Fertility stress

“We get calls from women in their 40s who say they exercise regularly, do yoga, look 27,” said Marla Libraty, vice president of marketing for the Massachusetts-based egg-freezing company Extend Fertility. “We have to tell them that it doesn’t matter how you look. The eggs are the age of your body.”

Christina was 34 when she and her husband liberated themselves from birth control with the intent of building their family. After two years of disappointing monthly periods, they reluctantly went to see a fertility specialist for diagnostic tests of sperm and hormone levels. The result was the common diagnosis: unexplained infertility.

With insemination, they experienced two pregnancies. And two miscarriages. They started the lengthy process of adoption paperwork. They did another insemination the day before they boarded a plane to meet their daughter for the first time. Their son was born a few months after they brought their daughter home with them.

Two years later, Christina-a straight-shooting St. Paul mom of two-said that even though her story might sound easy in summary, and has led to the family she hoped for, the three-year process of getting there was “horrendous.”

“Most of my friends are in their late 30s now, and I see it happening to them. The excitement of having unprotected sex and expecting to get pregnant. The disappointments. Resisting treatment. Getting pregnant and miscarrying. It’s devastating,” she says. “In the process you lose that innocence. The story becomes one of paperwork and technology and medical visits.”

Christina herself didn’t know how emotionally wrenching the experience was until she learned, several months into treatment, that her sister-in-law was pregnant. “My husband said it was as if he’d told me that someone had died,” she says. “I went into our basement to stomp around, out-of-control, so the neighbors wouldn’t hear me. I hated her. After that, I couldn’t face pregnant women. I’d be insanely jealous of their cute stories of how they learned they were pregnant. Even now, when I’m in my doctor’s waiting room, I have symptoms of post-traumatic stress.” For someone who hasn’t experienced fertility issues, Christina’s story might sound melodramatic. For anyone who has, it sounds all too familiar.

Fertility issues
When we’re teenagers learning about sex education, getting pregnant sounds almost easy. Preventing conception until the right time in a person’s life is the goal. So it’s with a cruel sense of irony that an estimated 1 out of 10 couples will need to see a fertility specialist to help them conceive. The primary reason the fertility business is thriving today is not because more people are facing traditional causes of infertility-such as blocked fallopian tubes or low sperm count-but because more couples are postponing childbearing until the women are well into their 30s when the quality of remaining eggs is reduced. A woman’s egg reserve peaks at age 24.

“The biggest stress for women is the loss of control,” said Dr. Jeanette Truchsess, a St. Paul-based psychologist who talks regularly with people affected by fertility issues. “Everything else they’ve set their mind to they’ve been able to accomplish. This is often the first goal they can’t achieve by hard work and smarts.”

Stages of grief
Dr. Lisa Erickson, a fertility specialist with the Minneapolis-based Center for Reproductive Medicine and Advanced Reproductive Technologies, said that the emotions of people she meets in her office mirror the stages of grief involved with any loss-denial, anger, eventually acceptance (a stage some people never get to), and then resolution.

“People can only work with a fertility clinic for so long,” Erickson said. “Some decide to remain child-free. They adopt. They use a surrogate. Each couple writes their own chapter. My role is to try to give them back some control. Talk to them about all available options, move to the most effective treatment options, and get them in and out before we get to know each other too well. Many really don’t ever want to see me again.”

Marital conflict
When a couple walks into a fertility clinic to identify why conception isn’t happening, they will face a long list of unusual stresses that can affect their relationship, as well as their level of comfort with family, friends and coworkers.

Marital conflicts naturally occur. Women tend to be more consumed with learning and talking about infertility, doing extensive research on the Internet, joining support groups. Men tend to want to jump right to the fixing stage, after a short period of talking. This can lead couples to disagree about how seriously they are taking the issue.

Truchsess said many women like to plan a year ahead, whereas men might prefer to take it one step at a time. “Women might say, if this treatment doesn’t work, what will the next step be? But their husbands might say, hey, I’m still on today.”

Some of the issues couples need to work out together is extensive:

• Will they tell family and friends that they are working on infertility issues? Can they agree on who those people will be and what they will tell them?

• Does the couple agree about what treatment means to them, and how to proceed? Most husbands and wives are not on the same page, and part of the struggle is accepting that. Guilt, shame, grief all take time to process-and individuals will get through them in different ways. Some couples subconsciously become divided because one considers infertility to be the other one’s problem, rather than as something they face together.

• How will they fit fertility treatments into their schedules? Work life can interfere with timing. Some careers don’t easily lend themselves to disappearances, sometimes on a moment’s notice when ovulation is occurring. Making a concrete plan, with spouse and doctor and medical staff, can help alleviate the logistical stress.

• How will it be paid for?

Fertility can be such an emotionally taxing issue that it’s hard to be clear-headed about the practicalities of paying for it. Some refer to their child as their Discover baby, with treatment paid by credit card. One cycle of in-vitro fertilization can cost $14,000.

Social stress
As Truchsess points out, social isolation can be substantial. Women are likely to withdraw from a friend who suggests “just adopt,” or “just don’t have kids,” without understanding the deeper emotions. They’ll withdraw from parents who don’t have the right words. From book clubs where kids are a frequent topic of conversation. From colleagues who gripe about her work hours missed. From church members who make personal judgments that reproductive technology is unnatural.

And, of course, couples can withdraw from each other, especially when intimacy is being lost by having sex on schedule. “Many men have trouble performing on command,” says Truchsess. “It takes the joy out of it and becomes mechanical.”

The stress and depression of fertility issues can also hinder the ability to conceive, according to some studies.

Truchsess indicates that depression can cut fertility success in half. Without the right signals, hormones don’t release eggs. “Reproductive hormones start in the head,” she says. Her view is that the pain of fertility loss is inevitable, but that suffering from it is a choice. One of her techniques is to challenge the negative thoughts that create feelings of hopelessness that will affect the body.

The long-term story
In the end, Christina points out, getting pregnant is only a tiny part of her story, even though it can seem momentous for many couples. After building a family, it becomes a matter of learning how to be a parent, year after year, with its new challenges.

“If you want to be a parent, you will be,” she said. “There are great options out there. And there is so much life after trying. It’s easy to lose sight of that.”

Dos and Don’ts:
If you are supporting someone who is facing fertility issues, Dr. Truchsess recommends:

DO NOT say “just adopt,” “just relax,” “try to adopt and you’ll get pregnant” (Christine’s story notwithstanding, it’s rare), indicate without experience that you know what it must be like, or suggest that they try the trendy new “conception cruises,” which are simply a means to cash in on vulnerable couples.

DO listen, say you understand that it must be very stressful, say “I’m sorry you’re going through this, how can I help?” Suggest they find other people going through fertility issues, in support groups or at Resolve workshops. Encourage them to see a fertility specialist or mind/body counselor. Support their right to not come to events that are focused on other people’s children if it is hard for them. Recommend that they find a specialist via word-of-mouth, not simply one recommended by their ob/gyn.

Knowledge is power:
Resources for working with fertility issues:

Harvard psychologist Dr. Alice Domar has written the highly regarded book Conquering Infertility: Dr. Alice Domar’s Guide to Enhancing Fertility and Coping with Infertility (Penguin, 2002).

American Fertility Association, 888-917-3777, theafa.org. This national network has a strong library of articles and resources.

Resolve: The National Infertility Association, regional chapter, 952-223-1339, www.midwest.resolve.org. This organization has an amazing array of support groups and educational workshops.

American Society for Reproductive Medicine,www.ASRM.org

Single motherhood by choice: choicemoms.org