Mind Matters: A Look Back - by Sherry Dale (Winter 2011)

MIND MATTERS

A LOOK BACK…

by Sherry Dale, MSW. RSW
Winter 2011

Since 2007, I have been privileged to write the Mind Matters column for this excellent journal Creating Families. In this issue, I write my final Mind Matters article.

In my years as an Infertility Counsellor, I have worked with so many people struggling with the unique emotional challenge of infertility. In choosing my topic for each article, my goal has been to write about topics considered important to “the experts” – men and women in the emotional trenches of dealing with infertility. My aim was to present the ideas and feelings of infertility patients along with knowledge gained from researchers. I hope these articles have given readers information they can use, and comfort from knowing that they are not alone in their infertility.

How I have enjoyed writing the Mind Matters articles! Doing the research and drafting the articles, and talking to clients and colleagues about the topics I’ve addressed has been a profound learning experience. In this last article, I look back at the topics I’ve covered in the last fifteen articles.

In my first Mind Matters article, I addressed the impact that infertility can have on a couple’s sexual relationship.1 While most couples find that infertility puts a strain on their relationship, it ultimately strengthens their bond. However, the majority of couples I have met have found that infertility interferes with their sex life. They are dismayed at how mechanical and scheduled sex becomes. “When it reaches the point where sex has become anxious ‘baby making’ rather than ‘lovemaking’ it usually loses much of its joy and pleasure. Sex may feel like a chore or a performance rather than an expression of love and desire.”

In the second article, I commented on the observation that when going through fertility treatments, many people wish for multiple births.2 While it is understandable that infertility patients hope they can complete their family without having to do repeated treatments, there is strong evidence that they tend to underestimate the physical, emotional, and financial costs of raising twins, triplets, and higher order multiples. If multiples are born, parents “may be reluctant to let anyone know how distressed and overwhelmed they are once the babies arrive. They may feel that they got what they asked for, and they should shoulder the burden without complaint.”

So many of my clients express frustration at how out of control their lives feel when they are trying to conceive. I addressed this question in the third article, pointing out that while the losses associated with infertility are many, the one felt most keenly is usually the loss of control.3 “All of us want control over our own lives. We all want to be the authors of our own stories… whether and when to become a parent is among life’s most important decisions – to have that choice taken from us can be devastating.” It can be very difficult that no matter how hard you work at it, or how much you want it, you cannot make a pregnancy occur.

A recurring topic raised by infertility patients is the message they get from other people that they must “think positive” and be optimistic in their quest to become parents. The assumption is that if you think in a negative way, or do not express confidence in treatment options, then a pregnancy will not result. This attitude places enormous pressure on infertility patients. In the fourth article, I presented research on whether or not thinking positive thoughts actually raises pregnancy rates. “I was unable to find any research linking optimistic attitude with better pregnancy rates from infertility treatment.” I also cautioned, “When we discuss optimism and positive thinking, it’s important to distinguish between attitudes, thoughts and feelings. Thoughts and attitudes are in our minds – feelings are in our hearts and bodies. Our feelings simply are what they are – we do not choose them.”4

The fifth Mind Matters article addressed emotional trauma and phobias in infertility patients.5 Many people are not aware that one in four people have a phobia of some sort, and one in ten has a needle phobia. For infertility patients, having a needle phobia can add a profoundly upsetting layer onto an already emotionally demanding experience. People bring past emotional trauma to infertility, and prior experiences can be triggered in a very distressing manner. “If you have been having difficulty getting pregnant or staying pregnant, the emotional toll of that experience demands much from you. If trauma-based triggers or phobias also impact you in the infertility clinic setting, your upset may well be compounded.”

If you are having trouble conceiving, you may feel that you are the only person who feels upset when yet another friend or coworker announces a pregnancy. You may find it very painful to visit friends’ new babies or attend baby showers or birthday parties. In Fall 2008, I wrote about jealousy and envy in infertility.6 First, I distinguished between “jealousy” and “envy” and commented that these feelings are triply upsetting because the emotion itself is painful, most people feel ashamed of it, and many women find their male partners do not understand why she can’t just be happy for her pregnant loved one. Underneath envy is most often simply the painful awareness of not having what you want so much. “As you recognize that sadness and fear are at the core of your envy, perhaps you will be more gentle with yourself (or your partner) about feeling it.”

Many men who come to counselling with their female partners express the frustration and helplessness they feel in providing emotional comfort to her. The majority of men say they are more upset about their partner’s upset than by the infertility itself. My seventh article addressed this feeling of helplessness and gave suggestions for how couples can feel they are battling the infertility together rather than feeling emotionally disconnected.7 I presented the results of a study we did asking men, “When your partner is upset about the infertility, how often do you feel you get it right and know just what to say and do to comfort her?” Almost always, partners want to help each other get through infertility. “Men very much want guidance in how to comfort their partners. They are eager to learn how to ‘get it right’ and to discern when they get it right.”

Sometimes, the strength of their desire for a baby takes a person off-guard. At times, they always knew they wanted a family; other times, they have felt ambivalent about becoming a parent. But when it’s not easy to achieve, the yearning for a child can feel deep and primal. In Spring 2009, I addressed whether there is, in fact, such a thing as the “biological clock” and if so, whether it is felt differently by men and women.8

In the ninth article, I quoted infertility patients as they discussed some of the aspects of infertility they find the most painful and stressful.9 Frequent themes include: waiting, feeling stuck, financial pressure, the feeling that one is letting their spouse down, the loss of dignity, uncertainty about outcomes, and others. In that same issue, I wrote another article about typical male emotional responses to the diagnosis of his infertility.1 I quoted infertile men: “I can’t handle the thought that I will not continue… my eyes, my thoughts, my dreams… I offered my wife a divorce because we had gotten married to have children. I felt bad, freakish, strange.”

Though many infertility patients are blessed with supportive family and friends, often, comments that may be well-meaning can be very hurtful. In Fall 2009, I addressed how people going through infertility can coach their loved ones in how to provide support that actually feels like support.1 I presented a letter written by an infertile couple to their families, and commented, “Composing and sending a letter like this assumes that your loved ones mean well and want to support you. It’s a rare relative or friend who purposely wishes to be hurtful. Asking directly, clearly, and compassionately for the support you need can be comforting to you and to people who care about you.”

When pregnancy or adoption are elusive, when news is bad and fertility treatments are not successful, many people speak about being depressed. The twelfth article explored the differences between grief and depression in infertility patients.1 “We tend to use the word ‘depression’ to describe feelings of sadness. However, not all sadness is necessarily ‘depression.’… thinking about the painful emotions arising from your infertility as ‘grief’ starts with understanding the connection between loss and grief.” I discussed the many losses involved in infertility and encouraged readers to “acknowledge, feel, honour and learn from your painful emotions.”

In Spring of 2010, I wrote about secondary infertility – the experience of parents who already have one or more children, but want another.1 These parents may have accessed fertility treatments to have the children they have, or they may have conceived easily. Infertile parents experience a unique set of emotional challenges. “Secondary infertility can be experienced as a disenfranchised emotional burden: the heartache of not being able to have a second or third child is not well understood or supported by others.”

For many people trying to conceive, there actually is a pot of gold at the end of the rainbow. The fourteenth article addressed what it is like to finally become pregnant after infertility.14 While we would like to think that it’s over when that pregnancy test comes back positive, many “pregnant infertiles” have a tough transition from fertility patient to expectant parent. “When you finally get the news that you are indeed pregnant, you will likely be exhilarated, relieved, incredulous…and terrified.”

In the most recent Mind Matters article, I wrote about the history of stigma and shame associated with infertility.15 This legacy can still make people feel reluctant to talk about their infertility. I quoted an infertility patient on this topic: “The reason people don’t understand infertility is because we don’t talk about it. We’re embarrassed, ashamed, angry, or depressed, which makes us clam up. To overcome the stigma of infertility, we really do need to start opening up – because sharing our infertility roller coaster can improve our emotional, mental, and physical health…There shouldn’t be a stigma attached to infertility, and the more we talk about it, the less embarrassing it will be.”

I thank Creating Families and IAAC Executive Director Beverly Hanck for the enriching opportunity to have been the Mind Matters columnist these past three years. I strongly encourage you to subscribe to this wonderful journal. It always contains information infertility patients can use, and personal stories that will make you feel less alone.

Now I pass the Mind Matters torch to Jennifer Vining, an Infertility Counsellor based in Victoria, B.C. I know Jen will do a great job of addressing issues about the emotional impact of infertility, and I look forward to reading her articles!

I express my profound gratitude to the clients and readers who have shared their infertility journey with me. You have taught me a great deal about hope and perseverance. For those of you still struggling to create or enlarge your family, I wish you courage and strength. My sincere hope is that you have as many gorgeous babies as you always dreamed of.

About the Author

Sherry Dale specializes in counselling for infertility and pregnancy loss. She works full-time at the LifeQuest Centre for Reproductive Medicine. Clients can see her at LifeQuest even if they are not patients there (e-mail sdale@lifequestivf.com or call 416-506-0804). Sherry also has a private counselling practice, where she can be reached at sherry.dale@pathcom.com or 416-410-8904. Sherry lives in Toronto with her two sons, both conceived through assisted reproductive technologies.

References: (All by S. Dale)

1. (Summer 2007). Untitled. Creating Families: Canadian Journal of Reproductive Health, 2(4) 46-49.
2. (Fall 2007). Infertility patients want twins and triplets. Creating Families: Canadian Journal of Reproductive Health, 3(1) 22-25.
3. (Winter 2007). Infertility as a loss of control. Creating Families: Canadian Journal of Reproductive Health, 3(2) 46-49.
4. (Spring 2008). Is optimism necessary for successful fertility treatment outcomes? Creating Families: Canadian Journal of Reproductive Health, 3(3) 54-58.
5. (Summer 2008). Emotional trauma and phobias in infertility patients. Creating Families: Canadian Journal of Reproductive Health, 3(4) 64-68.
6. (Fall 2008). The triple-headed, green-eyed monster: Jealousy and envy in infertility. Creating Families: Canadian Journal of Reproductive Health, 4(1) 42-45.
7. (Winter 2008). If men want to be supportive…why do they feel so helpless? Creating Families: Canadian Journal of Reproductive Health, 4(2) 22-25.
8. (Spring 2009). Why do you want a baby? Creating Families: Canadian Journal of Reproductive Health, 4(3) 20-23.
9. (Summer 2009). The worst thing about infertility. Creating Families: Canadian Journal of Reproductive Health, 4(4), 19-22.
10. (Summer 2009). When it’s his infertility: Men’s emotional responses. Creating Families: Canadian Journal of Reproductive Health, 4(4), 33-37.
11. (Fall 2009). Helping your friends and family to help you. Creating Families: Canadian Journal of Reproductive Health, 5(1), 49-51.
12. (Winter 2009). Is it depression or grief? Creating Families: Canadian Journal of Reproductive Health, 5(2), 21-24.
13. (Spring 2010). Wanting another baby: The unique heartache of secondary infertility. Creating Families: Canadian Journal of Reproductive Health, 19-22.
14. (Summer 2010). Pregnant at last! The emotional experience of pregnancy after infertility. Creating Families: Canadian Journal of Reproductive Health, 42-45.
15. (Fall 2010). Infertility, stigma and shame. Creating Families: Canadian Journal of Reproductive Health, 26-29.