December 2, 2022 • 26 mins
Being unable to bring a baby into the world can lead to a wide swath of emotions—sorrow, jealousy, anger and depression among them. Dr. Saltz advises a listener who feels all those things, as well as regret at not having started a family sooner.
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Episode Transcript
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Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm doctor
Gale Salts. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Most experts define infertility
as not being able to get pregnant after at least
one year of trying. Women who are able to get
pregnant but then have recurrent miscarriages may also be said
to be infertile. The World Health Organization definition based on
(00:50):
twenty four months of trying to get pregnant, is recommended
as the definition that is actually most useful in clinical
practice and research among various disciplines. It is actually a
growing problem and across virtually all cultures and societies almost
all over the world, and the effects are estimated to
be as high as ten to fifteen percent of couples
(01:13):
of reproductive age. In recent years, the number of couples
seeking treatment for infertility has dramatically increased due to factors
such as postponement of childbearing in women, development of newer
and more successful techniques for infertility treatment, and the increasing
(01:34):
awareness of available services. This increasing participation in fertility treatment
has raised awareness and inspired people to research the psychological
ramifications of infertility. Researchers have looked into the psychological impacts
and the prolonged exposure to intrusive infertility treatments on one's
(01:59):
mood and well being. While there is less information about
effective psychiatric treatments for people struggling with infertility, there is
data to support the use of various psychotherapeutic interventions like psychotherapies.
So today I am answering a question from a listener
(02:22):
who is struggling with feelings related to dealing with infertility.
Parenthood is one of the major transitions in adult life
for both men and women. The stress of the non
fulfillment of a wish for a child has been associated
with emotional difficulties like anger, depression, anxiety, marital problems, feelings
(02:46):
of worthlessness and hopelessness, and couples can become anxious about conceiving,
which ironically increases sexual dysfunction, and also feelings of so
shual isolation. Marital discord often develops in infertile couples, especially
(03:07):
when they are under pressure to make medical decisions. Couples
can experience stigma societally, a sense of loss and diminish
self esteem. In the setting of being infertile, men and
women partners can feel different differently from each other. That is,
(03:29):
in general, in infertile couples, women show higher levels of
distress than their male partner. However, men's responses to infertility
are very close to the intensity of women's responses. When
infertility is attributed to a male factor, men and women
experience a sense of loss of identity and have pronounced
(03:53):
feelings of defectiveness and sometimes incompetence. Women trying to conceive
off and have clinical depression rates similar to women who
have heart disease or even cancer. Even couples undertaking IVF
face considerable stress. General emotional stress and marital difficulties are
(04:16):
greater in couples where the infertility lies with the man,
so the psychological impact of infertility can be devastating not
only to the infertile person but also to their partner.
There are three separate factors or areas that seem to
contribute to the psychological stress that men and women experience
(04:43):
In order of importance. Those are for women, first having
children as a major focus of life and all of
the beliefs that surround that. Next is the female role
and the social pressure to conceive and be a mother,
(05:04):
and third is the effect on sexual life. Overall, for men,
it tends to be the reversed order of the importance
of factors one and two, but the third factor is
equally important to both men and women, the effect on
sex life. It's also been found that women experience their
(05:27):
infertility generally more strongly than men, and women showed a
more intense desire to have a baby than men. Stress, depression,
and anxiety are therefore common consequences of infertility. A number
of studies have found that the incidence of depression in
(05:49):
infertile couples presenting for in facility treatment is significantly higher
than infertile couples with the prevalence estimates of made your
depression in the range of anywhere from f to anxiety
has also been shown to be significantly higher in infertile
(06:11):
couples compared to the general population, with numbers going from
eight percent to twenty eight percent in infertile couples. The
role of psychological disturbances in the development of infertility is
another matter, a matter which is still somewhat up for debate,
but one study of fifty eight women reported a twofold
(06:35):
increase in the risk of infertility among women with a
history of depressive symptoms. But this study did not control
for other factors that also do influence fertility, like cigarette
smoking and alcohol use, low libido, and body mass index.
Although infertility has an effect on a couple's mental health,
(06:58):
different psychological fact have been shown to effect the reproductive
ability of both partners. The mechanism through which depression could
directly affect infertility involves the physiology of the depressed state,
so for example, hormonal issues like high prolactin levels or
(07:20):
disruption of what's called the hypothalamic pituitary adrenal access or
even thyroid dysfunction. One study suggested that depression is associated
with an abnormal regulation of certain hormones, like the lutinizing hormone,
which regulates ovulation. Changes in immune function are also associated
(07:44):
with stress and depression and could negatively affect one's reproductive functioning.
All of this is to say that more studies are
needed to look at the direct effects of depression or anxiety,
or even associated behaviors with depression anxiety, like low libidos, smoking,
(08:04):
and alcohol use that could interfere with reproductive success. Stress
is also associated with physiological changes, and this also can
raise the possibility of higher levels of stress being associated
with recurrent depression or anxiety and that being a cause
(08:24):
as well. Many couples presenting for infertility treatment have high
levels of psychological distress that's already associated with their infertility,
so the process of assisted reproduction itself can be associated
with high levels of anxiety, depression, and stress. A growing
(08:48):
number of research studies have tried to look at the
impact of infertility treatment at different stages. Most, however, have
focused on the impact of failed IVF aisles. Comparing women
undergoing repeated IVF cycles and first time cycles. Have suggested
(09:10):
that ongoing treatment can lead to increased depressive symptoms. That
sounds like it should not be surprising. It is still controversial, however,
because in fact, really not enough good studies have been done.
But in light of this, there has been an increasing
(09:31):
interest in what contributes to the dropout from infertility treatment,
since this population is not often looked at or looked
at well. The cost or refusal of physicians to continue
treatment has also been cited as a reason for discontinuing treatment,
(09:52):
and recent research has suggested that a number of dropouts
are due to psychological factors. A number of studies have
also examined stress and mood state as predictors of the
outcome in assisted reproduction. Most of these studies support the
theory that distress is associated with lower pregnancy rates among
(10:14):
women who are pursuing infertility treatment. This suggests that psychological
symptoms may interfere with fertility or successive infertility treatment and
the ability as well to tolerate these ongoing treatments. Again,
all this to say, the mind and the body are
(10:38):
very much connected. When one has a struggle with infertility,
one might become depressed. But when one is depressed, one
might also have difficulty with infertility or infertility treatments. So
the dilemma then is how to best help couples and
(10:58):
especially women were struggling to conceive with or without IVF,
especially with their psychological symptoms. So with that, right after
the break, we'll get to my listener's question. Welcome back.
(11:25):
Let's get to my listeners question and see how can
I help, Dear doctor Saltz. I am writing to you
to ask your advice on how to cope with infertility.
I am a forty three year old woman and I
got married later in life. I was forty one when
I got married. The pandemic also delayed our wedding by
(11:47):
a few months. Because we got married in I didn't
have the usual few years to try to get pregnant. Instead,
immediately after I was married, I saw fertility treatment from
a very reputable fertility center near where I live. I
went through three unsuccessful IVF treatments, most likely due to
(12:10):
my age. The first round we got very close. We
had five embryos for testing, but only one came back normal.
I went through an implantation that in theory, should have
been successful, but when I went back to the doctor
to take a pregnancy test and was not pregnant, my
(12:31):
husband and I were devastated. We did try for two
more rounds because our insurance covered three rounds altogether, but
the next rounds were even less successful. This took place
over a full calendar year. We needed time to process
what had happened, and my husband has had a hard
(12:51):
time talking about it. But Nat we've been processing for
about a year. We considered an egg donor, but neither
of us were very comfortable with the idea, since the
baby would not look like me, and it would be
out of pocket and very expensive more injections and a
great likelihood of miscarriage before a successful pregnancy. My regular
(13:15):
Obi g Iyen doctor very bluntly told me to just
do it, meaning get an egg downer, as if she
was telling me to borrow a pair of shoes. She said,
I would regret it if I didn't. I know that
my husband and I would be wonderful parents. We love kids,
We love spending time with our nieces and nephews, and
(13:36):
we have a lot to offer a child, a loving family,
vacations at the beach, a big back yard to play in,
We are financially stable, and a wonderful little mini Golden
Doodle dog that we got last year. My husband is
fifty and he is wondering if he is too old
and has beers and doubts doing anything else. He also
(14:01):
went through a difficult family tragedy when he was twenty,
so he understandably is trying to protect himself from getting hurt.
Adoption is still on the table for me, but I
know it would take a lot for him to get there.
Do you have any advice for me? I think about
my infertility every day. I have guilt for not trying
(14:24):
with my husband sooner, even though it would have been
out of wedlock. I have anger and frustration at the
men I dated in my twenties and thirties who either
weren't kind to me or weren't ready to settle down.
I am envious of women my age who have had
their own kids and got to marry at an earlier age,
(14:44):
or who were just very lucky to be a mom
later in life. I do home ovulation kits to see
when I'm most fertile to try to get pregnant, but
I have guilt that I didn't start this sooner. I
have tried support groups, which were helpful when I was
going through treatment, but the last two times I went
to a meeting, I felt out of place for being
(15:05):
the only one not in the middle of IVF. It's
almost like I feel like I'm a quitter, even though
I know that I'm not and I did everything I
could to have a baby. I'm really struggling and I'm
not sure what to do next or how to cope
with some of these feelings and help me figure out
(15:25):
next steps with my husband. I want us to have
a family, and I'm scared that I will have deep
regrets or even worse, resent my husband down the line.
First of all, all the feelings you describe are really
classic for struggling with IVF sadness, regrets, guilt, jealousy. They
(15:52):
are understandable, even if not all that realistic. Meaning being
angry with yourself for not line when you were dating
and unmarried takes out of the equation that you didn't
know if you would get married and didn't want to
choose to be a single mother. You feel regret in hindsight,
(16:14):
but hindsight implies you could have had a crystal ball
to know. It's normal to feel jealousy of those who
have something you desperately want, and it's normal to feel
sad about not being able to conceive when it is
something you very badly want. Sadness often comes from the
(16:35):
loss of the fantasy of what conceiving would look like,
how being pregnant would be, how that baby would be,
and of course it's possible that neither reality would match
your fantasy. But losing out on those hope for imaginings
is painful. Your O, B G y N is hearing
(16:58):
your anguish and trying to help you do something anything
to help you get what you want. But I think
the bigger question for you to wrestle with is exactly
what do you want most? You mostly talk about parenthood
and family. Parenthood and family are not only about d
(17:23):
N A. In fact, they're not mostly about d NA. Yes,
I can hear that not giving birth to your own
biological child is a painful loss, and that is very understandable.
Many women feel this way, and unfortunately, our society promotes
(17:43):
the idea of biological motherhood meaning success in some way.
But this is a cultural construct and one you can
choose to see through in order to get what you
most want. And once you give up, If you give
up on the idea of needing the same DNA, the
(18:05):
next question is whether your partner can also prioritize what
he might want. If it is his DNA above all else,
then an egg donor is feasible to try without losing
needed biological time to do something else biological down the road,
(18:26):
adoption does not require you to be younger than forty
five or fifty. If both of you can come to
see that looking like you matters less than having a
happy and healthy child to love and parent and be
a family with than adoption, which can also take some
(18:46):
time to achieve, may really be a wonderful route for you.
Giving a child who would not have a loving family.
Just that, plus the resources emotional and otherwise that you
have to bestow, can save a child. But also, in
(19:06):
my experience in practice, couples who adopt love and cherish
their adopted children every bit as much as any biological children,
including in families where they have both adoptees and biological children.
Right now, though you have anger about feeling robbed by time,
(19:32):
by your body and by your circumstance, this anger is
erosive and corrosive. Left unexamined and unprocessed, it is being
turned on yourself, causing you self blame and sadness, and
it can hurt your marriage. If turned on your husband,
(19:53):
as you suggest, may happen with regrets. So I urge
you to sit down now the couple's therapists to help
you sort out both of your strongest priorities. Given the
realities that I f F has not proved a solution,
and that an egg donor does have risks. When you
(20:15):
fear being a quitter, that is another method of blaming yourself.
And if not quitting means driving your mental health into
the toilet, I urge you to recognize that driving yourself
to depression will not make caring of pregnancy manageable and
will make any sort of early motherhood much more difficult
(20:38):
for all three of you, you, the dad, and any baby.
Your mental health matters. Hence a solution that doesn't prompt
misery matters. As well as far as continuing to benefit
from a group, First off, you do belong there. Part
(21:00):
of IVF groups are the failure of the IVF to work,
since often enough this is the case, dealing with the
psychological sequela of that, and people in the group helping
each other through that this can really benefit you. But
even more so getting on the same page as your partner,
(21:23):
a page that has viability and clear priorities, which you
say is parenthood and family matters the most right now?
I hope that was helpful. More often than not, the
emotions associated with infertility are not caused by one thing alone. Instead,
(21:47):
there are a tangle of expectations from both inside the
person and outside in what society tells the person they
should be feeling. Overcoming this requires you to identify, fi
and even name, the emotions that you might be feeling,
which may range from fear, fear of rejection by your partner,
(22:09):
feelings of being judged by others, feelings of failure or inadequacy, guilt,
the feeling of loss, even shame, financial stresses associated with
dealing with infertility, jealousy and anger, and loss of self esteem.
(22:30):
Once you identify your feelings, consider what those feelings are about,
and where they are coming from and who are they
directed at. It's one thing to feel guilt, but guilt
about what and are they really your feelings or they
expectations from others, others feelings being placed on you. Whom?
(22:51):
Do you feel guilty about? Your spouse, your family, the
future you would imagine for yourself. Ask yourself these questions
and you may start to understand these emotions and then
can be really helpful to share them with someone else,
sometimes someone who can help. Research is found that being
(23:14):
open about infertility and getting support does help people cope
with the emotional distress. The best place to find support
of course, is your spouse if you have one, but
sometimes this isn't the case, and the pressure that you
might both be feeling can make it difficult to sort
out your emotions together, so getting support from outside the
(23:38):
relationship can help you both. This can be reaching out,
of course to friends and family, but you want to
think carefully about your choices, because you might find that
the source of some of your negative feelings could be
coming from those closest to you. Support groups can definitely
be helpful, allowing you to voice the feelings and thoughts
(24:02):
that you've been unable to share elsewhere, and get an
understanding from those who have truly been there and therefore
feel less alone. Don't be afraid to seek help from
a mental health professional. You might need to see a
therapist individually, or together as a couple, or both. Well,
(24:22):
you don't have to see a therapist that specializes only
in infertility. It can be helpful if you need help
making informed decisions about your next move, because therapists who
do specialize in this will be more knowledgeable. Many IVF
clinics require counseling sessions before moving forward. If you're considering
(24:45):
using an egg donor or IVF or using a gestational carrier,
but some places do not. Whatever happens, you don't want
to let infertility take over your entire life. You might
want to consider even taking a break from trying to conceive.
(25:05):
A break can give you time to remember who you
are beyond your fertility, and give you a reprieve from
the stress of trying, and give you space to learn
some new coping strategies. If you're worried that you don't
have time to take a break, talk to your doctor.
You may actually find that you do have time to
(25:28):
step back for at least a few months, and this
could make a difference in your emotional well being. The
goal is to find acceptance of your own feelings and
those of your partner. Certainly, infertility is not easy, but
being compassionate with yourself and your partner as you experience
(25:48):
this life challenge together makes all the difference. Know that
this difficult time actually will pass no matter how infertility resolves,
whether you conceive and have a baby, adopt, or choose
to go on with a child free life. Things with
time do get better. Use time, counseling, support from family
(26:14):
and friends. Do you have a problem, I can help
with if so, email me yet. How can I help
at Seneca women dot com. All centers remain anonymous and
listen every Friday too. How can I help with me
Doctor Gail's Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm doctor
Gale Salts. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Most experts define infertility
as not being able to get pregnant after at least
one year of trying. Women who are able to get
pregnant but then have recurrent miscarriages may also be said
to be infertile. The World Health Organization definition based on
(00:50):
twenty four months of trying to get pregnant, is recommended
as the definition that is actually most useful in clinical
practice and research among various disciplines. It is actually a
growing problem and across virtually all cultures and societies almost
all over the world, and the effects are estimated to
be as high as ten to fifteen percent of couples
(01:13):
of reproductive age. In recent years, the number of couples
seeking treatment for infertility has dramatically increased due to factors
such as postponement of childbearing in women, development of newer
and more successful techniques for infertility treatment, and the increasing
(01:34):
awareness of available services. This increasing participation in fertility treatment
has raised awareness and inspired people to research the psychological
ramifications of infertility. Researchers have looked into the psychological impacts
and the prolonged exposure to intrusive infertility treatments on one's
(01:59):
mood and well being. While there is less information about
effective psychiatric treatments for people struggling with infertility, there is
data to support the use of various psychotherapeutic interventions like psychotherapies.
So today I am answering a question from a listener
(02:22):
who is struggling with feelings related to dealing with infertility.
Parenthood is one of the major transitions in adult life
for both men and women. The stress of the non
fulfillment of a wish for a child has been associated
with emotional difficulties like anger, depression, anxiety, marital problems, feelings
(02:46):
of worthlessness and hopelessness, and couples can become anxious about conceiving,
which ironically increases sexual dysfunction, and also feelings of so
shual isolation. Marital discord often develops in infertile couples, especially
(03:07):
when they are under pressure to make medical decisions. Couples
can experience stigma societally, a sense of loss and diminish
self esteem. In the setting of being infertile, men and
women partners can feel different differently from each other. That is,
(03:29):
in general, in infertile couples, women show higher levels of
distress than their male partner. However, men's responses to infertility
are very close to the intensity of women's responses. When
infertility is attributed to a male factor, men and women
experience a sense of loss of identity and have pronounced
(03:53):
feelings of defectiveness and sometimes incompetence. Women trying to conceive
off and have clinical depression rates similar to women who
have heart disease or even cancer. Even couples undertaking IVF
face considerable stress. General emotional stress and marital difficulties are
(04:16):
greater in couples where the infertility lies with the man,
so the psychological impact of infertility can be devastating not
only to the infertile person but also to their partner.
There are three separate factors or areas that seem to
contribute to the psychological stress that men and women experience
(04:43):
In order of importance. Those are for women, first having
children as a major focus of life and all of
the beliefs that surround that. Next is the female role
and the social pressure to conceive and be a mother,
(05:04):
and third is the effect on sexual life. Overall, for men,
it tends to be the reversed order of the importance
of factors one and two, but the third factor is
equally important to both men and women, the effect on
sex life. It's also been found that women experience their
(05:27):
infertility generally more strongly than men, and women showed a
more intense desire to have a baby than men. Stress, depression,
and anxiety are therefore common consequences of infertility. A number
of studies have found that the incidence of depression in
(05:49):
infertile couples presenting for in facility treatment is significantly higher
than infertile couples with the prevalence estimates of made your
depression in the range of anywhere from f to anxiety
has also been shown to be significantly higher in infertile
(06:11):
couples compared to the general population, with numbers going from
eight percent to twenty eight percent in infertile couples. The
role of psychological disturbances in the development of infertility is
another matter, a matter which is still somewhat up for debate,
but one study of fifty eight women reported a twofold
(06:35):
increase in the risk of infertility among women with a
history of depressive symptoms. But this study did not control
for other factors that also do influence fertility, like cigarette
smoking and alcohol use, low libido, and body mass index.
Although infertility has an effect on a couple's mental health,
(06:58):
different psychological fact have been shown to effect the reproductive
ability of both partners. The mechanism through which depression could
directly affect infertility involves the physiology of the depressed state,
so for example, hormonal issues like high prolactin levels or
(07:20):
disruption of what's called the hypothalamic pituitary adrenal access or
even thyroid dysfunction. One study suggested that depression is associated
with an abnormal regulation of certain hormones, like the lutinizing hormone,
which regulates ovulation. Changes in immune function are also associated
(07:44):
with stress and depression and could negatively affect one's reproductive functioning.
All of this is to say that more studies are
needed to look at the direct effects of depression or anxiety,
or even associated behaviors with depression anxiety, like low libidos, smoking,
(08:04):
and alcohol use that could interfere with reproductive success. Stress
is also associated with physiological changes, and this also can
raise the possibility of higher levels of stress being associated
with recurrent depression or anxiety and that being a cause
(08:24):
as well. Many couples presenting for infertility treatment have high
levels of psychological distress that's already associated with their infertility,
so the process of assisted reproduction itself can be associated
with high levels of anxiety, depression, and stress. A growing
(08:48):
number of research studies have tried to look at the
impact of infertility treatment at different stages. Most, however, have
focused on the impact of failed IVF aisles. Comparing women
undergoing repeated IVF cycles and first time cycles. Have suggested
(09:10):
that ongoing treatment can lead to increased depressive symptoms. That
sounds like it should not be surprising. It is still controversial, however,
because in fact, really not enough good studies have been done.
But in light of this, there has been an increasing
(09:31):
interest in what contributes to the dropout from infertility treatment,
since this population is not often looked at or looked
at well. The cost or refusal of physicians to continue
treatment has also been cited as a reason for discontinuing treatment,
(09:52):
and recent research has suggested that a number of dropouts
are due to psychological factors. A number of studies have
also examined stress and mood state as predictors of the
outcome in assisted reproduction. Most of these studies support the
theory that distress is associated with lower pregnancy rates among
(10:14):
women who are pursuing infertility treatment. This suggests that psychological
symptoms may interfere with fertility or successive infertility treatment and
the ability as well to tolerate these ongoing treatments. Again,
all this to say, the mind and the body are
(10:38):
very much connected. When one has a struggle with infertility,
one might become depressed. But when one is depressed, one
might also have difficulty with infertility or infertility treatments. So
the dilemma then is how to best help couples and
(10:58):
especially women were struggling to conceive with or without IVF,
especially with their psychological symptoms. So with that, right after
the break, we'll get to my listener's question. Welcome back.
(11:25):
Let's get to my listeners question and see how can
I help, Dear doctor Saltz. I am writing to you
to ask your advice on how to cope with infertility.
I am a forty three year old woman and I
got married later in life. I was forty one when
I got married. The pandemic also delayed our wedding by
(11:47):
a few months. Because we got married in I didn't
have the usual few years to try to get pregnant. Instead,
immediately after I was married, I saw fertility treatment from
a very reputable fertility center near where I live. I
went through three unsuccessful IVF treatments, most likely due to
(12:10):
my age. The first round we got very close. We
had five embryos for testing, but only one came back normal.
I went through an implantation that in theory, should have
been successful, but when I went back to the doctor
to take a pregnancy test and was not pregnant, my
(12:31):
husband and I were devastated. We did try for two
more rounds because our insurance covered three rounds altogether, but
the next rounds were even less successful. This took place
over a full calendar year. We needed time to process
what had happened, and my husband has had a hard
(12:51):
time talking about it. But Nat we've been processing for
about a year. We considered an egg donor, but neither
of us were very comfortable with the idea, since the
baby would not look like me, and it would be
out of pocket and very expensive more injections and a
great likelihood of miscarriage before a successful pregnancy. My regular
(13:15):
Obi g Iyen doctor very bluntly told me to just
do it, meaning get an egg downer, as if she
was telling me to borrow a pair of shoes. She said,
I would regret it if I didn't. I know that
my husband and I would be wonderful parents. We love kids,
We love spending time with our nieces and nephews, and
(13:36):
we have a lot to offer a child, a loving family,
vacations at the beach, a big back yard to play in,
We are financially stable, and a wonderful little mini Golden
Doodle dog that we got last year. My husband is
fifty and he is wondering if he is too old
and has beers and doubts doing anything else. He also
(14:01):
went through a difficult family tragedy when he was twenty,
so he understandably is trying to protect himself from getting hurt.
Adoption is still on the table for me, but I
know it would take a lot for him to get there.
Do you have any advice for me? I think about
my infertility every day. I have guilt for not trying
(14:24):
with my husband sooner, even though it would have been
out of wedlock. I have anger and frustration at the
men I dated in my twenties and thirties who either
weren't kind to me or weren't ready to settle down.
I am envious of women my age who have had
their own kids and got to marry at an earlier age,
(14:44):
or who were just very lucky to be a mom
later in life. I do home ovulation kits to see
when I'm most fertile to try to get pregnant, but
I have guilt that I didn't start this sooner. I
have tried support groups, which were helpful when I was
going through treatment, but the last two times I went
to a meeting, I felt out of place for being
(15:05):
the only one not in the middle of IVF. It's
almost like I feel like I'm a quitter, even though
I know that I'm not and I did everything I
could to have a baby. I'm really struggling and I'm
not sure what to do next or how to cope
with some of these feelings and help me figure out
(15:25):
next steps with my husband. I want us to have
a family, and I'm scared that I will have deep
regrets or even worse, resent my husband down the line.
First of all, all the feelings you describe are really
classic for struggling with IVF sadness, regrets, guilt, jealousy. They
(15:52):
are understandable, even if not all that realistic. Meaning being
angry with yourself for not line when you were dating
and unmarried takes out of the equation that you didn't
know if you would get married and didn't want to
choose to be a single mother. You feel regret in hindsight,
(16:14):
but hindsight implies you could have had a crystal ball
to know. It's normal to feel jealousy of those who
have something you desperately want, and it's normal to feel
sad about not being able to conceive when it is
something you very badly want. Sadness often comes from the
(16:35):
loss of the fantasy of what conceiving would look like,
how being pregnant would be, how that baby would be,
and of course it's possible that neither reality would match
your fantasy. But losing out on those hope for imaginings
is painful. Your O, B G y N is hearing
(16:58):
your anguish and trying to help you do something anything
to help you get what you want. But I think
the bigger question for you to wrestle with is exactly
what do you want most? You mostly talk about parenthood
and family. Parenthood and family are not only about d
(17:23):
N A. In fact, they're not mostly about d NA. Yes,
I can hear that not giving birth to your own
biological child is a painful loss, and that is very understandable.
Many women feel this way, and unfortunately, our society promotes
(17:43):
the idea of biological motherhood meaning success in some way.
But this is a cultural construct and one you can
choose to see through in order to get what you
most want. And once you give up, If you give
up on the idea of needing the same DNA, the
(18:05):
next question is whether your partner can also prioritize what
he might want. If it is his DNA above all else,
then an egg donor is feasible to try without losing
needed biological time to do something else biological down the road,
(18:26):
adoption does not require you to be younger than forty
five or fifty. If both of you can come to
see that looking like you matters less than having a
happy and healthy child to love and parent and be
a family with than adoption, which can also take some
(18:46):
time to achieve, may really be a wonderful route for you.
Giving a child who would not have a loving family.
Just that, plus the resources emotional and otherwise that you
have to bestow, can save a child. But also, in
(19:06):
my experience in practice, couples who adopt love and cherish
their adopted children every bit as much as any biological children,
including in families where they have both adoptees and biological children.
Right now, though you have anger about feeling robbed by time,
(19:32):
by your body and by your circumstance, this anger is
erosive and corrosive. Left unexamined and unprocessed, it is being
turned on yourself, causing you self blame and sadness, and
it can hurt your marriage. If turned on your husband,
(19:53):
as you suggest, may happen with regrets. So I urge
you to sit down now the couple's therapists to help
you sort out both of your strongest priorities. Given the
realities that I f F has not proved a solution,
and that an egg donor does have risks. When you
(20:15):
fear being a quitter, that is another method of blaming yourself.
And if not quitting means driving your mental health into
the toilet, I urge you to recognize that driving yourself
to depression will not make caring of pregnancy manageable and
will make any sort of early motherhood much more difficult
(20:38):
for all three of you, you, the dad, and any baby.
Your mental health matters. Hence a solution that doesn't prompt
misery matters. As well as far as continuing to benefit
from a group, First off, you do belong there. Part
(21:00):
of IVF groups are the failure of the IVF to work,
since often enough this is the case, dealing with the
psychological sequela of that, and people in the group helping
each other through that this can really benefit you. But
even more so getting on the same page as your partner,
(21:23):
a page that has viability and clear priorities, which you
say is parenthood and family matters the most right now?
I hope that was helpful. More often than not, the
emotions associated with infertility are not caused by one thing alone. Instead,
(21:47):
there are a tangle of expectations from both inside the
person and outside in what society tells the person they
should be feeling. Overcoming this requires you to identify, fi
and even name, the emotions that you might be feeling,
which may range from fear, fear of rejection by your partner,
(22:09):
feelings of being judged by others, feelings of failure or inadequacy, guilt,
the feeling of loss, even shame, financial stresses associated with
dealing with infertility, jealousy and anger, and loss of self esteem.
(22:30):
Once you identify your feelings, consider what those feelings are about,
and where they are coming from and who are they
directed at. It's one thing to feel guilt, but guilt
about what and are they really your feelings or they
expectations from others, others feelings being placed on you. Whom?
(22:51):
Do you feel guilty about? Your spouse, your family, the
future you would imagine for yourself. Ask yourself these questions
and you may start to understand these emotions and then
can be really helpful to share them with someone else,
sometimes someone who can help. Research is found that being
(23:14):
open about infertility and getting support does help people cope
with the emotional distress. The best place to find support
of course, is your spouse if you have one, but
sometimes this isn't the case, and the pressure that you
might both be feeling can make it difficult to sort
out your emotions together, so getting support from outside the
(23:38):
relationship can help you both. This can be reaching out,
of course to friends and family, but you want to
think carefully about your choices, because you might find that
the source of some of your negative feelings could be
coming from those closest to you. Support groups can definitely
be helpful, allowing you to voice the feelings and thoughts
(24:02):
that you've been unable to share elsewhere, and get an
understanding from those who have truly been there and therefore
feel less alone. Don't be afraid to seek help from
a mental health professional. You might need to see a
therapist individually, or together as a couple, or both. Well,
(24:22):
you don't have to see a therapist that specializes only
in infertility. It can be helpful if you need help
making informed decisions about your next move, because therapists who
do specialize in this will be more knowledgeable. Many IVF
clinics require counseling sessions before moving forward. If you're considering
(24:45):
using an egg donor or IVF or using a gestational carrier,
but some places do not. Whatever happens, you don't want
to let infertility take over your entire life. You might
want to consider even taking a break from trying to conceive.
(25:05):
A break can give you time to remember who you
are beyond your fertility, and give you a reprieve from
the stress of trying, and give you space to learn
some new coping strategies. If you're worried that you don't
have time to take a break, talk to your doctor.
You may actually find that you do have time to
(25:28):
step back for at least a few months, and this
could make a difference in your emotional well being. The
goal is to find acceptance of your own feelings and
those of your partner. Certainly, infertility is not easy, but
being compassionate with yourself and your partner as you experience
(25:48):
this life challenge together makes all the difference. Know that
this difficult time actually will pass no matter how infertility resolves,
whether you conceive and have a baby, adopt, or choose
to go on with a child free life. Things with
time do get better. Use time, counseling, support from family
(26:14):
and friends. Do you have a problem, I can help
with if so, email me yet. How can I help
at Seneca women dot com. All centers remain anonymous and
listen every Friday too. How can I help with me
Doctor Gail's Salts
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