury

can make you

emo-

feel like a failure,

gravely undermining your healthy narcissism and your sense of

being a fully functioning adult.

Everyone

If

What Did Healthy narcissism our

clients

come

their infertility.

is

Can Do

Else

Do

I

to

Why

This,

Can't

I?

99

Time

after time

Deserve This?

further diminished by guilt.

in feeling as if they are

They blame themselves

somehow

blame

for

for not taking care

of

may

themselves well enough, for sexual encounters they

may

or for birth control they

she used for

many

have had,

IUD

have used. Margot blames the

"My

years.

to

doctors reassured

me

that

it

didn't

cause any problems, but I'm not convinced," she said. "They can't

Of

find anything else wrong.

IUD in the first place." Women may also feel an

course

I

think

my fault

it's

for using

the

guilt if they

pregnancy

loss. Irene,

who

of as being a

is

it

left

is

to die?

must be mine." By

out.

it

safe haven,

my babies

has had three miscarriages in as

know why my babies

has been able to figure

so

regret, failure,

and

have had an ectopic pregnancy, miscarriage, or other

years, said: "I don't

causes

enormous sense of

are not surviving.

My womb,

apparently not.

It's

which

What is

not their fault that

idealizing her

with no choice but to blame

I

womb

I

many

No

one

always thought it

about

me

that

can't keep them,

and her

babies, Irene

herself. Yet she feels at fault for

something she truly cannot control.

Men ing

can experience

this as well.

when he was younger.

Todd

"In college,

I

feels guilty

about party-

did drugs, drank a

lot

with

the guys, had lots of casual sex," he confessed. "At the time, didn't think ther.

much

about

Maybe I'm paying

it.

for

But maybe

my

I

I

don't deserve to be a fa-

bad actions of the

sperm motility problems may not be connected

past."

Todd's

to his past party-

ing ways, yet he psychologically needs to find a reason for his infertility,

even

if it

outweighs

logic.

UNSUNG LULLABIES

100

We

see too often that

infertility find

more comforting

it

have no answers

many women and men

Many

at all.

struggling with

blame themselves than to

to

people gain a feeling of control over

the situation if they can point to a reason for their infertility, even if

the logic

when

it

is

faulty.

control, even if

They need

it

involves guilt,

of something

to feel in control

though everything

feels as

going haywire. Feeling in

is

may

actually feel better than hav-

ing nothing to blame.

But take a closer look causes

more pain

at this faulty logic. Feeling guilty

only

The

next

to an already diminished sense of

self.

time you find yourself feeling guilty, stop and check in with yourself.

What

really

just

happened

make you

to

make you

feel better to

over.

the reasons

Once you

It

it

never really helps

something that you have no

see the pattern

why you blame

out of control? Does

blame yourself?

to beat yourself up, especially for

power

feel

of your guilt and understand

yourself for

infertility,

you can break

this destructive cycle.

Unplanned Pregnancies. Abortions, and Talking to our

clients,

unplanned pregnancy

we have found in the past

that those

Guilt

who

have had an

blame themselves the most

for

the infertility they are experiencing today. Infertility can heighten

old feelings of guilt, remorse, and self-blame, whether the preg-

nancy was terminated or the child was given up

Women

and men

the right thing?

alike

may

for adoption.

be haunted by the questions:

Was that my only chance?

Did I do

Everyone

If

Else

Can Do

Why

This,

Can't

101

I?

Abortion and

Celeste, thirty-five-years-old

unwanted pregnancy she was too

was

young

admit to being irresponsible," she

I

I

my decision

to have

remember being very

an abortion.

They

really

She added,

I

if I

was going

to have sex,

do

me;

me

to

respon-

it

were great throughout the whole ordeal."

"It's ironic,

assumed that when again.

My mom even came with

scared. Afterward, she arranged for

have birth control. She said sibly.

"My

said.

me for getting pregnant, and supportive

parents were horrified with

of

knew

a child herself, she

Still

of her own. "Getting pregnant

to care for a child

and

a mistake

age sixteen.

at

had an

infertile for four years,

but because of that pregnancy,

was ready,

I

it

would be easy

I

always

to get pregnant

never thought there would be a problem."

Although Celeste had made the she questioned herself

teenager,

wanted a

right decision for herself as a

now

that she so

child. "I feel very confused," she said. "I

right thing

back then. But a small part of

my only chance.

I

wonder

have these thoughts. not sure what

I

.

.

am

being punished. I

this issue

"if

I

know

me wonders It's

know now,

would have done." Her voice

know," she continued,

baby now,

.

if I

Knowing what

desperately

if

I

did the

that

was

so weird to

though, I'm

trailed off.

"You

wasn't having such difficulty having a

would be

nonexistent.

It's

when you

can't

have something you want that you look for meaning wherever you

can find

it."

Having an abortion had made the

is

clearly a very personal decision. Celeste

right choice for herself

unwanted pregnancy. She

when

she was faced with an

certainly wasn't thinking about infertil-

UNSUNG LULLABIES

102

But when

ity then.

many doubts

for

infertility

becomes an

issue later,

it is

common

about the decision to emerge.

Adoption

When

a

woman

give her child feelings

up

chooses to go through with a pregnancy and

for adoption, she, too,

of remorse and

may

And

self-blame.

if,

struggle with intense

years later, she has

problems getting pregnant when she wants to become a mother, the intensity of those feelings

may

return with a vengeance.

Beth decided to give up her son for adoption when she got pregnant

at nineteen. "It

at that time," she said. "I

and life

was

it

—and

right for

as a single

me

was the best decision

knew

placed

I

I

my son with

good people,

mother

—would not have been

finish college

and

a

was not without

ket case after

minute next

I

I

was

wanted

feelings

Andrew was thrilled to

to

My

at

grief. "I

age nine-

was

a bas-

One

be giving him to such great people, the

somehow

to focus

it

close.

I

didn't

happened anyway.

I

want

to

kept

re-

on the long-term. Even though

feeling awfully sad, thinking about

what would be

baby, and ultimately best for me, was what got

Ten

thing."

emotions flip-flopped.

touch him and hold him

get attached to him, but

minding myself

of sadness and

born.

good

establish a career.

Although Beth was comfortable with her decision it

my

too. Raising a child at that time in

Beth was determined to

teen,

made

could have

me

was

best for the

through

years later, at the age of twenty-nine, Beth

I

it."

assumed that

having been pregnant once, she would easily get pregnant again.

So she was

all

the

more shocked and stunned when she couldn't

get pregnant right away.

had

Her doctor

left significant scar tissue in

discovered that an infection

her uterus, greatly reducing her

Why

Everyone

Else

Can Do

chances of conceiving.

And

with that news came an onslaught of

If

thought had been put to

feelings that she

"After

The

all

these years,

feel like

I

Now

ing good-bye to Andrew. I

am

103

I?

rest.

back

in the delivery

room.

as painful as say-

can't have a baby,

I

think

shouldn't have gone through with the adoption.

I

know

that

I

too late to change anything, but a hole in

it's

once again," she

me

has opened up

said.

Like other of our clients

who

or have had an abortion, Beth at

I

Can't

was painful, of course, but not

actual birth

maybe

This,

have given a baby up for adoption she had lost her only chance

felt like

parenthood; she blamed herself and

felt like

she was being pun-

ished for past decisions. Beth's reproductive story had veered off track not just once, but twice.

But

at twenty-nine,

when

The

time was at age nineteen.

first

she most desired a child, and was ready

psychologically and emotionally, her reproductive story again took a

Her

turn in an unforeseen direction.

trauma brought back powerful Celeste, Beth,

—

or re-grieve

do not carry the added burden of crisis.

of regret and remorse.

feelings

and others who have had previous reproductive

traumas need to grieve

rent

current reproductive

(In chapter 8,

we

—

guilt

their prior losses, so they

and sadness into

talk at length about

how

their cur-

to grieve re-

productive traumas.)

Silent Tears:

"Whenever anyone

asks

The Shroud

me

if I

of

have children

to say," said Andrea. "I'm a private person; ness, but at the

for not kids.

same time,

I

truth

is I

am

it's

I

don't

know what

none of

their busi-

worry that they think I'm being rude

answering their question

The

Secrecy

.

so ashamed,

.

I

.

and

selfish for

can't tell."

not having

— UNSUNG LULLABIES

104

—

"Do you have kids?"

This seemingly innocuous question

on new meaning when you

takes

Like Andrea, you

keep your

may feel

infertility

The need

unsure of

dimension of the trauma that

as

our

we

feel

it

affects the self.

feel

it,

so

we

that

As noted

of peers

circle

who

yet another

is

Because

infertility

ashamed of what we

are sharing the joys of

and

can close us out

new parenthood,

often are uncomfortable talking about our issues. Feeling

keep our

retreat

from others and

infertility a secret.

Hilary has been trying to have a baby for two years. At

thought about

telling a

when nothing happened,

vate.

Coming

some of her

into therapy

she decided to keep her travails pri-

was a great

relief; at last

"Everyone was gathered around, looking I felt

work know about

she could

my

infertility,

—they wouldn't include me

I

worry that

they won't treat

don't want people asking

"It's as if

would be the everybody

is

me

about

if

peo-

me

the

in sharing about their chil-

dren because they would be afraid of hurting me," she

I

let

from a co-

at pictures

so awful, so alone.

same way

I'm afraid

she

She shared a recent work experience.

feelings out.

worker's baby shower.

first,

few close friends that she was trying, but

then

I

see

nurturance. So

suffer a silent pain

in chapter 3, infertility

no one could possibly understand, we

ple at

is

can fuel our withdrawal from

many of the women and men we work with

of our

private

when we need support and

others at the very time

sense of isolation.

and want to

to respond,

and keep

ashamed of

The damage we

failure.

how

under wraps.

to conceal infertility

a narcissistic injury,

are struggling to have a baby.

my

treatment

said.

—

it's

"And

private.

fuel for office gossip."

on one

side of this fence,

and

other," she continued. "I can see through the gate, but

I

I

am on can't

the

open

If

it.

It feels

Everyone

as

it

need to keep

Can Do

Else

will never, ever

I

Can't

105

I?

be the same as them;

that's

why

I

this a secret."

Like Hilary, the isolation

going through to retreat

Why

This,

felt

Sometimes

infertility.

from others

both

is

by and created by people

it is

your

in order to protect

But the damage to your sense of

self

intensified

by your need

fragile sense

of

self.

adds to your need to with-

draw, and consequently adds to your pain.

Sometimes, we are forced to reveal our

would

new

rather keep

He

took

dentist. "It

to get pregnant

me

told

it

private. Hilary

had

all I

to confide in

him

got pregnant.

I

got

He told her to

years.

when we

after a visit to a

that

I

was trying

his taking dental X-rays.

a story about another patient of his

was so proud of himself

'take the

—

she had also

summer off.' He

to have thought that up!

Of

course, she

more and more uncomfortable and more and

more angry; he was implying never go back to

worst

was furious

and was concerned about

been trying for two

I'll

fertility status

him

that infertility

was

all

in

my

mind!

again." This experience confirmed her

fears.

These kinds of ples feel the

situations

all

the time as infertile cou-

need to explain and defend themselves against the

ideas that other people have.

In chapter 9,

come up

we

talk about

It's

how

no wonder you want

to hide away.

to handle these kinds of predica-

ments.

The

inherently sexual nature of reproductive difficulties also

adds to the impulse to avoid sharing your experience. For some, talking with family

members

is

a natural outlet, but for others, dis-

cussing sex or problems of a sexual nature possibly discuss this with

is

taboo. "I couldn't

my parents," said Thomas, who has

trying to have a baby with his wife Leah for three years. "I

been

know

— UNSUNG LULLABIES

106

that they

would be

than anything.

terribly upset; they

What I would

support, to just listen. But

really

want grandchildren more

want from them

me

to give

is

knowing them, they would

try to give

me advice and fix the problem. That would make me feel more like a kid than

already do. Also, aside from the cursory, obligatory

I

discussion about the birds and the bees

have never discussed

my

sexual

when

and

life,

to

I

was a teenager, we

do so now would

feel

weird."

Unfortunately, silence also exists

between the infertility

infertile couple. In

on your

—

frequently and painfully

we

chapter 7,

significant relationship. For

that the silence often

protective in nature.

is

the other person or bring

up painful

issues,

talking about the very things that need to be

The

silence,

discuss the impact of

now, suffice

Not wanting

it

to say

to hurt

couples often avoid

communicated most.

however, can be deadly to the relationship, making

matters worse.

The

irony about the silence that impedes discussing

whether

it is

infertility,

with our partner, friends, family or professionals,

we may become even more

that in our isolation,

insecure.

is

Our

sense of being alone gives us evidence (albeit not necessarily

sound) that

we have

wonder we want

failed;

everyone

else

can do

and nurse our wounds

to hide

this

but

us.

No

in private.

Healing Our Self-Esteem Just as the

heal

from a

visible, treat,

body needs narcissistic

to heal

from

a virus, the psyche needs to

wound. Because

narcissistic

wounds

they can be harder to identify, harder to

and consequently, harder

can heal.

to nurse

are not

know how

to

back to health. But they

Everyone

If

A case who

tor,

liked

in point

Else

Can Do

This,

Why

Can't

107

I?

Fran, a thirty-one-year-old college administra-

is

has been struggling with infertility for two years. Well-

by students and

staff,

she

is

someone who from

all

outward

appearances one would never suspect of feeling bad about herself. Yet even the most seemingly self-assured person

is

not invulnera-

ble to narcissistic injury.

"I'm having a good day today," she announced enthusiastically.

"Maybe

because

it's

my husband suggested

a vacation in Hawaii."

But with that comment, her bubble of optimism burst. Her face fat

grew dark and

and

sad. "I couldn't possibly

There

ugly.

is

no way

I

go to Hawaii.

can get into a bathing

I

am

—

suit

so

ever

again."

Any good criticism

feelings she

—and harsh

had had about herself dissolved into

self-criticism at that.

She didn't stop

self-

at feel-

ing badly about her looks; she lamented about co-workers she was

convinced didn't satisfied

like her, her boss

whom

she

felt

was no longer

with her work, and her friends that she was sure were

avoiding her.

Fran stopped midsentence and suddenly burst into

tears. "It's

my husband," she exclaimed. "What if he stops loving me because I

can't give

him

a baby?"

Fran went from feeling good to feeling lousy in the blink of an eye.

What happened? How

is it

that Fran's strong self-esteem

positive

mood

evaporated so quickly?

together

when

everything

What we

learn

feels so

from Fran

label

what has occurred. Key

sistic

wounds

is

is

How

and

do you hold yourself

wrong?

how

important

it is

to identify

and

to the process of healing your narcis-

bringing what has been hidden in the unconscious

to the forefront of

your attention, to understand what the "injury"

UNSUNG LULLABIES

108

really

So

is.

for Fran, as

it is

many of

for

to dig beneath the surface of her

tial

our

clients,

being able to have a baby.

sense of

infertility attacks

self, it

creeps into

at the root

facets

bad

of your

feelings,

life.

it's

of her pain;

in-

infertility

is

Even though you

important for you to

they crop up. If you give yourself the time and

space to get at the root of your anxieties, you

We

stemmed from not

your core and makes you doubt your

all

struggle to repress your

when and how

see

was

to get to

was the source of her self-denigration.

Because

may

Infertility

was essen-

mood swing

sudden

the heart of the matter. Fran's distress that day

fertility

it

may

well find that

the cause.

compartmentalizing

also find that emotionally

your sense of

essential to healing

put

infertility in its

and

isolate

it

own

from the

self.

infertility

In other words, you need to

psychological "container," fasten the

rest

of

is

who you are. To do

this,

lid,

you need

to

define infertility as something physical, and therefore separate

from who you your

as if

entire self

you need working glasses,

are as a person. Rather than thinking of infertility

to

view

it

correctly. If

would she

love her?

it is

essence of

who we

flawed (both physically and emotionally),

as a

part of your physical body that

is

not

Fran had a broken arm or needed to wear

still

Of course

pervasive,

is

worry that her husband would no longer

not, but because the effects

difficult to

of

infertility are so

keep perspective so we question the very

are.

In addition to compartmentalizing the physical aspects of infertility,

sets.

you need

As

it

have any

was

to disconnect

it

from your other strengths and

for Fran, infertility

skills

whatsoever, but

it

makes is

it

as-

easy to forget that you

vitally

important to bear in

If

mind you

Everyone

you

that

Can Do

Else

more than your

are

are a multifaceted

This,

Why

Can't

109

I?

Remembering

infertility.

that

and complex person, with numerous accom-

plishments and strengths, can help revive your healthy narcissism.

work and conscious

takes

It

points, but

doing so

once again.

When

will allow

Fran

different perspective

effort to

you

remember your strong

to feel

good about yourself

listed her positive attributes, she

on her

infertility

trauma

—

gained a

she was able to

from the actual knowledge of

separate the worries about herself herself. It's

even helpful to write

Are you tic,

a

good cook,

down

a

list

of your positive

athletic, creative, industrious?

conscientious, intelligent, funny? Are

caring, persistent? ities.

Don't be modest

Even though you may not be

as

you

up on your

—

refrigerator

negative feelings that seep

is

in.

So

how do we

cissistic

damage

we

heal? First,

artis-

you record your good qual-

able to feel positive

— even

all

the time,

putting the

a great reminder to counteract the

We

can repair the damage to our

self-esteem by giving ourselves credit where credit

ognizing the strengths that

Are you

sensitive, generous,

having evidence of your positive characteristics list

attributes.

is

due, and rec-

have.

by appreciating the depth of the nar-

that infertility can cause. Second,

ing that your reproductive story

isn't

by acknowledg-

what you hoped

it

would

be.

Third, by understanding the myths and cultural pressures that

make you alizing

feel less

than whole, and

less

than others. Finally, by

what makes you more than your

and celebrate your the rest of

assets

and

infertility.

strengths. Separate infertility

who you are. The more you are able

happens when you suffer a

narcissistic injury

re-

Acknowledge

to understand

from

what

and the more you can

UNSUNG LULLABIES

110

compartmentalize

infertility,

the better

and quicker you can regain

your sense of self-esteem.

your body recovers from a

Just as

from the trauma of take time sible.

—

You

infertility. It

virus,

your psyche can recover

might not be easy and

perhaps more time than you would

will feel better.

like

—but

it

might

it is

pos-

Six

Men Have

Men

are just as vulnerable as

feelings tive

Feelings Too

about

infertility,

women

are to strong

miscarriages, or

about

and

all this,

or even

fairly simple.

men

result

if

difficult

any other reproduc-

men

trauma. Yet too often, people think that

and

don't have feelings

they do, that their feelings are basically alike

This assumption

are too rarely asked

how

is

incredibly off base.

And

as a

they're feeling about what's go-

ing on. Everyone focuses instead on the woman's plight.

Craig

calls

me how

ask

while,

I'll

the "don't ask, don't

it

I

he

feel,"

start to

tell"

said, "I certainly

problem. "If you don't

won't

numb, and

lays,

I

forget

the periods that

my sperm even my male

I

Eventually,

—about

come when you hope they won't,

I

the de-

the tests of

any good, everything. But since nobody

are

asks,

friends,

for dwelling

my wife.

actually do have feelings

whether

me

you. After a

think I'm not supposed to have feelings myself,

that I'm just supposed to be supportive of get

tell

on any of

I

think there's something wrong with

this."

— UNSUNG LULLABIES

112

Men angry

feelings

—

lots

of them. They

feel frustrated

and

They

feel

not being able to take control of the situation.

at

helpless

and vulnerable when they

can't readily fix the

problem on

own, without outside help from doctors and medicine. They

their feel

do have

ashamed and

pregnant, even

if

manly when they

less

no male

factor

is

can't get their partner

involved.

When

there

is

a male

factor reason for infertility, a man's ego often takes a beating.

Men man

also get scared

can

fertility

feel

may

treatment, and if his

feel

impatient

own emotional

—

the longing for a family

must

scared even to admit

it.

A

depleted and worn-out by the ups and downs of in-

support, especially feel

—and may be

just as

when

needs

his wife

needs are dismissed.

much

women do

as

Men

—and

grieve the loss as well.

In this chapter,

we

explore

how men

can identify their repro-

ductive stories, and acknowledge the sadness, reactions they experience.

loss,

and traumatic

We also discuss some uncomfortable sit-

uations for men, including:

•

the infertility evaluation and dealing with the doctor

whose equipment •

learning

really counts

more than you wanted

to

know about

a

woman's

reproductive system •

coping with shots

•

how

to be

—being an

active participant in treatment

your partner's caretaker, yet not

sacrifice

your-

self to that role

Men's Reproductive Stories As we discussed stories.

Although

in chapter 2, not just

women

women

have reproductive

often respond to the idea of their story

— Men Have more

nun, with

readily than

they, too, have thoughts

Many men know much

think too

what

that's

they

but

reelings

whom.

Sometimes men

not be sure.

They may want

by age

may hope

boy.

kids someday, it

entails.

becomes an

issue. Sidney, in his early forties, infertility.

He felt tremen-

he had been undecided about starting a family.

trying not to get

talk about the irony of infertility after years "I

someone pregnant," Kenneth

went through

college buddies

hell

nant.

One wound up marrying

years.

The

I

a given

more con-

This ambivalence can be disastrous, espe-

start a family.

of worrying about an accidental pregnancy.

up.

little

not

persuaded to have kids because their partner

feel

And many men will

it

may

their first child

imagine a rough-and-tumble

thought his doubts might have caused the

and

it

because of the enormous responsibility

cially if infertility

ive

It is just

Other men give

think about having two kids, and they

feel reluctant

dous

discover that

they will be dads someday, but they

men may

guilt that

men

about having kids.

They may know they want

may

other

wants to

and

113

prompting,

about when or with

for a daddy's girl or Still

a little

they're supposed to do.

scious attention. thirty,

Feelings Too

other guy

when

the

—they had an

have spent years

said.

"A couple of

their girlfriends got preg-

girl,

which

abortion; he

lasted about three

was very support-

seemed they both agreed, but soon afterward they broke

never wanted to have to deal with

heat of the

moment

do with making

.

.

.

what

a baby." For

I'd

it,

but to be honest, in the

be thinking about had nothing to

most men, sex

is

more about

a feeling of release or closeness with a partner, than possibility

it is

pleasure,

about the

of reproduction.

But Kenneth, in

been cautious.

He

spite

of the heat of those moments, had always

took a deep breath and added,

"Now

after a

UNSUNG LULLABIES

114

year and a half of no birth control,

had

to

worry

Just as for

it

makes me wonder

women, men's

ideas about being a parent begin in

may tromp around

Daddy's shoes, talk about becoming big and strong

Dad

ever

in the first place."

childhood. Little boys mimic their dads: they

help

if I

like

Dad,

try to

or pretend they are going off to work. But

fix stuff,

boys also mimic their mothers, and

becomes part of

this, too,

reproductive story. Sometimes grown

in

little

their

men forget about having cud-

dled or scolded their stuffed animals. Kenneth was amazed at what

he remembered story. "I

where

when he

had three

—they were

mommy,

a daddy,

plastic

every night, and then

I

dolphins that

different sizes

all

and

started thinking about his reproductive

a baby.

I

and

They did

carted with I

me

made them

everyinto a

circus acts in the bathtub

tucked them into bed next to me."

Kenneth joked about getting

in

touch with his "feminine

side,"

but memories like these, hidden away and out of sight for years, exist for

most men. So

tive story,

you

start

contemplating your reproduc-

think about your childhood, favorite

vorite toys, as well as

bad.

as

More

and

help you reconstruct the early stages of

story, consider these questions:

•

What

kinds of things did you do with your father?

•

What

personality traits did

•

Do you remember

as a

how you wanted

be similar to or different from your

to

you derive from each parent?

younger person

(or

now) thinking fa-

ther or mother? •

Did you

fa-

memories of your parents, both good and

specifically, to

your reproductive

activities,

ever picture

what kind of things you'd do

ther with your child, like go

as a fa-

on hikes with the baby

in a

Men Have backpack, coach

ter,

interrogate the

As you

reflect

What

cars,

be a Boy

grade dance with your daugh-

fifth

young men she

on these questions,

the nature of the connections ents.

115

League, repair old

Little

Scout leader, go to the

Feelings Too

you

dates,

and so on?

also consider the feelings

felt

or didn't feel with your par-

parenting has meant to you in the past influences

you think about being

a parent.

It's

and

also important to think

how

about

whether you wanted to repeat the good parts or avoid the bad parts of the past when you were unconsciously scripting your reproductive story.

Men may

deny having

a reproductive story at first

— they may

not be used to thinking or talking about such things. But what

have found

that

is

their thoughts

when

encouraged, they open up and express

about children (beyond their

pregnancies), their recollections about their

what they imagine

it

will

we

be

fears

own

of unwanted

childhood, and

be a father someday.

like to

The Dreaded Evaluation After the requisite year of trying, feeling beaten

down by

not get-

ting pregnant, a couple turns with hope, dread, excitement,

embarrassment to an

women, did sell,

I

this

specialist.

For both

men and

a turning point in their reproductive stories. "Never

is

imagine

infertility

I

would be going

to this kind of a doctor," said Rus-

a forty-year-old businessman. It goes against the grain for

to ask for help

rections

and

—think about

—and

easy for others,

all

the jokes about

to seek help because is

not working right

"I've always prided

myself on

men

men

asking for di-

something so fundamental, so feels like a real defeat.

my

physical strength," Russell

— UNSUNG LULLABIES

116

continued. "Even

when I was

just to get the job done.

It's

exhausted, I've worked long hours

me where

what's got

am

I

working hard hasn't helped much with having a baby. get

today. Yet just can't

I

my wife pregnant." comment

Russell's say,

"We can't

stands out in sharp contrast to others

get pregnant."

It is, after all,

who

a joint effort. His sense

of sole responsibility, even before a diagnosis has been determined, is

not

uncommon. Many men connect

place male doubts about adequacy

common-

with

infertility

and functioning

in the sexual

arena, especially related to the size or functioning of their genitals.

that a

It is rare

when

even

blame and

from

woman will

the infertility guilt

is

"He

complain,

due

to a

comes from a man's

male

me

pregnant,"

Most

often, the

can't get factor.

internal sense of shame, not

his partner.

Men

often focus on their individual achievements; they pride

themselves on their accomplishments.

When

responsible for the couple's infertility,

and thus

his inability to "get the job done,"

not surprising that feelings

it's

the male

interprets this as

of shame and inadequacy are so overwhelming. Just tant for a

woman

get pregnant, a

woman

to separate her sense of self

man

the one

is

as

impor-

it is

from her

ability to

needs to remind himself that getting a

pregnant does not define his identity, his manliness,

or, ul-

timately, his "fatherliness."

When

an

infertile

himself to other

him

that

rialized

man

men who

starts to

easily

think negatively and compares

have children,

like to

remind

George Washington, the "father" of our country, memo-

by a huge,

phallic obelisk in the city

named

unable to have children with his wife. Although certain,

we

George probably had male factor

after

him, was

don't

know for

infertility

because

we

Men Have

Feelings Too

117

Martha had tour children by her previous marriage. Yet nobody

him

thinks of

masculine or

as less

less

heroic because of this.

The Doctor's Equipment Works, but Mine Doesn't Turning

to a fertility specialist

is

and women. The intrusion of third

men

parties into a couple's intimate

can be embarrassing and uncomfortable. Seeking help means

life

you

are admitting to yourself

need. This

man on

with feelings for both

rife

is

rarely easy to divulge,

than for a woman, since

their

and

men

you

to a stranger that

and may be more

are in

difficult for a

tend to want to solve problems

own, rather than admitting

their

need

for help.

A man may feel a particular threat if he makes a comparison between himself and the potency of the

infertility specialist's

medical

magic. Anthony, a thirty-five-year-old scientist at an infertility evaluation,

was reluctant

to reveal his difficulties.

bunch of technicians

and

a

felt

diminished in his capacity

He said,

will get her pregnant, as a

man and

the doctor. So during the evaluation, he

felt

when

someone

to talk

shop with,

I

can't."

He

a bit competitive with

compelled to impress

the doctor with his knowledge of technology. lighted to have

"This doctor

tried to

The

doctor, de-

engage Anthony

by discussing the laboratory equipment and other high-tech gadgets

Though

in his office.

gence of shame. "All

we only need

it

the doctor this

because

meant

well,

Anthony

felt

a resur-

equipment belongs to him, not me, and

my

'equipment'

isn't

working!"

Sometimes, the chemistry between a doctor and patient isn't right

—

for

for infertility or

the case,

opinion

it's

—

men

as well as

women

—whether

any other medical problem.

If

really

a consultation

you

is

find this to be

okay to follow your gut reaction and get a second

in fact,

it

may

be crucial to do so in order to make the

UNSUNG LULLABIES

118

whole process inadequacy

may

tolerable.

with

exist

If,

all

however, you find that these feelings of

the infertility specialists you consult,

it

have more to do with you than with the doctor.

Sometimes the

feelings

of competition and shame in relation to

men

the doctor can be reduced if

colleague or teammate.

No

can think of their physician

as a

one would dream of climbing Mt.

Everest without a support group, without food, oxygen, or the right tools. feel like

And as anybody who's

been there knows,

infertility

the steepest mountain in the world. Your doctor

can

on the

is

climb too, and will work with you, not against you.

To

achieve your objective of having a family, remind yourself

that doctors are not the enemy.

ment or

criticize,

manliness.

They

are not there to pass judg-

nor do they intend to dominate or diminish your

Think of

it

this

way: you are merely borrowing their

knowledge, their "equipment," and their support to reach your final goal.

Nerve-wracking Tests Unless a his

man

needs to go through a surgical procedure to obtain

sperm, the bulk of the testing

have multiple procedures, trial

biopsies,

actions to

less

any number of

for analysis

mand

is

—

is

all

Still,

more

and

re-

although a

woman may

be

of them are expressly medical.

—having

to

women

produce a semen

directly sexual.

face,

speci-

Masturbating on de-

hardly the same as masturbating for pleasure, but

sexual nonetheless.

will

drawn, endome-

most of the procedures that

the uniquely male procedure

men

levels

surgeries, painful daily shots,

more procedures,

invasive than

on the woman. She

having blood

hormonal medications.

subjected to

While

like

falls

it

is

Men Have Ir

Feelings Too

119

can also be absurd and embarrassing. At his

first

urology ap-

pointment, the nurse sent Murray to the bathroom to produce a

semen sample. "Not only did he

"but

said,

my pants what

I

it

take a while to get things going,"

missed the specimen cup! I'm standing there with

my ankles,

around

in the other.

What

specimen cup

the hell was

things weren't bad enough,

had

I

in

supposed to do then?

I

to explain

Although Murray laughed about

one hand, you know

later,

it

it all

And

if

to the nurse."

underneath

his story-

were painful feelings of shame. Though the nurse had been

telling

very professional, Murray was reminded of mistakes he had made, including his mother's anger and his brother's taunts for missing

when he was

the toilet

Murray

felt his

a

little

boy.

As

semen was analyzed,

his

old self-doubts reactivated. In his mind, the count,

morphology, and motility of

his

sperm translated into "there

aren't

enough, they are deformed, and they can't swim to save their lives."

Men

can cope with the anxiety and strain of these experiences

in several ways. First, finding to relieve

some

tension.

More

humor

in this absurd situation helps

importantly,

it

helps to realize you're

not alone. There's relief in acknowledging, sharing, and receiving validation for feelings of

men

other

many

"It

in similar situations have experienced can be helpful

Every

levels.

has his

shame and humiliation. Hearing what

own

man who

version of the

helped

me

has gone through infertility testing

bathroom story

to talk to other guys,"

just like

me." Talking about

feelings are normal,

rassed

by these

it

tell. I

re-

weird in any way. They

can help remind you that your

and that everyone

tests.

to

Murray said, "because

alized that they weren't aliens or geeks or

were

on

feels

humiliated and embar-

UNSUNG LULLABIES

120

Infertility

Acknowledging that partner

is

your relationship with your

infertility affects

may qualify as

question

and Your Relationship

the understatement of the century!

what part of your

relationship doesn't

anxiety, the financial strain, the physical

egos,

and lest we

forget, the tensions

on a couple. In

this takes

its toll

ent ways

men may

offer suggestions of

creates in the

respond to the strain

how

affect?

it

real

The

demands, the blow to

this section,

we

bedroom

—

all

explore the differ-

infertility

imposes, and

to cope.

A Woman's Anatomy— More You'd Know Infertility forces

it

The

men

to

than You Ever Thought

pay more attention to the female

Women, who

productive system than ever before.

re-

have had to

deal with their menstrual cycle since early adolescence, are used to the physical shifts

that occur

bloating, the blood. But

men

Even

aren't.

—

the cramps, the

sensitive

and mature

can be surprisingly squeamish and ignorant about menstru-

ation.

and

men

monthly

They may think of menstruation

sensitivity, irritability, messiness,

sexual activity.

When

infertility hits,

moodiness

in terms of

and

as

an interruption in

however, a

man

is

forced to

confront and deal with a woman's body in ways that weren't necessary before.

Some men cope by making ing temperature to

know

a scientific project out of monitor-

the exact timing of ovulation, assessing

changes in vaginal mucus, and charting the starting day of each menstrual cycle. While this helps some tive role in the process, others feel

men by giving them an

odd about taking an

ac-

interest in

— Men Have all

Feelings Too

121

ok the "female stuff" they previously avoided. This often de-

pends on

how much

exposure you

may have had growing

"Being the only son and growing up with three older Jerry said, "there were always boxes of

up. sisters,"

tampons and pads

in the

bathroom. Someone was always talking about how awful they were feeling at that time of the

periences, Jerry

was quite

month." Because of

at ease talking

his early family ex-

about these issues with his

wife and their doctor.

Clark wasn't. thing grosses

"I feel

me

bad admitting

As

out."

I

Whenever

don't

I

said,

"but the whole

remember bloody

know why my mother

them

up."

cycle,

he would involuntarily cringe.

ity

he

Clark had to empty the

a teenager,

wastebaskets. "It was disgusting. kins in the garbage.

this,"

Clark's wife

wanted

treatment together," he said, "but

"I I

to talk to

know we're

sanitary nap-

didn't

wrap

him about

her

in this infertil-

don't want to

know

all

the

nitty-gritty details."

Wherever you

are

on the continuum, from comfort with female

biology to avoidance of

it,

talking about

it

with your partner can

help your relationship. If she understands

why

certain things

bother or embarrass you, she can be more sensitive to your needs. Clark's wife, once she realized strual

how

he was by men-

blood and feminine hygiene products, minimized

sure to them. She also understood

longer took

knew

easily upset

it

personally; thus, he

why

his

expo-

he avoided them and no

was more supportive because he

she understood.

The Shots This treatment phase

and not

for the

same

is

agonizing for both

reasons. For

women,

men and women

the shots hurt. "I hate

— UNSUNG LULLABIES

122

needles," Trish

moaned.

going to have daily injections places!" For

emotions

men who

—and

may emerge: from

semen sample, but

weird way,

good

feel

I

had one

she's

that

I

much.

newfound

one

as the

into the positive category. "I felt so

fell

realized

I

was

abdomen, of

feeling positive in his

she was the one being subjected to so give the

my

into

I

all

are giving their partners shots, a range of

an active participant to feelings of dread Artie

when

almost passed out

"I

inflicting pain.

bad

All

I

role as

for

my wife

had

to

do was

test after another. So, in a

can help with the shots. At

least

I'm

doing something." After feeling peripheral to the treatment process, Artie felt

re-engaged with his wife and joked about playing

doctor with her. Giving the shots took away some of the helplessness he

had been

and allowed him

tence,

to

him

gave

feeling,

a renewed feeling of

do something

active regarding treatment.

After months or years of mounting tension about the shots allows

some men

compe-

giving

infertility,

to reconnect with their wives as team-

mates, and couples to experience this treatment phase together.

Other men respond quite

when he

on how

received instructions

"The nurse showed me how then sent

office,

differently.

to

me home with

do

it

Colin tried to seem

to administer the shots.

when we were

do

it

at

home,

I

was shaking

like a leaf.

insert the needle quickly, like a dart.

Adie's skin, needle ready to go, and while, Adie tient.

cry, it,

She

I

had

to fol-

I

I

when The

it

was time

for us

I

instructions said to

was standing couldn't do

there,

it. I

pinching

froze.

Mean-

was lying on the bed, getting more and more impa-

said, 'Just

and then

but

at the doctor's

a printout of the steps

low. It looked straightforward enough, but to

stoic

I

do

it

got angry.

already!' I

knew I

was doing the best that

I

And

so

I

did,

hurt her and

could and

I

I

and she

started to

felt terrible

about

didn't think she ap-

Men Have predated

do

this!'

that.

and

Feelings Too

123

shouted, 'Maybe you should get

I

that's

when we

It

all

the

else to

really started arguing."

Colin quickly realized that they were depleted but also from

somebody

— from

the shots

months of procedures and disappointments.

wasn't only the physical act of giving the shots, but what the

shots

represented.

He

brought flowers home. like a florist if

Adie her It's all

so guilty after their argument;

felt

He joked

that their

home

he had to bring

he

condo would soon look

flowers every time he gave

shots.

too easy to forget that

shots, as well as to receive

it's

them.

emotionally stressful to give the

can sometimes help to give the

It

shot in the doctor's office, with a nurse's support and guidance.

first

Any tricks you

can use to make giving shots easier are

fine.

Josh wor-

ried about getting the progesterone shots in the right spot, especially

one

after

and

particularly painful injection

his wife felt

For Colin,

ety,

it

Some men

and

his wife's hip so

helped to

he

know he

knew exactly where

their partner

their partners to give

must

them

an unnecessary appendage.

—

as if "here's

either find another person to help or

women

shots

is

don't want

the shots, preferring to maintain con-

It

can make

men

feel

man

as

you

to keep perspective

right."

struggle with this phase of

on what

and the tensions they arouse

feeling like

even more emas-

one more thing you can't get

What's most important treatment

to aim.

wasn't alone in his apprehen-

of the situation themselves. This can leave the

culated

He

can't administer the shots because of their anxi-

learn to give herself the shots. In other cases,

trol

close to a nerve.

much more comfortable after he drew a circle in per-

manent marker on

sion.

came too

is

really

going on. The

reflect the strain that infertility

imposes on a relationship. Reminding yourself of

this

each time

UNSUNG LULLABIES

124

you pick up

that syringe can help

you keep your focus on the big

picture.

Male Factor Treatment: No Although nostic

women

Picnic Either

typically bear the brunt

of the invasive diag-

and treatment methods when going through

are not far behind. infertility,

Male

factor

problems account

for

and recently the treatment of male

geoned. Male factor

infertility

poor sperm motility, poor sperm to penetrate the egg.

infertility,

men

40 percent of

factors has bur-

can be due to low sperm count, quality, or

Autoimmune

sperm that

are not able

reactions, female allergies to

male semen, and vasectomies that cannot be successfully reversed are also

problems couples encounter.

now

Medical procedures

male factor

TESA

hope

to couples with

ICSI (intracytoplasmic sperm

infertility.

(testicular

available offer

sperm

aspiration),

and

TESE

injection),

(testicular

extraction) are a few of the advances in interventions for

sperm

men.

While ICSI sperm can be obtained through masturbation, some of the other methods require that sperm be obtained

surgically, ei-

ther under conscious sedation or general anesthetic.

While very promising, these procedures can be extremely anxiety-provoking.

of

self,

The tendency

for a

man

to associate his sense

masculinity, and competence with his genitals

especially vulnerable to psychological injury

dures.

Normal,

evoked when a

makes him

from these proce-

early childhood fears of castration can be re-

man

faces genital surgery.

Little

boys protect

themselves from their fears by arming themselves with superhero capes and pirate swords.

Grown men may worry

that their "equip-

Men Have ment"

damaged, confirming

is

Feelings Too

their

125

childhood

fantasies, or that

it

could be hurt by a procedure.

These feel

even

ful for a

add

fears

to men's sense

of vulnerability, making them

manly. These fears and feelings are normal.

less

man

rate the

help-

from the

to compartmentalize his medical needs

of him, and actively use his cognitive and analytical

It is

skills to

rest

sepa-

medical procedure from his personal identity.

Sex as Baby-making. Not Lovemaking

Men

also

need to be reassured that

in

most

cases their partner

not looking at them as a baby-making machine.

asked

if

fertility,

When women

is

are

they've considered trading in their partner because of in-

most look shocked and

say,

"Of

course not!"

Cara, whose husband had a low sperm count and low motility, said, "I

married the guy because

matter what. Being able to

what kind of

father

I

make

love him,

a

baby has nothing

know Jamie will

to take a different path to

becoming

While most men don't complain

is

terested in

due

to

wanting a

We're

just

if their

It

may

feel as if

you

—no

do with

to

going to have

partner shows an in-

more complicated when the

baby. You may

act

do

still

feel that

she

someone or something other than you, and

gone from being a sensuous ing" task.

be.

I

parents."

creased interest in sex, things can get

upsurge

and

I

is

more

in-

that sex has

of love to a practical "manufacturare being used, almost as if

you

are

only good for one thing.

Graham,

a thirty-five-year-old general contractor,

feeling left out of

think part of

it is

lovemaking when he and

his wife

because we are on a schedule," he

described

had

sex. "I

said. "It's

not

— UNSUNG LULLABIES

126

like

it

more

used to be.

not

It's

'Hey, hon, are you in the mood?'

like,

Tuesday, gotta do

like, 'It's

wife either, but

I

have to admit,

it.'

know

I

feel like

I

my

not easy for

it's

It's

I'm a faucet that gets

used for doing the dishes."

Graham

dehumanized by the timetable of

feels

worst negative side effects of the couple's sex

life. It's

infertility

good

Some Things many men,

mind

to keep in

your relationship, the baby-making

For

treatment

make

not to say that there's a

nundrum

is

impact on

this

go on

forever.

Can't be Fixed

it

better.

Men

aren't reflective

that infertility

—and

is

a

is

just that

it's

to fix

problem that you

it.

The

co-

can't just fix

usually not without medical assistance.

make

that

things right. This

and thoughtful,

not only because you can't

is

like to take action;

make

problem, their natural response

not easily

feel helpless,

men

of the

that this phase of

years, will not

they repair things, take control, and try to

when

is

the most debilitating aspect of infertility

they can't do anything to

is

One

sex.

You may

a baby, but also be-

cause you can't help your partner stop feeling sad.

"Every time Heidi knots. sitive

I

never

and

tired

know what

liberated

just listening.

cries,"

Jonathan

to do.

I

there's

"my stomach

know I'm supposed

modern male who understands

on the

nothing

Internet. I

who

else got

ties

up

the value of it all.

I'm

pregnant or what

But mostly I'm tired of her

can do to stop them." Jonathan

tears

felt

because

inadequate

not only because, as he added, "Every other guy has kids and don't," but also because he didn't

tense waves of emotion.

know how

in

to be a sen-

But there are times when I'm fed up with

of listening to her talk about

she's read

said,

I

to handle Heidi's in-

Men Have

Feelings Too

127

Men as Caretakers

Men

can take the helpless feelings that Jonathan described and

translate earlier,

them

into taking care of their partners.

some men

As we discussed

empowered by administering

feel

the shots.

Other men make sure that they attend every doctor's appointment or they take control of the financial

and insurance aspects of

ment. Being actively involved in making sure

she's

treat-

okay, allows

him

to feel better too.

As long

as

your wife does not

needy or helpless If

helps

it

you

control slips

role,

feel belittled

and forced into

she can certainly benefit from your support.

more

to feel

away with

in control

infertility

—

much

especially since so

—putting energy

into caretaking

can be a way for you to regain some sense of effectiveness and store

some

ever,

become

aspects of your masculine identity.

way of avoiding

vulnerable side

—which

Some men, how-

their emotions.

They hide

they don't want to expose

larly anxiety

"Marie

and

"just talking"

a

all costs.

tend to avoid sad feelings and grief because

to have such feelings. Sitting

their

—behind

driven determination to take action and avoid passivity at

weak

re-

overly focused on the pragmatic side of infertility

treatment as a

Many men

a

it

feels

can be simi-

provoking. always nagging

is

can't she realize that

it

me

complained Rob.

to talk,"

makes me

"Why

feel terrible to just sit there

and

not be able to do anything?"

"But you keep never

let

or trust

me

me

in or let

what

I

at

me

such a distance," Marie responded. "You help. It

makes me

feel like

you don't value

could offer."

The problem with

driven activity and excessive caretaking

is

that

UNSUNG LULLABIES

128

they keep your

own

feelings

from ever being resolved because you

deny them, even

to yourself. Further,

it

to gain strength

by being helpful

you

chance to

feel

Women

to

robs your wife of the chance for a change,

connected with you by understanding what you

don't always grasp this need that

control of their

own emotions and

you throw yourself fashion, that

situations.

men

have to

feel in

Your wife may

feel, as

feelings

way

You may As we

think,

and that you

way

she does, she efforts.

What more does she want? I'm doing everything I can!

when under

how you cope

trauma,

this

and be unappreciative of your caretaking

discuss in chapter 7,

especially

about

she understands. Be-

cause you are not letting your feelings out the get angry

feel.

into aspects of the treatment in a matter-of-fact

you don't care or have any

because you are not expressing them in a

may

and of the

men and women cope very differently,

stress. If

you can educate your partner

best, she will realize that

you

you

are trying to cope as best as

do have

really

as to

feelings,

can, just as she

is.

Feeling Angry

The traumas and mas and

losses

losses, lead

of

infertility treatment, like

not only to feelings of sadness and

also to intense anger that people

what

to

do

with.

with multiple

—and

especially

men

when I'm

at

work, but as soon as

crying, or she barks at me.

for

don't

but

know

six years,

failed IVFs. Beatrice's depression over infertility has

dark gloom over everything," Duncan

if I

—

trau-

grief,

Duncan and Beatrice have been trying for

depleted her energy and drive. "I try to shut out stuff

most other

have something

me. That makes

I

get tired of

home,

I

can

feel that

said. "She's either silent, or

sometimes.

it

else to talk about, if

me want

get

I

the infertility

all

an

to bark back.

issue

Then

I

And

came up feel like

forget at

it,

work

a jerk."

Men Have Some

of

men

the anger

-

feel

Feelings Too

the natural result of the

is

made and

stressful

many men,

however, their situational anger

revival

129

circumstances surrounding

of feelings from

is

trail

For

infertility.

compounded by

earlier times in their lives.

Duncan

the

experi-

enced both. The oldest of three, he resented the attention

his

mother always seemed

So

Beatrice's intense focus

to be paying to his

on having

a

once again, to the most important

younger

baby made him

woman

in his

siblings.

feel

life.

secondary,

Understand-

ing that Beatrice's attention to infertility had nothing to do with her feelings toward

him helped Duncan

ent separate. After Beatrice reassured

keep his past and pres-

to

him of

his significance as her

partner and the future father of their kids, his anger dissipated.

Men well.

can deal with their anger and frustration in other ways as

Sometimes they need

to

blow off steam.

One

weekend,

after

a particularly stressful afternoon of listening to his wife rant about

her

sister's just- announced

"I listened,

wore on,

I

I

consoled,

wore

out.

were moments when

down,

I

went

to the

I

I

pregnancy, Richard was beside himself.

did as

much

as

didn't unleash

I

could, but as the day

on Akiko, although there

my tongue, but after she calmed batting cages with my brother," Richard said. I

had to

bite

"After smashing a few dozen balls and then talking with Jim,

exhausted, but calmer." Releasing his activity gave

own

I

felt

anger through physical

Richard renewed energy to support his wife during

this particular crisis.

Hidden Grief

Of course, men do

not only

seen, they feel anxious

and

feel

anger and resentment. As

we have

scared, out of control, embarrassed

their ineffectiveness (even if the infertility

is

by

not caused by male

— UNSUNG LULLABIES

130

factor),

and

terribly sad.

Their sadness

and the unexpected changes

is

due

many

to the

in their reproductive stories, the loss

of their views of themselves as masculine and strong, the timacy that

The problem

that

the other

all

comes up

men

who

out there

for couples, then,

is

and

women

Women

do.

are

more

they are sad and in pain.

They

of the

are dads.

men

them

in the

and

readily confess

more open about

are generally

in-

show depression

likely to

grief in easily recognizable ways: they cry

of

not that

don't have feelings, but that they often do not reveal

ways that

loss

infertility so insidiously steals, as well as the loss

sense that they are like

losses

ing they are depressed, and more likely to seek help

—by

say-

talking

to friends, joining a support group, reading books, or going to

therapy.

Since

men

don't necessarily open

even their wives For

many men,

—

the

up the same way, people

often don't realize that they too are suffering.

most unmanly thing of

ings of sadness, grief

all is

to

and helplessness that accompany

So how do men grieve and deal with the other along with only

rarely,

many men, profound

and usually when they

they reveal their feelings in

many men in

For

infertility?

come out

cally,

some

admit the

less direct

infertility.

feelings that

sadness and tears

are alone.

ways. As

area of their lives unrelated to infertility.

reproductive part of their

More

we

typi-

have seen,

If they can't feel

lives,

Sometimes they

accomplished in the

they can at least glean success at

something they do have control over, namely work. Other

ies

go

attempt to handle feelings by going into "action mode"

throw themselves into work.

ercise

feel-

more when they

are upset.

function properly in

this

At

least

they can

make

men

their

ex-

bod-

way. These can be constructive and

adaptive ways of dealing with stress and grief unless

it

becomes

Men Have

131

you away from other important aspects of your

obsessive or takes lire,

Feelings Too

including your relationship with your wife.

Still

men

other

build things.

Ted and

had

his wife, Sharon,

a

miscarriage at fourteen weeks after getting pregnant with IVF, and this

was

of various interventions. Returning from

after four years

the hospital after Sharon had a cabinets, ripped sink. "It all

D&C, Ted

tore out

all

the kitchen

up the old linoleum, and removed the kitchen

needed to get done sometime," he

perating from the surgery and

loss,

said.

Sharon, recu-

was stunned and wanted

to

know why now? Ted, not conscious of his motives alize that this

tion

work

let

was part of

me

take

do something." Ted thing new.

He

it

at the time, later

his grief. "I

out physically.

also

had a need

came

to re-

was so angry, the demoli-

My baby died and

had

I

to feel he could create

didn't have control over the miscarriage or

to

somethose

all

years of infertility, so he put his energy into something he did

have control over.

He

could rebuild the kitchen even

if

he

couldn't have a baby.

Unfortunately, sometimes

men

handle their feelings by throw-

ing themselves into alcohol, drugs, or other self -destructive behavior.

Drowning

one's sorrow

self-medication

is,

and pain

in drink or other

obviously, not in your best interests.

temporarily blunt your feelings, but never does

them. In

fact,

it

forms of

usually causes

it

It

help you get over

more harm and adds another

of trauma the couple must contend with.

may

level

Seven Relationships

Under

Fire

/ remember exactly when Ifell in love with Stephanie. She had invited me over for dinner. I was watching her puttering

had

suddenly

this picture

of us

as

around

changed

my

life.

Infertility

is

I don't understand what

what I pictured.

—

and I

married and that we had just put our

kids to bed. I was so happy. It was such a simple

different from

the kitchen

is

Eric, after

moment but one

happening

to us

two years of

not just an individual trauma.

The

now.

that

It's so

infertility

stress that the ex-

perience places on your relationship can leave you feeling that

you're alone in

team.

individually,

Not only do you you

like Eric,

also

We've

on

all

is

crisis

together as partners, as a

to feel closest to

may seem

also

to be

each have to deal with the trauma

must cope with how your partner

you must

reproductive story

toll

not facing this

The very person you want

pulling away.

And,

this,

come

to terms with

is

coping.

how your

shared

changing.

said this before but

it

bears repeating: infertility takes

intimate relationships. So the problems you

may

its

be ex-

periencing as a couple most likely don't stem from your relationship but from the enormous stress caused by

infertility.

Couples

Relationships Under Fire

must remember

— and be reminded— trauma

this reproductive

derstand

how

in their

own

each of you copes, you

133

that they each go through

way. Yet,

may

if

you do not un-

take your differences in

coping and reactions personally, feeling that

"if

my

partner really

loved me, she or he wouldn't act this way."

Even though both of you may

—

quate

helpless,

feel

guilty,

the difficult feelings we've been discussing

all

inade-

—you

are

not clones of each other, and you handle these feelings in different ways. Infertility to

endure so

far

may

be the toughest

—and you have

can help you come

closer,

What "I

was four days

late this

of an

it."

to learn

your relationship has had

and work on the

skills

that

not drift further apart.

Is

Happening

to

Us?

month," said Roseanne.

very swollen and sore and

might be

test

felt

I

exhausted.

"My breasts were

really

I

thought

this

Roseanne and her husband, Glenn, were in the midst

workup and

infertility

still

trying on their own.

When

her

period started, Roseanne turned to Glenn for support. He, understanding of

how

sad she was

— once

again

—

let

her cry, gave her a

big hug, then started talking about the lunch meeting he had with his boss that day. That's

on me," she

cried.

Glenn does

when

"Sometimes

care;

she lost I

it.

"He

just switched gears

think he doesn't care!"

he just doesn't

feel his grief

Roseanne does. For Roseanne, the experience feels

the hormonal shifts and

mood

changes,

is

the same physical

feels the

way

—

she

changes in

her body, feels the cramps of a menstrual cycle. She has to deal

with blood and tampons and pads, which under normal circumstances loss.

is

an annoyance, but with

Glenn's experience

is

much

infertility

less

marks

immediate; he

a significant is

physically

UNSUNG LULLABIES

134

removed from away from the

it,

and

as

we

discussed in chapter 6,

some men shy

biological aspects of the female reproductive system

anyway.

When you

you experience

infertility

you may worry

terribly

when

when you

find yourself in conflict with your partner, at a time

need each other desperately. Roseanne didn't understand what she interpreted as Glenn's indifference. She

wanted

to talk

and be

re-

assured, which Glenn attempted, but from her perspective

wasn't enough. Yet for Glenn to cope, he needed to cause dwelling on the feelings worse.

What

—

or the topic

move

— made

he wanted more than anything was to

fix

Roseanne and Glenn, each with their different coping

We

still

And

both

hurting inside, hurt each other

and

again: a disconnect

the couple since their coping styles are at odds. It

It

between

can happen with

can happen over financial matters that

affect treatment decisions. It

when any

decision

how many IVF

cycles to

can also happen

about treatment needs to be made, such as try,

feel

styles.

see this with couples time

each failed monthly cycle.

him

the infertil-

but this he couldn't repair. So he switched the topic.

ity,

it

on, be-

whether to use donor eggs or sperm, or whether or not to

adopt.

Differences of opinion are to be expected, but what's crucial

during

this

extremely stressful time

is

how you

negotiate through

divergent feelings with your partner. Because you and your part-

ner

may cope

with

stress differently,

understanding

how your

partner responds, and vice versa, gives you the opportunity to navigate these

rough waters together, rather than feeling alone and

adrift at sea.

Relationships Under Fire

How Do

You Cope?

When you are overwhelmed emotionally, a talker or

do you process your

or internalize anger?

Does

less?

Do

controlling or active or

feelings privately? Do,

would you

TV? What happens when you

more

you

feel

lash out

stressed or

rather relax in front of the

out of control?

do you relinquish

do you

what do you do? Are you

you work more when you're

exercise help, or

more

135

control?

retreat into passivity?

Do you become

Do

These

you become are questions

you and your partner can ask yourselves and each other

to help

you

identify your personal coping styles.

Nancy, 38, and Jake, 36, recently found out that Jake has a var-

and

iocele, requiring surgery. "Jake

since he cizes

was diagnosed, he

everything

nosis,

I

is

I

very irritable and moody.

do. I've never seen

Nancy has been

have always gotten along, but

him

He

criti-

like this." Since the diag-

researching online about this condition and

sharing her findings with Jake. "She's driving

she I

would

leave

me

me

crazy," said Jake. "It's

alone.

don't want to talk about

Are are

Jake's true colors

When it all

I

want

enough

already.

to talk about

it I

I

wish

will,

but

the time."

coming

out? Probably not.

He and Nancy

both in shock, reeling from the unexpected news about

condition. Jake, understandably, feels inadequate

and

defective.

his

To

cope, he's retreating into himself; he wants to ponder his diagnosis

and upcoming surgery sive.

privately, so

Nancy's prodding

She, on the other hand, finds that doing research

feels intru-

makes her

feel better.

By being honest with each

other about their coping

styles,

Jake

UNSUNG LULLABIES

136

and Nancy their

were dealing with the diagnosis in

realized that they

own ways

than the other.

—and To

that neither

negotiate their

method was

way through

inherently better

this stressful time,

they decided to be more patient with each other as well as pay more

what each other was saying

attention to

—not

just the verbal con-

versations, but the nonverbal cues as well. So, if Jake rolled his eyes

when Nancy

discovered a

personally, she

would put

wanted. Similarly, Jake

new it

article to read, instead

on

made

his night table to

a point of thanking

of taking

look at

when he

Nancy

for find-

ing the article and telling her what he thought after he read

Nancy and Jake

of

many couples

from talking about the next

benefits

process

are typical

it

internally.

option in great

detail,

may need

while your partner

it.

—where one person

step, while the other

Like Nancy, you

it

needs to

to research every

may feel overwhelmed by

the information. It's

also startling

when you've been on

the same page regarding

treatment decisions, but as time goes on and sions build over difficult decisions selves at

an impasse.

When

spirits deflate, ten-

and you suddenly find your-

Eric reminisced about falling in love

with Stephanie, and pictured tucking his kids in

dismayed

at

how

far afield his

at night,

dreams had come.

Up

he was

until this

point in their nine years of marriage, Stephanie and Eric were able to

compromise and negotiate when

Running

stressful situations occurred.

a real estate business together

practice in this. Yet now, after

had given them plenty of

two years of using Clomid and

at-

tempting four IUIs, they argue constantly about what to do next. Stephanie wants to try an IVF cycle, but Eric it.

"I

want

kids, but the statistics for

Eric said. "It doesn't

seem

IVF

isn't

sure

it's

worth

are not encouraging,"

like the best investment."

Relationships Under Fire

when

Stephanie bristled

money.

can think about

is

minded

like this?"

At after

at a

their

time

How

this. "I can't believe all

can he be so

low points, Stephanie wonders

and Eric

all,

she heard

wife. Just as

137

if

Eric

is

an individual can suffer a

man

the right

narcissistic injury, so

much money made them doubt what

that they were soul mates, that they

he

and closed

confused by feeling so disconnected from

is

couple. Stephanie and Eric's conflict over trying so

rigid

his

can a

IVF and spending

they had always believed:

would make good

parents,

that they were a team.

What

feels

an impossible impasse in their relationship

like

doesn't have to

do with

their closeness as a couple; the circum-

stances of their infertility have

thrown them off course. Their

dividual ways of dealing with stress

more emotionally driven

—he

in-

the logical thinker, she

—have always been

part of their attrac-

tion to each other, to say nothing of being an asset to their business.

But

and they

now are

at this crossroads, their

coping

styles are clashing,

pushing each other away in hurt and anger.

When you find yourself in of recognizing your

a similar situation, take the

own coping mechanism

first

step

(by asking yourself

questions like those at the beginning of this section), then your partner's. Second,

you must accept

that both of your approaches

are reasonable. If Stephanie can understand that Eric alytical later),

because he

she will

is

becomes an-

frightened of losing control (more on this

become

less

personally hurt. Similarly,

if

Eric can

appreciate Stephanie's fears of not having a family, he can provide

support and comfort rather than

you partner

will

feel defensive.

Likewise,

you and

have more empathy for each other and be better

able to accept each other's differences.

UNSUNG LULLABIES

138

Who's Loss of control

by

Imagine then

the same time.

Control Here

you

if

It's

feeling trapped,

two people

ii

some

feelings

and desper-

both

feel that at

feeling vulnerable,

it

may

cases people

becoming more controlling

But while taking control in some areas of

great antidote to helplessness, a

way

evoked

-adequate,

living together

pretty intense. In

regain a sense of control by lationship.

Anyway?

one of the most uncomfortable

is

infertility. It leaves

ate.

in

try to

in their re-

life

can be a

to protect yourself against

can also interfere with your relationship with

your partner.

Sometimes the need

met by your That's

for control

is

partner, even at the sacrifice of his or her

when

the power struggles emerge

partner both desperately want your time.

During

infertility,

teammates begin son

may

an attempt to get your needs

to

couples

who

view each other

own

own

—when you

needs.

and your

needs met at the same

previously saw themselves as as obstacles,

when

that per-

simply be trying to keep from drowning in his/her

own

feelings.

Taking control becomes a problem when you

why you

are doing

it.

Consider

Ed and

are not aware of

Joan, both forty-two and

trying to get pregnant for three years. Joan underwent two surgeries to clear

her blocked fallopian tubes; they also had one failed

IVF procedure. Their doctor suggested using an egg donor

to im-

prove their chances, but Joan would rather adopt. "If the baby can't be both of ours, then

While Ed expressed

it

should be neither of ours," she

his willingness to

has been a struggle every step of the way.

said.

proceed with adoption,

"He

says he'll

fill

it

out the

Relationships Under Fire

139

paperwork, and then he procrastinates," complained loan. "If

mind him, he do

"I'll

when

I

ealls

me

a nag.

I

re-

can't win."

responded Ed. "But I'm

it,

I

really busy.

I'll

get to

it

can."

"But you're always busy with something," exclaimed Joan. "I'm

beginning to think you don't even want kids!"

"You know

I

do.

You

just always

need to have everything on

your terms," Ed countered.

Ed

finally finished the

potential birth mothers

Joan

felt

desperate to

paperwork, only to find

who

move

fault

with the

expressed interest in choosing them.

on.

admitted that his heart was not

When she confronted Ed,

he

finally

he wanted to try

really in adoption;

using donor eggs. "She was so adamant about adoption that afraid that she

would

leave if

I

didn't go along with

Ed

Instead of being open with his feelings, resistance

As a

—

result,

around

—

the procrastination, the vetoing

fell

it,"

he

I

was

said.

back on passive

to solve his dilemma.

Joan was furious and hurt. Their power struggle revolved

their needs

of expressing

When Ed

and

their fears

—

her need for a baby, and his fear

his true feelings.

opened up

to Joan, their struggle

was defused. She

could empathize with his anxiety, rather than combating his negative behavior.

them, both

As they talked about the deeper

Ed and Joan

relaxed, able to respect each other's feel-

ings without feeling so threatened

Ed and Joan

felt

feelings motivating

more open

by them. As the

conflict abated,

to the different options available to

them, and agreed to use an egg donor.

Sometimes couples don't struggle tility issues

for control over the big infer-

but instead wrangle over the smaller

stuff.

"We

really

UNSUNG LULLABIES

140

try to stay connected," said

Samantha, "but sometimes Tony and

fight over the stupidest things!

dining

room

chairs

we

Where

to

I

go for dinner, or which

want. Everything always has to be his

way

or he's miserable."

want

"I

to feel like

I

have control in some tiny aspect of

life,"

Tony responded. "Everywhere

what

to

do

Sometimes

Tony lem

— I

at

at

look,

someone

is

telling

me

home, the doctors, and everybody!

want to be the one to decide."

understandably angry

is

from

arises

work, and

I

my

his

need to regain

at his loss

his sense

of control. The prob-

of control

at

Samantha's

expense. She too feels powerless about her inability to conceive, so

she fights If

you

partner,

Tony

to regain

some

sense of

find yourself engaged in this kind of bickering with your

it

helps to pause

and think: Will this

hour? A day? A week? A month?

no meaning

you go

empowerment.

in

Most of

and of themselves

— but they

to dinner

take

—

it

decision matter in

an

these disagreements have

doesn't really matter where

on meaning

in the

moment

be-

cause both of you are trying to grab hold of something to keep

your heads above water in the stormy seas of your medical

Control over

Under putes.

Money

the best of circumstances,

money can

bank

account for household expenses. If chases, spending large

It

trigger marital dis-

Couples handle money in varied ways; some pool

sources, while others keep separate

likely cause

can

huge

feel

ment when

crisis.

tiffs

sums of money on

their re-

accounts, with a shared

occur over small purinfertility

treatment will

fights.

frightening to invest your

there are

money

in infertility treat-

no guarantees. This anxiety may be the impe-

Relationships Under Fire

With

tus for control battles.

tance to

came

Eric

IVF stemmed from

141

and Stephanie, part of

his fears

his resis-

of spending money.

He

manage

controlling of the situation in an attempt to

bethis

anxiety.

Setting a limit

many

on how much you spend on

and Stephanie agreed they would

couples. Eric

mum of three

IVF

cycles.

fore consulting clear to both.

an

found

This road

that couples revisit

this

as

and

map

try a maxi-

ahead of time, even be-

flexible,

plan

is

though; your

We recommend

your situation changes.

revise their joint

for

helpful for our clients

it

needs to be

agreements about finances

and other treatment decisions periodically

We

works

infertility specialist if possible, so the

may change

feelings

We have

and agree upon some of

to negotiate

ART

—

say every few months.

explore these strategies in chapter 10, but, at this point, cou-

ples

need

to be aware that the financial tensions

of feelings about yourselves and

for all sorts

all

may

that

be a conduit

you

are going

through.

Control

in

During

the

Bedroom

infertility, sex

twined, as sex becomes

and reproduction become less

about pleasure and connection and

more about making

a baby. Sex

goal

When

is

ever elusive.

timetables and routines can ate a baby. effect

integrally en-

becomes goal-directed, and that

infertility takes center stage,

dampen

medical

the very spark needed to cre-

This invasion of sexual intimacy can create a domino

of loneliness and isolation by damaging each partner's

self-

esteem and their connection to one another. Control issues can also crop up in the bedroom. If one partner is

—

silently

—angry with

or actively

the other, or

is

depressed, the

UNSUNG LULLABIES

142

them widens.

gulf between

ner

may withhold

Interest in sex

may

decline, or a part-

sex to express anger. "I feel so fat

and

"When I'm

don't feel sexual anymore," said Janine.

ugly,

I

just

depressed,

I

don't care about sex."

Janine was resistant not only because of her body image; having sex underscored feelings of failure. Understanding this helped Ja-

nine and her partner, Oscar, reconnect.

time

I

wanted

ing a baby. lease,

said, "Janine

didn't connect the

I

two

—

good. But for her, sex

feels

it

Oscar

sex,"

"I didn't realize that

each

was reminded of not hav-

to

isn't

me

sex

what

was

it

for fun, a re-

used to be." So

Janine and Oscar separated out baby-making time from lovemaking the rest of the month, a compromise that respected both of their needs.

I

Blaming

Don't

Want

it

to

be

yourself, as Janine did even

My

though the cause of

tionship both inside the

bedroom and

outside of

may

one diagnosed with the problem, you

denying your partner the family he or she reassurances your partner

worry that Pete

Megan

said.

"I

is

may give

is

me

younger

if

who

If

you

desires. In spite

may still

because

are the

you

of

the

feel awful.

it's all

my fault,"

onset of perimenopause. Pete has been supcan't shake her anxiety.

he thinks about being with someone

else;

someone

wouldn't have these problems."

So Megan seeks repeated reassurances from Pete that she girl

all

are

only thirty-three, Megan's hormonal

and caring throughout, but Megan

wonder

it.

feel guilty that

you, you

going to hate

Although she

levels indicate early

portive

their in-

couldn't be specified by her doctors, infiltrates your rela-

fertility

"I

Fault

of his dreams.

Now that

he understands her

is

the

feelings, Pete has

Relationships Under Fire

143

been able to give her steady support, which has helped her separate her other good qualities from tle

infertility.

Realizing that she had

control over her body, she focused instead on

lit-

what she could

control.

Since guilt

is

a

heavy feeling to carry,

by becoming defensive or were

at

many

people fight

it

off

Madison and Trevor, 38 and 40,

critical.

each other about everything, from taking out the trash to

taking care of finances, from exercising (she didn't think he did

enough; he thought she was doing too much) to which friends they

would

see

on the weekend. This bickering masked

bitter feelings

they both had about their postponing starting a family, resulting in age-related infertility

and poor egg

quality.

Madison accused Trevor

of forcing them to wait while he finished graduate school. Trevor

blamed Plus

I

until

her.

got

"Madison keeps saying

my degree six years

we bought

When helpful to

wasn't ready, but

She didn't want to

it's

not true.

start a

family

a big house in the 'right' neighborhood."

a couple finds themselves in a raging battle,

remember what brought you together

Stepping back from the self

ago.

I

fray, calling a truce,

it

can be

in the first place.

and reminding your-

of the qualities you love in your partner can help to lower the

levels

of anger and re-establish your bond. Just

suffer narcissistic injuries

due to

infertility,

as individuals

can

so can couples. Your

sense of accomplishment as a couple mirrors your

own

individual

sense of yourself as a healthy, whole, competent adult.

When

treatment continues to be unsuccessful over a long period of time, it

becomes

difficult to resist the relentless

wearing away of your

sense of self as a couple.

Madison and Trevor each had

to

come

ous ambivalence about having children.

to grips with their previIt is

quite

common and

UNSUNG LULLABIES

144

normal

for people to question

But to blame each other for quite destructive as

When

earlier indecision

what, and the other a battle of wills that

is

is

about

sure, the couple

fair,

and can be apart.

can become engaged in

not only exhausting, but almost impossible

When

a couple stakes out opposite posi-

infertility

where one person must give

made under

not

not.

wanting a baby no matter

certain about

is less

to resolve comfortably.

sion

is

you push yourselves further and further

one partner

tions, decisions

whether they want a family or

treatments

become

a battleground

in to the other. Unfortunately, a deci-

these circumstances

is

invariably accompanied

by

resentment, guilt, and anxiety. If you have acquiesced, you

may be

you "won," you may

feel in-

furious at being forced to relent. If

debted to your partner for relenting.

None of

this

adds up to a

healthy relationship.

Madison and Trevor ized

how

resolved their differences

when

they real-

had been. They each owned up

similar their reactions

to

the role they played in the delay and no longer blamed each other.

"When we nally

stopped fighting," Madison

we were both on

something we both adopted a

little

said,

"we could

see that^z-

the same page about having a family.

really want."

It is

Madison and Trevor eventually

boy from Korea.

Traumas and Secrets from the Past As discussed

in chapter 5,

can resurface during

newed

guilt

infertility.

and worry that

may be judging fester

memories of past reproductive traumas

and cause

A member of a couple may feel re-

their partner will

judge them as they

themselves. If these issues remain buried, they can friction

within the current relationship.

Theresa had dated Brian for several years before they married,

— Relationships Under Fire

145

and during chat time they had broken up and reconciled times.

several

During one breakup, Theresa discovered she was pregnant

with Brian's baby, and without telling Brian, she had an abortion.

"At the time "I didn't

thought the relationship was

I

want

to involve

a

him

really over," she said.

baby under those circumstances, and

I

When we got back together,

in the decision.

could find the right time or the right words to

tell

faced with

infertility,

if

he would stay with her even

if

tell

Brian. She

own

much

needed to

at first,

and had

grief about this past loss, he could appreciate her

decision and agony over

of them

he knew.

she couldn't have a baby

and accept her past choice. Although he was angry to face his

if

her secret was eating at her.

Theresa decided to take a chance and

know

never

I

him." She kept

her secret because she was terrified he would leave her

Now,

want

didn't

telling

him. Ultimately

it

brought the two

closer together in their dealings with the current

infertility.

Any

unresolved

grief, if it

you progress through your alone

may

is

not dealt with, accompanies you as

life.

be heavy burdens.

Likewise, secrets that

Once you

talk about these issues

whether with your partner or with a therapist through, less

it

clears the

way

you bear

to proceed with

—and work them

your current challenges

encumbered.

How Can We

How

do you

Possibly Get Through This?

get through this as a couple? First,

can. Yes, the stresses of infertility challenge the

and your relationship individually.

room

is

undergoing a severe

most

test as are

But recognizing and acknowledging

to gain greater insight into

how your

know

that

solid

you

bonds

both of you

this gives

you

trauma

af-

infertility

is

UNSUNG LULLABIES

146

fecting both

you and your

partner. Second,

focus on two key tools: communication

—and

other

styles to

negotiation

—

so

we

you can accommodate your coping

help each of you get your needs met.

A Time to Tell, Not Show Why is communication essential? The

answer

we communicate, we can understand and be sult:

counsel couples to

—being open with each

confusion over the impact

partner decreases; the

infertility

is

simple:

when

The

understood.

re-

has had on you and your

more you understand each

other, the

more

intimacy increases.

How

do you communicate? That's more challenging. Some

ways of communicating are

than others. Consider

less effective

your doctor talking one hundred miles per hour about

you need

to have

done

—

he's telling

hard, even overwhelming, to absorb

you so much so

what

while he's screaming.

he

When

—

is

it's

Consider

communi-

to soothe his frustration

your husband withdraws into is

silence,

trying to

he angry? Sad? Tired? Depressed? Just quiet? Since you

can't read his versely, if

mind, you are

as likely to

your wife bursts into

—but what? Are they

ness? Tears

from hormones?

be wrong

tears at the

communicating

how

he's

communicating, but you must guess what he

is

say

how

hard to figure out

it's

—

the tests

fast that

he's saying.

your three-year-old nephew throwing a tantrum cating, but

all

If she

tears

drop of a

as right.

Con-

hat, she too

is

of anger? Tears of sad-

cannot put words to the

tears,

can you help?

Communicating about often you yourself don't

infertility

know

can be problematic since very

exactly

helps to pause in your most emotional

what you

are feeling. It

moments and think about

Relationships Under Fire

what you gument, that

feel,

rather than }ustfeel. If

try, as a

you

147

are in the midst of an ar-

couple, to take a quick time-out (sufficiently brief

no one withdraws completely)

to give each

of you time to

re-

group. Reflecting gives you the choice of whether to express your

anger directly to your partner, write

it

down, or

talk to

someone

other than your partner. Putting an argument on "pause" gives you

time to consider whether

it

should be pursued.

Despite the intense feelings that couples have, you really can help each other cope feelings.

This

is

if

you understand your

a time to

tell,

not show.

and

partner's needs

Words

one of your

are

and avoid

strongest tools in your effort to maintain intimacy alienation.

How do you ask your partner to help if you don't know yourself? A good place to start is with the reproductive What do you

say?

story. If

you can

your

dreams.

lost

They may be

tell

your story to your partner, you are sharing

And you

similar, they

can hear your partner's

may

be different

more you understand about each

bond you

dreams

lost

—but

too.

either way, the

other, the tighter the emotional

share.

Time to Negotiate

When we say it's

time to negotiate,

your partner to be the same

as you.

we

don't

Once

mean

again,

trying to get

you and your

we

partner should not expect to be clones of each other. Rather

mean

that

you find

a

way

for each

of you to cope

without leaving the other feeling flattened or though,

is

as

lost.

you need

to

Negotiation,

only possible once you have found the words to com-

municate what you need and

how you

can best obtain

Negotiation usually means a compromise

is

it.

in order.

When

loss

— UNSUNG LULLABIES

148

of control

is

so powerful, as

it is

with

we have found

finding a middle ground, but

you may

resist

this helpful for

many

infertility,

couples.

As you communicate and negotiate with your ber that this process

is

a lengthy one

get sorted out right away.

was a time

you can

translate if

is

rememgoing to

that each of

you

is

reproductive story. If ever there

of the doubt,

now

is it.

If

your partner's behavior into feelings and words,

you can ask your spouse

to translate

it

for you,

you

almost certainly find not a mean, cold, uncaring, overly emo-

demanding, or

tional, is

own

mind

in

to give each other the benefit

or better yet, will

—not everything

Always keep

struggling to deal with your

partner,

in pain

and needs

Finally,

controlled crisis

of

critical

someone who,

spouse, but

help.

by your partner. Your relationship

infertility

is.

Your partner

is

isn't

traumatic; the

neither controlling

causing the awful feelings; instead, the bad feelings

larger

become

efforts to

parents,

—have taken away your

If

You Are

Sometimes, though, ship, infertility

couple

if

makes

there it

is

come from

control.

Pulling Apart

something wrong with the

relation-

worse. Relationships crack along existing

when something

may

Still

you nor

and the circumstances

than either of you

fault lines

you,

important to remember that you are not trapped or

it is

your thwarted

like

as earthshaking as infertility hits.

A

unconsciously hope that having a baby together will

correct the problems in their relationship.

Then

the stakes really

go sky-high. In

many

cases, the crisis

of

infertility

the help they need as a couple. If

you

can spur a couple to get

still

find yourselves pushing

Relationships Under Fire

apart,

we recommend

which

to try to

together

couples counseling to have

work through your underlying

work through

in their lives

come

is

conflicts,

not

a

rifts

in

and then

couple realizes that the primary probbut the relationship

infertility,

They

itself.

baby could

to recognize that even if they could conceive, a

not heal the

haven

a safe

the issues that are specific to the infertility.

Sometimes, however,

lem

149

or incompatibility between them.

Ultimately, you each have to decide whether to stay together or not.

Sometimes

it is

harder to leave, sometimes

But whichever way you go,

let it

it is

harder to

stay.

be an informed choice, not an an-

gry reaction.

Reconnecting In spite of

all

the ways infertility can

have found that

many

come between

by

stered

And

their partner's support.

ens their awareness of

how much

Over the course of through

surgeries, a miscarriage,

Hank has been means lings,

with their family or

wonderful.

agreed.

I

"Through

to both of us.

Jeannie and failed

feel closer to

other.

Hank

IVF

said Jeannie, "but

we

Not just having

and of course, each

is

bol-

their infertility crisis height-

and two

this

bond

they love and need each other.

five years,

had so many ups and downs,"

Hank

feel

sticking together. This "us against the world"

by

They

couples grow closer as a result.

counter the sense of isolation that they peers

we

couples,

him than

realized kids, but

And we

are

have been

cycles.

"We've

through

it

all

ever."

how much

family

our parents and

sib-

going to have kids,

one way or another."

Wherever you vulnerability.

are in your journey, be aware of your partner's

Remind each

other that neither you nor your rela-

UNSUNG LULLABIES

150

tionship has to be defined

focus on

by

infertility.

the positive, healthy sides

We

encourage couples to

of their relationship whenever

they can, while simultaneously pursuing treatment. (with each other!) or take helps renew

When

weekend

trips;

what you enjoy about each

Go

on dates

carving out special time

other.

you can take a break from treatment, even

just a

month

here and there as long as medically permitted, use that time to regain a sense of your "old selves."

You can

reinforce the positive as-

pects of your connection, re-engage in spontaneous sex,

both your bodies and minds time to

rest,

before

and

moving on

give

to the

next intervention. In the end, try to recognize that your reproductive selves are

only a part of

who you are

—both

individually

and

as a couple.

are in this together, for better or for worse, but there

two of you. While the trauma of now,

it's

just

infertility

may

one chapter in the story of your

is

more

You

to the

be all-consuming

lives together.

PART

III

Grieving and Coping

Eight

Grieving for the Pregnancy or the This

Baby

month I thought

my period

that

it finally

was three days

Never Was

happened. After four years of

—and I'm

never

late

I actually imagined

late.

wrapping a cigar in pink-and-blue ribbons and presenting band. I was trying not to get excited, but the truth finally

my

turn to have a baby!

bathroom, there

it

But

through these

—

this

chapter,

In mourning

the

we

"little

grieve

when

a birth

is

is

to.

is

illogical; life.

an emptiness, that needs to be grieved

baby.

deaths?

you

face

when

So many people

infertility

the normal and expected course of a

was

into the

fail

of grief similar to the

no actual person

anticipated

hus-

ecstatic. It

Once again, no

explore the arduous task

challenging because there

my

when I went

little

deaths" Stacy refers

of a loved one, yet the grief of

it to

Stacy, infertile four years

to understand that infertility elicits a kind loss

I was

is

the next day,

was: that bright spot of hated red.

How many more months can I go

infertility,

to

is

much more

mourn. Having

it's

There

in the

that

to

out of line with is

a nothingness,

same way

as other

— UNSUNG LULLABIES

154

But

losses.

was?

how do you mourn

How can you

a

baby or a pregnancy that never

have a funeral for a longing or a wish?

you mourn your own

loss

when month

times must you grieve the same kind of loss

month

that next

not easy to grieve fully

it is

when

there

is

a chance

month, or with the next intervention, a successful preg-

may

occur,

mourning the

otherwise, grief can get stored

lems

after

the cycle repeats itself?

Although

nancy

How do

And how many

of identity as a parent?

"little

deaths"

very important;

is

up and cause more emotional prob-

later on.

The Complicated Task

of Grieving Infertility

How Do We Mourn When No One As painful kind of

loss

is

as

it is

made

to lose

easier

someone

Has Died?

close to us,

mourning

that

by reminiscing about the person. Being

member

able to recall the times spent with a family

or friend

shared meals, shopping outings, vacations, work, good times, and

bad

—

all

these fund a rich supply of

memories that

erased. Sharing the account of the deceased's

life

will never

with others en-

hances and aids the mourning process. Eulogies given celebrate

and recognize the treasured memories and

person has bestowed. As Leo recalled: "After

mother and

sister

old photographs.

ing old times.

It

and

I

sat at the

my

be

at funerals

feelings that

father died,

my

dining room table with a stack of

We laughed, we cried, we spent hours rememberwas helpful

to

know

that he

was

still

alive in

our

hearts."

But with solace,

infertility,

there are

no such memories

no photographs, no chronicles of a

know that what they're going through

to call

upon

for

life.

Infertile couples

feels like a

death in the fam-

— Grieving for the Pregnancy

— and more. Not only must you

ily

and the

loss

baby

—you must

having a family

tial

grieve the absence of a

of the desired experience of pregnancy

of your dreams, hopes, and expectations of

also grieve the loss

tion, a piece

155

—

in other

of yourself

parent. Grieving

is

still

words, your reproductive story. In addithat piece that

lost:

must take

you hold

as a

poten-

place, but in the absence

any concrete reminders, the mourning process

is

that

of

much more

difficult.

Because no actual person has died, rituals

—

otherwise

religious, cultural, or

the reproductive grieving process.

or sitting shiva

accompany the

dure has

In

people

failed.

fact,

who know

there

about the

is

No

little, if

—

you through

to guide

good chance

that the only

you, your partner, and per-

loss,

any, support. This

no

of a period when a proce-

a very

loss are

follows that there are

funerals, wakes, headstones,

arrival

haps your doctor. Alone with your

with very

it

is

you

are forced to grieve

a very private, very devas-

tating grief.

Even they

still

if

couples do find support from their family and friends,

complain that they

Stacy remarked with anger

feel alone.

that people didn't understand the impact these

having on her. "If

I

told an acquaintance that

just passed away," she said, "I

derstanding from them.

them if I

that

know I would

They would be

my period arrived once again

were from

another planet.

Or

horrid, encouraging words: 'Oh,

month,' that only make that everything

is

me

feel

my

favorite uncle

sympathy and unI

told

they would look at me as

they might give

you can always

worse.

deaths" were

able to relate. But if

—

else

get

"little

On

me

those

try again next

the outside,

it

appears

the same, like nothing has happened, nothing

has changed, and yet this

is

the saddest time of

my life."

UNSUNG LULLABIES

156

What

Stacy knows only too well

perienced infertility themselves,

it

is

that unless people have ex-

can be very hard for them to

late to the extent of the pain and the depth of the loss that

re-

infertile

couples face.

How Do We Grieve Added

If

We're

Trying?

and lack of support

to the isolation

also feel as if

Still

you cannot

you

fully grieve while

of trying to have a baby. If you

cess

for couples,

may

are

still

you may

in the pro-

possibly conceive next

month, how can you get any sense of closure on the experience? You're living in a cycle of hope (during ovulation) followed by the

enormous letdown (when conception doesn't take

place) followed

which often

lasts for years,

by hope once

makes

it

again. This pattern,

seem impossible

to fully resolve the loss.

similar to a boxer in the ring

It's

determined to keep going. get knocked down hurt, a still

little

more

again.

who

is

losing the match, but

He gets knocked down,

And

little less

marking the end of the match, he can nurse

If

With

But when does the

you

are

still

his

—but

the bell rings

wounds and

recu-

it is

very difficult to grieve each month.

the thread of hope, however thin, dangling in front of you,

may feel

and the

as if

you

desire to

the fight if feelings or tial,

When

more

final bell ring for infertile couples?

in the ring,

the task of grieving it

little

able to regroup

hopeful of a win, he remains in the ring.

perate.

gets up, only to

with each round he gets a

disorientated, a

is

you

may seem are getting

deny let

this

is

unnecessary or too

one step

final.

closer to the

normal. You

Each month

end of the road

may feel you are giving up

yourself grieve, and so the wish to disavow the

blame them on something

else

may

take over.

It is

however, to face the grief even as you continue to pursue

essentreat-

a

Grieving for the Pregnancy

tnent.

Acknowledging the multiple

157

from month

losses

to

month

will

not eliminate your pain, but releasing the pent-up feelings of anger,

and sadness

frustration,

will provide

Even when couples have decided

infertility specialist

to pursue other avenues

on, a persistent, nig-

—

still

trying to conceive.

I

am

when

I

ovulate,

and

But

each month, I

am

I

still

I

make

this,

we have

my life

I

next to im-

is

know

I

pay

even

if

perfectly

is

closure

on

this

it

also

phase of her

it

time and again with our clients

happen. Yet holding onto

with your

ability to

false

make

hamper you from moving on

So

get

life.

She

a losing

We have experienced it ourselves,

having a baby, no matter what any doctor has

fere

it's

may

normal and reasonable to hold onto hope,

the odds are against you.

and have seen

And

can't help myself."

does not want to admit defeat, even though she knows battle. It

exactly

seems crazy

off. It

hope keeps the door open, but

way of her having some

me knows

sex during that time.

my actions will but

unbeknownst

rational side of

at this point in

sure

hope

pursuing

"The

is,

menstruating regularly,

still

secretly

Elena's sense of in the

—

toward parenthood. Nevertheless, Elena,

that having a biological child possible.

maybe

just

and agreed that they need

has just celebrated her forty-sixth birthday,

to Ray,

that

move

to

might happen. Elena and her husband, Ray, have

still

stopped seeing their

who

relief.

hope may remain that maybe

gling ounce of

pregnancy

some

—

the feeling that

might

said, still just

hope, as natural as

it is,

may

decisions about your future.

to the next chapter in your

inter-

It

may

life.

How Do We Get Through This?

What we perience,

is

have found as therapists, and in our

that while

it's

own

personal ex-

absolutely necessary to grieve so

you can

— UNSUNG LULLABIES

158

from

heal

many. The

grief are

you

infertility's

are going

wounds, the roadblocks

first

through

loss as

tility

causes genuine loss

to recognize

and

The second

—

mourned

step

can be.

is

one that

to understand just

private

is

also grieving the loss

this

what

realize that

it

really multiple losses as

that

you

truly

is.

we have

see

Infer-

seen

of any loved one.

just like the loss

Remember

honoring

Even though others may not

comparable to a death in the family,

that needs to be

ble loss,

is

real.

is

your

infertility

step

to

how

difficult

mourning

an intangi-

are dealing with

and one that few understand. You're

of hope

—having

baby

a

—while

at the

same

time trying to remain hopeful for your next attempt.

The

third step

is

to

become

familiar with the phases typical of

the grief process.

Knowing

can be reassuring,

as illustrated in the next section.

the challenges of

What Grief

is

is

It

front

Grief?

an intense emotional reaction to a

threatened, can be of anything to which It is

mourning up

not merely sadness, but a response

you

felt

loss.

The

loss, real

or

are strongly attached.

throughout your body.

can affect your physical well-being, causing discomforts such

as

breathing problems, muscle aches, gastrointestinal pain, or exhaustion. Grief can affect your behavior:

some people throw

themselves into work, others into alcohol or drugs; some can't sleep,

while others

ing habits feel sad, less.

done

may also

grief can also

to terms

take naps as an escape. Likewise, your eat-

change, and you might gain or lose weight. You'll

but you

And

come

may

may

feel

angry, confused, frightened, or help-

wreak havoc on your sense of

with guilt and regret about things you

in the past.

self as

you

may

have

Grieving for the Pregnancy

159

Renee, a thirty-four-year-old teacher, entered therapy after being diagnosed with endometriosis. She had gone for a routine

checkup

of unsuccessful trying, only to get news she

after a year

Now,

hadn't expected.

shaken and wondering

had become

living

six

months

why

after her diagnosis, she

had happened

this

to her.

was

still

Day-to-day

and her husband had become impatient

a grind,

with her despondent and angry moods. "Phil thetic at

is

sick

first.

and

He

tired

of me.

But now, truth be

told,

he avoids

mote control has become plain, he shuts

children. is

you

don't

Of course, it,

know what

it

doesn't hurt?

it

anymore."

I

I

understanding and sympa-

me to my doctor's me

like the plague.

his best friend. If

He says

down.

get over

He was

even came with

he's sick

get

I

think the

and you go on. But

weepy or com-

I

it

can't

too.

But

his feeling

seem to do

and Renee was a

also

how

it

became

clear that the distance

result not just

they coped with their

of their

grief.

infertility

We have found that men

tend to grieve differently, especially in the face of

ity. It is

easier for

more acceptable

upper

ner, as

women to

we

lip,

feel that

for

cry openly

women

between

trauma, but

women

stiff

I

need to talk to him, but he doesn't want to hear

Phil

however, often

that.

supposed to do. Pretend I'm okay? Pretend

As her story unfolded,

turally

re-

of hearing about not having

he has been upset about

am

I

appointments.

when they are

sad;

and

infertilit is

to voice their feelings.

cul-

Men,

they need to be the cheerleader, keep a

and channel

their grief into support for their part-

discussed in chapter 6.

Ernie and his wife, Mara, have been through eight years of infertility

dures.

treatment, including six IUIs and two failed

They

are currently investigating an egg-donor

IVF proceprogram

as

UNSUNG LULLABIES

160

well as adoption. Ernie said, "I

somehow.

I

am

know we

positive about that." In private, however, Ernie

confided that he often goes for long drives "so car

and

I

can be alone in the

He couldn't show his vulnerable side

cry."

would upset her more

if

she

knew how

Not only do men and women also grieve in different

ways and

symptoms

abate,

tioning. But for

uphill line like a

often grieve differently, people

that ebbs

And each

and you return

and

time you

else

to

You

flu.

flows, ebbs

revisit

level

or relive a loss,

gain distance

if

is

in a straight

It's

like rereading a

we

it

book: you get

discuss in the next sec-

components and phases of

loss,

grief;

alters.

month

after

each

Usually

symptoms

particularly difficult because

the loss repeats itself

it's

you view and handle

with time and distance from the particular infertility

of func-

flows.

time you re-enter a phase, your outlook slightly

But grieving

lousy

to health, but then

your former

and

out of every reading. As

tions, there are different

feel

bad to getting well again. Instead,

differently as time goes on.

something

viewed

at different times. Phil

and nurse yourself back

feeling

he

also afraid

most people, grieving doesn't happen

— from

wave

Mara because

upset he sometimes was.

grieving as a condition, like having a cold or the for a while, stay in bed,

to

He was

he thought he needed to be strong for her.

the

be parents

will get to

lessen.

you

can't

month.

The Stages of Grief Most

ple go through, ness, anger, finally,

der,

on mourning points

research

from

and

initial

to a series of stages that peo-

shock and denial, to feelings of sad-

self -blame,

then the hope for a miracle, and

acceptance. Although these stages are listed in a certain or-

implying that you pass through one phase, complete

it,

and

Grieving for the Pregnancy

move on

to the next, the truth

Is

that grieving Infertility

You may experience

linear process.

jumbled order over the course of months or

ing,

you may accept your of

feel full

This

infertility, yet later that

are losing your

on top of everything

else

afternoon you

failing

you have gone through.

Cant be Happening to Me!

initial grieving.

news

One morn

mind, or that you're

Denial and shock are two of the most

of

years.

These unpredictable emotions are normal;

rage.

mean you

they do not at grieving

not a

is

these stages simultaneousl) or

in a

may

161

is

No

common

characteristics

When

one wants to believe awful news.

of a personal nature

—when your doctor

tells

the

you that you

have endometriosis or poor sperm quality, and that your chances

of getting pregnant are greatly reduced

overwhelming. lieve

it!

This

We hear from

just can't be

—

our patients

happening

the shock all

is

particularly

the time: "I can't be-

to me!"

Renee described the appointment when her doctor

first

sus-

pected that something was wrong with her reproductive system.

"My

periods had been painful with more intense cramps than

usual, but

doctor

at

I

chalked

my

it

myself tuning out

lems.

I

to

PMS. When

routine appointment

get pregnant for a year feel

up

—

he

listed

mentioned

it

was

to

my

tests,"

she said.

"I

could

what could be causing me prob-

kept thinking that he had to be wrong

matter with me,

it

the cramping and trying to

—he ordered more as

I

just cramps.

I

— nothing was

the

honestly don't remember

hearing half of what he said as he quoted percentages and proce-

remember

wanting him to stop talking so

dures. All

I

home and

crawl under the blankets."

is

could go

I

—

Renee, caught completely off guard, went into shock

a nor-

UNSUNG LULLABIES

162

mal reaction

bad news. Also normal was

to getting unexpected

her desire to shut out the world and deny the reality of painful information. "Phil

was

shock too," she continued. "That night when

in

him, we both just

we

Phil suggested so he could

What

sat

come and ask

helped Renee,

and not

feel

at

I

told

our dinner, barely able to

eat.

my

schedule another appointment with

infertility diagnosis,

ble

and stared

questions.

like

was

was

I

grateful for that."

most people when they

to compile as

much

alone in what was happening.

first

what your doctor

to take in

may

be some difficult decisions.

is

receive an

information as possi-

We recommend tak-

ing another person with you to your appointments; first

doctor

it

saying and later to

helps

you

make what

In addition, being able to voice your thoughts, concerns, sadness,

and

fears

with your partner can help you come out from un-

der the covers, lessen the need for denial, and face the reality of the situation.

become

less

When you

are able to talk about

whelming when they

are kept inside;

they become more manageable and

One Minute I'm

When

your

feelings,

they

burdensome. Things become unspeakable and over-

Crying, the

when you

give voice to them,

less frightening.

Next I'm

in

a Rage

the reality of the situation sinks

in,

you may

feel

sad and

depressed, angry and frustrated, and anxious and pessimistic about the future. All these emotions can occur at once

you, but these are

all

normal reactions when the reproductive story

does not go as planned, and

You may in the

feel

dumps.

and overwhelm

all

a normal part of the grief process.

despondent and hopeless, heartbroken and down

Felice, a thirty-nine-year-old attorney,

had been

di-

Grieving for the Pregnancy

agnosed with age-related

infertility.

163

Although her doctor was

ART

mistic about her chances of getting pregnant using

list

or donor

"It's

hard to want to

of options the doctor gave me," she

said. "I feel like

technology, Felice did not

pursue the

same way.

opti-

giving up before

the

feel

even get started."

I

Intertwined with her despair were feelings of intense anger. Al-

though the power of these emotions can be unnerving, they are a normal component of

grief. Felice felt

delaying childbearing.

have kids, but

it

"I

was always waiting

never seemed convenient.

I

hadn't put

it

cuse for waiting," she said. "If this mess.

when

in denial.

Anger

You may anyone it's

I first

I

I

always found an exoff,

wouldn't be in

I

wanted

to believe that nothing

mourning process

find yourself crosses

the people

"Why

didn't

I

I

we

tional eruptions.

more

It's

who

not because

and discover that we hate them;

as well.

to have a child.

Often

bear the brunt of our emo-

we suddenly it's

outward

with your partner, or with

who happens

are closest to

know I was

I

was wrong."

gets directed

irritable

your path

did."

go see the doc-

had signs of pain? Now, looking back,

in the

who

herself.

see all their faults

the opposite.

We

can

let

our anger with the people we are closest to because they are they will love us no matter what. But at the same time

confusing to explode

you may

feel

at the

more hurt and

people you love upset,

for

for the right time to

could kick myself for waiting as long as

I

Renee, too, admonished tor

most angry with herself

—and

after

it

out

safe:

can be

doing so

and scared that your intimate

relationships are falling apart.

We

advise clients to

remember

that the infertility

and

grief fuel

the anger. Your relationships are not falling apart because of fatal flaw in

you or

in them; rather,

it's

the trauma and

loss

some

you

are

UNSUNG LULLABIES

164

experiencing that's wreaking havoc on your sense of self and on

your relationships. Realizing that grief reaction can help

you

this

is

a normal

and expected

better prepare for this emotional roller

coaster.

How can you

emotions constructively? Renee

release these

uti-

lized therapy to put her sadness and anger into perspective. Talk-

why mourning

ing about her feelings helped her understand necessary and that anger

is

is

a natural part of that mourning.

Vigorous exercise can also

alleviate tension

and

stress.

Physical

which help reduce pain and promote

activity releases endorphins,

a sense of well-being. In addition, writing, drawing, or other creative activities

can

feel cathartic

fertile for five years,

was driving home, sic

flooded me.

hard

—

I

though,

I

It felt like I It

a

to stop driving to listen.

failed,

she

tears

I

was crying so

of rage poured out of me.

I

If

anyone saw me,

what they thought was going

on. Afterward,

was

immense energy

Diana described, can

manner

Diana, in-

I

was so angry.

like a

weight had

lifted off

of me.

had somehow been purged."

requires

out, as

had

a lot better. It

felt

When

Beethoven symphony. "The mu-

listening to a

the steering wheel,

can't imagine

relief.

found out that her third IVF had

of sadness and

tears

pounded on

I

and bring

to hold in our feelings; letting

feel liberating.

them

them

Letting go of

that doesn't point the finger at yourself or others

is

in

espe-

cially beneficial.

Remember

that infertility creates a state of chronic

peated trauma. You

more tually

in control

may want to

re-

control your emotions to help feel

life,

but discharging your feelings will ac-

feel better.

Sometimes you may not even recog-

of your

make you

and

nize the connection between

these intense emotions

and the

Grieving for the Pregnancy

trauma or denly,

it is

often difficult to

or mourning. But

emotional energy

danger

is

When

Infertility.

it

is

isn't

sadness or anger overtakes you sud-

remember

continually used

— denying

It's

a crucial

element

up

to stuff

these feelings

them

in.

The

—which masks

more depressed

feelings

and

anxiety.

IfI Wish Upon a

Who

Star,

Will My Dreams

Come

The only way poor

classic, Pinocchio.

Geppetto was going to get a

real

boy was

to rely

of the Blue Fairy. If only we had a fairy all

True?

can forget Jiminy Cricket crooning, "When you wish upon

a star ..." in Disney's

make

is

your backpack of emotions gets

as if

heavier and heavier, which leads to

more

that this

essential to release these feelings, so vital

in getting stuck

your sadness or anger.

165

our reproductive wishes come

at

old

on the good graces

our beck and

call to

true.

Lacking a fairy godmother, a magic wand, or other such charms, what

we do have

over infertility severe. cle

—

is

Hoping

hope.

for

to hold

Hope

on

to in the

midst of our anguish

provides us with the strength to per-

our dream to come true, wishing for a mira-

these feelings are not rational or logical. Nonetheless, these

feelings exist

without our even being aware of

it.

And just

emotions of sadness and anger, hoping for a miracle

is

like the

an integral

part of grieving.

Negotiating deals, making promises, setting up scenarios where

you

will

are

all

—

be able to have a baby if'you act accordingly

part of the grief process.

Many

an

infertile

themselves pleading for a chance at having a baby. anything to have a baby," so ation, people often try to

many

of our

these, too,

couple find "I

would do

clients tell us. In desper-

change and perfect their own behavior,

UNSUNG LULLABIES

166

as if that

makes the

difference between having a

Holly,

whose doctors haven't been

of her

infertility, listed

not exercising enough

•

not flossing every day

•

not calling her family enough

•

paying

•

eating too

•

watching too

I

many sweets

do

better

much

TV

look over this

understand

to

able to find a conclusive source

bills late

all this.

—

list,"

she said,

But another part of

doesn't

me

—then

I'll

me

make any sense

a baby. Rationally

feels like if I

of myself and

to take better care

people around

"it

would prevent me from having

that these things I

not.

her "faults," which included:

•

"When

baby and

my

promise

things and the

deserve a baby and only then will

it

happen."

Many

infertility patients

one intervention

try

afraid to stop the process, they always right bargain,

work.

When

come upon

will

we

believe that if

have a positive outcome.

much wished-for

bicycle

they

to conceive, even

tries

are against her, she

magical thinking,

if

make

the right formula, then this time

Elena secretly

knows the odds

hope that

after another;

—we

It's

hoping

is

hoping

in the right way,

will

our

we

for Santa to bring a

try our best to be

hoping that our good behavior

will

though she

for a miracle. In

we behave

like

it

the

good boys or

girls,

be recognized and rewarded

with a baby. The reasonable and logical parts of our thinking

know

that these behaviors are not at

all

connected, but irrational

Grieving for the Pregnancy

thoughts tend to creep in

when we

167

and des-

are feeling vulnerable

perate for explanations.

When we hope,

we

feel as if

wish, and

to insure that

there

we make

what we want

time of despair and

is

nothing

is

else

we can

do,

we

we

pray,

private deals with ourselves in order

will

come our way.

It

buoys us up

at a

yet another stage of the grief process.

Resolution

Most of ing through

the literature on death and dying posits that after gothe other phases of grief

all

the anger, the hope,

of resolution.

No

move forward, true for is

—you

and bargaining

find peace

loss,

infertility

is

however, that resolution

12, but suffice

we must

it

come

to the point

loss, it is said,

More on

is

may hold

uniquely different.

Infertility

this

loss.

And

couples, only after the feel resolution.

Others

not possible even after the

point will be discussed in chapter

to say that infertility

learn to cope with

some

do they

still

you can

this

but consists of multiple layers of

birth (or adoption) of their child

birth of a child.

will

and acceptance. Although

there isn't always a definitive end. For

feel,

the shock, the sadness,

longer in turmoil over the

many situations,

not a single

—

is

a life-altering event,

which

and incorporate into our reproductive

story.

Full resolution implies that

about

infertility.

nal resolution

of

loss

is

But

if

you

you have come

are

still

in the

to a firm conclusion

midst of trying, such

fi-

not possible. Additional failures increase the sense

and make the grieving process that much more

When each month brings another defeat, you will time to grieve that

loss before

you

get your hopes

difficult.

not have enough

up again

for the

UNSUNG LULLABIES

168

next

try.

Each

loss

along the

way reopens

the

wound

that

you

are

trying to heal.

Not only do couples

month, they

grieve each

also grieve

when

they shift from one reproductive technique to another. Each

change in the technology you choose

Going from

"the old-fashioned

procedures can

way"

feel like a defeat.

own

genetic child

may

be exciting, but

may

loss.

any number of ART

to using

Likewise, deciding to forgo your

and use donor egg or sperm, or

may

another

feel like

also feel like a failure

to adopt instead,

and

new

a

loss.

Because of Renee's endometriosis, she and Phil decided to pursue a gestational surrogate.

To

arrive at this decision,

grieve the loss of experiencing pregnancy. tance:

my original

And

me

reproductive story.

wasn't going to have a baby as as

it

sunk

other ways to

in,

olution.

An

had

further

It finally

a

mom.

But

in," as

Renee

called

this hasn't it, is

and

sunk

I

made

surrogate. Resignation, however,

is

is

to

easy."

here

—

of

res-

the dif-

means you

in Renee's case, using a

giving in because you feel you

have no other options. In coping with

tween resolution and resignation

—

I

would.

I

became open

been

resignation. Resolution

have come to a firm and clear decision

in that

really the process

important distinction should be

ference between resolution

and further

originally thought

guess you could say that

I

become

This "sinking

I

to

She described her accep-

"Each step along the way brought

away from

Renee had

infertility,

vast. It

the difference be-

can mean the difference

between accepting the necessary changes to your reproductive story or feeling as if

new ending

you

are stuck; or

between

fully integrating a

to your reproductive story or continuing to experience

turmoil and despair.

You may be

able to accept a

new ending to your story today,

but

Grieving for the Pregnancy

reel

unsure or

Once

romorrow. These

ir

169

vacillations, too, are normal.

again, the phases or grief are not linear; people

out or them, only to repeat them again and again. trating to think that a phase has been finished

midst of vides a

it

again.

Each time through the

new outlook and

perspective,

move

may

It

and

feel frus-

and then land

feelings,

in

in the

however, pro-

ultimately bringing you

closer to a sense of resolution.

The The

"Little

Deaths"

deaths" that you experience can and should be mourned,

"little

but often they are overlooked by family, friends, the medical com-

munity, and sometimes even by ourselves as we're undergoing treatment.

After struggling with infertility for four years, Suzanne came in

one day beaming.

hand was

a picture

"I

have something to show you!" In her

from her IVF procedure, and she pointed

with pride to the embryos in the photo.

"It's

the

first

picture for

our baby album!"

A week later,

Suzanne was

grief -stricken.

The embryos

failed to

implant, and, according to her doctors, this was not considered a

pregnancy

at

really wasn't a

pregnancy. I

Technically speaking, the doctors were right; this

all.

bona

The

fide pregnancy.

But for Suzanne,

picture she brought in

it's

had been

a

had been of her baby. "But

was pregnant," she cried. "For a moment,

And now

it

I

really felt pregnant.

gone."

As Suzanne noted, even though she was not

officially

pregnant,

she felt pregnant. In part, this happens because medical technol-

ogy allowed her to experience, both visually and emotionally, a process of

human development

that

most people never

see.

For

UNSUNG LULLABIES

170

Suzanne, feeling pregnant and losing the pregnancy before most

The

loss

might

women

all

occurred

even have a clue that they have conceived.

of her pregnancy was as

her as any other loss

real to

be.

These "pregnant moments" described by Suzanne need incorporated into the grieving process.

When

to be

in vitro fertilization

has occurred, infertile couples often experience the embryos as po-

and find themselves already

tential babies

tached.

When

those

cells

feeling emotionally at-

don't implant, couples feel as

if a

baby

has been taken from them. Until recently, there has not even been a

name

for

such a "death," which some researchers are

now calling

a "pre-implantation miscarriage," or "non-carriage." Giving this loss a label

makes

that

it

much more

real,

allowing couples to

feel

validated in their grief.

A failed IVF,

however,

is

not the same as a miscarriage. Having

a confirmed pregnancy after going through infertility carries with a confirmation that

you can conceive. Such validation

is

missing

it

if

an IVF doesn't take, or resolves as a chemical pregnancy. But even with a miscarriage, couples often

alone and misunderstood, as

were a nonevent. Well-meaning but insensitive remarks

if this, too,

from

feel

friends

and family (such

as "it wasn't

meant

to be" or

"you

can always try again") only add to the couples' anguish.

Eva suffered a miscarriage fertility

was

treatment.

early.' "

"My

at eight

weeks

after three years

sister-in-law said, 'You're lucky.

Eva was furious with her

in a car accident

that's

how

I

feel

and died?

now.'

"

least

it

sister-in-law for discounting

her feelings. "I wanted to scream at her, 'What

was

At

of in-

if

your daughter

How would you feel then?

Because

Grieving for the Pregnancy

171

Rituals for the "Little Deaths"

One

major problem

in dealing

with this kind of

loss

— be

carriage, chemical pregnancy, non-carriage, or the

riod

—

is

that

no commonly accepted

or your loved ones through the

having a

ritual helps to

vate losses.

also aid those close to

The

ritual

for

you who

you and your

of your pain and

when

first

is

pri-

necessary, although

you

way

it

to help.

to validate the

loss.

to set aside a special time ei-

and her husband, Tom, go out

for

Sophie's period arrives, no matter what

day of the week and no matter what

What may at

believe, however, that

partner, to allow

ther weekly or monthly. Sophie

uled.

help guide you

are looking for a

One ritual we suggest is for couples dinner once a month

monthly pe-

acknowledge these intangible and very

may

reality

We

grief.

not for others that a ritual

It is

is

rituals exist to

a mis-

it

else

they

may have had sched-

glance seem like a celebration

is

not. Their

dinner date allows them to spend time together, and acknowledge yet another sad

many

moment

times she feels so low that she doesn't want to go. "But

mately

I

am glad I

not in this alone. bring up the baby

would

Sophie admitted that

in their journey.

close

up

—

do," she said. "It always It

makes me

forces us to talk. Lots of times

issue. I

think

this forces

me

if

we

to

didn't

work on

do

feel that

we

this

us even

ultiI

am

don't even

each month,

when

I

I

don't

feel like it."

From Tom's would

eat

perspective he treasures these dinners.

me up

if

I

let

it.

It's

easier for

me

"My work

to avoid emotional

things than to deal with them," he said. "That's

why

having

time with Sophie has been so good for our relationship.

I

this

just

UNSUNG LULLABIES

172

wish we could be celebrating instead. But in a way take stock of

what we do have,

it

forces us to

rather than only focus

on what we

don't."

Other monthly

rituals

we recommend

for couples to

IVF, you

stantial

their

going for a walk together, lighting a candle,

loss include

or buying each other a flower. If failed

acknowledge

may want

to memorialize this event in a

who

way. Molly,

you have had a miscarriage or

miscarried after an

a

more sub-

IVF procedure,

planted a tree in her backyard. "I had been feeling so helpless after the miscarriage that especially

something

it

made me

positive. It felt

could nurture and watch grow.

minder that

I

mother

I

best

feel better to

It

good

to plant a sapling that

helps to have this visual re-

was pregnant and that for that short time

to

mark

Often anniversaries of the

loss,

way

to

commemorate

comment

the

or the baby's expected due

date, can be just as distressing as the actual loss.

for

was the

I

the date on their calendars

and, each year on the anniversary, find a

clients

I

could possibly be."

Other couples have chosen

loss.

—but

do something

Many

of our

that they feel sad, irritable, or unwell, seemingly

no reason, on or around the calendar date of

these grief reactions

seem

to

come out of

their loss.

the blue,

Because

knowing

that

they are normal and to be anticipated can help save us from feeling

bowled over by them. Yet another potentially helpful ritual vate.

is

more public than

pri-

Perhaps you can organize or become involved in a walk for

individuals

and couples who have experienced reproductive

trauma and

loss.

productive

loss.

Or you

can attend a workshop on

infertility or re-

Participating in these kinds of events, or even

Grieving for the Pregnancy

helping develop them,

you

another way to establish

a ritual to

help

grieve.

Many in

is

173

of our clients have described the solace they have found

No

doing something.

matter what

it is

that

you decide

to do, this

needs to be recognized and not hidden in some out-of -reach

loss

place. Creating a ritual for the

can help you make

real that

pregnancy or baby that never was

which has been so

intangible.

Getting Stuck in Grief Inevitably, in the course of grieving a reproductive trauma,

have moments

will

of

when you

grief, or obsessive

literally

stuck

—

either in a

mood,

a phase

rumination. Ilene was so distraught that she

got stuck on her sofa. She found herself blankly staring

out the window, and

— can be

when

she finally looked up, she discovered

hour had passed. Having structure

that over an

do

feel

you

a

way out of

times mustering up

—something

these terribly despondent times.

the energy to

do something

feels like

to

Some-

it is

just

too much, but having a focus or task, like going to work, or at-

tending a support group, exercise get

you through

class,

or other activity can help

it.

Even the most well-meaning people often imply should be "over

you

feel

you may

who

it"

even worse feel as

and able

to "get

— not only

though you

are

on with

life."

that

you

This can make

you struggling with

infertility,

are not even grieving right. Patients

have been encouraged to talk about their

infertility

get the impression that they have talked about infertile for three years, feels as if she

her support network. "I think

my

it

too

sometimes

much. Nina,

has alienated and "used up"

friends are sick of

me and my

UNSUNG LULLABIES

174

problems.

I

try not to dwell

to talk about

Phoebe has

know

I

it.

If

it.

I

can't talk to them,

similar concerns.

know

it's

up

ing here

I

mother

me

I

—

that he has "put

it

why

can't understand

their

are

what am

her about

I

I

my infer-

the subject.

wind

I

that she's the one suffer-

should just

when you and your

partner are

how

A very common scenario

she

is

still

feeling so devastated.

And

she

he could be so insensitive and not recognize

At times

like these,

you may

feel as

doing everything wrong. Knowing that people grieve in

own ways and that you and your partner may experience

losses differently

and

avoiding me;

behind him," wants to move forward, and

the giant emptiness inside her!

you

there?"

from her that

at different points in the grieving process.

if

do need

and move on."

it all

can't understand

is

really

I

get the feeling

Especially painful are the times

is

is

I

in pain, but

way of changing

have to take care of her

— and not me.

forget about

"My

but

else

I've tried to talk to

she has this unnerving

feeling like

who

hard for her to see

supposed to do? Whenever tility

my treatment,

on

can help you understand each other

sensitive time.

You don't want

these

at this crucial

to let the differences in

your

in-

dividual grieving styles and timetables cripple the relationship.

When

—

family

you that

get the message

you should be "over"

misunderstood,

you

feel as if

it

this,

it

partner, friends, or

not only makes you

also adds to the feeling that

you

you have used up your resources

—you may want

family

—from your

are

—your

to consider joining a support

all

feel

alone. If

friends

and

group

(see

the resource section in the back of the book) and/or pursue psy-

chotherapy or counseling.

Support groups can be plight

lifesavers.

Hearing others discuss

and talking about your own actually helps

their

facilitate grieving.

Grieving for the Pregnancy

Getting to

know

other people

who

175

are going through a similar c\

perience can ease the pain of isolation. Gillian found her support

group so helpful that she eventually became board.

"I

knew

I

could talk about

group would understand. with

my

problems

I

never

—we were

my

felt like

in

all

feelings,

it

a

member of

and someone

in

the i

he-

was overloading others

I

together."

Therapy, either individually or as a couple, can also help the grief process. Setting aside time each

can provide enormous

relief.

week

Knowing

to talk with a therapist

there

is

a time

and place

to

"unload" can be a source of great comfort and solace. Being able

your feelings into therapy and leave them there each

to bring

sion has the all

by

added benefit of freeing you from carrying the burden

yourself.

knowing

that,

be freeing to

Many of

"My

our psychotherapy

session

know

is

tomorrow.

clients sigh

have seen

many

relief

get time to talk!" It can

I

and

that your thoughts

with

feelings will be ac-

knowledged without being judged or burdening someone

We

ses-

else.

couples enter therapy so angry that they

could barely talk to one another. Evan and Liza began therapy because they were arguing talking things out at

all

the time.

home, they ended up

at

in a blowout.

tried

To avoid

Evan began spending more and

these painful combative duels,

more time

Whenever they had

work, which infuriated Liza even more. The more he

avoided her, the more nagging she became; he'd storm out of the

house and the pattern continued.

They were

able to break this cycle in therapy as they realized the

strength of their relationship. Liza said, "Talking about our relationship in therapy, really

is

a great guy.

I

began to appreciate Evan

We

stand that he's been in as

have so

much

much

pain as

in I

all

over again.

common.

have."

I

now

He

under-

UNSUNG LULLABIES

176

Evan concurred. "We a family so

of us

much;

knew what

I

really

know

have the same goals.

both want

Liza will be a great mother. Neither one

do with our

to

We

We took it out on each

frustration.

other."

Utilizing couples therapy, Liza their struggles

with

really part

from the

infertility

Therapy helped them

—

of their grief

and

and come

as a couple,

toward each other was

grief that their reproductive story as they

were able to

their grief together, they

to separate

of their relationship.

rest

to see that their anger

dreams of a family were not to be

als

and Evan were able

to

and

had hoped. As they faced

mend and

heal, as individu-

an agreement about the next step

in treatment.

How to As we have cess.

learned, grieving infertility

grieving these still

"little

own

and arduous pro-

deaths" so

timetable for grief.

much more

makes resolving

So what helps?

complicated

blankets"

grief very difficult.

First

therapist.

when

and foremost,

it

You

great

way to

you

at the be-

are forced to grieve

it is

essential to

communi-

friends, family,

to "crawl

under the

she found out about her endometriosis, she didn't.

down your

write

that

occurs.

Even though Renee wanted

She talked with Phil and garnered sible,

is

— not

Talk about your feelings with your partner,

and your

What makes

at the end. In fact, the prolonged nature of infer-

the same loss over and over each time

cate.

a long

in the middle of your reproductive story

ginning and not tility

is

Unlike a predictable bus or train schedule, you and your part-

ner will each have your

are

Get "Unstuck"

release

feelings.

your

his support. If talking isn't pos-

Creating your

feelings.

Any way you

infertility

diary

is

a

can get the feelings

Grieving for the Pregnancy

from inside of you on your

to reflect

to outside will help.

reelings It

Admit when you

and bottling them up

takes far

more courage

is

more

feel

overwhelmed and

Denying your

upset.

destructive in the long run.

to

acknowledge your emotional pain

this, try to find

ways to vent the anger that accom-

openly than to ignore

Along with

This gives you the chance

feelings, rather than feeling

controlled by them.

177

it.

panies grief. If you have a friend or therapist

your situation, go ahead and

rail in

marks others sometimes make.

understands

outrage at the insensitive re-

Sarcastic

humor, used

context, can be a valuable tool for venting if

you. Molly laughed and cried at the

who

list

it

in the right

comes naturally

of stinging

it

"Here's

my

tion?'

you!'

rip!

—my It's

didn't

I

favorite:

retort

—

know

someone

I

"We

could be so nasty!" Molly

says,

'I'd seriously

and

retorts she

her close friend, Becky, composed after Molly's miscarriage. just let

to

said.

'Have you considered adop-

think about

it

if I

looked

not that I'd ever use any of these, but saying them

like se-

myself actually helps. But what helped the most was

cretly to

spending the afternoon with Becky and letting

it all

out." Becky's

coaxing and support gave Molly permission to get "unstuck" from her anger.

Be true

to yourself.

Don't try to

someone

else thinks you should.

someone

tries to

It's

feel a certain

okay not

way because

to feel grateful if

cheer you by saying, "you can keep trying" or

"you can always adopt" or any number of other well-meaning marks. As

much

not to talk about

as

it

it

if

also

okay

mood. Being tuned

in to

helps to talk about infertility,

you

are not in the

re-

it's

your own needs allows you to be kind to yourself and your partner.

Even

if

you

get frustrated at times, be patient with yourself.

UNSUNG LULLABIES

178

Holly's

list

of her "faults" allowed her to separate

from

infertility

the rest of herself. She could then grieve her loss rather than focus

on

herself as a

bad person. Likewise, be patient with your partner.

Treat each other with the utmost kindness. Like Sophie and Tom's

monthly dinner

date, creating time to

from the grind and chores of daily nected.

The

living

can help you stay con-

would expect

tenderness that you

much-wanted

spend with each other away

your

to have for

child needs to be transferred to your partner

—and

to yourself as well.

Above right or

all,

remember

wrong way

tinue to experience. Phil

came

to It

there

manage

needed to

let

wrong way

way

to

become

to feel,

no

you have been through and con-

story, so will you.

things sink in before she could

of your reproductive

close.

all

right or

to grips with her endometriosis

a parent.

been through but you can and ter

no

takes time to grieve. But just as

changes to their reproductive

alternate

is

You

will get

Renee and

and the necessary

As Renee

said, she

move forward with an

can't erase

through

this,

what you have and

story, albeit rewritten, will

this

chap-

come

to a

Nine

Dealing with the World

amazing, It's

when

you're experiencing

infertility,

times a day you are bombarded with "baby stuff." ination, or

never have noticed so

but

fore,

now your

many

pregnant

sensitivity

is

TV for

bellies or

our imag-

Is it

do babies and pregnant women jump out

where? Are there suddenly more ads on

how many

at us every-

diapers?

baby

You may

strollers be-

heightened. Hearing a baby cry,

seeing a neighbor with her kids, watching a stroller brigade

down

the street

—

march

these daily reminders of the pain of infertility

confront you wherever you turn. It also

may seem

that

you're not pregnant again

When

whenever you get bad news

—someone

else

is

celebrating

a friend announces her pregnancy or a

maternity leave, you

may

woman

While happy

feel

even more

work

—such

as

good news.

colleague takes

like the perennial

odd

may

feel

Conversations with close friends and family members can

feel

or

man

out.

more sad and sorry

for

your friend, you

for yourself.

treacherous. You're always on guard against insensitive remarks or

UNSUNG LULLABIES

180

well-meaning but misguided advice. Even strangers inquire

off day.

when

you're going to have kids can rub you

You may

feel

incredibly angry

who

wrong on an

and vulnerable.

If people haven't experienced infertility, they are not

how

"in our face"

they don't realize

it is

moment of

almost every

how much

it

casually

aware of

every day.

And

can hurt.

Short of moving to a deserted island, you can't do anything to

change the family-centric world we it

live in.

We know how stressful

can be as you deal with the world of children, pregnant women,

and

advice-givers. In this chapter,

we

share coping strategies to

help you handle the onslaught of infertility-insensitive situations

you may

•

face,

you

when everyday

situations

feeling hurt

well-meaning

handling

but

insensitive

remarks

from

and family

friends •

as:

soothing yourself with self-talk leave

•

such

dealing with your family, from asking for their emotional

support to possible financial help •

realizing

it's

parties, or

perfectly

okay not to attend family gatherings,

baby showers

if

you're unsure about your ability

to cope •

seeking outside support

when you

feel

you need

it

You Can Only Protect Yourself So Much Usually

we

try to protect ourselves

from

might cause us pain. Afraid someone insensitive remark,

you may

is

situations that

we think

going to hurt you with an

find yourself avoiding friends or

Dealing with the World

181

dodging conversations. You worry ahead of time about an offhand remark

that can

be cutting, and you do what you can

to he

on \ our

guard.

But orten feet.

it's

the unanticipated situation that knocks us off our

way

Kathleen, on her

to a consult

with a new

second opinion, was already nervous going to

cialist for a

located in the local hospital. As she recalled,

unglued because

Can you

livery!

what

to 'see'

I

his office

believe

it?

was on the same

Even going

When Warren

an

to

became

"I

floor as labor infertility

really

and de-

doctor

I

had

and

Lila

looked

strangers are also unwelcome.

at the

Labrador retriever puppies

a local pet store, the salesperson chatted "aren't these puppies cute?

These

the store, upset by

them

this

at

up. "Oh," he said,

are the best dogs for kids.

two have kids?" Smiling and shaking left

his office

don't have."

The innocuous comments of

quickly

infertility spe-

You

their heads no, the couple

unexpected reminder of their

childlessness.

Sometimes seeing mothers with babies can feelings too. Barbara

trigger

became furious when she saw

a

unwelcome

mother ignor-

ing her crying toddler in the supermarket. "I'm sure she's a good

mom,

but

can't stop myself

my baby wouldn't

chance, It's

I

not easy to

own up

from

feeling that if

be crying

to the

I

were given the

like that," she said.

myriad

feelings

of sadness, inade-

quacy, anger, self-pity, and envy that can surface in everyday situations.

But remember, you are experiencing trauma, with heightened

feelings

and

way you

reactions.

So before you beat yourself up

for feeling the

do, acknowledge that those feelings are normal and under-

standable.

UNSUNG LULLABIES

182

Self-Talk

We have yet to

meet an

Can Save You

infertile

couple

who

hasn't been zapped at

one time or another by an everyday, unanticipated event. To survive these situations,

you engage

we

an internal dialogue to boost your self-esteem.

in

remind yourself that

Of

course you

sister's

new

baby;

how

other person, "No, feelings

is

tility.

feel

devastated

feel

embarrassed to

tell

yet an-

way

self-talk

that

is

to be expected.

does more than validate your feelings about infer-

Self-talk allows

you

to think about yourself differently.

—

When you feel bad, you can remind yourself over and over broken record your

own

don't have any kids"? Validating your

powerful, as you accept that you're reacting to a painful

situation in a

But

could you not I

wouldn't

she talked on

announced her unplanned third

a forty-two-year-old friend

pregnancy; and

who

if

First,

you do.

natural to have the feelings that

it's

would be angry with your mother

and on about your if

suggest a technique called self-talk, where

— of

all

that

you do have going and

intelligence, wit, talents,

strengths while feeling devastated

skills.

may seem

but with practice, you'll find that you

for you.

like a

Consider

Thinking about your easier said

than done,

can pull yourself out of a

rough spot rather quickly.

Monique, an advertising

when

she

felt

executive, utilized positive self-talk

uncomfortable in a recreational cooking

class.

"When

the instructor asked us to introduce ourselves, the

woman

said she

stay-at-home

was a

mom

biologist

and she had two

kids.

first

Next was the

with four kids, a teacher with two kids, the

next person had three.

Out of

ten

women,

I

was the only one

Dealing with the World

When

without children. hard;

didn't

I

Monique her

know what

now

trapped

felt

my

was

began

a

turn,

my

heart

— trapped by

to run out of the

and I

athletic,

smart

band who

how

At

don't.

to

is

make

least .

.

my

.

room. But

in-

dialogue with herself. Okay, she thought, right

and I

all,

50

the situation and trapped by

I feel completely out of place. All these other

they've got it

was pounding

to do."

Her impulse was

infertility.

stead, she

it

183

But

don't.

women seem

that's only because they

like

have kids

not yet. Here's what I do have: I'm attractive,

I've got

a job that I am good at, a wonderful hus-

best friend

.

.

and I'm

.

being creative by learning

desserts tonight.

Talking to herself about her strengths and achievements,

Monique remembered

was only part of who

that having a child

By

she was. Regaining her composure, she introduced herself. ning's end, not only did she learn also

some baking techniques, she had

exchanged phone numbers with

We help

our

several fellow bakers.

engage in

clients learn to

nal dialogue. Emphasizing the positive

works

—you

is

we want

to emphasize

your

life.

Not only can

tough feel

may seem

inter-

focus on what you do have, rather than on what

infertility in perspective

you

kind of active

it

your

ever

this

hokey, but

missing. Again,

tionally

eve-

down on

by placing

self-talk

situations,

it

how it

important

is it

to keep

in the larger context of

can help you through some emo-

also gives

you time

to regroup

when-

yourself.

Responding Despite the efforts you

to Stinging

make

avoiding situations that you

Remarks

—

to protect yourself

know

will

especially

by

be particularly difficult

UNSUNG LULLABIES

184

(more on

this later)

—

there invariably will be times

when you

caught in unavoidable conversations. Most people don't

mean

hurt you or to be insensitive, but sometimes they unwittingly

Monique ing

stung by

felt

meant

are.

Of course

they had.

those remarks weren't

to be barbs, but they hurt nonetheless.

Infertile couples are

asked

the time about having children,

all

Warren and

just as the pet store clerk asked

have kids?" question

and

sive

to

her cooking class companions announc-

all

how many children

are

may

be innocently posed, yet

hurtful. It helps to

may

question

Lila.

remember why

it

feels so

shame and despair

tap into the

it

that

The "Do you can

feel inva-

pointed

—

you already

the

feel

about your inability to get pregnant.

To handle

how

time

invasive

these situations,

to

we

suggest you brainstorm ahead of

respond to unwanted advice or well-meaning-but-

comments. This way, you are not taken by surprise and

have a ready answer "we're working on

at

hand. Answers

work

it" all

well

—

"not yet" or "soon" or

like

these brief responses are to

the point and end the conversation. Part of the

problem with such questions

people, feel that your reproductive

life is

is

that you, like

when

gry

people asked

was being rude

if

who

de-

infertility, felt

an-

private. Elaine,

cided to remain childfree after struggling with

many

she had children, but also thought she

if

she did not reply. Sometimes a

humorous

retort

can ease the tension: "Not

last

invisible" might, at times,

be appropriate. If your questioner per-

and wants

sists

direct If

ten

by

details that

stating: "That's

you

time

a

between

clumsy attempt

checked" or "Yes, but they're

are uncomfortable giving, be

more

my husband and me."

someone knows you have had

make

I

difficulty conceiving, they of-

to console you.

"Oh, be glad you don't

Dealing with the World

have kids

—

me

have four and they drive

I

crazy!"

as comforting, but instead feels competitive

tempted to

retort,

would," or you drive

you

You may be

cruel.

"Too bad you don't appreciate them.

may

explain

remarkably

feel

"Just relax

— once you

why you would

I

know

l

love to have kids to

called helpful

out advice on what to do.

free to give

stop worrying about

what happened

right away. That's

is

and

may be intended

crazy.

Others

ment

185

comment

that too

my

to

many

you'll get pregnant

it,

sister!"

another so-

is

people offer. But this com-

grossly insensitive, implying that your infertility

head and that somehow you are responsible

you may wish

definite diagnosis,

could explain

for

to share

it.

is

in

your

you have a

If

you

for example,

it;

how blocked tubes prevent conception from happen-

ing naturally, so there's nothing to relax about. You

may

choose to educate the speaker, noting that

a disease.

Or you may

just

want

to let

infertility

them know how

is

also

hurtful their "help"

feels.

"My

—and boom,

brother and his wife adopted a baby

pregnant"

falls

in the

that happens, but did

same category. You can

my husband

sometimes

you ever think how many couples adopt and

then don't get pregnant?" dear,

say, "Yes,

she got

Or

the offhand

look at

just has to

be someone's effort to empathize but

comment

me and is

I

that,

get pregnant"

"Oh may

incredibly thoughtless.

When you hear comments like these, remember that you do not have to respond right away, scious wish to be kind

know what you time or

if at all.

—most

—while you

to say

Focus on the person's con-

likely they feel

smile and count to

to choose a response. "Yes, that

"It's different for

everyone"

awkward and don't

is

works

five.

for

That

gives

some people"

polite but reinforces the idea that

UNSUNG LULLABIES

186

your experience

make you want is

from

different

is

theirs.

to lash out in anger.

and you may be tempted

natural

The

feel

comments may

these

desire to

do

to

when you

an option to not respond

Or

tell

someone off

so at times, but

it's

also

the need for privacy. "I

prefer to not talk about that right now," gets the message across

loud and If

clear.

you don't want

to respond directly to the person

you or makes you angry,

it

who

hurts

can be helpful to vent your feelings af-

A sarcastic retelling of the story to someone who really

ter the fact.

how you

does understand

friend, or a therapist

—whether your

feel

—can

partner, a trusted

often serve to help you purge the toxic

residue of such painful encounters.

Talking about Loss It

can also be hard to figure out what to say

a miscarriage or an unsuccessful

if

you've experienced

ART attempt.

Miscarriage can be

excruciating

when

it

because the

loss

so misunderstood.

is

comes

to the responses

the best," devastated Alana,

her

first

friend

IVF

carriage

is

not

A

friend

to

who

said, "It's for

miscarried at eight weeks after

Even though Alana knew

cycle.

was trying

who

of family and friends,

that

on some

level

her

comfort her, Alana responded: "Having a mis-

would be

'for the best'. 'For the best'

to have a

baby!" If miscarriage

unsuccessful that

is

IVF

you weren't

and you

so misunderstood, imagine the reactions to an

or other

ART

really pregnant,

feel the loss just as if

tion your grief,

How do you explain

but you did create an embryo,

you were pregnant?

you might say

baby and were so

intervention.

that

If people ques-

you want so much

close this time, that

you

felt

to have a

pregnant, even

if

Dealing with the World

not technically

so.

You can

understand about what

and

leave

also say, "There's a lot that people don't

it's

like to

go through these procedures"

excuse yourself from the conversation by

at that, or

it

saying that you would rather not talk about

People often don't

may

awkwardness yourself with

admitted that years

how

wasn't sure it

know what

earlier,

to handle

or avoid bringing

know how

it

it.

to say in these circumstances

be looking to you for guidance. You

this

187

may

and

have experienced

Alana

others, prior to infertility.

her cousin had a miscarriage, and she

it.

"I

didn't

up," she said.

know

if

I

should talk about

even more confusing to

It's

to talk about IVF.

What we

have found

is

that if you're in the midst of infertility

treatment, or have experienced a loss like miscarriage, you aren't

looking for advice or helpful hints. Instead, you want others to

and acknowledge the

spect

suffice.

A

need

you

if

friends

is

simple "I'm sorry," will often

statement like "It must be so difficult" can be

you might have

are in the midst of IVF. But

and family that

understand what loss

A

loss.

it

that's

re-

all

you

to teach

what you need. People don't always

means. You

may need

to explain

how

real this

to you.

Maya, who has a

five-year-old daughter, has struggled for

two

years with secondary infertility. Attempting to comfort her, her

mother-in-law

But

this

said,

"You should be thankful that you have one."

enraged Maya. She replied,

my daughter;

I

want another

child. Just because

not upset by

my

her

course I'm happy

absolutely adore her. But that doesn't

comment was

It

"Of

infertility."

off the

I

mean

I

I

have don't

have one child doesn't mean I'm

Her mother-in-law recognized how

mark and

helps to have ready answers at

apologized.

hand

so

you

are not caught off

UNSUNG LULLABIES

188

guard.

Of course it is not possible to

arises,

but being prepared can help protect you from falling apart.

It

anticipate every situation that

won't necessarily take away the sting or the emotional bruises,

but having a repertoire of responses helps armor you against

feel-

ing helpless and speechless.

Dealing with Your Family

You may laws.

feel a special

pain

and

with their disappointment

Tell

Many

parents try to

"She

said.

it

baby may be

for a

can be especially

as well as

to provide

difficult to deal

your own.

or Not

mask

sometimes that backfires. law.

dealing with your parents or in-

Remember that part of the wish

a grandchild for them,

To

when

talks incessantly

"I can't

their feelings or avoid the topic, but

Gwen

cringes describing her mother-in-

about her friend's grandchildren," she

stand being around her anymore." Although her

mother-in-law never questioned her about children,

Gwen

feels

pressured nonetheless by her indirect comments.

Meredith's mother also has not

come out and asked Meredith

how hard

about having kids, but she expresses concern about

Meredith said. "I

is

working.

"I

can read between the

know she wants me

to focus less

having a family. She doesn't every time she hints at

What in

to

tell

depends on

tween

it, I

know

that

resist telling

on

lines,"

Meredith

my career and more on

we have been

trying,

and

her what's going on."

your family and which family members to confide all

parties involved.

their desire to

There

is

know and your need

a delicate balance befor privacy.

Gwen

de-

cided not to disclose anything to her mother-in-law because she

Dealing with the World

knew

would not be held

it

She became adept

in confidence.

changing the subject and maintaining

189

a "grin

and bear

it"

at

altitude.

Meredith, tired of feeling angry and defensive with her mother, decided to have a heart-to-heart chat with her. "Once

my mom,"

Meredith

my

so ashamed, but

made

said, "I felt

much

better.

I

had been feeling

mother was very understanding." Meredith

clear to her mother, however, that she didn't

it

talked to

I

cuss the details of the medical procedures,

want

to dis-

and her mother agreed

not to bring up what was going on unless Meredith did.

Discussing your the choice decide.

up

is

may

There

when you

you

to

or not,

infertility,

—and

be times

there's

no

yet another situation right or

when you want

As discussed

don't.

is

wrong

what you

to

to disclose

where

and times

you and your partner

in chapter 7,

need to come to some agreement on how to handle

this

and

stay in

tune with each other as time passes.

How much ner.

There

you

reveal or

you choose

to

tell is

also

up

to

you and your

part-

nothing wrong with setting boundaries about what

is

what you want

you may decide

to

tell

to be asked about. In other words,

a family

member

that

you have been trying

to get pregnant, but not give medical details. Like Meredith,

can make

it

clear that you'll talk

prying questions.

comfort

level.

always

aren't willing to discuss, its"

to,

but prefer no

depends on the parties involved and your own

It

And

when you want

you

know

that if a question arises that

you

can simply respond, "That's off lim-

you

or "I don't want to talk about that."

If

you do choose

times, the family it all

in.

This

member you

isn't

be having their

to disclose your situation, be aware that at are talking to

because he or she

own

feelings

may not be able

isn't interested; rather

and reactions

to

your

to take

they

may

infertility. Leila

UNSUNG LULLABIES

190

noticed that her mother sometimes abruptly changed the topic after Leila explained the latest procedure she

mother didn't

tually realized this wasn't because her

needed some time to understand and afraid

of burdening Leila with her

It also

your

may help

infertility.

becoming

to imagine

may

own

Leila even-

care,

but she

sink in; she was also

reactions to such news.

how your parents

feel

learning about

own emotions by

excessively worried about you. Rather than encouraging

fret

you go through IVF or

as

about the

risks or the stress that

you. This can be difficult to deflect,

Remember tect their

let this

Parents sometimes deal with their

and supporting you they

had undergone.

a corrective surgery,

treatment creates for

when you

are already anxious.

that your parents feel helpless at not being able to pro-

own baby

from pain and

(you!)

suffering.

Asking Your Family for Financial Help

—

In addition to enlisting your parents' emotional support

you choose

to

—you may

consider asking

them

if

for financial help,

since the cost of infertility treatment can be exorbitant. In chapter 10,

we

discuss

how money

often defines the course of treatment,

but while we're talking about family

when

the

money

issue

comes up

or you might want to ask

them

Brandon, a teacher, and salaries

can be times

issues, there

—your

parents

may

offer to help

for a contribution.

his wife

Naomi,

a nurse, have

good

but a small savings account. Their medical insurance cov-

ered four IUI procedures, but

when none worked,

dered

IVF, which their doctor strongly

if

they should

recommended. But

if

try

they did,

how would

"We immediately thought about our "But

how awkward

is

that?

It's

the couple

they pay for

parents,"

won-

it?

Brandon

not like I'm seventeen asking

said.

my fa-

Dealing with the World

191

ther for the keys to the car. I'm thirty-five years old, and feel right to ask.

Especially because

could pay them back." As discussed feeling the regressive pull of

know when,

don't

1

in

if

doesn't

we

ever,

chapter 4, Brandon was

dependency on

Naomi, who described her family

it

as

his parents.

being very conservative

with money, also was in a quandary about approaching them

for a

loan. "I'm afraid they'll say no. But worse than that, I'm afraid they'll

we

think

something so

are ridiculous for spending so

risky.

The

last

thing

squandering hard-earned cash.

do you have

do

to

I

I

much money on

want from them

can hear

my

is

on

a lecture

father saying,

spend money on having a baby? Everybody

'Why

else

can

" it

for free.'

After

much

consideration,

go to their families for help.

wanted loan

it

to help

—and

Brandon and Naomi did decide

Much

to

to their surprise, their families

offered to give

them

the

money

rather than

to them.

But parents don't always have the financial resources to help, or if

they do, they

nancial help

may

may

not want to lend the money. Asking for

fi-

bring up difficult and complicated family dy-

namics that are unique to each couple and each family.

It's

important to weigh the cost/benefit ratio of being in debt to your family.

Although not a given that there

quences in asking for financial help,

it

will

be negative conse-

may affect your

relationship

with your parents in ways you haven't considered. Will borrowing

money

give your parents control over

you or your treatment

sions? Will they feel entitled to updates feel

deci-

on your progress? Will you

emotionally indebted to them or

feel

guilty if treatment

doesn't work? If you are struggling with keeping your reproductive issues private,

you may not want your family involved

at

all.

UNSUNG LULLABIES

192

Or you may future

—

feel

awkward about asking

any other help

for

financial or otherwise.

Adriana's family generously offered to pay for her treatment.

became about say

At

Adriana

first,

felt relieved.

we weren't

my parents offered

to pay,

it

sure

how to

seemed

when Gordon and Adriana thought

"What

money the

if

for us to try

them.

I

IVF

were stressed

I

the time," Adriana said. "Neither one of us wanted to

to IVF, but

take the

first

"Trying to juggle finances

Gordon and

a roadblock to treatment.

it all

no

in the

it

after

IVF

knew

I

didn't

I

it

would want

to

But

through, they decided not to

Would

want

when

like the perfect solution."

"It just didn't feel right," she

all.

didn't work?

again?

cover our costs. So

they

feel

continued.

obligated to pay

to have the feeling that

—not

pay them back

I

failed

necessarily

with money, but with a baby." Adriana and Gordon decided to

on

take a second mortgage

their

home

instead.

Parental involvement in your treatment can

spill

over into your

relationship with your partner as well. If his parents are willing

and able

to finance treatment

the better grandparents?

and hers

What you

are not, does that

make

his

don't need at this time are dis-

paraging remarks about either side of the family. There's enough tension as

it is

which could

Many

without feeling as though someone

also affect

couples find

monetary

it

burden to spread out the

makes

We

it

Knowing

keeping score,

your relationships in years to come. easier to ask several family

assistance rather than just one. It

ing funds."

is

cost.

And some

may

members

feel like less

for

of a

couples ask for "match-

that they are contributing half of the cost

easier to ask for the other half.

have found that

quests for help

when

many

families respond positively to re-

they have the resources. Your parents also

Dealing with the World

may

have a reproductive story, which

include

ents; helping to finance infertility treatment

dreams come true

to have their

as well.

But

193

becoming grandpar

can he

for

them

such

deci-

way

a

in all cases,

sions and requests must be carefully discussed, thought

planned

way

in a

that respects the feelings, needs,

out,

and

and personalities

of everyone involved.

Dealing with the Rest of the World

As we noted bies

—and

cially

earlier, selective

the stuff

when you

perception can

you can buy

for

them

make

—

it

seem that ba-

are everywhere, espe-

are trying to avoid those reminders.

When you are

feeling particularly vulnerable (after a failed cycle or during that

interminable two-week wait or just on a bad day), exposure to children and families can be unbearable.

Going Out and About Although

it is

ing particularly

impossible to isolate yourself,

down you may want

avoid situations where you

may be

we're not suggesting that you

when you

to protect yourself

are feel-

and

try to

overexposed to children. Again,

move

to a desert island or isolate

yourself to an unhealthy degree, but taking charge of the things

you can control (and learning perfectly reasonable.

when

it's

less likely

You may

To

work

avoid seeing so

if

when

weekends.

it

was open

late

can't)

is

Or you may opt

your usual one takes you past a

many

Denise decided to buy her groceries mall

you

choose to venture out in the world

children will be out and about.

to take a different route to

playground.

to cope with the things

children while shopping,

later at night

Thursday

and go

nights, rather than

to the

on the

— UNSUNG LULLABIES

194

Even though you may

to the cooking class or Kathleen

when you simply

can't.

everywhere you turn.

What

I

display.

could

feel

I

it's

"My

store.

want

to

go

doctor

infertility are

home

heart sank as

down

I

right

Again, recognize that

like this? it's

when you

only natural that you will

You can choose

new

to break

by the family-centric world we

get jolted

when Monique

as

myself welling up."

can you do in a situation

happens,

to the

didn't

your feelings are normal. So often,

you

went

infertility-

On her way to purchase a new toaster oven,

window

then and there, but

—

As you know, reminders of

Raquel passed a maternity clothing glanced at the

times

many

insensitive situations, there are

went

your best to avoid

try

live in.

feel awful, as

put on a

if possible,

expect

least

stiff

it

that

When

this

Raquel did.

upper

lip

and

go on with your business, use self-talk to boost yourself, or sometimes, as Raquel did that day, let yourself have a

though

I

didn't

better after

I

want

to cry in public,"

Raquel

good

cry. "Al-

said, "I felt so

much

did."

Remember

that Free to be You

to cry"? Unfortunately too as a sign

of weakness.

crier feels

more

tension, anger,

tune moments.

We

vulnerable,

to stop the tears.

many

It's

lyric, "It's all right

and view crying

of us forget that

tend to be embarrassed by

and those around her

But crying

and

and Me song

is

—

necessary

it is

feel

have endured because of

the

their job

a healthy release of

frustration, even if tears well

essential to

it's

tears;

shed tears to grieve

up

all

at

inoppor-

the losses

you

infertility.

Socializing Social situations also can inundate stuff. Social

you with family and kid

— even

gatherings of friends or family

if

they are for

:

Dealing with the World

adults only a

—

often revolve around children.

who was

baby-sitter

started, or

how

their

or the new

late,

little

one

195

Someone

in chapter 5, children are extensions

of a parent's

child

As we

just learned to walk.

about

talks

school (hen

has

disc ussed

no won

self; it's

der that parents boast about their kids.

But these situations make place.

What might

dreaded obligation.

infertile

have been fun in the past

bad and out of

feel

now may

windows and never go out

again.

It's

want

I

every infertile person at some time or another.

to be stronger

when

may

I

to shutter

all

been a long three years."

This normal and to-be-expected ambivalence about hits

feel like a

As Rhoda described: "At one moment

going to a party, while the next

really feel like

the

couples

social events

And

it's

likely

you've had bad news or are feeling low, be-

cause you are more sensitive and fragile at those moments. In handling social obligations, that there it's

no

right or

wrong way

to emphasize once again

to approach social functions;

your choice whether to attend or not. There

ordinarily family's in

is

we need

you would never miss

Thanksgiving

feast

—

a friend's

may be

events that

baby shower or your

—but they may be

too painful to go to

your present circumstances. Be careful not to get caught up

the "shoulds." Part of Rhoda's ambivalence

is

tied

in

up with her

feeling she's supposed to socialize. It is

to

—

perfectly

especially

okay not

to attend everything

baby showers, children's birthday

you

parties, or holi-

day events focused on family and children. You can

we'd love yes,

but

to,

but we've already

at the last

made

are invited

say,

"I'm sorry,

other plans." If you do say

minute change your mind, give yourself per-

mission to cancel. You need to take care of yourself, even disappoint a friend or relative.

if

you

UNSUNG LULLABIES

196

As we discussed

with so

stressful time,

family.

previously, the holidays can be a particularly

You may want

emotional

much emphasis and

to consider

Many of our

stress.

making

clients

attention placed

on

alternate plans to reduce

opt to go on vacation during

the holidays. Others decide to have a quiet dinner at

home and cel-

ebrate privately. It's

may

not always easy to change family traditions. Your family

not understand

why you

don't want to be with them, or

take your not attending personally.

you

As much

will hurt their feelings.

sometimes that

is

make

take care of yourself during this

and they If

may

members

will

be times

to

go to an event,

when your Try

or vice versa.

we wish

it

it

otherwise,

You need

better for them.

and

crisis,

some

at

have to handle their

will eventually get over

you have

as

or feel guilty that

unavoidable. Be prepared to field their reactions,

but realize you cannot always

that your family

You worry

may

to

point, accept

own

feelings

it.

how

should you handle

it?

There

partner wants to socialize, but you don't,

to find a balance

and

a

compromise

so both your

needs can be met. You can decide to go separately, or you can

choose to arrive Also,

feel.

arranged begins to

is

and/or leave early to limit the trauma you

we recommend

feel

Mandy

that

you and your partner have a

of cues or signals to

set

"We were saw

late

let

know if one of you

each other

at

my

cousin's house for Easter," said Roger, "and

my

eighty-five-year-old

well-meaning but can talk your ear

my

Mandy needed from

pre-

upset or overwhelmed while you are out.

cornered by

to be nice to

may

his aunt.

aunt, but

I

could

to get away."

off.

tell

Poor

Aunt

Betty,

Mandy was

I

who

trying

by her body language that

So he stepped

in

and rescued her

Dealing with the World

retreat to the rest

room

And

an easy way out. for

awkward conversation, excuse

you're stuck in an

If-

197

yourself to

or leave the party. "I'm not feeling well"

is

you and your partner can keep aw eye OUI

if

each other, that can be

a life-saver.

Dealing with Friends

"My best who

announced

she's pregnant," Chelsea,

has had two chemical pregnancies, said. "That's the third one

my friends

of it

friend Linda just

makes me

worse,

to get pregnant this year. feel

feel like

I

my own

such a

sadness

They

more

terrible friend

are

all

—why

so

happy

To make

deeply. can't

I

that

things

even be happy

for Linda?"

As you know

too well,

all

it's

easy to feel like the

out and become isolated from your closest friends.

want

cult to

—

don't

want yet

to feel

that instead

to

do the

you

feel

for

them but

And

it's

diffi-

you

realize that

just

remarkably sorry for yourself. You

right thing with

how do you do

With

happy

odd woman

your friend and congratulate

her,

the right thing for yourself?

close friends,

you may want

to

open up and share what

you're going through, as you might with a trusted family member. It

can be more comforting than you expect, in part because you

may

learn that others in your circle have shared your experience,

but never talked about

it.

Sometimes, though, you

may

find that talking about

what you

are going through with a friend doesn't work. Your friend

understand or a betrayal

may not

when you

be able to handle your pain.

can

not

feel like

confide in someone, only to have your friend

change the subject, or worse, talk about someone pregnant.

It

may

else

who

just got

UNSUNG LULLABIES

198

It

can

feel

awkward

are angry or hurt

by

But

their response.

your hurt feelings out in the open than

and feed

it

might be better

to get

them build up

inside

let

doom

growing resentment that could

a

can also be a way of educating your friend

made aware of

How

the friendship has been.

spond

You

Is it

But

bet.

Right now,

feel better.

from

it is

people,

if

okay to

you find that they

when

close

know how

your friend

let

are not able to re-

to limit the relationship until

more important

to take care

you

of yourself,

even to the point of temporarily suspending a relationship, than is

to nurture a friendship that brings

some

truth that

many

don't berate yourself a friend

How Do

Handle

think there

is

at a later date.

if

who

away from

"I

you mostly

pain.

It's

it

the sad

friendships will dissolve over infertility, although

can be resumed

I

It

their mistakes.

may depend on how open and

you may need

positively,

the friendship.

— most

their painful actions, will learn

the conflict resolves

you're feeling?

and share that you

to confront your friend

you

this

is

painful, please

find yourself needing time

hurts

this at

While

you more than

and space

helps.

Work?

a population explosion going

on

in

our com-

pany," said Marion, a personnel director of a large corporation.

She and her husband, Walt, have been trying

for

two

years. "In

this past year alone, there

have been eight births, and three more

women

week

are pregnant. Last

which was hard enough ingly asked 'It'll

me when

it

to

sit

through,

was going

be a while' and tried to shrug

that another stupid person said

daggers."

office

baby shower,

when one of

the guys jok-

was an

there

to be it

—but

my

turn.

I

smiled, said,

off as another stupid thing inside

I

was ready

to spit

Dealing with the World

How do you situations

—

handle these interactions

you

work? Those are tough

at

may

not want everyone

your workplace to know you're struggling with

in

Marion

ple talk,"

thing

last

This

I

need

said. "I

know

because

it

hear

I

for people gossiping

is

and

private

is

work

at

infertility.

me

about

"Peo-

the time.

all

it

needs to stay that way, but

mask Marion wears

cheerful

The

or pitying me.

not easy."

it's

The

ready to crack, especially

feels

vulnerable moments.

At times ity

as

and may spend more

see these people every day

time with them than good friends, yet you

at

199

is

not

like these,

who

she

Marion needs

remember

that her infertil-

Being cared about

as a person.

is

to

is

not the same

being pitied, or gossiped about. She needs to be prepared to

people that she would rather not talk about she cannot control

how others

think and

someone outside of work can provide It's

also incredibly upsetting if

one, only to hear about

pen

at

work

it

later

a

you

feel

it,

but recognize that

about her. Venting to

much-needed trust

why

from someone

she needed time off work;

it

when

in

some-

This can hap-

else.

work

felt

than hiding what was going on. At lunch a few days she was shocked

release.

and confide

or with friends or family. Sylvia told a

in confidence,

tell

colleague,

better to her

later,

however,

a different co-worker started talking about

who

got pregnant

when

she went on vacation.

an

infertile friend

"It

was a double whammy," Sylvia raged. "Not only was her advice

ridiculous, but

my

situation

trayal

—

The

I

I

knew

the only

was by talking

couldn't believe

feelings that

my

to

Marion and

it.

she could have colleague.

It

known about

was such a be-

it."

lated cases. Unfortunately, they

place and outside of

way

Sylvia bring to light are not iso-

happen

all

the time

—

Like Marion and Sylvia, you

in the

may

workfind

it

UNSUNG LULLABIES

200

and hurt with someone you can

helpful to discuss your anger trust

—be

it

a spouse, a friend, a support group, or a therapist.

ing your infertility diary at these times release

your

When

is

also

Us-

an excellent way to

feelings.

Dealing with the World

While we hope

Becomes Overwhelming

that the suggestions in this chapter help

you cope

with everyday situations, we also encourage you to look elsewhere for help

when you

feel isolated

Web sites,

port groups,

and

and confused by your

therapists can

all

feelings.

Sup-

help during these try-

ing times.

Warning Signs You Can't Ignore Before

we

proceed, a

sometimes the pression, in help. tal

Here

stress

infertility

trauma,

you're experiencing can turn into clinical de-

which case

are

word of caution: during

it is

important that you seek professional

warning signs that you should get help from a men-

health professional:

the time (not just sometimes)

•

crying

•

being unable to get out of bed (more than occasionally)

•

feeling unable to concentrate (not just

•

having suicidal ideas (even

all

if

now and

then)

no plan)

Your primary-care physician, your gynecologist, and your ity specialists are all

good

infertil-

referral sources.

Often, a course of antidepressant medication can help.

women

resist

Many

taking any medication because they worry about the

potential effects

on the baby and research on

this issue

is still

on-

Dealing with the World

201

going. But depression, which can lead CO not eating or sleeping properly,

may

pose substantial

during pregnancy. In some

risks

cases, the risk of not taking antidepressants

of taking them.

physician

who

essential to consult

It's

may outweigh

the risks

with a psychiatrist or other

can make the best recommendations for your par-

ticular situation.

Support Groups Fortunately, there are fertile

couples,

and

many

in the appendix we've

topics

—some

are

women

experiencing secondary

who you

compiled a

You

infertility.

group

ous Internet bulletin boards and

mously discuss your

will

be able to meet others

and support.

situation, there are also

Web

sites

knowledgment that you

numer-

where you can anony-

it is

Web

sites

provide reassurance and ac-

are not alone.

comforting to

They

know

offer a

venue

so

a sense of belonging,

much,

which

encouraging, even

is

hoped or expected

help group

is

led

we

too.

not the "club" you had

please consider whether or not

by a professional moderator.

members understand

their experiences

it

couples struggle with

to join.

When choosing a support group, the group

infertile

if this is

for air-

that other people will

understand your experience because they are experiencing

Having

If

situation.

Support groups and

ing your feelings;

of organ-

only, others are for couples, or those

are in similar situations to receive comfort are not comfortable in a

list

Support groups have different focuses

izations that sponsor groups.

and

support groups specifically for in-

and provide

A

professional can

the psychological complexity of

referrals if further help

discuss below, they can also

is

needed. As

help group members keep

a handle

UNSUNG LULLABIES

202

on the

can occur when someone in the group becomes

feelings that

pregnant or has a procedure

fail.

While support groups can be highly

some

pitfalls. It's

wonderful to have a group to commiserate with,

but what happens fore,

do have

beneficial, they

when someone

in the

group gets pregnant? Be-

when some-

everyone was on the same side of the fence, but

one gets pregnant that group member moves to the other

Once

again, there

couple

how

who

to

make

is

a sense of not belonging anymore.

has become pregnant

manage

discuss these issues.

Then,

it is

if

Here

we do

This can

a professional

the group can openly

situation occurs, every-

its

own

drawbacks.

It

can be a valu-

easy to be overwhelmed by the vast

of information. While we don't discourage our the Internet,

know

it.

Likewise, the Internet has able resource, but

is

and when the

if

prepared to deal with

well

Even the

uneasy and not

their relationships within the group.

—what works

is

feel

the group feel strained and awkward.

moderator can help

one

may

side.

caution

them

clients

to pace themselves

take everything they read at face value.

On bulletin

amount

from using and not

to

boards, for ex-

ample, people share experiences and advice, but misinformation also abounds.

It's

fine to ask

your e-friends questions, but always

confirm what you learn with your physician. Sometimes, to set a time limit for

manage

anxiety, but

your

Web

surfing. Information

becoming obsessed with

Web

it

helps

can help to

searches

and

bulletin boards can be counterproductive.

Therapy Sometimes couples need more individual support than talking with family, friends, or fellow group members.

It

can be enor-

Dealing with the World

mously valuable Sessional help

for infertile individuals

through

and couples

rough period.

this

203

It's

to seek pro

uncommon

not

foi

people to worry that seeking therapy means that something more is

wrong with them,

der assault from

time

at a

when

their self-esteem

But remember that

infertility.

already un-

is

infertility

is

unique trauma that goes outside the range of what we expect life.

Not only can therapy

an effect on your partner

ease your

as well.

own burden,

Even

men

if

but

a in

can have

it

don't want to see a

therapist (unfortunately, not an atypical reaction) they can benefit

from what

their wives learn. It can take the strain out of those

times in your marriage

and your partner

Candace

felt

is

when you

she was unraveling at the seams after her

on the

fail

first try.

She

"

Candace understood

needed to vent.

"It's

I

number two

this rationally,

chest

else

with

People

it

is

many

will

much

be that

bet-

all

the other stuff

—and

in therapy.

—and I'm not going

still

also I

to

what we

can get

it all

we are

off

burden anyone

this." feel better after

stirring inside

work

that keeps staring

you

ing voice to your feelings

Talking about

it

they are able to put into words what has

of them.

been

is

It's

as if

in the face

you have an in-box and driving you

like getting

some of

that

it all

in the "finished"

file (literally

getting

it

full

crazy.

of

Giv-

work done.

takes the contents of the "to be done"

has been banging around inside of you and causing so

and puts

that

but emotionally she

not just this IVF, but

know I won't be judged

—whatever

my

IVF

first

'Now we know how your body

have gone through over the past four years facing next.

me

tried to reassure

said,

reacts to the medications; trial ter.'

need someone to talk to

not, or cannot be, available.

was unsuccessful. "The doctor IVFs

really

file

(what

much grief) out of you).

UNSUNG LULLABIES

204

Many

times, the

progress, but

it is

that relieves so

Therapy

work

the process of getting

much

judgmental environment

your feelings about your

—

having a good

expressing anger to

cry.

it

it

work

a

it is

in

out from inside of you

establishes a confidential

a safe space for

is

who

you

and non-

to explore

trauma. Being able to vent and

infertility

blow off steam to someone lar to

it

as

of the burden.

unique in that

is

much completed

not so

is

is

supportive and caring

And you may

someone trained

feel safer

shedding

is

simi-

tears or

to handle those feelings,

someone who can normalize your experience and help you understand

As

you

it.

therapists

and

to develop as

fects

of

as therapy patients ourselves,

deep an understanding of the psychological ef-

infertility as possible.

about yourself and the

The more you know and understand of

effects

This goes for your partner as

feel.

can identify the sources of your ual

we encourage

infertility,

well.

the better

The more

the

feelings, appreciate

you

will

two of you

your individ-

ways of coping and grieving, and your unique reproductive

stories,

the

more you can

give each other support without feeling

misunderstood. If

you decide

to pursue therapy, choose a therapist

knowledgeable about the issues related to therapist

who

listens well

infertility.

chologists, social workers,

individual

matter

less

for a

Psychiatrists, psy-

and other licensed professionals can of-

and marital psychotherapy.

Specific

credentials

than finding a well-trained therapist experienced in the regarding reproductive trauma and

sensitive

issues

around

you need

if

Look

is

and does not have preconceived opinions

on how your reproductive story should unfold.

fer

who

to,

but don't just pick a

name from

loss.

Shop

the

phone

Dealing with the World

book; ask your doctors, your friends this,

pist

and your support group can provide

who

205

The

leader for referrals.

a safe haven, a place

going through

are also

where you can

and understood, and where you can put the

then

right

accepted

feel

pieces of

\

our per

sonal puzzle back together again.

You Are Coping, Even Though There event.

no way around the

is

The world no

you may not changes ers.

feel

how you

How

you

how

to

Feel Like

fact that infertility

it

a life-altering

is

longer feels like such a welcoming place, and

very safe navigating

in general,

is

every day. Infertility

it

think about yourself and

interact with

with the world

May Not

it

how you

deal with oth-

your family, friends and co-workers, not the same as

cope in an environment that

is

once was. Learning

it

so family-focused

is

a chal-

lenge, to say the least.

As you it's all

struggle to find your footing, please keep in

right to laugh, or cry, or get angry;

it's all

way

the crazy things you're feeling. Feeling one

and another It's all

in the evening

right to hide

is

not only okay,

when you need

to, just as

out to others. You are not alone in this if

you

it is

is

is

the center of your

only one part of

may

infertility it

in the

all

morning

to be expected.

it

right to reach

often feels as

are.

achieve this goa)

but

that

right to feel

it's all

— although

While wanting a family and going

that

it's

mind

still

when you

are.

life

enormous lengths right

As we mentioned

down

—

who you

it's

are.

why we

a tool to keep

to

now, remember

be a gigantic piece of the puzzle of

only one piece. That's

feel

the rest of

who you

to

before,

who you

are,

encourage self-talk

infertility separate

Reminding yourself of your

from

strengths

UNSUNG LULLABIES

206

when you

feel so

vulnerable can be hard. But

self-esteem, giving

number of tough

And

you the energy you need

can also boost your to get through

can step

far

feel like

laughing now,

away enough from

through your

any

situations.

never forget the power of your sense of humor.

you may not

all.

it

tears, try to

it

much

of

— can be

this process

Though

—

strangely funny.

if

you

Even

keep in perspective the absurdity of

it

After Raquel cried in front of the maternity store, she chuckled

about

it

later

when

she was home.

"Of

all

the different routes

could have taken to get to the appliance store," she pick the one that

would land me

right in the

said, "I

middle of

had

it all.

is

as

important as letting yourself

cry.

to

Geez,

talk about a sense of direction!" Letting yourself laugh about this

I

all

PART

IV

Rewriting Your Reproductive Story

;

Ten

Knowing When

One

of the most profound decisions an

make the

first

— —

as

place

you'll never

This decision certainty

the decision to stop trying.

know when

popping up

Or in

to stop.

it's

isn't

always crystal

feel as if

when

to stop

is

ini-

at

clear;

you can

feel

what your next move should

much

un-

be.

At one

to stop, the next you're ready to try

infertility treatment.

For others,

it

actively pursuing treatment for a biological child.

you stopping your

effort to conceive naturally?

means So

you stopping IVF?

Wherever you sider carefully

When do

are in

how you

are

Are you stopping

taking medications such as Clomid? Are you ceasing the IUIs? are

to

not always clear what stopping means. For some,

stopping means limiting

no longer

You may

your mind.

and confusion

And

couple must

You may not even be ready

perhaps the question of

moment, you may be ready again.

infertile

important as the decision to try to conceive in

is

consider this yet. tially

to Stop Trying

Or

you stop trying?

your journey, we encourage you to confeel

about going on

at every stage

of the

— UNSUNG LULLABIES

210

process.

Too

blindly,

without considering the ramifications of your next move.

ART,

Yet

and

as

spiritual

you must

Of

tinue.

often, in a haze of stress

remarkable

as

it is,

carries

and

with

anxiety,

it

a

you move on

number of moral

dilemmas, to say nothing of the financial cost that

factor into your decision about

whether or not to con-

course, the decision about whether or not to stop also

depends on what your doctor

says; you'll

need to find out

all

you

can about treatment options and what's right for you medically.

These

issues

can complicate the decision process, so

important

it's

that you confront and discuss these issues head on.

In this chapter,

you may

face as

we

you pursue

which interventions termine

pens

explore the emotional issues and dilemmas

are right for you.

when "enough

when you

finally

is

child.

treatment and try to decide

We

also discuss

how

to de-

enough" psychologically and what hap-

make

can be agonizingly

It

infertility

the decision to stop trying.

difficult to face

And when you do make

not having a biological still

more

couples

come

that decision, there are

decisions to be made. In chapter

1 1

,

we

explore

how

to terms with rewriting their reproductive stories, incorporating

the story lines of

such tion

as

—

becoming

means

using donor eggs or sperm, a surrogate, or pursuing adop-

or deciding to be childfree.

You Made a Choice It's

a parent through alternate

to Start,

often hard to figure out

fertility

when

You Make a Choice

Stop

to stop treatment because the in-

treatment process becomes all-consuming.

you and your partner on an emotional and medical the process of infertility treatment can treadmill with

to

make you

Not only

are

roller coaster,

feel

no off-switch. You keep trudging ahead

stuck on a as the

myr-

Knowing When

iad treatment options teed the

to

hope

Stop Trying

we

thai "if

211

one more

try just

time, that will be the one that works."

Your longing

ror a

baby can

pull

you deeper

treatment than you would ever have imagined started. "I

was

Clomid

tle

who

ple

to help

chance

I

it

want

will

a

later, still

clients are

like Sally, feel conflicted

on. Are

you

feeling this

sions as

you

try

open or

close as it

take a

I

lit-

I

three years, six

can't quite believe

say no

when

there

is

a

work?"

So many of our

and how

I

am

I

not pregnant.

baby so much, how can

that

first

was one of those peo-

said Sally. "I

hated taking medicine. Now, here

But

when you

when my doctor suggested

me ovulate,"

and two IVFs

IUIs, this.

horrified

into Infertility

and

exhausted by their treatment, and

about their decisions but compelled to go

way

too?

You keep making treatment

deci-

try again to have a baby; various doors either

you and your doctor

responds to treatment.

learn

And all

more about your body

of

this

happens with the

added pressure of time passing hanging over your head.

Assuming

there's

no medical contraindication,

it's

okay to take

short breaks off the treatment treadmill. Taking off a

two

—

— can

or even six

when you

clear

or

your head and refuel you, particularly

are feeling bewildered

and unsure of what

Slow down to give yourself a chance

and

month

to listen to

to

do

next.

your body, mind,

spirit.

By

releasing the valve

on the pressure cooker of treatment, you

consider your options more clearly. plans

may

Of

course your feelings and

seesaw from one day to the next, but with a break you

have the time and space to think about what next steps seem best for you, or establish a time frame for

particular treatment.

how

long you will pursue a

UNSUNG LULLABIES

212

Remember,

just as

ments, you can

make

you made

a choice to start infertility treat-

the choice to continue treatments or to stop

them.

Your Reproductive Story

Whether

the decision to stop trying seems clear-cut or not,

important feelings critical to

It's

story

is

arise at this

juncture of the reproductive story.

explore and acknowledge

changing

—and how you

feel

Part of the challenge in deciding

pursue, and

how many

times,

many components. The

many

is

how your

reproductive

about those changes.

which treatments you want

to

that the path to parenthood has

aspects of parenthood that are

most im-

portant to you play a role in determining the interest or comfort level

•

you have with any type of treatment.

Is

the act of conception the most important part,

that

you

are only comfortable

becoming

meaning

a parent if

you

can conceive "the old-fashioned way"? •

Is

having a biological child the most important? If

you might be willing "naturally"

•

to relinquish

and use IUIs or IVF, and your

so,

then

your wish to conceive

if it

would mean

that the

baby

carried your

Or

is

having the experience of pregnancy the most essen-

tial

piece of your story, even if the child

partner's genetic selves.

yours and your partner's? If that

is

is

not genetically

the case, then donor

technology of sperm, egg, or both might be options that

you would consider. •

If

having a biological child

is

more important than preg-

nancy and birth then you might consider using a surrogate

Knowing When

to

Stop Trying

to carry your embryos, or your husband's

donor •

Or

if

baby

213

sperm and

a

egg.

you

realize that the

to parent,

most important

regardless of

its

part

is

biological

to

have

roots,

a

then

adoption might be the answer.

As you consider these questions,

you

—

no

again, there are

per off treatment or

right or

let their

figure out

what

feels right tor

wrong answers. Some couples

ta-

various options overlap, such as be-

ginning the adoption process while continuing with another IVF or IUI. This route,

and

may

less

your next step

help you from feeling too invested in any one

devastated by the setbacks, since you will be.

The Finances Infertility

is

of Infertility

financially as well as physically draining.

know, the cost of

infertility

some cover

other plans

may

tests for diag-

certain aspects of treatment but not others, while

set a dollar limit

on payments

ment. Figuring out the finances of

overwhelming ordeal

Even

As you well

treatment can be exorbitant. Insurance

coverage varies: some health insurers cover only the nosis,

know what

to

ment expenses, such

is

another confusing and

for infertile couples.

in the rare instance

most couples have

ART

for infertility treat-

pay

for

when some

insurance covers part, if

not

as co-pays or medications.

all,

IVF

of their

You may

position to pay for these procedures yourself, but

cycles, treat-

be in the

many

couples

need to borrow money or go into debt. Financial considerations often define the course of treatment.

Balancing your longing for a baby with the other economic de-

UNSUNG LULLABIES

214

mands of

Couples often make great

order to pay for treatment

fices in

car?

tricky business.

life is

Not go on

milestone

vacation?

— do you put

sacri-

off buying a

A choice in the service of one need or life

may undermine

another. Lillian and Kevin, after a year

of unsuccessful interventions to clear her blocked tubes, must decide whether to spend their savings on a house

an IVF

cycle.

"We thought

and husband," Kevin

sister

it

would be

said.

now

thought we'd have one by

on

payment on

As

dream of

their

now

down payment

"They've got a six-month-old; too.

a house,

or

great to live near Lillian's

We

we

thought we'd baby-sit for

each other and raise our families together." to defer

new

They

ultimately chose

and spend part of

their

down

IVF.

their

a couple, you'll grapple with tough issues figuring out

finance your treatments.

It's critical

that

how to

you and your partner be

honest about what resources you have, what options are available,

where you might be able

to sacrifice.

Maybe,

as

we

discussed in

chapter 9, you'll decide to approach your families for help.

Is

Investment Worth

this It's

it?

also important to recognize that not only are large

volved, the

outcome of

this

expense

is

risk,

and

if

spending a nest egg or taking out a second mortgage, you

ently,

it

in-

by no means guaranteed.

People vary in their response to financial

extremely anxious. If your

sums

you

are

may feel

partner experiences financial risk differ-

can fuel a struggle over whose values should be honored.

Lance,

who grew up

in a

home where money was

very

tight,

worries about "running out of cash." His wife, Jenny, thinks that

even

if

money

is

tight

now, she and Lance can make more

the course of arguing,

later.

In

they realized that their disagreement

Knowing When stemmed from

to

Stop Trying

their conflicting attitudes

actual financial resources.

By

215

toward money, not

spend a certain amount on treatment, and then continue

when

cussion

established; to

they reached that cap. Lance

Jenny

felt

the

theii

talking this through, they agreed CO

amount

reflected

fell

their dis-

better with a limit

what they could afford

spend now.

How Can You

Place a Price Tag on a Baby?

Yet another tricky feeling can creep into your discussions about

treatment costs.

Some

people struggle because they worry that

when

they are "buying a baby,"

they must pay ten or twenty thou-

sand dollars (or more) for an IVF Jane and Tim, years,

still

like

we

but

it is

"We want

How much

feel like if

I

we

is

—

baby

a

killing us financially.

a family?

to stop, but

didn't

Figuring

We

that,

on making

Tim wants

have been undergoing treatments for four

argue about the costs.

doubt about price tag

who

cycle.

How do you

'too

much'

no

there's

put a

to spend?

don't keep trying, we'll

feel

do everything we could."

Out What

to

Spend

advise our clients to consider the expense in the context of

the bigger picture of their

you repaid over many

life.

Did you

take out a college loan that

years? Perhaps if

treatment as an investment in your future, ucation,

it

might be

easier to accept.

take years to pay back. "But

it

it

carries

does a college education.

much

might not work!" you exclaim. is

some degree of

What

infertility

like a college ed-

Even education loans can

That's true, and in that regard, infertility

vestment, in that

you think of

if

you go

even more

like

financial risk.

to college

an

in-

But so

and major

in

UNSUNG LULLABIES

216

business and then decide to

you want

to be a teacher instead

an opportunity that you

Knowing when

may

to stop

is

not guaranteed, but

tolerate the anxiety that

vestment gamble

baby

to

show

spending

is

a highly personal decision,

Finally,

it's

it.

okay to

what others do

for

much

costs so

accompanies financial

—

But

risk.

This

feel resentful that

for free. It can be

these invasive tests

still

an

is

in-

not have

an opportunity.

it is

that doctors

couple to

ability as a

—you may be spending money and

for

buys you

it

not have otherwise.

which depends on your resources and your

all

Of

go back to school? Does that make your degree a waste?

course not. Infertility treatment

a

and have

and

you have

to

pay so

hard to accept that

clinics are

much

this all

making money from

and procedures. You may find yourself

feel-

ing ambivalent about the business aspects of your doctor's prac-

This

tice.

them

is

feels like

work

patients,

What

is

a professional business for

the key to your future. But try to stay focused on

hand and the

the task at tors

understandable.

services

your doctor provides. Most doc-

to create soothing, comfortable

environments for their

with the best possible equipment and

It is also

the case, however, that being charged for every single

step in the process

There's no

services.

harm

—whether

it

—

works or not

is

in asking for a discount if you've

very

stressful.

gone back to a

doctor or clinic for repeated cycles. If your insurance doesn't cover medications, sometimes clinics have extra medications on

programs where other patients donate unused meds. asking.

break;

Some people it's

feel

hand

It's

or

worth

embarrassed or needy by asking for a

yet another affront to their self-esteem. But doctors are

aware of the financial strain these procedures can cause and

be willing to discuss their

fees

with you.

may

Knowing When

to

Stop Trying

217

Spiritual Considerations

Feeling Guilty never considered myself to be that religious," noted Maril}

"I

ART,

"But thinking about using

Maybe I'm

me and

for

but

I

just don't

know what

has

infertility

mother

says that only

ing,

because

it's

am

I

now

she's

can make a baby and

"I

Many people face tough consider

ART. And

infertility

Some

know what

religious

and

infertility treatment.

You may

A

feel

person

faith."

I

At

first,

feel guilty,

believe anymore."

faith.

different

These

God"

dilemmas

spiritual

when

it

comes

to reproduc-

believes that medical

Why

anxious

knowledge

when con-

should reproductive technol-

from other medical technology? The anxiety

of judgment

may

infertile.

reflect one's

own

sense of guilt and

People define themselves by their

productive capacities in ways that they simply do not a

happen-

spiritual questions as they

God may become

sidering infertility treatment.

shame about being

"My

no compunction about using other

who

was provided or inspired by

ogy be any

plan

coincide with the other ways you view medi-

medical technology, but draw the line tive technology.

a

the despair and confusion you feel about your

ART may not

fear

isn't

people, like Marilyn, worry that they are "playing

cine or religion.

and

it

making her

can also spur mixed feelings about your

when they pursue about

don't

for

if

my

haven't been strong enough in

not so sure.

has

her question basic beliefs.

Marilyn was furious with her mother but

Maybe God

it is."

in fate as the driving force of her

made

God

n.

having second thoughts.

not supposed to have a child.

Marilyn had never believed life,

I

problem with some other body

part.

The

if

re-

they have

anxiety evoked regard-

UNSUNG LULLABIES

218

ing religion

may

their reproductive story,

People

may

ceptions of

some

also speak, to

with

its

beginnings in early childhood.

bring an almost childlike fear to their images and per-

God and

church when

it

They worry that they will be judged

know

selves

deep roots of

extent, to the

better.

It's

comes

to reproductive issues.

harshly, even

as if their infertility

when

means

their adult

that they are

fundamentally bad or lacking, and that the church will view them that

way

as well.

When you infertility,

are struggling with the moral or religious aspects of

you may

You only remem-

also tend to rewrite history.

ber what you've done

wrong

in the eyes

of your

religion;

"bad" past deeds or thoughts or past sexual behavior.

comes

a self-indictment, a

punishment

—even

have made in the past resolved at the time.

The

if

yourself. In

self -judgment

and

anxieties;

your mind,

Abandoned

Some people may

or Angry at

feel

you

spiritual issues

your

may

fear

of

angry with or abandoned by

God

pun-

—and

about their doubts. Brad, a highly religious

man

who

van-

good

per-

volunteers at his church, had an alcoholic father

when Brad was

son," Brad said. "I

something

reprisals

God

who

let

can be-

crisis.

feel guilty

trying to help

you

your own

reflect

then

ished

feel

infertility turns into a

ishment from God, rather than a medical

Feeling

Infertility be-

for the errors

religious leaders or the congregation

judgment of

recall

the decisions were thoughtful and

come interwoven with your own from

you

eleven years old. "I've tried to be a

grew up

fast. I've

my mother make like that

worked

ends meet.

happen when

I

I

since

swore

became

I

I

was fourteen

would never

a dad." Brad did

Knowing When

things "right" and yet

be a father, and

by

I

young

his rather at a It is

can't?

"How

Where's the age,

and

out in

to

want

all

of

good and

God

have.

justice in that?"

Abandoned

now Brad

feels

abandoned by

this?"

it is

"Why me? Why wasn't God

Tracy came to

iod.

else, a

for

your

helping

she had stopped seeing the world

infertility,

about

just place. "I forgot

hasn't pushed

spiri-

realize that, in her depression

—

me away

I

all

the blessings that

I

do

have retreated." Comforted

by her recognition that her relationship with

much

(

natural to question, to

blame something outside yourself

to

over her seven years of as a

Father gel CO

a loser like

bound, and that

misfortune. Tracy wondered,

me

my

could

important to remember that your psychological and

tual selves are closely grieve,

219

has no kids of his own. "Yes, I'm angry

still

with God/' he continued.

Stop Trying

to

God

was, like so

highly personal, internal experience, Tracy

felt less

alone.

Those who don't consider themselves tion their belief system.

When

Edie

may

religious

also ques-

desperate about having a

felt

baby, she was surprised to find herself praying. "I'm not exactly sure

I

was praying

to

God, but

'Please, please, let this work.' It

I

closed

my

eyes

and whispered,

was so automatic." For Edie, pray-

ing expressed her hope that someone or something outside of herself

Is

could help her.

Yours a Loving

God?

In working with people on these

them

to think

about their particular

themselves whether they see

them

spiritual issues,

to consider

why

God

a loving

God

—and

as loving or

God would

we encourage to clarify for

judgmental.

punish them

We ask

for

want-

UNSUNG LULLABIES

220

God

ing to have a baby. If they feel that ever sin they feel they

committed

them

forgives

in the past,

why can

for

what-

they not for-

give themselves?

We also encourage people to try to separate their personal views God from

of

formal religious doctrine

these issues. This can help

them

their true spiritual beliefs or if

it

when

they are considering

clarify if their anxiety reflects

has more to do with their fears of

being judged by their social community, family members, or by themselves.

We

you

also encourage

your

to speak with

spiritual leader

about your concerns. Often you will receive more support than

you expected.

Am "There

is

I

something about creating a baby with assistance that

doesn't seem right to me," Melanie said, three years. "I desperately

maybe seems

I

selfish

little

want

should adopt a child not to adopt.

You too may be

A

ART?

Selfish for Using

to

I

has been trying for

be pregnant and give birth, but

who

Am

who

has no other opportunities.

wrong

for

wanting

It

my own?"

struggling with feeling selfish about using ART.

voice inside your head nags:

stead? There are lots

Why

aren't

of babies who need homes.

pressure from family

members and

friends

you adopting

And you may

who

infeel

suggest that you

"just adopt."

But self-criticism and for

Melanie

ably

—makes

guilt

it all

about wishing to be pregnant

the

more

difficult for

move forward with medical treatment

talk to

many

couples

who

and yet struggle with the

feel

—

you

—

like

to comfort-

or decide to stop.

We

that they "should" do something

feeling that they don't

want

to.

These

Knowing When feelings about using

ART may

and shame about being

Stop Trying

to

reflect

infertile.

deeper

221

wounds

narcissistic

helpful to separate feelings

It's

about yourself from the specifics of your decision, SO

thai

you do

not unduly punish or deprive yourself of what you truly want.

At any

stage of this process,

made without remorse with treatment, by

all

it's

crucial that

your decisions be

or guilt attached. If you want to keep on

means do. Adoption

is

a

wonderful choice,

but to adopt and deny yourself medical treatment out of

guilt

is

not constructive for yourself or the baby you are adopting. If and

when you choose

to adopt,

do so because you want

to,

not because

also

need to ac-

you think you should.

Impossible Decisions

As you move through the treatment knowledge the decisions

risks

and concerns

you may have

pregnancy

is

to face if

process,

raised

you

—

by AJIT

the impossible

you get pregnant. While every

inherently risky, using

ART may present you

higher instance of complicated circumstances.

Women

with a

over the

age of thirty-five are at a greater risk of miscarriage and genetic anomalies.

ART

also increases the likelihood of multiple births,

which can increase the It's

may

risk to

both mother and babies.

important to recognize that

this

medical technology, which

give us our only opportunity to have a baby, also can present

us with difficult and agonizing choices. Consider that diagnostic tests

such

as ultrasound

mation that

Of

and amniocentesis provide you with

in the past wouldn't have

course,

no one knows what

you do become pregnant. But tential risks

it is

been

infor-

available.

decisions you'll have to

make

if

important to recognize the po-

and decisions involved. What might you do

if

amnio-

UNSUNG LULLABIES

222

come back

centesis results

What might you do

badly?

How

more embryos?

yourself pregnant with three or

if

you

find

you might

may inform your

handle these difficult and complicated decisions treatment decisions.

Each individual and couple it's

how

go with treatment.

to

have to decide what

is

right for

important to face these questions as you consider

them. But far to

will

best to gather information, talk

It's

your doctors, consult with genetic counselors, and search within

yourself to prepare for different scenarios.

pecting the worst, but of being

realistic

not a matter of ex-

It is

and prepared

for the risks

ART.

involved with

What Makes

it

So Hard

to

Stop

Like a gambler hoping for a win, infertile couples find themselves enticed by the lure of "one

new procedure, cessful

when you

duce enough

she's

I

about adoption

her support group. after

an under-responder and simply does not pro-

—he

it

if

told

doctor. "Everyone

got to go see

He's had

me

if this

we

new

'I've

thrilled.

—but what

With

possibility,

been told by two different doctors

thought,

husband won't be

could stand

on that

eggs. Still reluctant to accept her diagnosis, she can't

about him and

I

be the ticket to a suc-

new doctor through

help but be excited about a

adopted

the next try, that

if

hear about other people's successful attempts.

thirty-four, she has

two IVFs that

What

so hard to turn your back

It's

Sara heard about a

Only

time."

this different clinic really will

outcome?

especially

more

last

it!

him

too.'

night about a

door

I

know my

He's been hinting around

work

doctor really can help us?

close the

was raving

I

friend

who

don't think

right now."

a carrot dangling in front of you, enticing

you

to try yet

Knowing When

another doctor and

vet

another procedure,

ping can be hard to do. Sara

is

we have

it

223

no wonder slop

IS

not alone in not wanting CO leave

any stone unturned. Combine achieve what

Stop Trying

to

with

that

natural

a

out to do, and we have

set

instinct

to

formula that

a

keeps us going for a very long time.

Knowing When Enough Some

Is

couples set limits right from the

Enough

start;

know which

they

treatments they are willing to undergo and which they are not.

they

know

their insurance covers a certain

so that's their limit.

When

they set out to do, they

Most

others don't

they have tried

know

—

know

is

driven by finances.

or find their "limits" changing as they

Few of

dedicate to infertility treatment.

options

—

the interventions

all

the right time to stop.

it's

go through the treatment process. For to stop

Or

number of procedures

many

couples, the decision

us have unlimited resources to

And

if

you

are considering other

like adoption, surrogacy, or donor technology

—

those re-

quire a significant financial investment as well.

Other couples stop

actively trying for a biological child

their emotional resources

run dry. As you well know,

ing to go through one loss after another.

your soul

as well as

your body

is

The wear and

tremendous.

thinking about other avenues to parenthood, stop

when you

still

it is

And

it

is

if

when

exhausttear

you

on are

important to

have some emotional energy to devote to your

next steps. Trisha

knew

exactly

when

saw a robin build her nest

and couldn't wait gone.

When

I

her emotional coffers were empty. "I

last spring,

to see the

went outside

baby

watched her

birds.

to look,

I

sit

on the

nest,

But one day the robin was

found

shells

broken on the

UNSUNG LULLABIES

224

ground.

I

sobbed and sobbed.

emotional tipping point.

ment;

it

The

was time

move

to

physical drain

is

I

knew

right then that

on with any more

couldn't go

I

was

I

my

at

treat-

on."

another factor to consider.

The hormones

and other medications you take place great strain on your body.

You

feel bloated,

out of

not yourself. While

sorts,

procedures are "routine," they

gical

have to go into a hospital again,

Even

you've

if

stop after two

IVF

known

will

— deciding not —you

to try

any longer

for

bit stressed

and depressed.

—

No wonder

to stop trying

—

is

never

to

can be an emotional

you rewriting your reproductive

are likely also feeling vulnerable,

change

I

you always were going

child

life

"If

be too soon!"

cycles, the decision to stop

are

the sur-

and those

risks,

As Trisha added:

for sure that

and painful one. Not only story

it

have their

all

requiring anesthesia have even more.

many of

that

your own biological

worn

out,

and

still

a

making another major

difficult.

Waving the White Flag Wrestling with the decision to stop treatment feelings treat,

of defeat. After fighting a valiant

but you

may

battle,

may

it is

time to

go of

try, try

this "project"

again."

may give

Sometimes people choose sadness or fertility

grief. It

re-

have an uncomfortable feeling that you are

quitting. All of us are too familiar with the cliche, "If at

don't succeed,

bring up

may

It's

first

you

so deeply ingrained that letting

rise to a

sense of failure.

to continue trying to avoid feeling

be easier to hold onto the identity of "in-

patient" than to feel that

you have reached the end of the

road.

As your treatment has progressed, you have already come

to

Knowing When

terms with being

to

Stop Trying

225

in.

With

each option you gain something- new hope, another chance

bill

you

you never thought vou'd be

in a place

also lose something: the lost opportunity

that didn't wotk. In a weird way,

of parenthood even

The

as

from the procedure

you move hut her From your goal

you move forward

to the next technique.

decision to stop treatment encompasses yet another

couples must mourn. For some,

loss that

step off the treadmill for good, that

grieving process. In

its

own

long

may

there

was no time before

Paul and

to grieve.

felt it

finally

full effects

So be prepared

of

when you

begin your

mode this

for so

trauma;

for a potentially

decide to stop.

Donna knew from

do IVF; they

only now,

way, being in the coping

have protected you from the

when you

big crash

it is

you can

level oi

was too

the get-go that they didn't want to

risky

and expensive. But when they

reached their self-imposed stopping point, Paul was besieged with questions regarding what to do next.

he

felt

The only son of an only

responsible to carry on his genetic line.

son,

Donna, while sad

about not experiencing a pregnancy and not having a biological child,

was ready

to proceed with adoption.

"I'm having a hard time understanding

happy about ter to

that

Paul

said.

we wouldn't do IVF, but

many

ment was up

his

his

the loss he ized he

this

is

I

let-

agreed

fast."

continue treat-

to circumvent the crash; he wasn't yet ready to

dream of having

would

know we

happening too

infertility patients, Paul's drive to

way

can be so

"She has already started writing a

introduce us to prospective birth mothers.

Like

give

this,"

how Donna

a biological child

inevitably face. Yet he

felt

and wanted

relieved

was experiencing a normal phase of

phase. "I finally understand that

my

to avoid

when he

grief

—

real-

the denial

push to continue medical in-

— UNSUNG LULLABIES

226

was an evasive maneuver.

terventions

the obvious need to say good-bye to

Coming

And

as

he did

was

my way

of avoiding

my dreams."

was able

to this realization, Paul

a biological child.

It

to grieve his hopes for

he shifted the story line of

so,

his

reproductive story and joined his wife on the path to adoption.

His decision

now

felt

proactive and positive rather than a defeat.

Giving Yourself Permission to Stop It's

okay to stop treatment. But

some outside

pressures

may make you

We've noticed many times that

how

that infertile couple

trying yet another It's

new

important to realize that feel

you "should" go on.

a couple deciding

to stop treatment will start talking ing,

it's

is

whether or not

about what their friends are do-

trying their sixth

IVF

cycle or

treatment protocol.

easy to compare yourself to others and feel yourself

up short

—

were a true

as if this

You may even

test

means (emotional or

coming

of your strength and stamina.

angry or jealous of friends

feel

is

if

they have the

financial) to continue treatment

when

you're

not sure you can go on. Being aware of these unconscious comparisons can help

What's It's

you avoid a "keeping up with the Joneses"

right for

natural

one couple

when you

not necessarily right for another.

hear about what someone else

what new technique they have it

is

attitude.

tried

—

to think that

is

doing

you should

try

too, but question that automatic reaction. "Well, if they can

hang

in there, then

we should be

able to"

—

that's a

can interfere with your personal decision-making. to other couples, also

burden that

When

talking

keep in mind that your decision to stop

might be threatening to those in the same boat

as you.

Knowing When

The

decision to stop

is

to

Stop Trying

yours alone and

agnosis, experience, and circumstances.

certain about

how

to proceed,

it

may

227

particular to yout di

is

When

von are feeling un

help to consult with vour

doctor, to review the medical options and recommendations once again.

If

you

means seek time,

are having difficulty deciding

a second or third opinion

know

if

what

that will help. At the

that the decision to stop treatment

doctor can always

make

for you.

He

to do, bv

is

same

not one that a

may recommend

or she

other procedure, and even encourage you to continue, but mately,

you must decide what

just as

you

it.

It is

initially

that

you

gave yourself permission to seek treatment.

I

Part of the challenge of

we change

that initial shift

ulti-

important to give yourself permission to stop,

Who Am Now? Who Will each step

an-

best for you.

you can do something does not mean

Just because

should do

is

all

the

making treatment

way we think about

from healthy and normal

So what happens when you

Even though you may have

are

I

Be?

decisions

is

ourselves.

that with

Remember

to "infertility patient"?

no longer an

infertility patient?

disliked aspects of your treatment, the

process did provide structure and progress that could be comforting, or that at least

became

After spending so

much

diagnosis, your identity

is

familiar.

time engrossed in your treatment and

being jolted again. This shift

ing on the ride to getting off feel

confusing.

Once

again,

you want, and where you

"When

I

— can

feel like a relief,

you must

figure out

— from

be-

but can also

who you

are,

what

fit in.

finally got off that interminable infertility treadmill,"

UNSUNG LULLABIES

228

Natasha

said, "I felt sad, angry,

got excited because

parenthood that

I

Not everyone will

want

fer to

I

and defeated. But

realized that

now

—

I

there were other paths to

could pursue."

feels that

excitement, though.

And

not everyone

some

to pursue a different path to parenthood;

will pre-

be childfree. But please be careful not to cling to treatment

in order to avoid facing the disappointment feel

also felt free.

I

the loss of your reproductive dreams.

loss, as

will inevitably

Only by

facing your

Paul did, will you gain a sense of closure.

Yet your stop. It

you

is

work

is

not done. You need to honor your decision to

an emotional and complicated process to come to terms

with not having a biological child. Even reproductive story, you

on your medical

may

situation,

ogy or surrogacy, or

feel

still

at this crossroads in

have choices to

face:

your

depending

you may be considering donor technol-

ready to

move onto

adoption, or decide to

remain childfree.

Coming

to a

mutual decision, finding something that works

both of you, and reaching the same conclusion can prove to be hard work. In the next chapter, issues

you may

face as

at the

we will

you proceed individually and

rewrite your reproductive stories.

for

same time explore the

as a couple to

—

Eleven

A New

New

Ending, a

Beginning:

Rewriting Your Reproductive Story

been poked, prodded, medicated, discussed. You've

You've

fought, cried, struggled, grieved, and

self-esteem has been

made

Your

sacrifices.

pummeled, your sense of yourself has been

muddled, and your marriage has been stretched

to the limit. Fi-

No sooner do

nally you've said, "Enough!" If only

it

you declare

to have a biological child than

that you're

another question forms

At

done trying itself:

this pivotal point in

stopped there.

What do we do now?

your reproductive

story,

you and your

partner are faced with more life-altering choices. You to pursue

these choices,

each,

for

decide

parenthood through donor technology, surrogacy, or

adoption, or you

way

may

you

may still

choose to remain childfree. With any of

must

grieve

your new experience

what you have

—with

or without children.

you must rethink your reproductive

the most important elements in

it

lost to clear the

for

story,

With

decide what

you and your

partner,

are

and

then rewrite your story to incorporate these changes.

Your story

will not

be the same

as

you

originally anticipated

UNSUNG LULLABIES

230

become

that has

choose,

come

its

joys

—and no matter what path you

and challenges. But whether you be-

a parent or not, your reproductive story continues to unfold.

How you

have

will

it

painfully clear

do you

you want

are sure

would be

figure out what's right for you?

to adopt, yet the next

Or you

better to be childfree?

your partner doesn't

like

your choice?

change your mind midstream? In

What

if

one day

day you think

it

find an egg donor, but

What

if

this chapter,

you

we

and

get scared

discuss

how

the

ending you are facing means new beginnings, what options are available to you,

you and your As sad

as

and how you can decide what

will

work

best for

partner.

it is

ing,

remember

and

this

new

that a chapter of your reproductive story

that

you

are at the threshold of a

new

is

end-

beginning,

chapter of pursuing parenthood or not holds untold

possibilities.

What Do We Do Next? Couples vary in

Some

how

they approach decisions of what to do next.

begin to consider other options even as they try one

final

procedure for a biological child. They need to have their plan

B

motion before they can bring themselves

This

more time

eases their anxiety about losing for

whatever comes next.

their story,

it

may also

to stop treatment.

When

in

as they actively prepare

couples overlap these pages of

soften the pain of giving

up

their

dreams of

having a biological child. Ella

and her husband Brett began researching adoption even

they tried one

minute," said

last

IVF

cycle.

Ella. "I will feel

"I

as

don't want to waste another

awful

when

the

IVF

doesn't work,

A New especially

too long.

if

we

Fm

Ending, a

New

nunc

arc not prepared to

tired of

being sad.

We

Beginning

need

But not every couple has the next step

231

on, We've been

this

at

to be parents." in

mind, and

docs not

it

always have to be decided immediately. Its okay to catch your breath and reflect on the

need time

ples

you have been through. Often, cou-

trials

to research

— and

soul search

them before they make

their next

about IVF," Cliff

"But before

said.

And

finish this last IUI.

some down It's

at

time.

if

I

can look into

it,

thought

we need

to

realize that

anything more right now."

ending

producing your own biological child

times, if

you jump too quickly

may

you may bypass the need

be,

right for

is

I've

doesn't work, we're going to need

it

We can't take on

important to

—what

move. "Of course,

infertility is

treatment aimed

yet another loss.

Some-

to the next treadmill, whatever that to respect

and grieve how

this

chapter of your reproductive story ends. Yes, this can be painful

and

sad,

but you need to

move forward. Some

may

reflect

couples,

and accept

who

this loss in

have been grieving

be ready to explore their options right away. But

burnt out from treatment,

what

to do.

may

it

order to

all

if

along,

you

are

not be the best time to decide

Talk to each other to discover whether you need

take a break before

you decide what's

next, or

whether you

to

feel

ready to proceed.

To Parent or Not to Parent

To be it

is

a parent or not, that

is

the question

a complicated one, even

you

are facing now.

And

though you've been pursuing that

goal for so long. At this crossroads in your reproductive story, the

answer

isn't

always

clear.

UNSUNG LULLABIES

232

As we discussed

in chapter 10,

knowing what

is

vital to

your

re-

productive story and, of course, knowing your medical options will help

you

sift

through the options of

Donor technology,

post-infertility treatment.

surrogacy, and adoption can provide wonder-

ful opportunities to infertile couples

who

This major change in your reproductive

must be

grieved, but if

can be boundless. story,

what you

seek, the rewards

part of the process of rewriting your

It is all

more

fulfilling

all

of your

your alternate road to parent-

will be.

Here we

raise

some

you can consider and concerns tant

is

story, like all the others,

and the more prepared and aware you can be of

different feelings, the

hood

parenthood

long to become parents.

it is

is

issues regarding each

discuss

them ahead of

insurmountable, but

we want

to understand the options

to

and

of these options, so time.

None of

emphasize

these

how impor-

talk things out at every

stage of the process.

Donor Technology If

child

you want is

to experience

pregnancy and

birth,

even

not genetically connected to both of you, you

sider trying

an IVF cycle with donor

eggs,

if

may

the

con-

donor sperm, or do-

nated embryos.

As much

as

donor technology may

fulfill

your reproductive

dreams, the fact remains that the baby will have a biological connection to one parent, but not to the other. (Unless you are using

donor embryos,

in

which case neither of you

connection with the child.)

of yours. This

must come

is

The baby will

a very real loss

to terms with

it.

will

have a genetic

not be biologically both

and every person who uses a donor

A New Some

Ending, a

people worry they

New

will not

Beginning

233

fed as attached to the babj

not "theirs," while others worry that the biological parent

it's

somehow

feel

more authority or "ownership" over

course, these ideas are feelings, not facts. But

acknowledge and discuss these worries up

how you both

When known

or

is

baby.

Of you

front, in order to



infertility

trauma, 3-43

how

surrogacy, 23

what's righi

3-21

infertility

]

sexual relationship, rebuilding,

what

118-19

testing,

not

^

ith, 2

242

infertility specialists

infertility

273

ART

(assisted reproductive

technology), 220-21,

221-22 financial considerations,

213-16

Index

274

infertility

treatment (when to stop

trying) (continued)

new

infertility),

132-50

blame, 142-44

identity, adjusting to,

227-28

communication, importance

knowing when enough

a choice,

control, loss of,

210-12

reproductive story, changes

in,

exacerbating,

guilt,

220-21

men

and, 120-25

negotiation,

spiritual considerations,

217-20 stopping, difficulty in,

stopping, giving yourself

permission,

222-23

International Council Infertility

on

Information

Dissemination (INCIID),

266

147-48

overwhelming emotions, coping with,

222-23

148-49

140-41

finances,

and

138-42

existing fault lines,

212-13 self-criticism

of,

146

is

enough, 223-27

making

marital relationships (and

135-37

partner, in conflict with,

133-34 past reproductive traumas,

memories

of,

144-45

reconnecting, 149-50 sexual intimacy, survival,

141-42

145-48

marital relationships (and sex) Jaffe, Janet, xiii—xv

sexual relationship, rebuilding,

242 "little

deaths,"

rituals for,

169-70

171-73

60-62

sexuality intimacy, control of,

141-42

loss

talking about,

sexuality identity, loss of,

186-88

sexuality intimacy, loss of,

58-60 male factor treatment, 124-25 marital relationship

parenthood and, 249-50

sexuality privacy, loss of,

media

myths

of,

88-90

62—64

Index

men

(and

111

infertility),

31

275

National

and anger, 128-29 caretakers,

hidden

men

grief,

as,

c

127-28

12^-32

inadequacy, sense

)rganizariofi

(

(NHPCO), 266

1

229-43

26

115-17

adoption, 23* childfree,

117-18

\6

choosing

to be,

236-37

infertility specialist, intrusion

by,

\uc

Palliative

new ending, new beginning,

of,

infertility specialist, evaluation

by,

and

lospicc

1

donor technology, ^.M 33

242-43

male factor treatment, 124-25

ongoing

parenthood and, 249-50

other choices,

relationship, infertility and,

other people's opinion,

120-25 stories,

112-15,

242

sexual identity, loss of, sexual intimacy, loss

60-62

of,

sexual privacy, loss of,

58-60

62-64

treatment phase, 121-24

woman's anatomy, 120-21

DES

10-11

(diethylsilbestrol),

cultural myths,

surrogacy,

what

32-33

to

do

233-34 230-31

next,

what's right for us,

237-39

normal loss

not

of

how

feeling,

it

55-57

was supposed

to be,

3-21 assisted reproductive

myths, 88-92

91-92

technology (ART), 9

media myths, 88-90

Clomid, 11-12

reproductive technology, myths

emotional and medical

of,

coaster,

90-91

narcissism (healthy),

96-98

narcissistic injury,

it,

98

21

infertility patient, shift

healthy person

99-100

roller

7-9

getting through

guilt and,

238-39

239-42

sexual relationship, rebuilding,

212-13

miscarriages,

231-36

partner, conflict with,

reproductive

a

story,

to,

miscarriages, 10-11

from

9-10

Index

276

not

how

it

was supposed

to be,

own

regression and,

(continued)

ovulation, procedures until,

16-18

69-74

person, becoming,

70-71

parenthood, transition

to,

73

parents, connecting with as

20-21

pregnancy, anticipation,

reproductive trauma, what

is,

equals,

73-74

separation process,

72-73

5-7 treatment, loss of control,

treatment, starting,

14—16

11-12

treatment, undergoing,

12-14

waiting, 18-20

parenting (and adulthood), 67-86 adult identity, consolidating of,

80-82 adult identity without baby,

85-86 82-83

Ourieff Diamond, Martha, xv-xvi

connection, longing

outside world (dealing with),

generativity (giving to future),

83-85

179-206 becoming overwhelmed,

200-205 205-6

family,

188-93

parenting (after

197-98

self-protection,

186-88

180-81

182-83

socializing,

at

194-97

183-86

more

244-61

them

259-60

babies, deciding to have,

257-58 of,

249-50

parenthood and family relationships,

256-57

parenthood and the marital

work, 198-200

relationship,

249-50

postpartum depression, signs

ovulation

procedures

about,

parenthood, reality

stinging remarks, responding to,

69-74

infertility),

child's origins, telling

talking about,

self-talk,

person, becoming,

74-79

going out and about, 193-94 loss,

own

parents, competition with,

coping,

friends,

for,

until,

16-17

and treatment, 171-8

for,

252-53

postpartum reactions, 250-53

Index

pregnancy, 2^6—47

277

pregnane)

pregnancy, high-risk, 24

49

sense of belonging, 254 -55

(aftei

infertility

>,

246-47 high

24

risk,

19

'

parents

competition with, 74-79 equals, connecting with

relationships (and inreitilit]

as,

73-74

separation, achieving,

personal identity

79

(infertility

realization of),

communication, importance

67-86

adult identity without baby,

85-86

men

140-41

and, 120-25

147-48

negotiation,

82-83

generativity (giving to future),

83-85

148-49

exacerbating, finances,

for,

138-42

control, loss of,

existing fault lines,

80-82

connection, longing

of,

146

and

adult identity, consolidating of,

overwhelming emotions, coping with,

135-37

partner, in conflict with,

person, becoming,

69-74

parents, competition with,

133-34 past reproductive traumas,

memories

74-79

and the reproductive

story,

36-37

144-45

postpartum reactions, 250-53 depression, signs for,

252-53

Postpartum Support International

145-48

remarks responding

to,

1

reproductive story,

changes

266

141-42

sexual intimacy, survival,

in,

83-86

22-43

212-13

culture influences and,

pregnancy anticipation of,

and a sense of

of,

reconnecting, 149-50

popular culture

(PSI),

132 50 blame, 142-44

old conflicts, reworking, 78

own

I,

20-21

loss,

49-50

34-37

family members, role others

must

play,

31-33

1

,

Index

278

reproductive story (continued)

how

it

was supposed

to be,

24-25

how

40-42

25-27

parents' part in,

telling story as step

what your

is,

toward

self,

42-43

reproductive story

beginning),

229-43

adoption,

234-36

childfree,

choosing to be,

donor technology, 232-33 story,

partner, conflict with,

sense of belonging,

247-49

254-55

unused embryos, 258

209-28

trying),

ART

(assisted reproductive

technology)

,

220-2 1

financial considerations,

238-39

239-42

sexual relationship, rebuilding,

213-16

new

identity, adjusting to,

227-28 knowing when enough

242 surrogacy, to

246-47

221-22

242-43 231-36

other people's opinion,

what

252-53

postpartum reactions, 250-53

and

other choices,

249-50

reproductive story (when to stop

236-37

ongoing

256-57

pregnancy, high-risk,

reproductive story (new ending,

new

relationship,

pregnancy,

209-61

rewriting,

parenthood and family

for,

your

do

230-3

what's right for us,

237-39

reproductive story (parenting after infertility),

is

enough, 223-27

233-34 next,

249-50

postpartum depression, signs

22-24

story,

of,

parenthood and the marital

38-40

healing,

babies, deciding to have,

257-58

relationships,

28-31

them

259-60

parenthood, reality

medical technology and, 37-38 and,

about,

more

27-28

story develops,

infertility diary,

men

child's origins, telling

244-61

making

a choice,

210-12

reproductive story, changes

in,

212-13 self-criticism

and

guilt,

220-21

Index

spiritual considerations,

stopping, difficulty

in,

myths we

2

22:

2

;

stopping, giving yourself

permission,

of,

222-23

self,

not

how

90-91

it

issistk

injury,

shroud

98 103

of, l)

tianges in,

I

(i

96 ks,

abortions, and guilt,

100

5-7

103

why do

was supposed

to be,

3-21 story,

22-43

reproductive trauma (becoming

overwhelmed), 200-205 support groups, 201-2 therapy,

202-5

warning

signs,

200-201

RESOLVE: The

National

l

so bad, )2

(eel

1

^

180-81

self-protection,

182 83

self-talk,

your reproductive

sense of self

64-66

loss of,

sexual relationship rebuilding,

242

sexuality identity

Infertility Association,

resources,

live by,

unplanned pregnane

reproductive trauma, 3-43 definition,

nan

se< recy,

reproductive technology

myths

279

60-62

loss of,

sexuality intimacy

267

265-67

control of,

141-42

58-60

loss of,

sexuality privacy

62-64

loss of,

secrecy

shroud of and self-esteem,

SHARE

Pregnancy and Infant

Loss Support, Inc., 267

103-6

socializing,

self loss

of sense

of,

64-66

self-esteem (undermining),

87-110 healing,

106-10

healthy narcissism, 96-98 healthy narcissism, guilt and,

99-100

194-97

spiritual considerations,

feeling guilty, loss

of

faith,

217-20

217-18

218-19

spiritual issues,

219-20

stinging remarks

responding surrogacy,

to,

183-86

233-34

Index

280

new

trauma, 3-43

how

not

was supposed

it

227-28

to be,

knowing when enough

3-21 your reproductive

story,

22-43

trauma (becoming overwhelmed),

200-205

is

enough, 223-27

making

a choice,

210-12

reproductive story, changes

support groups, 201-2 therapy,

202-5

warning

signs,

self-criticism

200-201

in,

212-13 and

220—21

guilt,

spiritual considerations,

217-20

treatment

of control, 14-16

loss

identity, adjusting to,

starting,

11-12

stopping, difficulty

222-23

stopping, giving yourself

undergoing, 12—14 waiting,

in,

permission,

222-23

world (dealing with), 179-206

18-20

becoming overwhelmed,

200-205

unused embryos, 258

unplanned pregnancies, abortions,

and

guilt,

100-103

coping,

205—6

family,

188-93

abortion, 101-2

friends,

adoption, 102-3

going out and about, loss,

when

to stop trying,

and

ART

209-28

(assisted reproductive

197-98

talking about,

1

93-94

186—88

self -protection, 180-81 self-talk,

182-83

194-97

technology), 220-21,

socializing,

221-22

stinging remarks, responding

financial considerations,

213-16

to,

at

183-86

work, 198-200

About the Authors Janet Jaffe, Ph.D.,

Martha Diamond, Ph.D., and David Diamond,

Ph.D., are psychologists

in private practice

and

are

cofbunders and

codirectors of the Center for Reproductive Psychology

In

San

Diego. They have presented nationally and internationally on the

psychology of the reproductive process. a faculty

member of

chology (CSPP),

and Janet tive

A

psychoanalyst,

1

)a\ id

is

the California School of Professional Psy-

at Alliant International University,

also serve as instructors.

Psychology Study Group

at

David

where Martha

also leads the

Reproduc-

CSPP.

Martha Diamond, Janet Jaffe, and David Diamond.

Photo by Rebecca

Uwson

"I

would highly recommend

anyone with

infertility, all

this

book as required reading for

who work with

infertility, as

well as the

families of persons with infertility."

— Marjut Herzog, president of RESOLVE, South Florida "A new,

creative

approach

that avoids psychological

jargon and makes the issues accessible

—Miriam Tasini, professor of psychiatry,

is

any reader."

UCLA Medical School

For people experiencing infertility, wanting a baby intensity of their longing

to

and medical

is

a craving unlike

any other.

The

matched only by the complexity of the emotional maze they

must navigate.

With insight and compassion, Drs. Janet Jaffe, Martha Diamond, and David Diamond — specialists in the field of reproductive

psychology

who

have each experienced their

own

struggle with infertility — give couples the tools to: •

Reduce

•

Identify their mate's coping styles to erase unfair expectations

•

Listen to their "unsung lullabies" — their conscious and unconscious dreams

their sense of helplessness

and

isolation

about having a family — to mourn the losses of infertility and move on

Groundbreaking, wise, and compassionate, Unsung Lullabies panion for anyone coping with

is

a necessary

com-

infertility.

Martha Ourieff Diamond, Ph.D., and David

from

left to right)

J.

Ph.D., Janet Jaffe,

Diamond, Ph.D. (pictured

are cofounders of the Center for

Reproductive Psychology in San Diego, California.

Visit their

Web sites at www.UnsungLullabies.com

and www.ReproductivePsych.org.

$14.95/

Cover design

by

Amy King

ISBN D-3LE-3L3flR-h 495> 5 1

www.stmartins.com

tf 175

ST.

MARTIN'S GRIFFIN

FIFTH AVENUE,

DISTRIBUTED

PRINTED

IN

IN

CANADA BY

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