INFERTILITY

The Emotional Roller Coaster

Infertility is a crisis of the deepest kind. It threatens every aspect of a person’s life – one’s sense of self, one’s dreams for the future, one’s relationship with others. Few crises are as challenging and overwhelming.

Yet, most of the attention is focused on the physical aspects of infertility. The emotional ones often go ignored and untreated. As a result, most people suffer intensely and alone.

But they don’t have to. Knowledge brings understanding and comfort. On the following pages, two couples (fictitious names) struggle with the emotional impact of infertility. Their experiences are representative and combinations of what many infertile couples go through.

After the experiences of each phase of infertility, common emotions and coping strategies are discussed. With time, patience, humour and knowledge, each couple will find a resolution to the emotional crisis of infertility.

PART A: INTRODUCTION TO THE COUPLES

Couple number 1

JENNY AND TOM JACKSON

Jenny, in her early thirties, is an administrative assistant. She and her husband, Tom, a manager in a small business, met in high school but fell out of touch when Tom married. Three years after Tom’s divorce, the two met again and married a year later. Tom has two children from his first marriage. Both children live with their mother but visit regularly. Jenny and Tom decided to have a child after being married for a year.

Couple number 2

GINA AND RICHARD GALLO

Gina is in her late twenties and works as a teacher. She’s been married to Richard, a sales executive, for two years. Gina wanted to have a family immediately after she and Richard got married. But Richard, in his late thirties, wanted to postpone children until he was making more money. Gina agreed to wait a year to start a family.

PART B: REALIZATION AND ACKNOWLEDGEMENT

Couple 1 – JENNY AND TOM

After a year of unprotected intercourse, Jenny was not pregnant. The Jacksons decided to see a doctor.

JENNY:

“I was really excited about trying to get pregnant. All my friends had children, and I felt left out and a little behind because I didn’t have any. I hated going to friends’ baby showers. To make myself feel better, I used to dream about the child I would have for my own one day.

“Tom has two children by his first marriage. They’re great kids – a girl six and a boy seven, but I thought having a child with Tom would anchor our marriage.

“When we first started trying to conceive, sex was fabulous, bigger than both of us. I couldn’t wait for the middle of my cycle. Without birth control – a first for me – I felt like we were doing something slightly dangerous – exciting. It was liberating.

“Once we had made the decision to start trying, I began to notice pregnant women on the street, maternity clothing stores, new babies -I guess I was finally letting myself feel all the maternal instincts I had repressed for so long. It seemed like anytime now, I’d be walking around, showing off my big belly.

“Then I kept getting my period and I started to feel uneasy. Everybody else in my family – I have three sisters – had no problem getting pregnant. I began to be haunted by the abortion I had had years before. It had been so easy to get pregnant then. Now, when I was really ready for a family nothing was happening. Did something go wrong when they performed the abortion? My fears began to get worse and worse, so I finally told Tom I thought we should see a doctor.”

TOM:

“I was a little apprehensive about having another child. I’m close to my two children from my first marriage. They give me a lot of pleasure, and I’ve worked hard to keep a good relationship with them. Another child might make them jealous, cut into my time with them and add more financial responsibilities for me.

“But I knew Jenny really wanted a child. I knew it wasn’t fair to prevent her from having what I already had. I was reluctant to give up our freedom. I had been tied down in an unhappy marriage for several years, and life with Jenny was so much better. I was afraid of upsetting the balance we had struck.

Couple 2 – GINA AND RICHARD

“When Jenny wasn’t pregnant after a year of trying, I wasn’t worried. Since I had two children, I felt pretty sure it wasn’t my fault. I figured it would just take some time. But Jenny was dead set on seeing a doctor.”

After trying to conceive for a year and a half, Gina – without telling Richard -decided to see a doctor.

GINA:

“I wanted kids as soon as we got married. I’ve always loved children. That’s why I’m a teacher. But Richard had real reservations about having children so soon. I agreed to wait, but a year later, he was still reluctant. He finally agreed to start trying, yet I could tell his heart wasn’t entirely in it. But, I figured that once we had a child, he would be thrilled.

“When I still wasn’t pregnant after a year and a half, I decided to go on my own to see a doctor. I didn’t tell Richard I was going. He didn’t want children at this point in his life. I felt angry and resentful at him.

RICHARD:

“My parents raised me to believe that I shouldn’t get married and start a family until I was financially secure. I didn’t feel that I was making enough money to support a family.

“On the other hand, Gina wanted children so much. That’s all she talked about. I hated to deny her. She would be such a great mother. When she kept getting her period every month, I felt a little relieved that a baby wasn’t on the way.”

SUMMARY:

Most couples assume that they are fertile, and when they want to conceive, they will. They are shocked and dismayed when they can’t produce a child. What if they never have children? Are they sterile? These thoughts are so frightening that many couples deny that they have an infertility problem.

The following may be experienced at this stage:

The woman is often the first to realize that there may be a fertility problem.
The man may need to be convinced that the couple needs medical intervention.
Feelings of anger, denial, guilt, blame, self-pity and jealousy predominate.
Emotions, disagreements, etc. become magnified. Issues take on greater importance than under ‘normal’ circumstances.

COPING STRATEGIES:

• Read as much as possible.
• Talk to others who have experienced a similar problem.
• If you are over 30 years of age, see a doctor if you have been trying to conceive for six months or longer.
• If you are under 30, consult a doctor after you have been trying to conceive for one year or more.
• If you know that you have a problem, see a doctor immediately.
• Be prepared to feel relief, anxiety or a combination of the two when you consult a doctor.
• Approach infertility as another job. Map out a strategy and a timetable.
• Try to empathize and communicate regularly with your spouse.
• This may not always be possible, but keep trying. Communication is very important.
• You and your spouse may not experience the same feelings at the same time or in the same way.
• You may feel frustration and anger – things aren’t going as you planned.

PART C: EVALUATION AND DIAGNOSIS

Couple 1 – Jenny’s doctor gave her a full infertility workup and found that she had blocked fallopian tubes. Tom had several semen tests. The results were normal.

JENNY:

“When I went to the doctor, I had no idea what I was getting into. He outlined a series of procedures, all of which sounded scary and expensive. Worst of all, he confirmed what I had been dreading, that I might have a problem. I remember feeling overwhelmed – the bottom of my stomach felt like it was falling out.

“I stayed in a state of shock for about a week. I was so threatened I couldn’t talk to anyone. Then I pulled myself together and set up a schedule for the procedures. The schedule made me feel more in control.

“Some of the tests were worse than others. But I was always afraid of the results, angry at the procedures, frustrated by the intrusion into my life of all these unwanted appointments. I felt invaded – sometimes even violated. It was like my body had turned against me. I was unfeminine, malfunctioning.

“When the doctor determined that I had blocked fallopian tubes, I felt overwhelmed with guilt. It was my fault we didn’t have the child we wanted so much.”

TOM:

“Jenny was very brave going through the tests. She was determined to find out what was wrong. I wasn’t as involved emotionally because I still thought we’d conceive in time.

“She asked me to take a semen test, and I agreed, although I felt resentful. When the test came back normal, Jenny felt even more isolated. I think she was afraid I would blame her, or that I wouldn’t love her anymore because she couldn’t conceive.

“Jenny felt defective when she found out she had blocked tubes. She was so frightened. Her fear began to infect me. I tried to be patient and dismiss her worries, but underneath I began to realize that we might never have a child together. We did a lot of crying.”

Couple 2 – They agreed to be tested. The tests revealed that Richard had a varicocele, which might be the cause of his sperm counts being low.

GINA:

“Richard wasn’t very understanding during the time I was being tested. I felt so alone going to the doctor’s office for all of those horrible tests. I used to come home and get into arguments with Richard. When my tests came out negative, I was happy, but then I grew scared that Richard would refuse to be tested.

“Richard agreed to be tested but reluctantly. I think he was beginning to realize that it might not be so easy for us to have children and I think that thought scared him.

“When we found out that Richard had a varicocele, I was glad that they had finally found something. I was a little nervous that Richard might not want to go through with treatment though.”

RICHARD:

“I knew that I wasn’t involved in Gina’s pursuit of a family, and I felt confused. I wanted to have kids but not right now. I was so afraid of the responsibilities. I guess that’s why I was angry at Gina for going to the doctor. Gina was unhappy that I wasn’t supportive; we argued a lot.

“Actually, my work was going well. I couldn’t really use money as an excuse for not having a family anymore.

“When the test results revealed that I had a varicocele, I was devastated. I felt bad for Gina, like it was my entire fault. I was the reason she wasn’t getting pregnant. I started to panic. What if we couldn’t produce kids? Gina would never forgive me if we didn’t have children. And my parents would feel like we had failed them if we didn’t produce grandchildren.”

SUMMARY:

During this phase, couples are searching for answers. The testing period can be gruelling, anxiety producing, and expensive.

Common feelings are:

• Shock/numbness/relief when a problem is confirmed. Loss of control – tests are taking over your life.
• Isolation from friends and family. A sense of being misunderstood by the fertile world.
• Anger at the world – your body, others who are pregnant or have children, your mate.
• Self-punishment – why me? What did I do to deserve this?
• Lack of privacy-invasive nature of tests.
• A sense of sexuality threatened.
• Shame and embarrassment over not functioning “normally.” Inability to communicate with spouse, family, friends.
• Need for secrecy, which breeds isolation.
• Blame and guilt.

COPING STRATEGIES:

• Work together. It takes two to make a baby. The couple is being treated, not the individual. Try to go to doctor’s appointments together.
• Take control of your visits to the doctor. Write your questions down prior to your appointment so you don’t forget them.
• Read and learn as much as possible.
• Communicate fears and emotions to your spouse on a regular basis.
• Support one another, but understand that at times it will be difficult to do.
• Allow for periods of depression and anxiety. Cut down on stressful activities.
• Allow yourself private time.
• Try sharing your problem with supportive friends or other family members.

PART D: TREATMENT

Couple 1 – In an effort to clear her fallopian tubes, Jenny underwent surgery. After six months of trying to get pregnant without success, Jenny tried hormone therapy on and off for a year.

JENNY:

“I was hopeful after the surgery. I began to relax for the first time in months. I realized that it took so much energy to cope with my infertility that I had lost touch with my husband and my friends. It was almost as if I had been in another world for a year. My confidence began to rise, even though I was still guarded. Tom and I made special efforts to do things together, to try and laugh and enjoy the things we had always had fun doing. I began to feel less frantic, more centred.

“When I still wasn’t pregnant after six months, I worried again. The doctor decided to try hormone therapy. I had to make frequent visits to the clinic during the first two weeks of my cycle. I hated being so dependent on the medical establishment. Machines and blood tests were now directing what should have happened naturally. I felt even more tampered with. And I began to wonder if the doctor was the one making the baby instead of Tom and me.

“Sex became a dreaded event – as enjoyable as shovelling snow off the driveway. We had to have sex at specific times – goodbye spontaneity and passion. Lots of times neither of us felt like even looking at one another. It seemed like the days we knew we had to have intercourse were the ones Tom had to work late or I didn’t feel well.

Work began to be a big problem because of all my unexplained absences. And when I was at the office, mentally I was miles away. I had never been very excited about my job. Infertility made it even harder to face. I decided that I wanted to quit and focus on getting pregnant.

“Each time my period came, it was like a little death. I felt so empty inside and out. I would cry – or worse, feel numb for a couple of hours and then explode over the smallest thing. A few days would go by, and then I’d begin to think about the next cycle. It was a weird process of mourning for what could have been; at the same time, I was hoping for what might be.

“Because I was on such an emotional roller coaster, times spent with Tom’s children were stressful.”

TOM:

“After Jenny had surgery, we were both hopeful she’d get pregnant. Without the endless tests and doctor visits, normalcy began to return to the house. I realized how much infertility had affected our lives, how we had become so isolated from each other. I began to wonder if it was all worth it. We were happy together without a child; trying to have one was making us miserable.

“It was hard giving Jenny the hormone shots. She was really courageous, never complained. I felt sure I was hurting her, that she was angry at me for sticking her. It was tough, too, in terms of scheduling. Once we had some people over for dinner and the two of us had to retreat to the bedroom for the shot. The guests must have thought we were so rude. But Jenny just set her jaw and said that we had to do it.

“Our sex life really suffered. I sometimes felt like a baby making machine rather than a man. There were times I would try to avoid having sex when we were supposed to. Jenny would either beg or demand me to ‘perform’, which only made things worse. But eventually, I got better at it. I realized that we were making a baby, not having fun. Sex was a job.

“It bothered me that the stress we were under was affecting our visits with my children. We both were short-tempered and impatient.

“I had mixed feelings when Jenny quit working. It put a lot of pressure on me financially. She was much happier though. We had to do something to cut down the stress in our lives. Because she felt more in control, I felt less helpless.”

Couple 2 – The doctors recommended that Richard have an operation to correct the varicocele and hopefully improve his sperm count

GINA:

“I felt somewhat hopeful that if Richard had an operation we would become pregnant soon. I was tired of waiting for a child; I just wanted something to happen.

“Richard was very self-conscious about his problem. He wouldn’t let me tell anyone. I felt isolated from my family and friends. I had always been close to my mother, and I told her everything. Now I had to shut her out. I felt that her questions were intrusive and that she would never be able to understand our problem.

“I was so happy when Richard agreed to the surgery. It proved to me that he, too, wanted children. We started talking, and I felt closer to him than I ever had. He was really making an effort.”

RICHARD:

“I was embarrassed that I had a problem. I wasn’t a real man. I didn’t want anyone to find out. When it came time for the operation, I lied and told my boss that I was having dental work done.

“I had never set foot in a hospital, and I was scared. I started to rely heavily on Gina. We were really communicating. Some days we could even laugh about all of the insane procedures that we had to endure.

We made jokes about the inseminations, the doctors and our programmed sex life. At those times we were able to put our relationship ahead of everything else. Going through the tests and later the operation made me realize that I had been kidding myself…I really wanted to be a father.

“At one point our doctor suggested that we try donor insemination. I flatly refused. I didn’t want to be left out. I wanted us to have a child together. I think Gina understood how I felt. She would have done it though if I had said yes.”

TREATMENT

Allow yourself to feel bad when you have reached your limit.

Remember, you are not a bad person because you’re having trouble

SUMMARY:

At this point, infertility dominates the couple’s life. It is the peak stress point. Invasive, high stakes treatments are exhausting – emotionally, physically, and financially.

Other common feelings may be:

• Anger at infertility ruling your life without permission.
• Frustration over treatments that don’t guarantee a baby, after spending so much time, money and emotional energy.
• The inequity of infertility treatments. In most cases, women carry more of the burden than men.
• Feeling of victimization—by drugs, doctors, and technology.
• Anger at the passivity required to be injected, scanned, dosed, inseminated, operated on. The desire to fight back and gain control.
• Drug side effects – uncertainty about effects, heightened senseof sensitivity and vulnerability.
• Sex becomes a chore and a battleground for many negative emotions.
• Emotional roller coaster – hope at the start of treatment, disappointment and mourning when the cycle fails.
• Growing anxiety over the financial cost.
• Life on hold, inability to make short/long-term plans.
• Punishment – maybe I don’t deserve to have a child. Bargaining – if only we’d done this then we’d have a baby.
• Allure of one more high tech effort – IVF, GIFT, ZIFT. Balanced by fears of high stakes failure and expense.

COPING STRATEGIES:

• Take the long view. Don’t emphasize the short term ups and downs of the treatments. Set up a timetable and live by it.
• Don’t expect your partner to feel as you do. Share when you can, but don’t push it.
• Consider the possibility of restructuring your life if treatment becomes overwhelming.
• Try to live with baby making sex. Don’t feel guilty about it. Sex will be perfunctory most times.
• Have sex for fun during unfertile times of the cycle. Try to bring back your original closeness.
• Seek emotional support from an experienced infertility counsellor or support group

PART E: RESOLUTION

Couple 1 –

“I was happy when Jenny said she wanted to stop trying. We had done the very best we could to have a child. It didn’t work out but it wasn’t our fault.

“Our infertility makes me treasure the children ‘I do have. And it made me admire and respect Jenny’s courage and strength. I’m sorry we’ll never have a child together, but we still have each other.

After a year of drug therapy, Jenny was still not pregnant. Exhausted emotionally, physically and financially, the Jacksons decided to stop treatment and consider the possibility of not having children.

JENNY:

“When I wasn’t pregnant after a year, I knew I had to stop treatment. I couldn’t take it anymore. I was running on empty. It felt futile to continue. I needed to stop turning myself, my husband and my life upside down for a child who might never be.

“The amazing thing was the first feeling I had was a relief. No more shots, tests, doctors, probing’s, out-of-control days. I was in charge for the first time in years. I wasn’t running after something that kept slipping away. I had myself, my husband, our marriage, and the rest of my life ahead of me.

“We thought about other options – adoption, IVF and GIFT. But we both decided we just didn’t have the energy or the money to pursue them. We needed time to collect ourselves, to close a chapter, and to have our lives revolve around something other than infertility.

“I still feel confused, angry, scared and betrayed. But not in the same overwhelming way I had in the early stages of infertility. I was grieving about something that was over, not about something that might be.

“I decided to go back to school and get a degree in nursing. If I couldn’t have a child, I still wanted to nurture and help others.

“Our infertility was a fact, but Tom and I still had each other. The challenge of infertility had brought us closer together. We loved each other in a deeper way after all we had been through. And we didn’t take our marriage for granted.

“Tom’s kids became even more important to us. They began spending more time with us, and I was able to express my maternal feelings with them. Because I wasn’t as emotionally brittle, the time spent with them was pleasant, enjoyable and fulfilling.

Couple 2 –

While unsuccessfully trying to conceive for eight more months, the Gallos contacted a support group.

GINA:

“I couldn’t believe that we had failed to become pregnant. We had gone through so many tests and operation. I thought surely we would be pregnant by now. I was totally frustrated. Although Richard and I were communicating and getting along, I knew we needed some outside help. We just couldn’t deal with our emotions.

“We joined an infertility support group that met once a week. After a few weeks of talking, we realized that we were putting too much emphasis on getting pregnant. We’d lost sight of our real goal – to become parents. One of the couples in our group had recently adopted a baby, and I knew the minute I saw their child that I wanted to adopt a baby, too.

“I thought that Richard wouldn’t want to adopt. He was still trying to work through his ‘failure’. I told him over and over that the only way that he could fail me was if he refused to adopt a baby.”

RICHARD:

“The support group enabled me to talk about my guilt, that this whole problem was my fault. Gina and I liked the people in the group. We all had similar feelings, and we were very open with each other. I hadn’t even given adoption a thought until we met the adoptive parents in our group. Their baby was adorable, but I was still holding out for a biological child.

“Gina started to push for adoption, but I wasn’t convinced. It took me a long time to understand that I could truly love a child even if the baby didn’t have my genes. I realized that many of the people I am the closest to aren’t biologically related to me. By adopting, Gina and I would go through the experience together.

I wouldn’t feel left out like I would have if we had used donor sperm. After a lot of discussion with Gina and the group, I decided that I wanted to be a father and that I could happily adopt a baby. For the first time in years, I grew hopeful.”

One and a half years after their initial adoption investigation, Gina and Richard adopted a healthy baby girl.

SUMMARY:

Many people who experience infertility say, “If I can get through this, I can get through anything.”

This can be a time of reordering priorities and changing goals.

Here are other common feelings:

• Exhaustion
• Grief, emptiness and despair
• Sadness
• Having to realize that you can’t control every aspect of your life
• Greater ability to empathize with other people’s problems
• Acceptance

COPING STRATEGIES:

• Talk to oth  to speak to Dr Gan if you have any question regarding infertility here.