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!

Infertility: A Nobel Prize in Medicine for IVF Pioneer!

There is no question that the perfecting of in vitro fertilization has revolutionized treatment options for millions of infertile people world wide. Today the Nobel Prize in Medicine was awarded to Dr. Robert G. Edwards who, with his now-deceased colleague Dr. Patrick Steptoe, spent years perfecting the IVF procedure while battling controversy, lack of institutional funding and criticism on ethical and religious grounds. For those of us who have faced our own infertility struggles, it becomes easy to bask in the glow of this belatedly-awarded Nobel Prize. Drs. Edwards and Steptoe demonstrated more than medical brilliance in their work together, they also set a high bar for unwavering determination to overcome the many-pronged resistance to their scientific breakthroughs.

The celebration of the birth in 1978 of Louise Brown, the first IVF baby, was the beginning of a revolution in infertility treatment, just as that very birth was met with intense criticism of IVF as subverting the natural order of how conception occurs. Ultimately medical follow-up on IVF babies demonstrated that the IVF technique is safe and does not pose a risk to the healthy development of IVF babies. And most criticism, except that of the Roman Catholic Church, has melted away as some four million babies worldwide have been conceived, to the joy of parents who considered IVF to be their last hope for pregnancy and parenthood. IVF is now used in 3 percent of all live births in developed countries.

Since those of us who have grappled for years with infertility often come to feel singled out for unwarranted reproductive distress, I thought readers of this blog might be interested to know a bit about the multi-pronged battles waged by Dr. Edwards and Steptoe (Dr. Steptoe, who died in 1988, is not being named as a co-recipient of the Nobel Prize, as it is not awarded posthumously). My empathy for their ordeal is only surpassed by my gratitude that ultimately they triumphed so magnificently!

Medically, Edwards and Steptoe did their work in England, devoting over 20 years to solving problems related to getting eggs and sperm to mature and unite successfully outside the body. They were denied government funding for their IVF research, but their persistence paid off in their abilities to procure private funds. They were attacked, both by clinicians and by ethicists, many of whom were ultimately won over as their own colleagues became more familiar with the successes of IVF. Dr. Edwards, who filed 8 libel actions in one day, proclamed "I won them all, but the work and worry restricted research for several years."

Edwards's and Steptoes's initial medical research was slowed by a series of frustrations in being unable to get eggs to mature outside the body, then in being unable to get fertilized eggs to implant in the uterus successfully, and ultimately in transferring more than 40 embryos before obtaining their first pregnancy. That pregnancy was ectopic and was aborted before Louise Brown was born from the second pregnancy.

But that was back in 1978. Why has it taken so long for the Nobel Committee to offer much-deserved public recognition to these IVF pioneers? Dr. Steptoe is now deceased, and Dr. Edwards, age 85, is "not in a position to understand the honor he has received today," says Dr. Michael Macnamee, a longtime colleague. Since the prize-giving committee's deliberations are confidential, it is not possible to know for certain about the delay in awarding the Nobel Prize. The New York Times reports that the committee shies away from controversial people and issues. Certainly the prolonged ethical objections to IVF may have contributed to the delay, as may have Dr. Edwards's political views as a committed socialist.

Whatever the reason for the delay, today is a day to celebrate! People with infertility the world over know what it is to wait, we know what it is to be misunderstood, we know what it is to persist through emotional turmoil and medical disappointment. Some of us know what it is to rejoice. In the spirit of empathy for Nobel Laureate Edwards's grit and determination, for his medical persistence and vision, and for his magnificent contribution to the joy of many families around the world, I join with millions of others to salute him!

Infertility and Recipients of Embryo Donation

Last week my blog concerned embryo donation. This blog will focus on the recipients of embryo donation. With the large number of cryopreserved (frozen) embryos available in the U.S., only a small percentage are designated for donation to other individuals and couples. Who might be the recipients of these embryos? Why might this option be more appealing than egg (oocyte) donation or adoption? What psychological issues will recipients face as they pursue parenthood via embryo donation?

Among those individuals who consider becoming recipients are infertile couples whose treatment has been unsuccessful, single and lesbian women, individuals who have experienced repeated pregnancy losses (based on other than uterine implantation factors), and individuals with transmissable genetic diseases, absent or nonfunctional testes or absence of or nonfunctonal ovaries (with a functional uterus). However, the choice to be a recipient may not be available to these populations in all countries, so in this blog I will focus on options in the U.S., where practices can vary by agency/clinic.

So why might an individual or a couple decide to become a recipient of embryo donation, where the embryo is placed in the uterus of the woman recipient, with the hope that it will implant and develop into a healthy fetus? Many recipients pursue embryo donation because it is a less expensive family building option than egg donation or traditional adoption. Also, the process of obtaining donated embryos may take less time than adoption. Some couples are drawn to this option because of their wish to experience pregnancy, delivery and nursing of an infant. Others value that it offers greater control over prenatal care and nutrition than would be likely with adoption. Still others anticipate that future pregnancies using the same embryo donors would allow their children to be genetically related to one another, even as they do not share the genes of their gestational mother and her partner.

So what are the words of caution for individuals considering this alternative form of family building? In one's eagerness to locate a donor, some potential recipients may decide to travel to other countries to receive treatment that would be much less available or more expensive in the U.S. Known as reproductive tourism, this practice shortcuts the education and counseling provided in U.S. agencies/clinics, may not be performed under ideal medical conditions and, in some cases, is both financially and emotionally exploitive to the non-domestic embryo donors.

However, assuming that you remain in the U.S. working with an agency/ clinic whose staff are skilled in supporting both donors and recipients, you and your partner may need to travel for treatment and counseling, will need to have a home study performed in advance of receiving the embryo, and are likely to be expected to explore issues with a mental health professional in several areas: how have infertility and infertility treatment affected you? what are your concerns/fears/fantasies about building your family through embryo donation? what coping strategies do you envision using as you proceed with this option? how will you contend with the knowledge that any offspring born via embryo donation will probably have genetic siblings who are being raised by the genetic parents? will you disclose to any offspring about their embryo donation origin? how "open" or "closed" do you want your relationship with the donor couple to be? (Clinics make every effort to match donors and recipients with the same preferences) and how have you and your partner come to terms with giving birth to a baby not genetically related to either of you?

The World Health Organization recommends that counseling should be made available to all individuals and couples undergoing embryo donation. In the U.S. this is typically provided through embryo donation agencies. In the U.S., RESOLVE, the national infertility organization, has published extensive materials related to embryo donation (see www.resolve.org/) Among other issues, these resources will inform you about a number of financial expectations, which can include the cost of fees for medical examination, blood testing and professional fees that must be assumed for both the donating and recipient couples, psychological counseling before and after the transfer process, shipping of embryos, reimbursement to donors for storage expenses, the agency fee for its work in facilitating the donation, medical and genetic screening, and the home study.

So do you think of yourself as a potential recipient of donated embryos? With this as a relatively new parenting option, there exists some beginning research, an increasing number of agencies serving both donors and recipients, and excellent publications through RESOLVE for U.S. residents who would like to become more fully informed. If you are intrigued by this option for building your family, I hope my blog has pointed you in several directions to explore further!

Infertility and Embryo Donation

Embryo donation does not receive much publicity, yet it is important for people with infertility to know about it, as well as about embryo adoption, which I will discuss in next week's blog. Today I will focus on the donation of remaining embryos from one couple's IVF treatments to another couple, followed by the placement of those embryos into the recipient woman's uterus for the purpose of pregnancy.

When an infertile couple's treatment enables them to produce embryos, they very likely begin by having some of those fresh embryos placed via in-vitro fertilization into the woman's uterus, with the remaining embryos frozen for possible later use. If an implantation occurs, followed by a healthy pregnancy and successful delivery, the couple still have the option to use the frozen embryos at a later date in an effort to have more children. However, at some point the couple will decide that they will not use any more frozen embryos, either because they have been able to have their desired number of children or because IVF has not been successful and they have decided not to pursue future IVF efforts.

So the question becomes what to do with any remaining frozen embryos. The options available to the couple at this point include keeping them in frozen storage, asking that the embryos be thawed and disposed of, donating the embryos to stem cell research or donating the embryos to an adopting couple. There are currently 500,000 frozen embryos in the U.S. and one million worldwide. So why is the option of embryo donation not considered by more couples? For the most part it has to do with their emotional ties to the embryos and the reluctance to address their inevitable grief as they donate the embryos to another couple hoping to become the gestational parents.

Having put a great deal of time, expense and emotional energy into creating the embryos, a couple will want to be very certain they will not seek to achieve another pregnancy. The couple also may consider these embryos to be extensions of themselves, and in that sense have a genuine emotional attachment to each embryo, which could be considered a potential child. Thinking of donating their embryos can feel like letting go of an important part of themselves, and many potential donors resist the inevitability of the grieving that will accompany a decision to donate. Yet to allow their embryos to remain for years in storage presents its own set of dilemmas.

Yet many couples with stored embryos have a very real appreciation for the emotional yearning of infertile couples unable to give birth to a baby with their genes. The empathy they feel for couples whose treatment for infertility has been unsuccessful can promote a willingness to address the emotional grieving process in order to proceed with donation of their remaining embryos.

Well over half of embryo donations are anonymous donations, but the legal option exists for a donating couple to specify that they want an semi-open or an open embryo adoption. In an anonymous donation/adoption, medical information about the donors would be disclosed to a couple adopting the embryo(s), but no other identifying information. A semi-open donation/adoption could include sharing such information as family interests, first names, e-mail addresses, but not a mailing address. An open donation/adoption would typically include an initially signed agreement, specifying the level of contact with which both couples are comfortable.

So, as I find myself moving more toward sharing information about embryo adoption, I encourage you to stay connected and keep your eyes open for next week's blog on that subject!