FACING THE CHALLENGE OF INFERTILITY
by Andrew Geller, Ph. D.
51 Circuit Ave.
Newton, MA 02161
617-332-1072

 

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 husband.

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 and discomfort.

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 from it.

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.