Friday, July 16, 2010

A Vacation from Infertility?

In my large library of books on infertility, I could find only one with "vacation" in the index. And, no surprise, that book ("When You're Not Expecting") was written by me! In today's blog I'll offer my thoughts on why a vacation from infertility can be such an important and challenging issue to consider.

The very word "vacation" tends to elicit memories from our earlier lives of restful and restorative times that we have tucked away, simply because they have been memorable in such a positive way. And then all of us have memories, perhaps better forgotten, of vacations filled with stress, mishaps, unmet expectations, and other disappointments. So we begin this blog already aware that the word "vacation" can be a double-edged sword.

On one edge of the sword are the lost vacations. These are the vacations never taken because you need to use your savings for infertility treatment or costs associated with adoption or surrogacy. Or these are the vacations never taken because you need to be close to home for clinic visits and treatments. Or these are the vacations not taken because the family members who would join you all have infants, toddlers and pregnant relatives in their midst. And that would be a lost vacation from your perspective.

So how about the other edge? Is there an alternative to lost vacations?
We need first to consider whether we are talking about a vacation or a vacation from infertility. If we're talking about a vacation, you and your partner need to make time in your crowded lives to decide how to avoid the lost vacation syndrome. One strategy could be to plan an inexpensive vacation (think close to home, bed and breakfasts, camping, new experiences big on spontaneity but low in cost). Another strategy might be to see whether a clinic in the vicinity of your destination could administer straightforward tests and procedures. And still another strategy would be to break the news gently to your family that you and your partner are taking a vacation this year where reminders of your infertility are at a minimum -- much as you love tiny nieces, nephews, pregnant sisters and doting grandparents, you and your partner need some vacation time to restore your own emotional energy.

And it is this issue of restoring your emotional energy that is actually behind the concept of an infertility vacation. This vacation probably will not be on the beach or in some yet-unexplored new environment (although it could be). An infertility vacation is a choice made by couples who feel their lives have been so consumed by their infertility that they have lost sight of themselves in the process. They decide to take several months off from treatment, not to touch adoption applications, not to investigate surrogate possibilities, and not to time intercourse with fertile times of the month.

So why would one come to the point of considering such a vacation? Well, I suspect I really don't need to elaborate on the obvious for most of my readers who are infertile, but in the spirit of hoping that loved ones and health care providers may be reading too, I'll elaborate briefly. Being infertile can consume your life: your schedule is no longer your own (in my book, one chapter is subtitled "When Life is on Hold"), you are constantly facing decisions that relate to your diagnosis or treatment, you may feel as though you are stuck too long in a particular treatment regimen, side effects from treatment (which can include weight gain and mood swings) are debilitating and, to top it off, your sex life is suffering. Who wouldn't need a vacation from this?

Well, yes, but an infertility vacation also means losing valuable months of treatment and medical continuity. Depending on your age, you may be feeling as if each month is a precious opportunity not to be wasted. So now the question becomes whether taking a few months away from infertility might enable you and your partner to rejuvenate your relationship, to see how it feels to be a family of two indulging yourselves with more spare time, more flexible schedules and more focus on restoring your own resilience. This is not a vacation meant for decision-making, but the mental and physical rest from treatment may give you enough new perspective after a few months that you are ready to begin facing new options, new decisions and new support systems.

Dr. Seuss, author of "Oh, The Places You'll Go!" has identified The Waiting Place as one detour that both children and adults face during their travels through life. Individuals with infertility will identify with Seuss's depiction of this involuntary life pause, as well as his assurance that life can move forward in new ways after a wretched waiting period.

So, in the spirit of encouraging you to appreciate that both vacations and involuntary waiting involve double edged swords, I hope you will take time to consider how several months of an infertility vacation might offer an opportunity to open your sensibilities and awareness to new ways of thinking about your life.

And, while I'm on the topic of vacations, I will be taking one of my own for the next month: no computer, no academic reading, but hopefully some time for rest and relaxation. I look forward to resuming my blog and reconnecting with faithful and new readers in mid August.

Tuesday, July 6, 2010

Infertile? Feeling Left out of "The Club?"

Infertility has many dimensions, and the longer you are infertile the more dimensions you are likely to explore. One of the more challenging is how to handle relationships with good friends who have become pregnant or who are new parents. These women, often very preoccupied with how to anticipate or to juggle the new role of motherhood, seem to attract one another like magnets. Whether through childbirth prep classes, La Leche meetings, playgroups, or just the coincidence of several acquaintances becoming pregnant within months of one another, these women often bond together to form what I refer to in my book as "The Club." Happily (or apprehensively) counting the months until their due dates, new Club members seek out more experienced ones for advice on everything imaginable. All very well, unless you, grappling with infertility, are on the outside looking in.

The first sign of discomfort with Club members may come in an ob-gyn's waiting room. There the literature tends to focus on pregnancy and early parenting. Nothing on infertility. And the conversation tends to focus on pregnancy, nursing, labor and delivery apprehensions. Nothing on pregnancy loss, IVF or adoption. In other words, women with infertility feel in the minority, feel silenced, and feel hurt in the presence of talkative Club members.

In the early 1980's, Helen Hooven Santmyer finished 50 years of writing ...And Ladies of the Club. This 1,334 page novel refers to a small Midwestern town literary club whose members are involved from 1868-1932 in their town's political, cultural and social changes. The author, a determined individual, was in her 80's before giving birth to this book, which subsequently remained for weeks on the New York Times best seller list. So why do I think of Ms. Santmyer as I write this blog?

Well, let's see. She hung in there, as many women with infertility do, hoping that her efforts to produce might ultimately meet with success. She appreciated the support system that women can offer to one another, even as political and social change efforts pre-1932 were couched in the context of a literary club. She poignantly portrayed lifelong friendships, as well as the tensions and difficulties that threatened them. And she depicted women who, for whatever reasons, departed from the Club or never were included in it.

So, although that book is not directly about clubs of fertile women, it is about women supporting other women, juggling roles, sustaining friendships and meeting life challenges head on. And Club non-membership is, both in the Santmyer book and in the lives of women with infertility today,one of the challenges for which there are few road maps.

Non-membership tends to be an issue only for those women not in The Club. Club members assume that their doors are wide open to women who are pregnant; they just don't realize how stifling it can feel to be frozen out of a conversation because you have no reproductive stories to contribute. Or maybe you do, but who wants to hear about a chemical pregnancy, a miscarriage or hormone shots?

So how can women avoid the hurt of being sidelined from the Club because of infertility? If we assume the hurt is caused by unintended insensitive behavior, one strategy is to take your pregnant and parenting friends and co-workers into your confidence. Or, if you don't want to do this, see whether a close friend will pass along whatever details you are willing to share, along with hints of ways others could demonstrate their support. This could include not shouting new pregnancies from the rooftop, not waving sonogram pictures every which-way, not making a big deal about new maternity clothes and swollen ankles, and not expecting your presence (or presents) at baby showers.

Another strategy may be to distance yourself from some Club members, especially those who are unable to contain their pregnancy or parenting excitement and enthusiasm. In their place you can tighten your relationships with empathic friends and make friends with empty-nesters or women who are not setting their sights on motherhood. You may also find that an infertility support group offers the kind of Club membership that you need right now.

Some individuals will benefit from a direct approach. These are the folks who don't "get it" when the grapevine spreads word of your infertility, but who are capable of changing their behaviors if told specifically what they can do to help you feel better supported.

And then there will always be a few people who are so focused on their own needs that they have no plan to consider yours. These folks won't miss you when you close the door on your relationship. Unless they're family members, in which case things get more complex. Under those circumstances you can try the direct approach of speaking about what you need from them; you can write a letter emphasizing your expectation that they will take your needs into consideration; or, as a last resort, you can engage someone else in the family to run interference for you. Whichever route you choose, the takeaway message is that you deserve to protect yourself from selfish and manipulative behavior.

So, even though the subtitle of my Club book chapter is "on the outside looking in," this blog is less about being envious than it is about being articulate. Don't be shy about telling others what they can do to help you feel supported. Be clear about behaviors that are hurtful. Enlist your friends to help with this if it feels too overwhelming. And remember that new friends can be found in many places where the topics of pregnancy and parenting are not on anyone's tongues.

Thursday, July 1, 2010

You're Infertile and Your Friend is Pregnant -- How to Cope?

The emotional challenges of infertility increase whenever your support network feels shaky. And, for many of us, either because we have been cautious about sharing news of our infertility, or because our network is fairly small to begin with, the news of a close friend's pregnancy can feel like an especially damaging lightening bolt. It may reverberate through your network, causing everyone to wonder how you're "handling it." It pushes your own buttons about how you can continue to be a good friend as you are aware of your own jealousy and envy. And it stimulates so many questions about your ongoing relationship (Can we remain friends? Can I count on her sensitivity? Will other friends forget about me and my feelings as they celebrate her pregnancy? Will I cringe as I look at her swelling abdomen? Will she be willing to talk with me about how our friendship can coexist with her motherhood?).

Of course so much depends on the history and the nature of your relationship. Let's consider a few scenarios:

This "friend" may actually be your sister or your cousin -- in other words, you go "way back," share many memories, have ongoing ties with other family members, and probably have some experience in ironing out rough spots that have developed in your relationship. But, for now, the uniqueness of this relationship is that she is plunk in the middle of your family. So it feels as if this pregnancy will echo and reverberate around the family system, with other relatives wondering how they can be sensitive to you and attentive to her news. Just keep in mind that if you and she can talk about this between yourselves and vow to be as emotionally open and clear as possible, other family members will take their cues from both of you.

This friend may be someone in your infertility network who, like you, has struggled with her reproductive health. If so, she will be apprehensive for months about whether this pregnancy is a healthy one, and her own anxieties about this may interfere with her capacity to focus on your ongoing infertility concerns. So your relationship with her will be complex: at the very time she may appear as a beacon of hope that pregnancy can happen to someone with infertility, she also will have her own worries about burdening you with her pregnancy concerns. So, the bottom line is that you and she will need to be as aware as possible, both of one another's needs, and of your own needs as you determine how or whether to lean on each other. It is possible that each of you will decide that certain topics are still good to share, whereas the strong shoulders of other friends are more suited for other topics. And, as her pregnancy continues, you will constantly need to revisit your relationship and how you can remain emotionally responsive to each other. Should she experience a pregnancy loss or some unexpected pregnancy complications, you both will learn still more about how resilient your relationship can (or cannot) become.

And then your friend may be "just" a friend. But friends come in many shapes and sizes, so you'll need to think about your shared history, how you have worked through past difficulties, her empathy as you've struggled and coped with infertility, and whether she has plenty of other friends with whom she can discuss her pregnancy and plans for motherhood. And, just as you will do with a sister, a cousin or a member of your infertility network, it will be easier to move forward in your relationship if you and she can be clear as possible about how to keep your communication open.

Although I began this blog with the assumption that your friend is pregnant, we should keep in mind that an impending adoption can bring about many of the same responses between you and your friend. If she is adopting, she may share your experience with infertility. Or she may be a single "mom-to-be" by choice. Or she may be a lesbian. Or she may have chosen adoption as a way to expand her family for a wide range of reasons. However, she is progressing along this adoption pathway with high hopes for motherhood, and it will be challenging for her to contain her excitement as she anticipates the arrival of her child. So you and she, as with any other pregnant friend, will need to be as open as possible about how to move forward in your friendship.

So, what are some of the topics that you and your friend are likely to need to discuss? Here are a few:

  • How do you feel about hearing about the details of her pregnancy? How does she feel if you would prefer she keep these details to herself? Does she have other friends with whom she can have these pregnancy discussions?

  • Is it difficult for you to be with her as her abdomen swells, as she wears maternity clothes, and as she looks increasingly pregnant? Can e-mails and phone conversations substitute for in-person lunches, coffees and walks in the woods?

  • Will it be painful for you to be included in/invited to her baby shower? If so, will she understand and be willing to help other friends and family members to be sensitive about your absence?

  • Is it likely you will be asked to be her baby's godmother? If so, you need to think this through carefully. To accept this new role will cause you to have feelings of obligation and responsibility that will guide your connections with this baby for many years.

  • If there is a christening, a baptism or a bris, will it be painful for you to attend? Will she be supportive of your decision and help other friends and family to support you in this choice?

  • After the baby is born, what sort of contact will be most comfortable for you? This may not be something you can know in advance, but you and your friend should keep all options open, which can include baby-less lunches/coffees/healthy walks as opportunities to spend time with your friend.

At any time during her pregnancy and early motherhood, both of you will want to check in with each other about whether there are things you need to revisit in your evolving relationship. Remember that this is a two way street and each of you wants to understand how to be as thoughtful as possible about the issues that arise, many of which will be unexpected (think of your baby-less times being interrupted by mutual friends descending to ask your friend about the baby, as they compare notes on their own pregnancies and new motherhood experiences. Those of you who have read the chapter entitled "The Club" in my book When You're Not Expecting, will understand this example all too well).

Another decision you may find yourself making, either during your friend's pregnancy or during her months of new motherhood, could have to do with expanding your own friendship network. It isn't to say that your friend will be less available to you (which certainly is very possible), but to emphasize the creativity you can use at this time. Not only may you need more friends without pregnancies or young children, but you also may want to find friends who can distract you from the challenges of your infertility. So, with that in mind, consider befriending individuals/couples who happily think of their lives as child-free, individuals/couples who are empty nesters, and individuals/couples who share interests or hobbies you would like to develop more fully.

A friend's pregnancy may arrive like a bolt from the blue, but once you've caught your breath you can use this new event as an opportunity to think more purposefully about what you need and can offer in a friendship. Remember to keep the emphasis on mutuality, on open communication and also on expanding your friendship network in new ways.