Navigating the Beta Test / (2WW)

Waiting to find out if you are pregnant is stressful, especially after IVF or FET. To keep the beta test result wait from completely taking over your life, make a plan of action in advance. While there is no way to not think about becoming pregnant, it is helpful to find comforting distractions and reduce obsessive thoughts. Most beta test days are typically 10-12 days post-transfer, then there is a secondary wait for the actual beta result, which can seem unbearable.

Use mindfulness to help let go of what you can’t control. You can’t control the outcome, but you can control your response. Find a mantra that helps, such as ‘so far, so good’ or ‘my body is ready to be pregnant’ to ground and center yourself.

Try to control obsessive thoughts re pregnancy symptoms, and resist the urge to take a pregnancy test before your beta hcg test. It’s truly too early to tell.

Stay busy: connect with friends; spend time with your partner not focused on pregnancy; practice calming rituals; do creative projects; deep breathe; get outside into nature; clean your house; or distract with reading fiction or watching relaxing media.

If you find yourself obsessing too much in unhealthy ways, give yourself up to 10 mins/day to structure formal worry time to express or write down all of your worries and then let go and move on with your day.

Sitting in uncertainty is challenging; waiting to find out if you are pregnant after a long infertility journey even more so. Make sure to continue to live your life and be hopeful, open and curious to what may happen next.

Impact of Infertility on Couples

One in eight couples experience difficulties trying to conceive. Infertility is a major life stressor and treatment cycles can be intensely stressful on partner relationships. Many couples feel like their lives are on hold and struggle with communication challenges and relationship dissatisfaction during fertility challenges. Additionally, one member (or both) may experience anxiety or depression. Other influences on relationship strength include:

  • Impact of unsuccessful cycles and the passage of time

  • Feeling left behind or not fitting in with peer group

  • Financial stressors of fertility treatment

  • Different coping styles for handling stress (emotional release vs problem solver)

  • Reduced intimacy and emotional connection

  • Secrecy - not sharing struggles openly with family or friends

  • Intrusive questions by friends and family (and society in general).

How to approach the stress of infertility as a team?

  • Remember you have the same shared goal: to become parents together

  • Be open with one another and express vulnerable feelings

  • Ask directly for what you need from your partner

  • Discuss treatment options, including your physical and financial limits around trying

  • Understand the impact of infertility on intimacy

  • Continue to live your lives - find ways to connect and enjoy one another.


If conflict has increased to a high level, it can be helpful to meet with a therapist for communication help and overall relationship support during the added stressor of infertility treatment cycles.


The Challenges of Donor Anonymity

Our modern world makes it inevitable that donor anonymity is simply not possible. More donor-conceived children (and sometimes their parents) are turning toward direct to consumer genetic DNA testing to find a possible genetic link to 1) the donor, or 2) a family member of the donor, or 3) a full or half bio-sibling. This can create confusing boundaries and ethical considerations on potential contact and what to do with this information. The ability to quickly find donors on Facebook using donor agency profile information adds to this modern reality. Egg and sperm donation is a mostly unregulated industry. These modern ways of making genetic connection and lack of true anonymity will ultimately change that.

Have you ever had to keep a secret? Or made a decision in young adulthood that with time and reflection, was understood differently? It’s helpful to consider that privacy expectations of intended parents or donors may change over time. When that happens, it can be challenging to look for ways to reach out and promote connection or rescind contact. This is where direct to consumer genetic testing has stepped in for better or worse — to fill this void.

Finding genetic connection can be an important part of becoming secure in one’s identity. It also can be an important part of making sense of a younger decision to become a donor and help build families. Let’s start reframing this path to parenthood as a family story with connectors from the onset. Note the difference in hearing ‘this is how we had help in becoming our family and there are others who were also helped that we can connect with’ versus one day being sat down and told about donor origins with no additional information. Time will stand still at that moment. A family story with openness and information offers fluidity and integration over time.

Infertility During the Holidays

This time of year can be especially painful for couples experiencing infertility. Many couples feel isolated at family holiday gatherings and wonder how they belong if they haven’t yet become parents. Some notice an intense focus of being the sibling without kids or feel a heavy heart from the loss of not providing a grandchild for their parents. Some worry about other family members feeling sorry for them or fear that others are secretly talking about their infertility situation. The year-end also represents the passage of time, and can heighten feelings of loss around not having a family. It’s also the darkest time of the year when people generally feel depressed or have low energy, on top of general holiday stress for the most ‘wonderful’ time of the year.

Here are some ideas on how to navigate this complex time of year.

Plan together ahead of time how to respond to unwanted questions about family building or unsolicited advice from others. Some couples create a code word or phrase to help each other exit uncomfortable situations.

Be selective about which holiday parties to attend and try to focus on adult get-togethers without young children present.

Give yourself permission to step outside or even leave an event if you feel overwhelmed.

Create rituals for you and your partner as a family of two.  

Spend time treating yourself or doing activities that you enjoy.

Exercise or at least get outside for a walk daily to have a release.

Make space for your feelings.

Turn to your partner and friends who can hold what you are going through for support.

Should You Freeze Your Eggs?

Are you considering freezing your eggs? The decision to freeze one’s eggs for the possible preservation of future fertility is subjective and full of complexity. Professional reproductive/medical organizations (ASRM and ACOG) have promoted oocyte cryopreservation for medical reasons (e.g. prior to chemotherapy treatment) for decades. However, fertility specialists and private egg banking companies have increasingly been promoting fertility preservation for elective reasons, such as delaying childbearing, making this option readily available to all women. 

The egg freezing process involves: 1) stimulation of the ovaries through hormone self-injections and monitoring follicle growth via ultrasound, 2) the egg retrieval procedure, which is quick and performed under sedation, and 3) the egg freezing procedure done through vitrification and subsequent storage of the frozen eggs. Remember, this is just the egg freezing process. You will later need to undergo the rest of the IVF process (using sperm from your partner or a donor to create embryos, and transferring embryos into the uterus) in order to become pregnant using frozen eggs. 

In making the decision, it is helpful to explore the numerous psychological, emotional, spiritual, financial and medical considerations involved in this process. Also look at success rates based on your age and fertility, as well as possible risks involved. Have an understanding that the procedure is invasive, that egg retrieval / freezing and storage costs are expensive yet separate from later IVF fertilization and transfer expenses, and there is no guarantee of future success. Take time to imagine how you would feel building your family this way, or what it may be like to be an older parent.

You should also consider the research: ACOG/ASRM studies have shown that the age of the oocyte (egg) at retrieval correlates with success rates, with viable studies ’supporting the use of these technologies in well-selected patients aged 35 years and younger,’ while ASRM/SART state that ‘even in younger women (under 38), the chance that one frozen egg will yield a baby in the future is around 2-12%.

There are many pros/cons to consider in making an informed decision. It can be helpful to meet with a reproductive mental health professional to explore feelings and navigate expectations and possible outcomes so you may make the best decision for yourself.

For more information and resources, check out:

Motherhood, Rescheduled: The New Frontier of Egg Freezing & the Women Who Tried It
by Sarah Elizabeth Richards

 

Decision-Making for Third-Party Family Building

There are many things to consider before moving forward with third-party assisted conception. One of the most essential tasks is understanding that having a child with donor assistance is more than just a solution to infertility. It’s considering the future child’s experience and needs,  as well as your own. Here are some questions to start exploring this path:

  • What are your assumptions about alternative family building? 
  • How would you or your partner feel about the absence of a direct biological link to your child? 
  • Have you processed feelings of grief around this genetic loss?
  • Would both you and your partner feel comfortable having a third-party involved in your family story? 
  • What is important to you in choosing an egg or sperm or embryo donor?
  • With genetic/ancestry testing and social media, do you believe anonymous donation truly exists?
  • How will you talk about your family story and share your child’s origins with your child? 
  • How do you feel about the possibility of bio siblings?
  • What will you share with friends or family about your child’s conception?
  • How will you respond to your child’s direct questions about the donor’s background or wanting to meet the donor or bio siblings? 

There are many ways to become a parent, and there is much to consider before choosing this path to parenthood. It can be helpful to meet with a mental health professional to explore these and other considerations. Find someone with whom you feel comfortable exploring thoughts and feelings around this decision.

 

Infertility Between Friends

While friendships naturally evolve over time, infertility can really test a friendship. Learning that a friend has become pregnant, while you have not, is unbelievably hard. You are happy to hear about the pregnancy, but the news is painful and naturally may bring up feelings of envy and frustration. You become angry from yet another reminder of your own challenges to conceive. Having these feelings in response to your close friend’s news creates feelings of guilt, so you end up feeling even worse.

How can you handle this situation? It’s important to be honest with your friend. Let her know that you are having a difficult time due to your current infertility experience. You are thrilled for her and would like to be there for her, but it’s simply too much at this time. 

Take some time to consider your history together and determine your needs in this relationship. Also look at your personal limitations on what you can offer your friend during her pregnancy.

•    Has she been supportive during your infertility experience? 
•    How have the two of you handled past friendship concerns? 
•    Are you comfortable offering support and remaining close during her pregnancy?
•    What are your boundaries around her sharing pregnancy details and baby shower planning? 
•    Do you want her to continue to check in with you around your fertility treatments? 
•    Have you considered her experience of being the one who became pregnant? What if it was you?
•    What changes would be needed to keep the friendship intact?

Infertility is a stressful time and requires support from friends who can hold what you’re going through. Remember you’re not always going to feel this way. Identify what works for you and express those needs to your friend. Many women have navigated fertility friendship bumps with grace. Some may decide to let the friendship dissolve, while others are able to reconnect when they are ready. Give yourself time to reflect on the support you need and find resolution that makes sense to you.  

Where Did I Come From?

At some point every child will ask a parent the big question, ‘Where did I come from?’ This standard inquiry becomes more complex when the child asking was conceived through third-party reproduction. Many parents experience anticipatory anxiety over these conversations; however, it is natural for donor conceived kids (like all kids) to be curious about their origins.

Research has shown that disclosure strengthens the parent-child bond, and how and when you tell your child has great impact on their identity development. It is essential to be open with your child, explore feelings and support their search for answers. Sharing from an early age allows children to progressively learn more about their family story, become comfortable with their origins, and develop a strong identity.

How can you prepare?
Begin thinking about how your family came to be during pregnancy. Consider what connected you to the particular donor(s) to help build your family. Your gratitude for their help. How you felt when you found out you were pregnant. How you felt seeing your child at birth. What it means to be a family. Start talking to your child during infancy so that when your child is old enough to understand basic concepts a bit more, you will feel more confident in sharing your family story. The more comfortable you are with talking about your family story, the more comfortable your child will feel too.

Limits around Trying to Conceive

How do you know when you are ready to stop trying?

The decision to stop fertility treatments and live childfree involves much self-reflection. Some things to consider:

  • Emotional, physical, and financial limits of fertility treatment.
  • Cost to the relationship with yourself and your partner.
  • Readiness to stop keeping life on hold.
  • Finding meaning in the experience of all of that you’ve gone through with pregnancy losses and fertility treatment.
  • How to cultivate letting go of the idealized family and refocus on being a family of two.
  • Existential concerns on finding purpose and connection and an openness to living life on a different path.
  • Finding new ways of looking at personal meaning around femininity and what it means to be a woman.
  • Recreating relationships – finding a new way to fit in with family and friends.
  • Acceptance of the decision and integrating it into a new identity.

All of this self-inquiry essentially encompasses grief work. There is much grief work to do. As you can imagine, the decision to stop trying is subjective - every woman or couple has to decide when they've had enough and reached their limits around trying to build a family. Through infertility research, we know that over time, the pain of infertility lessens but it doesn't completely go away. It is in integrating infertility into your identity, while no longer letting it completely take over, that the healing begins.

Coming into Motherhood after Infertility

How to let go of one's infertility identity? 

Many women report not knowing how to accept a pregnancy, or to transition from years of living in the uncertainty of infertility and longing for a child, to becoming a mom. During pregnancy, there are often two paths:  feeling ambivalent or detached from the pregnancy, or feeling overwhelmed by anxiety of something going wrong.

Post-birth, many women are thrilled to become a mom, but complex feelings may arise. How wonderful to finally be part of the motherhood club, yet familiarity with the previous infertility identity and associated thoughts, feelings and behaviors makes it difficult to leave that way of being behind. Some experience loss of support from moving onto a different path from friends whom they bonded with during infertility treatment. Others may have a difficult postpartum experience, which can heighten feelings of guilt and maternal ambivalence.

It can be challenging when partners and family quickly accept this identity change, and forget about the complex emotions of the previous fertility journey. Yet, for someone who has gone through this journey, infertility may always be a part of them. It’s hard let go of something painful that has defined you for so long. Thoughts of the long TTC journey may resurface during the first few years of parenting. That's part of the healing. It is only with time that you can integrate the previous parts of your identity into new ways of being, and become more confident in the new mother role. 

Resolve has some great resources to help with this transition.

https://resolve.org/support/pregnancy-after-infertility/
 

Later Motherhood

A recent CDC study reports that the 2016 birth rate for women ages 40–44 was 11.4 births per 1,000 women, the highest rate in more than four decades. Since 2007, the birth rate has risen 19% for women in their early 40s and 11% for women in their late 30s. For women 41+, attempts at utilizing assisted reproduction through IVF have risen by 50%. Since this path is no longer considered a ‘trend,' it is essential to consider some of the positives of later parenting. (We are all familiar with the negative aspects reported often in the media.) 

Many women report feeling a stronger sense of self and increased financial stability as an older parent. Some were initially ambivalent about motherhood and chose to wait until they were in a more emotionally secure place to provide for a child, even with declining fertility. Other women wanted to be in a strong, supportive relationship. Most report carefully considering their current life circumstances in order to ensure a healthy environment in which to raise a child.

Some surprises do occur: experiencing the perimenopause or menopause transition so close to giving birth, reduced time for self after having a longer phase of independence prior to becoming a parent, and an increase in ‘sandwich generation’ responsibilities from caring for an older parent while also caring for a young child. 

Having a child at any age is a very personal decision. There are many paths to parenthood: natural pregnancy, assisted reproduction, third-party family building, adoption, and foster parenting. The decision is based on one’s subjective experience. One thing is certain: the age range for becoming a first time mother continues to expand.

 

The Uncertainty of Infertility

Nothing tests our ability to deal with the uncertainty of events beyond our control as experiencing infertility. This is living in the grey area. Nothing is concrete.

Treatment cycles can be unpredictable and women experience many ups and downs through cycle cancellations, negative beta cycles, or positive cycles that later result in miscarriage. This grey area requires women to learn to sit with not knowing and ultimately, come to terms with the fact that sometimes answers simply don’t exist. Even if you do everything ‘right,’ things may not always go as planned.

Through this process, women experience feelings of hopelessness, disappointment, anger, loss of control and frustration. It can be exhausting carrying this burden for years and feeling as if your life is on hold.

How can we learn to let go?

  • Understand what’s in your control and what is not. Loosen your hold on wanting things to be a certain way. Know that so much of infertility is not in your control.
  • Acknowledge that this moment is challenging. Identify and express your feelings.
  • Promote feelings of acceptance. Things are as they are. Surrender.
  • This means not blaming yourself or your partner for something beyond your control.
  • Notice and release any judgments, expectations, or comparisons to others.
  • Increase self-compassion. How would you support a friend going through this? Show the same care and concern for yourself.
  • Learn coping skills to help face uncertainty without feeling overwhelmed. Try mindfulness exercises, relaxation techniques, spend time in nature, express your feelings through journaling or speak with someone who can hold what you are going through, find humor in this process.
  • Find a mantra that works for you: I let go. Some things are out of my control. The only thing I can control in this situation is my response to what’s happening. Delays can be beneficial. My life is unfolding as it’s meant to be.
  • Remind yourself that you are not always going to feel this way.

Through all of this, make sure to continue to live your life. Remember, infertility is just a part of you; it does not have to define you. The fertility journey is challenging, but what you learn about yourself through the uncertainty of this process can be a beautiful thing.

Secondary Infertility

Secondary infertility is a common experience for many women, but it is not often discussed.  The struggle with secondary infertility affects approximately 12% of women in the US. It is a unique circumstance because you’re not fertile or infertile, and many women feel stuck between two worlds. This unanticipated stressor can be a frustrating and painful experience filled with grief and disappointment as plans to increase family size do not go as planned. 

Having difficulties conceiving a second child can be a major shock to the ego, leading to feelings of anger, shame, guilt and depression. Women often report secrecy and isolation and no longer belonging to a peer group. Many feel misunderstood and express being viewed as ungrateful since they already have one child, causing them to withdraw from others as their feelings are quickly dismissed.

Maternal identity concerns arise as women question who they are as a mother since having one child may not mean their family is complete. Special considerations may arise regarding current child(ren). Being present with your child can feel conflicting at times; you love your child and are thrilled to be a mom, but they can remind you of possibilities of siblings and adding to your family size. It can be helpful to consciously separate the two parts, and to schedule specific time to focus on fertility considerations when your child is not around.

Many complex issues come up during fertility treatment. Besides the physical and emotional toll of treatment on women, the child may notice if there are suddenly more doctor visits or medicines for mom. Special considerations arise when the decision is made to use assistance from third-party donors after having one biological child. Decisions around what to share with others, including the current child (depending on the child’s age), can increase stress. The emotional toll of secondary infertility also affects couple relationships and intimacy. This can be heightened when partners have different limits around when to stop trying or different ideas about family building.

Resolution takes time and involves grieving losses (physical and of the idealized family), and acceptance of the current family size or growing your family in a non-traditional way. It is essential to be able to move forward feeling grounded in your family identity, however that may evolve.

I was interviewed for a Huffington Post article on coping with secondary infertility. This beautiful piece brings awareness to this issue and discusses the emotional journey of secondary infertility. If you are experiencing secondary infertility, reach out for support. Find someone who can hold what you are going through and take care of your emotional health.

Coping Skills for Infertility Support

Infertility can completely take over one's life. Here are some ideas of how to take care of yourself through infertility treatment and beyond. I contributed this article about infertility and trying to conceive to the GoodTherapy blog. I am hopeful it will provide helpful resources for women seeking coping skills during this transition. 

12 Coping Skills to Center Yourself through Infertility
http://www.goodtherapy.org/blog/12-coping-skills-to-center-yourself-through-infertility-0709144