Monday, February 22, 2010

The Many Faces of Infertility

Too often infertility is thought of as an "invisible disability." This is because couples, at least initially, often are reluctant to divulge an infertility diagnosis. To those individuals and couples, infertility may represent failure, it may feel like an insult to their sexuality, it definitely feels daunting with its uncertain outcome, and for most people it is their first time on this new journey and they're not sure how they feel about sharing this part of themselves with others in their lives. My next several blogs will depict the many faces of infertility: "coming out," secondary infertility, social factor infertility, pregnancy loss, prenatal diagnosis issues, and deciding when "enough is enough." For today, I want to feature a well known face, Celine Dion. She was recently featured on Oprah and in People Magazine, as she spoke of her infertility experiences over the years.

As I looked at the photo of Celine Dion on the cover of the Feb 22 People Magazine, I was heartened to see a much-admired person openly proclaiming infertility as an ongoing issue in her life. Clearly with the financial means to seek the very best treatment, she also takes a deep breath as she says, "It's not 'Oh, poor Celine,' but it's a lot." I found myself thinking how much I appreciate her public "coming out" as she faces the many lost hopes and disappointments of this current infertility experience that no amount of money can soften.

Celine's hope for children is undoubtedly rooted in her own family, where she grew up with 13 siblings. Her one child with 68 year old husband Angelil, is nine year old son, R.C.,who was conceived on her first IVF attempt. Now, after four recent IVF attempts, she is planning for a fifth. But she and her husband, unlike many couples with infertility, have the comfort of a birthchild in their lives, which enables her to say quite convincingly..."One way or another we're going to be good." And in her sensitivity to R.C., who is well aware of his mother's IVF attempts, she says "But honestly I'm more than blessed with my son. He is everything for me."

So this very public figure is depicting for all of us in a very public way the various balancing acts that infertility plops into our laps: how/when to disclose and how much to disclose; the emotional and physical challenge of ongoing treatments; the sadness as those treatments don't result in a healthy pregnancy; and the juggling act of career and treatment.

How familiar do these quotes sound and feel? "We go crazy waiting for the results" (Angelil speaking ); "sometimes Dion cries for no reason at all;" "The hormones that help make a pregnancy possible also bring a tidal wave of emotions;" This month's publicity certainly puts a public face on what often is regarded as a fairly private matter.

With that in mind, stay tuned, as I explore in future blogs the faces of infertility that we often don't think of when that word is added to our vocabulary. We may not have celebrity faces to add to each example, but each reader knows this expanding vocabulary all too well.

Thursday, February 11, 2010

Can Steamy Sex and Infertility Go Hand-In-Hand?

Some readers may wonder how I came to devote an entire chapter of my book When You're Not Expecting to the topic of the sex lives of couples with infertility. My answer would have to be that, among the hundreds of couples I have counseled about issues affected by their infertility, well over 90 percent identify their sexual relationship.

And this is now backed up by research just posted on an e-mail of RESOLVE to its members today: "A study conducted at Duke University Medical Center, and presented at the American Society of Reproductive Medicine by Dr. Jennifer Norten examined 'sexual satisfaction and functioning in patients seeking infertility treatment.' The results of this study suggest that women undergoing infertility treatment experience significant changes in various aspects of sexual desire, arousal, orgasm, length of foreplay and frequency of intercourse."

For both male and female readers who have been diagnosed with infertility, this will come as no surprise, although it may be something of a relief to know that you are not alone. As my blog earlier in this week preceding Valentine's Day indicates, scheduling sexual intercourse to coincide with ovulation can take a real toll on spontaneous lovemaking! So, what to do? To be truthful, most of these ideas have come from my clients over the years, as they tried to put the zing back into their sex lives. So read along, and see whether any of these can counter the image of your infertility specialist perched on your bedpost:

  • Make a real effort to save the bedroom for lovemaking and for sleeping -- no reading, no computer, no TV, no Blackberry, no eating, and especially no talking about problems, including infertility. If you have distractions or unpleasant associaltions with what you do in the bedroom, it will be harder to associate that room with sexuality, with intimacy, with desire and with emotional closeness.

  • Before even coming into the bedroom, talk to your partner about the changes in your sexual intimacy since you began trying to conceive. Use these converations as a way of blaming infertility for any lack of sexual spontaneity. Affirm how erotic you still find your partner; how much your cherish the closeness, comfort and joy of good sex, and how you want to think of ways to recapture and reinvigorate your love life.

  • Once you are openly communicating about your wish to welcome lovemaking, as contrasted with scheduled sex, back into your lives, see if you can pinpoint the deterrents and figure out how to work around them.

  • Be kind to yourselves. Start out slowly, celebate small sexual pleasures, and don't be deterred by inevitable missteps and disappointments. Keep the lines of communication open so you stay on the same page about what brings you joy and what you need to rethink. Be sure to give positive feedback to each other.

  • Experiment with new sexual strategies. Take turns initiating sex, rent DVDs, read books, wear some sexy clothing -- and remember that this is not a scientific experiment! Laugh, be tender, be goofy, be loving. There's always time to create sexual closeness.

  • And remember: no pressure! Sexual expression needn't involve intercourse if this reminds you too much of scheduled baby making. You can even forget orgasms if you're not in the mood. Kissing, licking, caressing, snuggling, touching -- the number of ways you can pleasure one another to reaffirm your sexual joy is endless. Don't wait!

Monday, February 8, 2010

Intimacy for Infertile Couples: Lovemaking or Baby Making?

As Valentine's Day approaches, my thoughts focus in unique directions, given my experience as a therapist working exclusively with infertile clients. Couples who have difficulty conceiving or carrying a pregnancy to a healthy birth often find themselves shifting their love making to "baby making." This shift tends to be gradual, and it builds on a foundation of increasing disappointment and sadness as, month by month, the woman's menstrual period begins just at the time she had hoped for a positive pregnancy test. Or, if a positive pregnancy test is followed by a pregnancy loss, the sadness becomes active grief as hope for this baby vanishes and, once again, efforts to conceive are the focus of the couple's life.

So, with my pre-Valentine's Day postings, I hope to resonate with infertile individuals and couples, as well as to sensitize those readers who may have loved ones who are trying to conceive. Today, I will focus on the impact "baby making" can have on one's love life. Subsequent blogs this week will address how to bring some zing back into your love life (clearly this can apply to all couples, not just those who struggle with infertility!).

The infertile couples whom I counsel are often somewhat shocked when, in our very first meeting, I work in a question about their love making. Yet this provides a perfect opportunity for me to share with them that well over 90 percent of my clients are clear that their infertility has interrupted their pleasure in love making. We can then begin to talk further about their preoccupation with creating a pregnancy, rather than enjoying sexual closeness and arousal as a way of heightening their emotional intimacy.

Sometimes it is the diagnosis of infertility that casts the initial shadow on a couple's love life. A low sperm count can cause a guy to believe he is "less masculine," and if he understands himself to be the cause of the couple's incapacity to conceive, he may struggle with his own image of himself as a desirable sexual partner. In addition, even if his sperm health is not identified as a cause for concern, the man will be less than enthusiastic about having sex on schedule or producing semen on demand for use by an infertility specialist in medical procedures. A diagnosis that identifies the woman as the source of the couple's infertility may very well cause her to think of herself as barren or guilty (perhaps because of having waited so many years to begin trying to become pregnant, or because of a decision earlier in her life to terminate an unplanned pregnancy).

For many couples diagnosed as infertile, this emphasis on conceiving begins with a focus on timing intercourse to coincide with ovulation. Whether it is simply a conscious effort to have intercourse around the time of the month when the woman is ovulating, whether it involves the use of ovulation kits to identify when ovulation occurs, or whether a physician is involved in timing medical intervention with ovulation, there is no question that the couple's attention to conceiving is heightened and focused to the few days each month that the woman stands a chance of conceiving. So what does this do to one's love life the other days of the month? In the words of one couple I quote in my upcoming book, When You're Not Expecting, "Once we began a formal infertility workup, it was as if the doctor was right there in bed with us. Somehow, sex became a very medical thing, and in the process of timing our intercourse, we pretty much let go of being spontaneous."

So, now that we can see "baby making" as an expectable shift in the sexual intimacy of individuals diagnosed with infertility, stay tuned for my next blog on putting the zing back into your love life!