Infertile and ringing in the new year: anxious or hopeful?

If you have been grappling with infertility in 2010, and perhaps for months or years before that, ringing in the new year is a time that is symbolically and practically filled with both hope and anxiety. Symbolically you are facing the new year without a baby in your arms, without a healthy pregnancy, and perhaps without much conviction that medical intervention is going to lead to parenthood. On the flip side of this coin, you also may have learned some lessons from your infertility experience and decided in the new year to try some new strategies. This leads to the practical dimensions of how 2011 can be different: can you and your doctor get clearer about medical expectations? Can you find ways to nurture yourself better through the inevitable anxiety of infertility? Can you and your partner discuss timeframes and begin to explore options in case a healthy pregnancy is not in your future?

There's no question that months of medical interventions can take a serious toll on your hopefulness. All too often doctors will continue with the "same old, same old" without re-engaging you in a discussion of possible future steps to consider. So for the new year, why not make an appointment with your physician to discuss a treatment time frame for 2011. This would include future treatment options, for how long to continue them, costs involved and statistics on healthy pregnancies for women of your age and with similar health conditions. Having this conversation will alert your physician to your expectation that you expect ongoing assessments of what treatment options are open after a reasonable time period of trying standard medical interventions. If you are currently being treated by your local ob-gyn, this might be the best time to discuss whether an infertility clinic could offer more comprehensive medical services (and more flexible days of the week for medical procedures and lab tests).

And while you're thinking about timely medical interventions, the new year also is a time to think about whether you are getting enough emotional support, as the months or years of infertility take their inevitable toll. In my just-published book When You're Not Expecting: An Infertility Survival Guide, I offer a number of suggestions for how to access emotional support, ranging from how to communicate differently with your partner to ways of identifying a therapist or a support group. Even if you are not feeling a compelling need for an extra shoulder to lean on, now might be a good time to check out potential resources in your community, since it is best to have this information in advance of being assailed with feelings of desperation. Prevention is what you'll want to aim for in terms of your emotional health, since you will always cope better with your infertility journey if you have the capacity to absorb ongoing news with a resilient emotional perspective.

So what if 2011, like 2010, progresses with no signs of a healthy pregnancy? Here, again from the perspective of your trying to exert some control, is the opportunity to discuss the "what ifs?' with your partner. Would you be open to adoption? Working with a surrogate? Learning about donated eggs, sperm, or embryos (please see my earlier blogs for information on these options). Whereas you might be saying "yes, maybe" now, some more research on your part will let you know how viable these options are. For example, some countries only accept applications from prospective adoptive parents in good health, of certain ages, in first marriages, etc. Some sources of donated eggs/sperm/embryos are highly questionable or ethically inadvisable. Some attorneys specializing in services for infertile individuals and couples have strong professional reputations, where others do not. Rather than wait until you are ready to take the next step towards parenthood, 2011 might be the year to investigate costs, restrictions and waiting lists. You may not be ready immediately to pursue these options, but you'll feel more in control if you begin your initial investigations (both emotioal and practical), so you can be aware of how much time and money you want to invest in current medical procedures.

So, as you ring in the new year, admittedly with both hope and anxiety, perhaps you can take comfort in knowing there are some proactive ways that you can move into 2011 with new and informative resources. The key word for this new year is "resilience," as you strive for the best outcome possible in your quest for parenthood!

Infertility and the Holidays: A "Double Dose of Hectic"

December holidays are busy for almost everyone, and those of us who grapple with infertility feel especially challenged at this time of the year. Those challenges are both practical and psychological. So let's see what we can do so as not to become overwhelmed by the "double dose of hectic."

In terms of practical challenges, not only do we face the expectable tightness of our schedules as we shop for presents, wrap gifts, send out cards and holiday letters, attend (or host) various parties and events, bake special goodies and decorate our home for the holidays. In addition to the usual holiday tasks, our infertility may place unique pressures on us at this time of the year. Is our doctor's office going to be open around the clock during the holidays? If not, does that mean missing treatments, being delayed in hearing lab results, or needing to be seen by unfamiliar medical personnel as the clinic copes with absences of key staff during the holidays? If your physician also sees women without infertility concerns, does this mean infants, children and pregnant women in the waiting room, many of them dressed in holiday garb and reminding you of what you'll be missing this year -- sharing the holiday excitement with a wide-eyed child? Perhaps you have the opportunity to be out of town during the holiday period. Does this mean that you need to schedule blood tests in a distant location, feeling all the while that there's no escaping your infertility? Or maybe the costs of infertility are becoming especially apparent at this time of the year, when you have less to spend on holiday celebrations?

These practical challenges are aggravating for some of us and downright depressing for others. At a time when we have so little control over the one thing that matters so much -- our dream of becoming a parent -- it especially hurts to have additional losses of control because of unexpected schedule juggling during the holidays. So what can you do? One thing to consider is to scale down on your expectations for yourself in terms of your productivity or activities related to the holidays. This is probably good advice for anyone at this time of the year, but if you feel extra pressure from infertility concerns, then for sure you need to reduce your stress wherever you can.

Think about what could be dropped from your "to do" list; enlist your partner or friends to do tasks that can be shared; hire some help; alert family and friends that you're striving for a restful holiday this year. Next, in the spirit of being restful, think about how you can psychologically take some time out from holiday pressure. A good book? a funny DVD? some time on the treadmill? tea or eggnog with a few close friends? a nap? Undoubtedly you can think of what works for you -- and your challenge then becomes putting yourself first at a time of the year when it is easy to get caught up meeting others' expectations. Just remember, you're experiencing the "double dose of hectic," so you, especially, are entitled to take some quiet time to regain your perspective.

Now, remembering that I also mentioned the psychological challenges of this time of the year, let's see what that might mean for you. Since several of the December holidays have a major focus on children, there's no escaping their excited presence -- whether enjoying school vacations, playing in the snow, sitting on Santa's lap at the mall, or being wheeled everywhere in carriages and strollers. This, often combined with harried parents' complaints, can set our teeth on edge. It is such an emotional reminder that we don't yet have a child and, when and if we do, that we will be accepting, not resentful, of the inevitable stress of parenthood. So, whether you encounter the excited children head on when you venture out to malls and restaurants, or whether you consciously choose to avoid those locations as much as possible over the holidays, be purposeful about how many doses of childhood excitement you can psychologically absorb. When you are reaching your limit, try to find a quiet place to regroup, consider postponing your tasks for another day, and head for a peaceful place where you can focus on more calm thoughts.

But what if leaving the scene isn't an option? Here I am thinking of family gatherings, holiday meals, and traditions where your presence is expected. Here is where some anticipatory planning can provide a safety net. You and your partner are probably aware of what is likely to occur at these various family events and how those occurrences may push your buttons. Make a plan, and clue your host in, that if it all begins to feel "too much," you will retire to a quiet bedroom, or for a short (or not so short) drive, or excuse yourself with a headache (yes, I know it's really a heartache...), and head for home, or your hotel room, or a peaceful place you've identified in advance as emotionally safe. Once there pull out a book, listen to music, light a fire in the fireplace, meditate, or do whatever you can to feel more calm and relaxed.

Holidays are a mixed blessing, and infertility makes them even more mixed, as holidays often mark another year that has passed without a baby. You are entitled to feel the sadness that accompanies these yearnings, and you also are entitled to make whatever conscious efforts you can to soften the impact of your infertility at an emotionally vulnerable time in the calendar year.

Even as you are feeing vulnerable, remember that you also are loved and that your loved ones deserve the opportunity to support you through this season. Clue them in. Let them help.

Infertility: How to Brighten the Holidays

Many of us find our struggles with infertility are especially difficult during the winter holidays. Perhaps our medical specialists have curtailed their office hours; perhaps we are overwhelmed at the mall with the numbers of children sitting on Santa's lap or the number of parents pushing strollers; perhaps last year we had looked forward to being pregnant by this holiday season, and we're not; and very likely it is hard to get excited about holiday gifts and celebrations when the only rejoicing we could imagine would be to revel in a positive pregnancy test or having our own baby to cuddle under the holiday lights.

So with this acute awareness that the holiday lights seem dimmer this year, I'd like to offer some thoughts on ways that you can turn up the wattage. Of course, being infertile does not make you the only person feeling some disappointment in the holiday hecticness. We all tend to have inflated expectations of family togetherness and spreading joy at this time of the year. But infertility does present itself as a reminder of reproductive sadness to couples, and it also is an unresolved issue that keeps tugging at your heartstrings. So how can you get beyond this emotional disappointment at a time of the year when others seem so effortlessly to be celebrating the joys of the season?

Perhaps one thing to consider is to decide with your partner how you want to acknowledge the holidays this year. Would you like to host a party or to go to lots of holiday gatherings? Would it be soothing to spend some peaceful time together before the fireplace or hiking outdoors? Would it bring you satisfaction to do some volunteer work in health care facilities or soup kitchens where regular staff would appreciate having time off during the holiday season? Do you enjoy baking holiday goodies to share with friends and family? If the local shopping scene is stressful, might you consider home made gifts or ordering from catalogues instead of braving the crowds? Rather than getting swept up in the hectic pre-holiday rush, think purposefully about what will bring you pleasure among the many choices available and then indulge yourself in these activities.

Another aspect of the holidays to consider is which rituals have meaning for you. You may decide that you no longer want to participate in familiar family rituals, like watching nieces and nephews open their presents, if this now feels more obligatory than joyful. Now is the time to absent yourself from rituals that no longer are satisfying and to invent or participate in new rituals that are more uplifting. How about a midnight walk in the snow, or a nighttime stroll to enjoy the holiday lights, or a peaceful cup of eggnog before a crackling fire? Or maybe a try at ice skating after many years off the rink or a visit to a local nursing home or watching some favorite DVDs with loved ones? There's nothing magical about inventing rituals -- just an opportunity to let your imagination travel in creative directions!

So what if your family objects that your new holiday rituals prevent you from participating in their favorite familiar ones? Every family is different, and you know best how to counter their objections, but keep in mind that you have every right to assert your belief that change can be good, new rituals will bring you happiness, and you would appreciate family support as you move forward in seeking happiness during the holidays.

Since we're in the midst of the holiday season, now is a good time to rethink what can make this time of year more uplifting for you. Let your imagination soar, let your creativity flow, and get in a holiday spirit that offers a chance for your infertility to co-exist with love, with embracing unique rituals, and with discovering new aspects of yourself as you move forward into the new year!

Infertility: Creative approaches to Thanksgiving

Thanksgiving causes many people with infertility to pause and re-evaluate the meaning of this U.S. holiday. Not only do we feel distinctly unthankful for what have become elusive and unsuccessful efforts at parenthood, but we also feel apprehensive at the prospect of sitting at the holiday table with pregnant women, nursing mothers and infants in high chairs.

So what can we do to anticipate new ways of approaching and getting through this particular holiday? For starters, it may help to figure out just what is likely to cause the most emoti0nal difficulty this year. Is it the tradition of family togetherness when your family of two feels especially small next to the burgeoning families of your fertile adult siblings? Is it the expectation that you will need to pitch into meal preparation and clean-up with more energy as the parents in the group attend to their offspring? Is it the anticipation that enthusiastic conversation at the table will focus on the children, a recently announced pregnancy or, worse yet, that there will be complaints about the exhaustion of parenting or the discomforts of pregnancy? The list could go on and on, but we all know our most vulnerable issues connected with our infertility and how they change over time.

So, in the spirit of trying to be creative about those vulnerabilities, what are some things to consider? I know some couples who decide to make Thanksgiving less about tradition and more about celebrating in a new way: volunteering time in a workplace that could free up some of its employees to enjoy the holiday with their loved ones; serving food and offering conversation at a homeless shelter; or delivering Thanksgiving baskets to families who have requested them. Other folks without children may choose to enjoy nature through hikes, renting canoes and kayaks, camping out or preparing their gardens for the winter. All of these may very well be done before or after the traditional family Thanksgiving, and they will give you the opportunity to carry the conversation in interesting directions for others around the table.

But what if you are at a point where the length of time or effort others expect you to devote to Thanksgiving is already feeling like a burden? There's nothing that says this year has to be like other years. If you are feeling emotionally depleted and not celebratory, figure out what you are willing to do to contribute to the holiday, let the hosts know far enough in advance so they needn't count on you for your famous stuffing/pie/gravy or whatever, and offer to do only as much as you can comfortably. Try to arrange to be seated near people whom you enjoy, and arrange a signal (and a prearranged excuse) with your partner if you need to make a retreat from the celebration in favor of some peace and quiet.

For some people grappling with infertility, Thanksgiving may represent a wish to be absent from family altogether. The prospect of an extended weekend out of town, or with distant friends or relatives, or submerged in a favorite city, activity or indulgence just hits the spot. Do it! Explain in whatever way you choose to the usual Thanksgiving crowd, perhaps contribute some homemade desserts for the meal, and then disappear to enjoy yourself without the reins of tradition holding you back.

Creating your own traditions is a valid an approach to the holidays. Although your infertility may be the catalyst to your creativity, this also represents resilience on your part to taking care of yourself, to expanding your horizons and to thinking about the continuing holiday season in new and more fulfilling ways.

Infertility and Halloween: Cheers? Jeers? Tears?

Halloween, as the ultimate children's holiday, may evoke your own childhood memories of that magical day and evening. Or it may have a darker side as children fill your yard, just for this one evening, with joyful anticipation. What's so dark about that? Well, for one, they're not your children, even though they may stimulate your fantasies about how much fun it would be to create imaginative costumes for your own little one(s), usher a child through the neighborhood on that night, and sort through the goody bag once all the treats have been collected.

So what is this holiday like for those who yearn for parenthood? To many of us it serves as a reminder of the cheers that children echo again and again in the weeks before Halloween as they shop for or create their own costumes, visit pumpkin patches, carve the pumpkins and stock up on sweets. There's lots to cheer about if you're listening to the kids, but I often found myself feeling emotionally sidelined as other parents shepherded their little ones through the anticipatory preparations. Then when Halloween actually arrived I could put on a happy face at my front door, but at the end of the night I knew it had been just that - a happy face covering the wistful emotions in my heart.

Emotional jeers would jab at me too. I would grouse at the huge amount of sugary snacks being purchased, knowing that the money spent on them could better have been donated to a local food bank so low income children could have nutritious food available. Or I would mumble to myself that the last thing any child needs these days is extra calories -- and for several years I followed the example of a neighbor dentist who passed out toothbrushes to trick-or-treaters (my virtuous choices ranged from pencils to apples to raisins, evoking surprise but not enthusiasm from the local kids, who clearly viewed me as a kook!)

And inevitably there would be some tears shed. Sometimes they were an over-reaction to smashed pumpkins or T.P.'d trees the next morning. More often, though, my tears were in response to the feeling of not being in The Club, to which I devote an entire chapter in my book When You're Not Expecting. This feeling of being left out of parenthood, of being deprived of cuddling a child each day, of missing the opportunity to re-live aspects of my own childhood if only I could share them with my child...these were the precipitants to my misty eyes as Halloween approached, peaked, and life moved forward again.

And, of course, as I came to learn and dread over the years of my infertility, Halloween was just the beginning of a long series of family holidays (more of this in future blogs). So each year I would view Halloween as a testing ground to prepare me for how I would try to reconcile my infertility with others' celebrations of holidays that often had children, pregnant relatives, nursing mothers and infants in attendance.

Having begun this blog with some reference to "cheers," I will end it by sharing a personal "cheer." After three years of battlng infertility, my daughter was born in late October, and we arrived home from the hospital the morning of Halloween. With no time to carve pumpkins and barely enough sense to purchase some candy bars, we welcomed trick-or-treaters with genuine joy and enthusiasm. Many of the neighborhood kids had been curiously observing my swelling abdomen, so they considered themselves very privileged to get a first introduction to "the newest kid on the block" that evening. My husband and I had decided to dress her in the most symbolic of costumes: a Red Sox hat and bib. To us, as loyal Red Sox fans who met during the World Series season many years earlier, who had cheered the Red Sox on for countless years without a World Series victory, we knew what it was like to hold out hope eternally. We had held out hope for our child's birth for what felt like an eternity, never knowing we would have the joy of a baby to cuddle on this special children's celebratory holiday.

Infertility: So Now What Do I Say To My Pregnant Girlfriend?

Sympathetic as your girlfriend may have been to your infertility struggles, now that she is pregnant you know your relationship is facing some unanticipated twists and turns. What are some of the issues you'll both need to discuss? What hopes and fears do you share? How can you keep your communication with each other as open as possible? As I mentioned in my blog last week, both of you will need to recognize the imbalance you are facing, as she is potentially experiencing joy and ambivalence and you are likely feeling envy, envy and more envy.

So, let's look at the envy issue head on. It is there and both of you know it. But how you handle it can make all the difference. And it will probably be up to you to broach this subject. You might begin by saying to your friend that you are feeling both happiness and envy as she anticipates the upcoming months of her pregnancy. You may say that you worry about feeling left behind as her life becomes increasingly preoccupied with plans for the baby's birth. And you will want to reach out to her to affirm that this is a friendship you treasure and to ask if both of you can spend some time now anticipating how you can keep the relationship resilient.

Hopefully she will be relieved that you have taken the lead in opening this conversation. And hopefully she will ask for your ideas on how to remain close friends as her pregnancy progresses and as she becomes a parent. So here are the things you'll need to think about as you and she pursue this conversation. What do you think will cause you emotional pain? Conversations that focus on the pregnancy? Seeing changes in her living arrangements as some space is set aside and furnished for the nursery? Seeing your friend with a distended abdomen? Wondering whether she cares to hear about your continuing saga of infertility treatment? Feeling that you are the logical one to give her a baby shower and recoiling at the thought? Recoiling at the thought of even attending her baby shower? Anticipating that she might ask you to be her child's godmother? Knowing that you would be devastated to visit her in the maternity wing of the hospital after the baby's birth? Wondering about how both of you will have time to invest in your friendship after the baby is born?

Those questions and possibly others suggest that you will need to look within yourself to anticipate the experiences you can handle, those you want to avoid, and those you don't even want to hear about. And, of course, when the reality presents itself you may feel differently than you had anticipated, so you and she may need to leave some room for re-discussing some of these issues as time moves forward. But the glue that will hold this friendship together rests with both of you being willing to bring up potentially painful issues and ask each other how you can handle them so both of you feel supported. You both may need to accept that the changing face of the friendship may include sharing discussion on some topics but not on others. It may include more telephone conversations, more texting and less face-to-face time during certain periods, It can include an awareness that your friend is reaching out to others for support and shared happiness when she knows certain areas are just too painful for you.

And this leads to another issue for you. As you find that certain areas of conversations and contact with your girfriend are diminishing, you may decide to fill that potential loneliness, at least temporarily, with other activities or relationships. As I discuss in my recent book When You're Not Expecting, this time when friends and loved ones are pregnant or young parents often propels individuals with infertility to develop relationships with acquaintances who are empty nesters, who are child free, who are infertile, or whose children are away at school or otherwise not a time consuming presence in their lives. In addition to a shift to new relationships, you also might choose to get more involved in activities, social causes, political concerns or community issues that capture your interest or passion. Doing this can offer new relationships, distract you from being overly preoccupied with infertility, and make you a more conversational partner for new and familiar acquaintances.

So this blog is not about how envy may poison a treasured friendship. It is about how relationships evolve over time, how even envy can co-exist with mutual thoughtfulness, how your own insight about a friend's pregnancy and young motherhood can guide you in the way you raise with her your hopes and fears, how your friendship may change but need not deteriorate, and how you can continue to nurture a treasured ongoing friendship at the same time you reach out for new relationships. Resilience is the key here, as both of you seek a new balance in your changing lives.

Infertility: My Best Friend Is Pregnant!

If you have been trying for months (or years) to get pregnant, the news of anyone you know having achieved this triumph can be a real bummer. But when the news comes that your best friend is the mother-to-be, there are lots of emotional issues for both of you. Was hers a planned pregnancy?Did you hear the news from her directly? How open have you been with her about your struggles with infertility? Is she sensitive to your emotions upon hearing her news?

All of these issues will play a part in how your friendship continues to unfold in the coming months. If hers is an unplanned pregnancy, your friend may confide in you as she makes future decisions. Not only will it feel difficult for her to confide her ambivalence about this pregnancy, it may be just as difficult for you to empathize with her at a time that becoming pregnant is at the top of your wish list, without an ounce of ambivalence on your part. Should she decide to terminate the pregnancy, your feelings will be even more painful. You know at one level you should reach out and offer emotional comfort, but where are you going to find comfort for yourself? It is emotionally complex to watch this friend end a pregnancy because she assumes that when she is more ready for parenthood her body will be ready as well. Her decision to end the pregnancy may be one time that you will probably need to offer her whatever comfort you can muster and then turn to others in your life for solace and understanding. If, instead, her decision is to continue the pregnancy, then you and she face a new set of relationship issues as she seeks to resolve her ambivalence and you seek to keep your envy at bay.

So, let's go back to the beginning and explore how you first heard the news. If it was not from your friend but, instead, from a mutual acquaintance, you have every reason to ask her why, as her best friend, you were not among the first to know. Even as you ask, you already know the answer. She could not bear to see the pain in your eyes, hear the catch in your voice, wonder about the genuineness of your hug. So now is the time that both of you must talk about how her pregnancy might affect your relationship, what your hopes and fears are, and how you can keep your communication as open as possible while both of you are treading unexplored territory in keeping your friendship alive.

If you heard the news of her pregnancy directly from your friend, how did she share her news and what was your reaction? If you knew she was trying to become pregnant you had probably already rehearsed a few phrases in anticipation of her news. She, on the other hand, also probably had done her share of rehearsing before breaking this news to you. If you had not known that she was trying, then the news will likely have taken you by surprise, with many mixed emotions. It is a real challenge to receive ordinarily joyful news when both of you know there is more than a tinge of sadness in you, the recipient. Certainly the sadness is not about wishing her anything but happiness -- but you know already that you will be left behind on this particular happiness journey, and you wonder whether your friendship can be resilient or whether it will crumble or wither under the shadow of your friend's upcoming anticipation of parenthood.

And, just as you hope she will have some empathy for your yearning for a pregnancy of your own, it is important to reflect on how familiar she has been with your infertility struggles. Many couples grappling with infertility agree to be fairly discreet with friends and loved ones, preferring (at least initially) to contend quietly as a couple with sadness, with diagnostic test results, and with treatment decisions and outcomes. Others are far more open, both in terms of emotions and medical details. Your friend's capacity to empathize with you now will be affected by how much you have shared in the past about your own infertility, both its medical aspects and its emotional impact. If you need more empathy than she is offering, this may be the time to be more open with her about what she can do to offer emotional support. Both of you will need to recognize the imbalance you will continue to face, as she is potentially experiencing joy and ambivalence and you are likely feeling envy and envy and more envy.

My next blog will focus on how to keep emotionally strong during a friend's pregnancy, along with some tips for how to negotiate expectable pitfalls looming in front of both of you. Stay tuned!