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Coping with Infertility & decision making

INTRODUCTION
Infertility is usually diagnosed after one year of trying unsuccessfully to conceive. You may suspect that you have a. fertility problem before finding out for certain, but the reality is often difficult to accept. The ability to conceive is usually taken for granted and many couples are unable to imagine leading a fulfilling life without children Although many infertile couples can successfully have children with the help of today’s advanced reproductive technologies or through adoption, being diagnosed with a fertility problem can result in painful and disturbing emotions.

If you and your partner are experiencing infertility, you are not alone. Infertility affects about one in 12 American couples who are trying to conceive (8 to 9 percent of all couples) Everyone’s response to infertility is different and depends upon individual situations, personalities, and coping styles. You will probably experience the emotional impact of infertility at different stages: before, during, and after treatment Although you may have friends who have experienced infertility and you’re aware that it is a common disorder, the news that you or your partner is infertile usually comes as a surprise. You may find yourself experiencing some of the emotional responses described below.

EMOTIONAL RESPONSES To INFERTILITY

Shock

Upon being diagnosed with infertility, most couples initially respond with shock and disbelief. After thinking for years about having a child, you may feel that your life’s plan has been traumatically disrupted. Shock generally lasts only a short while and actually helps you to adjust.

Denial

You and your partner may react initially by thinking. “This can’t be happening to us.” and denying rather than confronting the problem. This denial phase also serves an important purpose by allowing you both to adapt to the infertility experience at your own pace. Denial becomes unhealthy only if it persists for a long time and prevents you from accepting reality.

Guilt

At times you may wonder if infertility is a punishment for past behaviors. You may feel guilty for depriving your fertile partner and your parents of the opportunity to have children and grandchildren. Guilt is an uncomfortable but common response to infertility.

Anger

Anger results from the sense that infertility is unfair. You may find yourself feeling a great deal of anger and frustration upon being diagnosed with infertility. It is not unusual to resent pregnant women and to feel angry at health care providers, family, and friends who do not seem to understand the stress and emotions associated with infertility. These feelings are normal, but when anger is internalized it becomes depression.

Depression

The losses associated with infertility make depression a common response. Infertility may jeopardize the dream of a much-anticipated pregnancy, birth, and parenting experience. Friends and family often underestimate the emotional impact of infertility, making it a lonely experience.

Isolation

Feeling alone is commonly expressed by infertile couples and makes coping even more difficult. Most people cannot comprehend the complex emotions associated with infertility. “Relax and you’ll get pregnant” or “After you adopt you’ll have a child of your own” are insensitive remarks that cause a great deal of pain. You may notice changes in relationships with friends or family members who are unable to understand and empathize with your feelings.

Loss of Control

Many couples plan when they will have a baby as carefully as they plan other aspects of their lives. Until now. you may have been successful in achieving the goals you set out to attain. As you realize that you are not in control of this aspect of your life. your self esteem can be affected. Not only does your life-plan feel out of control, but your body feels beyond your control as well. You may be putting other aspects of your life on hold or avoiding making decisions as you try to gain control over your infertility. However, the more you neglect other parts of your life to focus on infertility, the less in control you’re likely to feel.

Hopelessness

Hopelessness can result from the up and down cycle of the emotions associated with infertility and its treatment. You may feel hopeful at the beginning of a treatment cycle. then begin to lose hope if repeated cycles are unsuccessful. It can be difficult to maintain a hopeful, positive attitude after months of disappointment. Professional counseling is sometimes necessary.

HOW INFERTILITY AFFECTS COUPLES

It is important to remember that infertility is a “couple” problem. In fact. Factors causing infertility are often present in both the male and female partners, rather than just one partner. Whatever the case. partners usually respond differently to infertility. Your individual response will depend upon your personality, life experiences, and coping style. You may feel hopeful and optimistic while your partner feels hopeless and despondent, or you may blame each other, especially when only one partner is infertile.

Men and women may respond differently to infertility. Most infertile women tend to have a heightened awareness of their menstrual cycles. As a result, the beginning of each menstrual cycle can he emotionally traumatic. It signals the absence of a pregnancy after a month of hope and the need to begin all over. Men may silently suffer the emotional impact of infertility because they are not accustomed to sharing these types of concerns, whereas women may he more accustomed to dealing with reproductive issues.

Communication

Communication in your relationship may change as you and your partner deal with infertility and its treatment. You may avoid expressing your thoughts in order to protect your partner from painful feelings. However, suppressing your feelings may create aimer and resentment, resulting in additional pressure on your relationship.

Try not to lose sight of your relationship with your partner. Make sure that you understand how your partner feels about each stage of treatment. Both of you may experience ambivalence about treatment or even having children. This is a normal reaction, and you need to remember to have realistic expectations of each other.

Keep communication open with your partner during this difficult time. Read and learn about how other couples respond to infertility. Talking to other couples in a support group is a useful way to deal with your feelings. Not only will you feel less isolated, but you may learn new coping skills.

Sex

Sex is another way people communicate, but the demands of infertility treatment will undoubtedly affect your sexual relationship. Having sex on schedule can diminish spontaneity and intimacy. Sex may feel like more of a chore than a pleasure. It is essential that you and your partner set aside time together to enjoy sexual intimacy without the pressure of achieving pregnancy. Giving each other a massage or having a romantic dinner can help nurture your relationship. Try to make intimacy and fun priorities in your life.

COPING WITH INFERTILITY

There are specific steps that can decrease the stress of infertility. First, remember that you and your partner are different people, with different styles and feelings. You cannot expect your partner to behave or feel a certain way or that you will both feel the same way simultaneously.

Becoming Informed

Become informed about infertility and its treatment. Begin by learning about your body and how it works. Ask your physician to supply you with as much information as you feel you can handle. Read books and articles about infertility, ask questions and discuss your ideas with your health care providers. You will feel more confident at your physician’s office if you understand the various tests and procedures. Talking with individuals in a support group who have experienced similar situations is also helpful. Ask your physician to provide you with the necessary contact information for support groups in your area.

Sharing Your Feelings

It is essential to share your feelings when dealing with infertility. Friendships are especially important at this time. However, friends and family may not fully understand infertility and they may make insensitive remarks. Many people will not realize what you’re experiencing unless you tell them. If friends make thoughtless comments, try not to become discouraged. Some of the following tips may be helpful:

• Try to identify your feelings and share them. Writing your thoughts down on paper is often a helpful exercise.
• Don’t assume that everyone understands your needs, thoughts, and feelings.
• Don’t always put on a brave front. Friends and family may think that you are not distressed and therefore not in need of emotional support. Tell friends or family members what does and doesn’t help you.
• Offer friends and family reading material concerning infertility. Articles or books with quotes from individuals dealing with infertility are especially beneficial.
• Examine your expectations of others. You will probably be disappointed if you expect others to always he there for you.
• Become aware of your own anger. This anger may be directed toward yourself. your partner, medical caregivers. friends, and family. It is important to recognize the effect anger has on you and your ability to communicate with others.
• Accept your own feelings. Acknowledge that there may he times when it is okay for you to avoid emotionally painful situations such as baby showers and birthday parties.

Anticipating Difficult Times

Certain aspects of your everyday life may become painful. The birth of a friend’s baby. acquaintances who are pregnant, or even television commercials can stir up emotions. Remember that you don’t have to participate in activities that depress you. If you feel that attending a baby shower is too difficult, send a note and gift certificate instead.

Sometimes you may be confronted with unavoidable circumstances, such as when conversations at work or social gatherings focus on pregnancy and parenting. You might have friends or family members who become pregnant during your infertility treatment. Holidays and birthdays may also he upsetting because they remind you that time is passing. Talking with your partner, close friend, support group, or therapist can help you deal with these difficult times.

Setting Limits

You and your partner should set limits during treatment to help you feel more in control, diminish stress, and define your goals more clearly. Decide which treatments you will try and when to stop if unsuccessful. Consider taking a break if medical therapy becomes too stressful. A vacation from treatment can give you an opportunity to regain strength, reassess expectations, and possibly explore alternatives.

WHEN COUNSELING MAY BE HELPFUL

Infertility can feel like an emotional roller coaster, and professional counseling can help you negotiate the ride. You may feel so preoccupied with infertility that you can’t make decisions in other areas of your life. You and your partner may be having difficulty deciding about options. Feelings of anxiety and depression affect other relationships and your ability to enjoy life. Counseling can help you examine your feelings and address the losses and grief associated with infertility. Through counseling you can clarify your priorities, find ways to renew self-esteem, and improve your coping skills.

You should know some warning signs which indicate serious depression. If you constantly feel sad. desperate, or worthless, seek professional counseling. Other indications include feeling too sensitive, vulnerable, or guilty, withdrawing from social activities, and having suicidal thoughts. Physical symptoms of depression can include difficulty sleeping or sleeping too much. change in appetite, excessive fatigue or loss of sexual desire. Fortunately, depression is highly treatable with the assistance of a skilled therapist.

Choosing a Therapist

Select a qualified mental health practitioner who specializes in infertility treatment. Interview several therapists in order to select one who is right for you. Ask therapists about their background, training, and what percentage of their practice deals with reproductive health issues. To begin the process of finding a therapist, ask your physician for a recommendation or contact RESOLVE. You will find the address and phone number of RESOLVE’S administrative office at the end of this booklet.

DECISION MAKING IN INFERTILITY

Coping with infertility also involves good decision making. While dealing with the emotional distress of infertility, you and your partner may find yourselves faced with seemingly endless decisions concerning evaluation and treatment options. When confronting these dilemmas, you’ll need both physical and emotional energy.
as well as strategies to help you sort through the information and your feelings.

Identifying Your Goals

Most likely, your original goal was to have a child biologically related to you and your partner. Because of your fertility problem, you may he unable to achieve that goal. Examine your deepest feelings about family, children, and parenting. You may find that you must re-evaluate your initial plans in order to have the family you want. For example, many couples lose sight of the tact that their main goal is to become parents, even if they can’t both he biological parents.

As you and your partner identity your goals and examine your options, you’ll discover that there are essentially four choices. Depending on the cause and treatability of your infertility, you may need to choose at least one of the following:

• To pursue having a biological child by continuing the infertility evaluation and
treatment.
• To pursue having a child biologically related to only one parent, either through
Donor insemination , egg donation, or surrogate parenting.
• To adopt a biologically unrelated child,
• To decide upon child-free living.

For some infertile couples, having a biological child or child-tree living are the only options. For others, adopting or having a child biologically related to one parent may he more desirable than having no children at all.

Some couples may pursue infertility treatment for several years and subsequently find themselves over the age limit to adopt an infant. Furthermore, since a woman’s fertility decreases with age. the chances of successful treatment also decrease with age. You. your partner, and your physician should take these possible consequences into account when evaluating and choosing your options. Consider exploring other options at the same time you are undergoing medical treatment.

Looking at Treatment Options

Although some couples are diagnosed with unexplained infertility, physicians can usually identity one or more factors contributing to decreased fertility. If your physician identifies your fertility problem(s). you’ll discover that there are a number of treatments available. Treatment options include:
• Medication for either partner to improve fertility.
• Surgery to correct structural problems in the reproductive organs.
• Assisted reproductive technologies such as in vitro fertilization (IVF) to facilitate conception.Other options to consider include:
• Donor insemination if the male cannot produce sufficient sperm.
• Egg donation if the female cannot produce eggs.
• Surrogate parenting if the female cannot carry a pregnancy.
• Adoption.
• Child-free living.

What You Should Ask Your Physician

Alter a thorough medical evaluation of both partners, your physician may identify the problem and recommend treatment. Ask the following questions to learn the medical information necessary to make informed decisions:
• How much will this treatment improve our chances of pregnancy ?
• What are the potential risks, complications, and side effects ?
• How long will we have to undergo this treatment in order to give it reasonable time to work?
• Will undertaking this treatment eliminate other options ?
• How much will this treatment cost ?
• Will our health insurance cover the cost ?
• Are there other options if this treatment fails?

your physician can help you determine how much time. risk. and money will be required for a particular treatment option. You should ask what your chances are of achieving pregnancy without treatment and how much treatment will improve your chances. Always consider the emotional risk and financial cost involved in any infertility treatment. You must decide how much lime is available to you how much physical and emotional risk you are willing to endure, and how much money you are willing to spend.

Consider each option your physician has suggested. Gather all the information you can from libraries, bookstores, professional organizations like the American Society for Reproductive Medicine, and especially your physician. Analyze each option in terms of time. risk. chance of success, and cost. You and your partner must become thoroughly educated about each option in order to make informed choices and decisions.

If You Do Not Get Pregnant

It you do not conceive after pursuing your initial treatment plan for a set period of time. you should re-evaluate your goals and options. You may want to discontinue medical intervention or seek a different kind of treatment.’ Partners often have differing views and feelings about infertility and its treatment. Maintaining open communication helps you make the best decisions together. A therapist can also be helpful if you and your partner disagree on treatments, other options, or when to end treatment.

THE DECISION TO END TREATMENT

One of the most difficult decisions is whether or not to continue medical therapy. You and your partner may find yourselves asking. “When will we know that we have done all we can do?” and “How will we know when it’s time to move on’. Infertile couples often have trouble answering these questions. First, there always seems to be a new medical option bringing hopeful opportunities. You may feel reluctant to pass up a new treatment after trying everything else up to this point. Secondly, physicians may not recommend ending treatment in a timely fashion because they are generally optimistic that treatment will eventually work. Sometimes this optimism biases their ability to provide advice about ending treatment.

You may discover that you and your partner do not agree on the time to end treatment. Remember, it’s perfectly natural for people to move at different paces especially through a process as complex and challenging as infertility and its treatment.

Facing the Decision

If you think that you are ready to end treatment, there are several steps which may help you finalize the decision. Consider establishing a time frame. Designing a schedule is often helpful, even if you modify it later. You could decide, for example to try for another year. or until your next birthday. You might want to take a brief “vacation” from treatment. Afterwards, you may feel better able to decide on continuing or ending treatment.

Talk to others who have decided to end treatment, especially if yon are undecided. Ask them how they made the decision and how they feel about it now. Professional counseling can also be very helpful in assisting you with decision making.

If your infertility treatments have failed, accept the fact that infertility will remain an aspect of your life. Adoption, donor insemination, and egg donation may cure childlessness, but they do not cure infertility. The decision to adopt or remain childless provides a certain amount of resolution and closure, but the ache of infertility may remain. Once you accept your decision however, you will probably find that your disappointment gradually lessens.

SUMMARY

Coping with infertility is never easy. but you can cope. Preparing yourself for the difficulties ahead, making informed decisions, and sharing your feelings will make the situation immensely more bearable. You may also discover that learning to cope with infertility allows you and your partner to grow and become closer as you share your feelings throughout this challenging time. Above all. remember that with patience, a positive attitude, and the appropriate treatment, many infertile couples can eventually become parents.