Friday, March 9, 2012

Eventual Moms-To-Be: Heads Up!

How many of us really know how our age affects our fertility? Judging from a recent study, we shouldn’t be bursting with confidence.

Sure, our doctors and ob-gyns have probably cautioned us in general about keeping healthy: avoiding too much weight gain, stopping smoking, being careful about STD’s and STI’s, getting exercise, eating nutritiously, preventing unplanned pregnancies – we all know the drill. But have any of those doctors asked us about the age at which we may decide to try to become pregnant? Not very likely and, if the question is raised, many of us would feel that we have plenty of time (and plenty of plans to pursue) before stopping birth control. And, frankly, our lives may have revolved for so many years around birth control of one kind or another that actually trying to become pregnant may feel like it is light years away.

But, should we look more carefully at those light years? A knowledgeable physician would offer a resounding “Yes!” And we, watching all the famous Hollywood new moms in their 40’s, may have been telling ourselves that we don’t need to be in any hurry. After all, many of us are looking and feeling younger than our chronological ages. And with exercise, help from a dermatologist or plastic surgeon, and careful use of makeup, we are pleased that we can slow the hands of time with a youthful appearance.

But, here’s the deal. Many of those Hollywood 40-something moms cuddling newborns have not shared the more private details of their efforts to conceive: hormone treatments, in vitro fertilization, use of donor eggs or donor embryos. And the couples who have used a surrogate to carry their baby/ies are so blissful at the healthy births that they focus on the bliss of parenthood rather than dwelling on the anxiety of finding and working with a surrogate. Few of those moms need to count their pennies the way most of us would need to do when seeking help with our infertility (which is covered by health insurance in only a small number of states).

And, then, there are some “eventual moms-to-be” who protect themselves against the emotional sadness of infertility by looking at adoption as another path to parenthood. But here again, being informed is important. There are very few healthy Caucasian babies available for adoption in the US, so prospective parents are being encouraged to consider children of color, sibling groups, special needs children and older children. As far as international adoptions go, some countries and agencies have restrictions on parental age, marital status and length of marriage, criminal history, health factors (including obesity), and/or work status (e.g. requiring one parent to be at home full time). So, attractive as domestic or international adoption may seem in the abstract, the specifics require patience and fortitude (which may be especially difficult as we grow older without yet having become a parent).

So what is the concern around women being uninformed about age and conception? A new fertility awareness survey’s results were presented at the American Society of Reproductive Medicine’s recent annual meeting. The poll of 1,000 women ages 25 to 35 who had talked to doctors about fertility found that fewer than 50 percent of participants could correctly answer seven out of ten basic questions. Women were wrong most often about how long it takes to get pregnant and about how much fertility declines at various ages. The facts? At age 30, a healthy woman has about a 20 percent chance of conceiving per month and by the time she reaches 40, her odds drop to about 5 percent. Yet the women surveyed thought that a 30 year old woman would have a 70 percent chance of conceiving and that a 40 year old’s chances could approach 60 percent! They also believed that a 20 year old woman might get pregnant in less than two months of unprotected sex, rather than the five months that is the average.

We are now suffering the effects of not being proactive about understanding our bodies and the way age affects our reproductive capacities. Many fertility specialists bemoan the fact that many women seek their services only when they reach age 40, by which time the biological clock will be ticking very loudly and their reproductive options are increasingly limited.

With infertility as a condition that affects some 7.3 million women in the US (this is 12 percent of the population of child-bearing age) or about one in eight couples, understanding the fertility facts of Bio 101 is important for all couples. Statistically all women should know that after age 35 their fertility plummets, their chances of genetic abnormalities in pregnancies rise, and the number of pregnancy losses increase. So the take away message for all women is to begin conversations with our ob-gyns no later than our late 20’s to be fully educated about any conditions we might have that could compromise our fertility (e.g. endometriosis, diabetes, hypertension, weight extremes, polycystic ovarian syndrome, irregular periods). Then that conversation should move in the direction of when (or whether) you might feel ready to consider parenthood. Better to educate yourself about your fertility early than to face the stunning news that conception will require expensive, time consuming, energy depleting and anxiety producing fertility treatment. Begin these conversations early!

Wednesday, February 8, 2012

Banishing your heartache on Valentine's Day

As Valentine’s Day approaches, my thoughts turn to people whose plans for indulging in an evening of love may feel uniquely challenged. I’m thinking of people with an ache in their hearts, with an aura of hopelessness, and with a distinctly non-passionate approach to Valentine’s Day. In short, I’m thinking of couples who are grappling with infertility.

Given my experience as a therapist working exclusively with infertile clients, I’m fairly familiar with individuals and couples who no longer feel passion as the overriding dimension when they slip between the sheets. Couples who have difficulty conceiving or carrying a pregnancy to a healthy birth often find themselves shifting their lovemaking 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. Of, 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 posting, I hope to resonate with infertile individuals and couples, as well as to sensitize readers who may have loved ones who are trying to conceive. Today I will focus on the impact of “baby making” and how to bring the “zing!” back into your love life. The infertile couples whom I counsel are usually 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 may 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, the 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 focuses on the few days each month that the woman stands a chance of conceiving. So what does that do to one’s love life the other days of the month? In the words of one couple I quote in my recent book “When You’re Not Expecting,” “Once we began a formal infertility workup, is 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, with Valentine’s Day as a possible catalyst, let me share with you the ideas my clients and I have discussed over the years to bring back the “zing” into their love life. As you read along, perhaps you can use some of these strategies to banish your physician from the 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 associations 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 conversations as a way of blaming infertility for any lack of sexual spontaneity. Affirm how erotic you still find your partner; how much you 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 love making, as contrasted with scheduled sex, back into your lives, see if you can pinpoint any deterrents and figure out how to work around them.
• Be kind to yourselves. Start out slowly, celebrate 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. Make any day Valentine’s Day!