FACING THE CHALLENGE OF
by Andrew Geller, Ph. D.
51 Circuit Ave.
Newton, MA 02161
Being faced with infertility can
pose a serious challenge to our sense of existence in the world. By this I refer
to our beliefs about belonging in a world where there is logic, predictability,
justice or fairness, where there is a natural order and progression to things,
and in which we play a part and have a recognizable place. What has been
completely taken for granted and just assumed is thrown into doubt. From seeing
ourselves as sharing a common biological heritage with all of the living world,
we may start to see ourselves as different, cut-off, and apart. We become
increasingly self-conscious and are thrown off balance.
As a result, we may come to know a range of responses including, but not limited
to, fearfulness, dread, rage, sadness, grief, confusion, shame, resentment, and
numbness. I will talk at greater length about some of these responses for us as
individuals and as a part of a couple.
How we respond is greatly affected by the fact that there is usually
considerable uncertainty about the "prognosis"--that is, about our future and
the future of our biological offspring. One of the areas of uncertainty that can
lead to a crazy-making roller coaster ride (during in vitro treatment) is
wondering whether the end result will be, God forbid, no pregnancy at all or,
almost as overwhelming, twins or triplets! With a definite, permanent,
untreatable infertility, at least there is the possibility of grieving one's
loss and making room to consider other options; however, infertility often
becomes the home we permanently move into even though we had hoped to only stay
overnight. We walk from room to room seeing the world outside which we want to
join, but we are not able to find the way out. We are obsessed and vulnerable in
this state of captivity. We never bargained for this. Unlike a bad dream, we can
not shake ourselves and wake up. And we puzzle over how we got here.
Infertility challenges our belief, faith and hope in the normal workings of our
body, and may leave us feeling broken and defective. If part of your
reproduction system has ever been referred to as a "hostile environment" by your
physician, these words may become branded in your psyche-- our body killing
rather than supporting life. This hits us at our very core. We may also be
mystified with the workings of our partner's body which is no longer seen as a
whole, normal, or perfect.
The experiences of infertility may severely test our belief in the justice of
life, perhaps even our faith in God. Why did this happen to me? Why do bad
things happen to good people? Who can I blame?
Perhaps the most wrenching part of the experiences an anticipatory, and often
unrecognized, sense of grief and mourning over the death of our unborn child,
the death of possibility to extend our blood line. This may haunt us like a
presence we sense is hovering nearby, but, when we turn to look, is gone.
Inner life-maps and scripts concerning adulthood, parenting, and family are
threatened with extinction. Inner scripts about masculinity are undone. If the
infertility problem is due to a male factor, the man may feel wounded, impotent,
small, unmanly, and unable to adequately care for his partner. Guilt and shame
can drive him inwards. Even if a male factor is not responsible, he may witness
his wife undergoing invasive, dehumanizing procedures, taking medications with
frightening side effects and possible long-term consequences, and find himself
unable to do or say the right thing. Perhaps his partner has withdrawn into her
own world, seemingly never to be right again. He feels abandoned, angry and
confused on one hand, wanting to make it all better on the other hand. He may be
scared of his own wishes to run and hide and be afraid if appearing weak or
"breaking down". If he feels ripped of and furious with his partner, guilt may
be not far behind. Anger can be so much easier to tolerate than fear and grief.
Ambivalence experienced around the decision to get married me be heightened
again. Why be married if we can't have children.
From the women's perspective, to see herself as the cause of the infertility can
be devastating, especially to the degree that motherhood--including becoming and
carrying a pregnancy-- is a defining characteristic for her of successful
womanhood. She may find herself intensely envious, jealous, and angry at women
who are pregnant or have children. Such reactions can feel alien and disturbing.
Bitterness raises its head. She may strike out at the person nearest to her--her
If the infertility is due to a male factor, the woman may be quite openly and/or
shamefully angry and resentful at her husband's inability to provide this one
thing for her. Or she may be puzzled and impatient with her husband's difficulty
moving on to some other alternative. Her husband's unexpressed grief feels like
a weight around her neck. She wants to move on and wants to feel supported by
her partner in doing so.
Instead, the situation mimics that of two rowers in a boat, rowing out of sync
with one another. Needless to say, a couple's ability to carry on as a couple
can be severely tested, sometimes to the breaking point. Distance eclipses
closeness. The relationship itself may feel barren and bereft.
The sheer amount of information, options, choices, and procedural details can
seem overwhelming. If adoption is entertained, that too brings its own overload
of possibilities, uncertainties, and the potential for financial depletion.
To summarize, we feel possessed. Our bodies and intimate functions are no longer
our own. Our emotions may feel out of or close to being out of control. We may
lose our usual get up and go and enthusiasm for life. Depression can set in.
Cynicism replaces optimism, and, in a self-protective way, we no longer allow
ourselves to hope for success. Into this vortex of powerful emotions steps our
OB/GYN doctor, reproductive endocrinologist, or infertility specialist. As with
many illnesses or chronic conditions, we sometimes find ourselves in a
child-like, trusting state, reminiscent of a time when our parents could make it
better with a hug, a touch, a hot bow1 of soup. All too often, however, the
diagnostic and treatment procedures are objectionable, completely painful,
expensive, and down-riqht inconvenient. Injections have to be self-administered
or administered by a spouse. Medications can be quite powerful in their effects
on both body and mood. We so much want our physician to guarantee and reassure
us, but they are only human and have to protect and soften for themselves the
impact of the torrent of feelings experienced by their patients. In fact,
physicians can appear and act unfeelingly as they focus on what they know
best--physiology and treatment. I have heard several women angrily relate how
their doctor consistently would underestimate the amount of pain and discomfort
they would experience during or after a procedure. They would then be left
wondering what was the matter with them should they experience significant pain
Organizational and bureaucratic realities, as well as personal insensitivity, do
not help. I remember my wife telling me how close to homicide she came when, on
the day of an insemination, she was stopped at the door by someone from the
financial office because of a $30 balance which she was told she'd have to pay
first! Many a time we felt that our veneer of politeness and civility was worn
down to the grain. Feelings of powerlessness can feed on themselves. Feeling
like a supplicant, a beggar, a child who will do anything, put up with anything,
for the chance of a pregnancy, you may find yourself accepting whatever
treatment (medical and non-medical) is given. You may notice a war within
between the side of you that wants not to make waves or offend the powers that
be, and the side of you that feels demanding, entitled, and constantly on the
brink of erupting.
While reflecting on the words I have written, I find it necessary to reassure
you that, if you are not experiencing many or all the things I've been
describing, it certainly doesn't mean there's something wrong with you. I have
purposely drawn the portrait darkly in order to legitimize a wide range of
possible reactions to this crisis. You're supposed to feel lousy! I believe that
bringing these feelings into the light of day, and, especially, sharing them
with someone who can understand, can lessen the burden and sense of isolation to
some degree. This, in turn, can allow for the emergence of coping resources.
So what are some of the ways we can make this trying experience more bearable?
How can we counter some of the negative effects of stress ,on our self-esteem,
our body, our mood, and our relationships? Rather than compiling a comprehensive
list of coping strategies (Several good ones are already available through
RESOLVE.) I will describe some of the things which helped me and my marriage
survive approximately l 1/2 years of fairly aggressive infertility treatment
(mostly IVF and GIFT).
Early on, I tried to gather and digest a lot of information about infertility
procedures. If only I could conceptually sort out and understand some of the
issues involved and the probabilities of success for different procedures, then
I could "solve" things rationally and logically. While not unimportant, this
strategy was, in part, a way for me not to deal with some frightening, feelings
and scenarios concerning my wife's infertility. This information based approach
did not help me deal with my wife's depression over her feelings of failure as a
woman. Information and probabilities did not touch the core of her pain, nor did
they touch the turmoil I was experiencing.
For me to be able to sit with the depth of her feelings, it was necessary for me
to be able to sit with mine. What became absolutely critical for me was to have
one friend with whom I could think the unthinkable, feel what was intolerable,
and speak the unmentionable. This friend did not try to fix it, solve it, or
talk me out of anything. Talking allowed me to be conscious of and deal with
what could otherwise have gone underground, remained a secret, and became quite
destructive. When I could talk to my friend about how angry and disappointed I
sometimes felt with my wife, I didn't have the same need to express those
feelings to her in as raw and intense a way. It was also true that my wife and I
were able to talk quite a lot with one another. We could share how disturbing it
was to see pregnant women and doting parents. We unashamedly reveled in more
black and sadistic humor than I new we were capable of. We often felt very
anti-social. We could listen to each other's pain and not infrequently aimed it
at one another. I learned (again) that her ways of handling emotional pain and
stress were not the same as mine.
So between having both a good friend as well as a partner with whom I could
communicate, I was able to prevent some very dark feelings from turning into an
emotional abscess which would just fester. It was helpful for both of us that I
take on some of the infertility treatment duties rather than only be a
bystander, even though my administering some of the injections and making calls
to the clinic seemed minor compared to a11 she had to go through. It decreased
my wife's feelings of aloneness and some of my guilt over how easy, at least
physically, it was for me.
Despite infertility treatment dictating many of our lives scheduling decisions
and diminishing spontaneity, it was very important for us to take some vacation
time--even if it was only an overnight or to somewhere sufficiently removed from
our everyday life. I can not overstate the importance of taking a short break
from the relentlessness of life-as-usual-with-infertility; otherwise, you can
end up feeling constantly under siege, with the wagons always circled around
you. You often can't eliminate a stressor, but at least you can take a break
During the time I was still hoping for the infertility treatments to be
successful, I was unable to seriously think about or consider adoption; however,
as the months passed, I realized that, if I wanted to have the experience of
being a father, I would have to face head on to my negative feelings about
adoption. What helped me do this was talking just once with the therapist my
wife and I had seen before getting married. He happened to be an adoptive parent
himself, so I knew I'd be speaking with someone I trusted who had had first-hand
experience with some of these issues. Before speaking with him, several parents
had stressed the essence of parenthood was not so much the biological connection
as it was the day in and day out feeding, changing, dressing, and loving this
young being. All this was reassuring to hear, but it did not seem to be enough.
Speaking with my therapist did suggest a new and crucial perspective on
adoption. This perspective helped to loosen the grip of a mindset that often
occurs towards one's biological offspring whereby, because a child is
genetically linked to us, he or she will look like, act like, and, of course, be
like us in some crucial ways. For adoption to work for me. I would have to be
able to place a premium on and appreciate difference rather than sameness. Oddly
enough, thinking about it this way was a big relief--a lifting of expectation--
as well as a challenge to appreciate and love what would be unique about an
adopted child. I realize that my relief was due to my feeling that I had never
really fulfilled my father's expectations of me to be more like him. And so,
perhaps I could escape repeating the same pattern with my child.
So when my wife finally stated that she could not tolerate another cycle of
drugs, injections, surgery, and disappointment, I too was ready to stop. There
was another door I could try. We both new it would take some time to mourn and
to change gears, and that we would not end up dead in the water. Of course,
appreciating otherness and difference does not have to wait for the appearance
of an adopted child. We can practice it every day with our partner who,
undoubtedly, will have their own unique way of approaching these questions.
Looking back, I can see that muddling through a crisis has a flow and a rhythm
that's different for each person and each couple. What may be out of the
question at one point in time can be considered at another. It's a testimony to
our ability to adapt to adversity that allows for this flexibility.
Being true to yourself and staying connected to your partner both take hard
work. It may not be the kind of work you've been used to or comfortable with,
but it's work nonetheless. And there are many ways to facilitate doing the
individual and couple work that will help you negotiate this crisis. Turning to
a close friend, joining a support group, and making use of a therapist
knowledgeable about infertility are all avenues that have their place.
Reflecting on my experiences over this year and a half brought to mind a
principle that I had known in a more ademic way from my study, as a
psychologist, of human stress. There exists a well documented relationship
between an individual's sense of being isolated and their level of chronic
stress and illness. So if you don't have any place where you feel safe enough to
show who you really are and any person with whom you can really be yourself,
then you will probably find your experience of the infertility crisis to be more
stressful than it need be.
In Chinese, the symbol for crisis is comprised of two characters--one for danger
and one for opportunity. Infertility is certainly a crisis that confronts us
with dangers, some of which I hope I have been able to describe in this paper. A
crisis can bring out the worst in you, and it can magnify the conflicts which
exist in every relationship. And yet, there are also opportunities and room for
growth, for doing things a new way. This crisis can push you to build on
strengths you always had but, perhaps, didn't realize, and it can stretch you to
discover and create new ways of relating to your partner; but, you may first
have to pass through the crucible of your pain and confusion.