Wednesday, February 23, 2011

Infertility: "His" and "Hers"?

Much of the research on reactions of individuals to infertility divides along gender lines. Women often are portrayed as more likely than men to reach out for social support and to use certain escape or avoidance strategies (wishing, hoping, fantasizing and social avoidance). Men, on the other hand, are seen as more likely to distance themselves emotionally by focusing their attention on other issues, carefully regulating their emotions, and viewing infertility as a series of problems that need to be solved. Actually, all of these reactions are developed in an effort to protect yourselves against the emotional dangers of the infertility experience. In their own ways, both males and females are striving for feelings of mastery, as well as searching for opportunities to distract themselves from the inevitable painful realities of their infertility. So what might this mean for you in your relationship with your partner?

I would suggest that one way couples can join together more supportively is to have conversations about how infertility is affecting them, both individually and as a couple. This will prevent falling into the common trap of complaining that “H/She doesn’t understand what I’m going through!” Furthermore, as you and your partner are sharing your separate perceptions of how infertility is affecting you, each of you can use that time to express how you hope your partner could be supportive and comforting. As you have this conversation, it is important to fully concentrate on what your partner is expressing, and to ask for clarification whenever you need to. By the way, I wouldn’t overdo these conversations; once or twice a week for 30 or 40 minutes should be enough time to feel as if both of you are staying connected emotionally. And be sure not to have these conversations in the bedroom – that is a place that should be saved for sexual pleasure and sleep, not associated with sadness and problem solving.

While I’m on the subjects of sadness and problem solving, let me encourage both of you to admit together that sadness is probably an inevitable response to many aspects of infertility: unclear diagnoses, failed treatments, pregnancy losses, dwindling finances, and diminished self esteem. It is important not to discount this sadness for yourself or for your partner; rather, this is the time to ask for support and to ask your partner what you can do to offer comfort. Even though you may not share the same sadness at the same time as your partner, or even the same hopes for comfort, being able to be emotionally responsive to one another is the challenge you are both hoping to embrace. And as for problem solving, which can be initially discouraging, if you can share this time consuming and emotional load, you may find yourselves feeling even more united in your efforts to be resilient against the challenges that infertility poses in your lives. In my book When You’re Not Expecting: An Infertility Survival Guide, I offer a wide range of examples of how couples I have counseled come together emotionally to face the hurdles that infertility has thrown into their path.

Inevitably you and your partner will need to make decisions, whether about treatment options, alternative paths to parenthood, financial planning, or keeping your relationship resilient at each new stage of your infertility journey. Just as earlier you may have had different perceptions about how you responded emotionally to some of the infertility challenges you faced, here too you may find significant differences in your readiness to make decisions or in the outcomes you are valuing. And, here again is my encouragement to share your perceptions about what is important to you now, and then listen very carefully to your partner about where s/he is in being ready to contemplate some decisions. If you hit an impasse, it may be a good idea to invite a trusted third person to help both of you to sort out your differences, clarify your priorities or assess what issues are most compelling right now. What is important is that you as a couple are committed to communicating as openly as possible, to respecting each other’s right to think differently about your infertility, and to seeking resources when you feel “stuck,” either emotionally or practically.

And, remember too, that even as infertility may hover over you like an unwelcome cloud, you both need to seek respite from that cloud. So on your “to do” list, be sure to include hobbies, time with friends, weekend getaways, and other fun experiences to reinvigorate you emotionally and reinforce your commitment to being together, even through the unknowns that your future may hold.

Monday, February 14, 2011

Couples with Infertility: Nourishing Your Love

Valentine's Day is a special day in the lives of most couples. But what happens after the cards have been opened, the chocolates consumed and the flowers begin to wilt? Every couple faces the challenge of how to keep that spirit of love alive after February 14, and couples with infertility experience unique challenges. Fortunately there are lots of creative ways to re-ignite and nourish those loving feelings 365 days of the year!

Let's begin with the "hectic" challenge. Everyone knows the feeling of having too many things to do and not enough time, but if grappling with infertility is one of those "things," you know the frustrations: scheduling doctors' appointments, balancing responsibilities with c0-workers, balancing the homefront responsibilities with your partner, fitting in fun with friends and enjoyable hobbies, as well as trying to think a few months ahead to see whether a vacation is going to conflict with your treatment schedule. So, with these multiple balancing acts, how do you and your partner find time to focus on your love for each other? Chances are you have fond memories of earlier times in your lives before infertility crowded your psyches and your calendars.

So, with Valentine's Day so close in your awareness, perhaps this is a good time to talk about consciously re-igniting those fond, but distant memories. If both of you share the commitment to bring back into your lives some of the kindnesses that kept your love well-nourished, then you can decide together how to do it again. Some of this will take time, like planning a trip, planting a garden, exploring nearby communities, hiking in the woods, taking a class or undertaking a new hobby. But with two of you, it will take less time, and anticipation can be half the fun! Other nourishing efforts may require conscious effort, but they take no time at all: a good morning kiss, a 15 minute walk together after work, a long hug after dinner, telling jokes or humorous anecdotes, cuddling on the couch while watching TV...the opportunities are only limited by your imaginations!

And while we're on the subject of "hectic," and hugs and kisses, did I mention sex? You know, not the preoccupation-with-babymaking sex, but rather the steamy, spontaneous, joyful sex that was so much a part of your pre-infertility days. I know that once sex becomes associated with conceiving, spontaneity can go down the tubes. And even if you know the only way a pregnancy will occur for you is through medical technology, the tension of infertility can take its toll on your libido. But if you once shared a passion for sex, there are all sorts of ways you can bring this passion back into your lives once you decide to talk about it.

So here are some things that can be a part of that conversation. If you find yourselves too exhausted at bedtime to do more than fall into bed, then you need to find other times of the day when your energy level lends itself to making love. How about a small snack before dinner, topped off with some fun in the bedroom? Or how about having dinner wearing some skimpy undergarments, and leaving the dishes to soak in the sink while you enjoy some after-dinner lovemaking? Or how about going to bed an hour early a couple of times a week, so you can kindle some of the romance with the help of low lights and music? You can use your imaginations to add to my suggestions, once you agree that re-igniting your passion is something you want to try. And each of you can make the effort to initiate your lovemaking in creative ways, so that it is both fun and surprising.

And, in spite of my examples, don't restrict yourself to the bedroom! Creativity may take you to other parts of your living quarters, just for the fun it it! But if you DO plan to enjoy yourselves in the bedroom, please keep in mind some important reminders. Lovemakling in the bedroom is greatly enhanced if you save the bedroom for sleep and for sex. No computers, no food, no TV, no talk about infertility, no reminders of anything except the passion and the relaxation that help to re-charge your relationship.

And, although I seem to be waxing and waning on the topic of re-igniting your sexual passions, let me also say that I fully understand many couples grappling with infertility find themselves shying away from intercourse. That may be because for so long intercourse has been associated with babymaking, rather than with passion. Or it may be that incidents of producing semen samples on demand have interfered with feeling aroused on other occasions. So the take-away message is that passion and love can be expressed in many ways, and intercourse does not need to be an outcome (except, of course, when ovulation is occurring!). So you and your partner should feel fully creative in the ways you express your love as well as your passion, with the emphasis being on mutual pleasure rather than intercourse or even orgasm.

As Valentine's Day, 2011 recedes in our memories, I hope that some of the ideas in this blog will stimulate you and your partner to nourish your love together in as many ways as you can imagine!

Monday, February 7, 2011

Infertility and Stress: Could Yoga be the Answer?

Yoga is enjoying a broader audience as "yoga for fertility" classes are appearing in various metropolitan areas. Described by some as a support group in motion, these yoga classes draw together women who hope to learn skills that will take their minds off the tension of infertility and reduce their anxiety. In addition, these classes provide the added opportunity to share confidences informally with their yoga-mates. But does yoga increase pregnancy rates in infertile women?

An article in the February 6th Sunday Styles section of the New York Times provides some useful information about these classes, which are called the latest in a succession of holistic approaches to fertility treatment, including acupuncture, mind-body programs, massage, and Chinese herbs. In that list, only mind-body programs have generated research data demonstrating effectiveness. No one leading yoga classes makes claims about increasing conception rates. So what draws women to these classes?

It seems to be several things: The opportunity to learn relaxation skills is a relief for many women who carry a load of anxiety over the uncertainty of whether they will ever become parents. For women who have been reluctant to confide in others, the yoga classes provide a natural gathering where infertility is the common bond in a group whose members fully empathize with each other. And for those women whose doctors have told them to avoid strenuous exercise, especially while they are taking drugs that stimulate their ovaries, yoga enables them to feel that they still can stay lithe and limber.

So, even though there's no evidence to show that yoga classes for infertile women increase rates of conception, there are other rewards that may be highly appealing. Unlike formal support groups, the yoga focus is not on group discussion of infertility issues. Instead, all participants can come together for yoga, share (or not) whatever infertility information feels relevant that day, take away coping strategies learned from their classmates, and feel physically reinvigorated. For many, yoga helps to quiet the infertility chatter in their brains, diminishing the negative messages in this chatter that fuel their feelings of being desperate or hopeless. By learning yoga poses, women force themselves to concentrate and to put their minds and bodies in a good place. And being in the company of others who share the unique condition of infertility, women can develop empathic bonds in what can be a lonely journey.

Dr. Alice Domar, one of the first researchers to advocate stress reduction in infertility treatment, has conducted much of the research demonstrating that mind-body programs can be an important and successful adjunct to medical treatment for infertility. Whether through meditation, deep breathing exercises, bodily relaxation, visualization or other strategies, it appears that de-stressing is therapeutic on many levels for women with infertility. So perhaps the take away message is: even if yoga has not been found to increase conception, are there aspects of a yoga fertility class that might work for you? Might you make new friends? Learn new coping strategies? Quiet your negative brain chatter? Find ways to tone your body when your doctor discourages vigorous exercise? Distract yourself from your infertility preoccupations?

Only you can decide whether this new "resource" for infertile women is something to investigate. But if you're intrigued, give it a try!