The pathway to a family can be an emotional roller coaster for those who experience difficulties becoming pregnant. But there are techniques to help you cope with this uncontrollable hurdle.
“When are you going to have children?” It’s an innocuous question for some, but others may be surprised at the intensity of their emotional response to it.
If you’ve had your life neatly planned out – for example, travelling after study, building your career, finding a life partner and starting a family – you may be caught off guard if biology refuses to co-operate with this plan. A diagnosis of infertility is a shock. We tend to take for granted that when we are ready to have children, we will be able to. So when it doesn’t happen, after many months of trying, we wonder what’s wrong.
Infertility is commonly defined as the inability to conceive after a year of regular, unprotected sexual relations. It is also used to describe the inability to carry a pregnancy to live birth. In Australia, it affects one in six couples of childbearing age. In about 40 per cent of infertile couples, the problem is with the woman; in 40 per cent of cases it is with the man. For the remaining 20 per cent, the problems lie with both partners, or the cause is unknown.
While there is much information on the treatments available for infertility problems, typically less attention is paid to the many emotional issues experienced by those dealing with infertility. This may result in people feeling isolated and wondering if they are going crazy, according to Karyn Floyd, a psychotherapist and fertility mind-body specialist.
“People find they’re so sensitive. They can’t sleep; their life has become infertility. They don’t care about their job; they’re losing friends because their friends have babies and it’s difficult to hang out with them,” she says. She helps normalise these feelings and believes there are ways of coping with the process that can be helpful to mental and physical wellbeing.
Research confirms the distress people experience when they are undergoing infertility treatment. A systematic review investigating quality of life in infertility, published in the Journal of Psychosomatic Obstetrics & Gynecology in June 2010, found that women experiencing infertility had significantly lower scores on mental health, social functioning and emotional behaviour. Men, too, experienced quality-of-life impacts, although they did not appear to be as intense. However, long-term studies show that infertile couples do not differ from the general population with respect to levels of mental distress, anxiety and depression. In other words, the good news is that although difficult and stressful at the time, infertility tends not to leave a lasting psychological mark.
Floyd says there is significant grief associated with infertility. It is unlike other grief experiences because it is so repetitive. “If it was anything else in life, like trying to get into a course and you’d tried 12 times, you’d probably give up, adjust expectations and do something else … Infertility is so different to that.”
A book released last year, An Inconceivable Notion: Stories of Coping With Infertility and Childlessness (HarperCollins, $27), edited by Justine Davies, provides a window into the difficulties experienced in struggling to have a family. Eighteen people have written about what they have faced, using their first names only.
Alexandra talks about grief in her story: “The hardest thing about struggling to get pregnant is the cyclic nature of chronic grief. It’s almost like re-grieving every month, when you get a very real reminder that your body isn’t doing what you want.”
Grief can be compounded by the inadvertent comments and actions of others. Floyd gives an example of an everyday experience, such as being at the hairdresser, where one can be seated next to a pregnant woman who is chatting about the various aspects of pregnancy, oblivious to the fact that this may be painful for others. “Women with babies love talking about babies, and there’s nothing wrong with that … but it is very ostracising for people going through infertility, like they’re on the outside of society.”
MOVING BEYOND SELF-BLAME
Because infertility cannot be explained in some cases, people tend to blame themselves. Floyd says her clients wonder, “Is it stress? Am I not eating right? Is it that I’m not a good person?” She reflects that infertility is often the first major life crisis for people and they become confused about its meaning. “We tend to live [with] the philosophy that if we work hard and are good people, we’ll get what we want. With infertility there is a lack of control – the randomness of it,” she explains.
So what of stress, depression and anxiety and their role in fertility?
Many assumptions follow from the belief that if people could just relax, they would conceive naturally. “This is unhelpful, as there’s no doubt that infertility is stressful,” Floyd says. People can be trapped in the vicious cycle of knowing they should be relaxed, and knowing they’re not, which fuels more self-blame. Interestingly, research from the Journal of Psychosomatic Obstetrics & Gynecology in 2010 indicates that chronic stressors that have accumulated over a lifetime (for example, a history of abuse or drug use) – rather than current stressors – tend to diminish ovarian reserve (the number of eggs that can be fertilised). Floyd also makes the point that women in incredibly difficult circumstances, for example war zones, can get pregnant.
Given that infertility is usually a time of intense and changeable emotions for the woman or couple involved, coping with others’ perceptions and reactions can be fraught. “One challenging thing about being childless is having people assume that it is by choice … people telling us how lucky we are or applauding our decision to delay children,” says Alexandra in An Inconceivable Notion.
Similarly, in Davies’ book, Tanya recalls one of her pet peeves: “I’d flinch when my own friends get frustrated with their kids and say things like, “Are you sure you want to have kids?” or “Here, why don’t you have one of mine?”
It’s no wonder, then, that many people choose not to tell others about their struggles. “It’s really individual,” says Floyd. “Most people don’t tell; everyone’s ringing you on the day you get your result and then when you’re not pregnant, it’s really hard.”
She encourages her clients to think through the support they would like if infertility treatment works, and similarly what they’ll need if it doesn’t work. This means that support people know of pregnancy from as early as one month after conception when there is still a high chance of miscarriage; most people keep the fact that they are pregnant secret until 12 weeks.
Telling people about the process can also remind others of the large unmet goal that in many cases becomes the focal point of people’s lives. Related to this is a sense that life is in limbo, says Floyd: “Careers are on hold, they haven’t gone for the promotion, they haven’t gone on holiday. They haven’t known whether they’ll have a baby or not.”
DIFFERENT COPING STYLES
Floyd says in her experience, couples experience infertility as a shared problem, but tend to deal with it differently. Because most research has focused on heterosexual couples, more is known about the different ways of coping between genders. “Men are typically problem solvers,” she says. “They’ll think, ‘This cycle of IVF didn’t work; I’m sad about that, but what’s the plan for the next cycle?’ whereas for women it can be much more personal.”
This difference is borne out by research reported in the Journal of Behavioural Medicine that found women used strategies of seeking social support; escape avoidance (wishful thinking or trying to avoid the problem); planful problem solving (efforts to alter the situation) and positive reappraisal (looking to create positive meaning) to a greater degree than men did.
What can people do to cope with their infertility experience given that it is likely to be a chronic, unpredictable, uncontrollable stressor? Here are some tips:
1. Teach people how to respond to you. If you know others who are also trying to conceive, think about how you want them to tell you when they’re pregnant. Would you rather email, text, letter, phone, or discuss it over a coffee? These are areas you can negotiate.
2. Choose who you socialise with. Consider mingling with people whose children are older, maybe in their teens or 20s, so they’re not talking about babies.
3. When invited to christenings and baby showers, figure out if it helps to be around babies – some people find it quite comforting – or whether it is too hard and you should avoid it. “It is about figuring out what’s right for the individual,” says Floyd. “Some people tell white lies, like ‘I’ve got a headache’ or ‘We are away that weekend’; for others, the internet is a great alternative – buy a present and send it.” It also depends on the quality of the friendship. If you can talk about it, and work through it, friendships can survive.
4. Have strategies for parties/social occasions. These might include talking to people who aren’t pregnant, getting out of uncomfortable groups/conversations (with the assistance of your partner, if necessary) to take a walk around the garden. It can also be useful to have replies in your pocket to pull out for awkward questions – for example, “When are you going to have children?” could be answered with “One day” or “When the baby gods decide” or “We got a dog instead”.
5. Choose what to focus on: Alexandra, in Davies’ book, shares one of her strategies: “I take a step back and think of all the wonderful things that I’ve been able to achieve so far … I do need to take that step back and give myself a reality check from time to time, because it is very easy to become overly disheartened with the day-to-day struggle otherwise.”
6. Consider psychological treatment. Research indicates that it can improve pregnancy rates. In a review published in Human Reproduction Update (2009), which pooled the results from 21 studies examining mental health and pregnancy rates, some patients had higher pregnancy rates after receiving psychological intervention. These people were not undergoing assisted reproductive technology (e.g., IVF). The authors suggest that one way of explaining this result is that it is common for sexual activity to be disrupted in more than half of the couples suffering from infertility. Psychological interventions may positively affect sexual behaviour, particularly among couples not receiving assisted reproductive technologies, and thus increase their chances of becoming pregnant.
7. Learn what works for you to enhance your day-to-day life. Consider relaxation, breathing, mindfulness and coping statements – for example, “I’m doing all I can to conceive right now” – to get some of the control back. Find a healthy balance between not getting your hopes up too much and remaining positive. A good book in this regard is American author Dr Alice Domar’s Conquering Infertility (Penguin USA, $26).
8. Get help if you need to, in order to come to an acceptance of the situation and find new goals when you’ve decided to stop treatment. As Tanya says in An Inconceivable Notion: “I do know that life without kids is acceptable so long as that life has something else for me to do. Something that gives me purpose and meaning and something that makes me feel that I actually make a difference to the world.” Equally, Julie comments, “We have talked at length about what we will do if our lives are going to be permanently childless. We started putting some of those plans into practice already … I know that we can be happy and fulfilled together without kids – provided that we find the right thing to work towards.”
9. Consider joining a fertility support group. Access Australia (access.org.au) is a non-profit organisation that offers helpful information and contacts for those facing the challenges of infertility. It also strives to provide a voice for the infertile through “representation in the general community and in the medical, scientific and political arenas”. In New Zealand Fertility NZ is a good resource.