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.

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

 

The New Sibling Adjustment

Here are some ideas to help with the second child / big brother or big sister transition.

When you share the baby news with your current child during pregnancy, it can be helpful to frame it as adding to your family. Let your child know how much you and your partner wanted a family, and you were so happy to have him or her. Now you and your partner are excited again to add to your family. Express some of the complex feelings s/he may be experiencing: I imagine you may feel happy, sad, excited, angry, etc. Name whatever emotions s/he seem to be sharing.

  • Talk with your child about the logistics of what will happen when you are in the hospital: who s/he will stay with; when s/he will come visit you and meet the new baby, etc.

  • Make sure to have some solo time with your older child in the hospital when the baby is in someone else’s arms or sleeping in the newborn crib. Have him or her sit or lie with you and check in together.

  • When you get home, you won’t be able to do everything s/he wants you to do during your birth recovery, but you can do slow paced things each day with your older child like reading books or cuddling.

  • Once you are more mobile, have special outings with just your older child. When you are out remind them that only s/he can eat pizza or go on the big slide, etc., not the baby.

  • Tell him how much you love him or her and how grateful you are that s/he will always be your first baby, and how special it is that now s/he is a big sister or brother.

  • Use positive reinforcement for each time s/he does something helpful and kind with the new baby.

  • Expect some regression or acting behaviors. It's natural and this behavior is a young child's way of processing such a big family transition.

Books for kids:

Daniel Tiger: The Baby is Here
by Angela C. Santomero and Jason Fruchter

I am a Big Sister or I am a Big Brother
by Caroline Jayne Church

Books for parents:

Siblings without Rivalry
by Adele Faber and Elaine Mazlish

Understanding Postpartum Anxiety 

Postpartum anxiety is confusing - it can be hard to distinguish from regular new mom worry. What we look for is severity - has worry completely taken over? Are you unable to relax and enjoy your baby? Are you unable to rest at all? Are you having trouble turning off your brain? Are you worrying about everything? Is it difficult to focus on one thing?  Do you have nervous energy? Do you have a relentless to-do list? Are you ‘present’ but really in your head the whole time? Are you having sleep difficulties due to excessive thoughts? Is your appetite non-existent? Did you quickly lose your pregnancy weight? Do you have perfectionist traits? Are you focused on trying to do everything 'right' (when there is no right way to care for a new baby)? Are family members constantly telling you to just relax or calm down but you can’t?

Postpartum anxiety is experienced by approximately 10 percent of new moms. It can be related to having a history of anxiety before or during pregnancy, or from birth trauma or a newborn health concern. It can be impacted by higher levels of cortisol (the stress hormone), which are present during pregnancy and early postpartum. Postpartum anxiety can be challenging to identify – it often gets grouped under the more commonly known postpartum depression, but is its own maternal mental health concern. It is a common concern in SF - I see more moms with postpartum anxiety in my practice than postpartum depression. One of the biggest regrets I hear from moms with postpartum anxiety is they feel they wasted their maternity leave worrying and constantly doing, rather than just slowing down and being with their baby and enjoying this special time. 

It is not always easy to tell others that you are having scary thoughts or excessive amounts of worry. Please know there is much strength in being open with others about feeling this way. If any of this describes your experience, please reach out for support to help manage these thoughts and stabilize your mood.

I’m glad to see that postpartum anxiety has received more media coverage in the past year. Below are links to some helpful articles.

Postpartum Anxiety Is a Thing—Here’s What to Watch Out For
https://greatist.com/live/postpartum-anxiety-symptoms-and-treatments

This is What It's Like to Have Postpartum Anxiety
https://www.scarymommy.com/postpartum-anxiety-exhaustion/

Postpartum Anxiety Affects 1 in 10 Moms
https://www.vogue.com/article/postpartum-anxiety-vogue-april-2018

The Lonely Terror of Postpartum Anxiety
https://www.thecut.com/2017/08/the-lonely-terror-of-postpartum-anxiety.html

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.  

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.

Lonesome Motherhood

How do you find your mom tribe?

The loneliness of parenting an infant takes many new moms by surprise. You may wonder where you fit in now - your main group of friends may have older children, or be childless. It can be hard to connect and feel you are contributing socially with these friends  – you may worry you don’t have much to say since you don’t do much on maternity leave outside of caretaking an infant. There will be days when you don’t talk to any adults all day. This is where many women really feel like they lost their previous identity – the isolation and reduction in social interaction can really impact mood.

Parenting a newborn can feel isolating. As soon as your partner leaves for work, you’re looking at a full day with a blank slate with a baby. Then comes the complex anxiety feelings around staying in or attempting to go out. The challenges of getting out of the house with a baby plus all the baby gear seem insurmountable, so of course, staying home seems most appealing.

It’s essential that new moms find the strength within oneself to do the opposite action and find some source of connection. Joining mommy and me or breastfeeding support groups can help reduce isolation. It’s ok to be late to these meetings. It’s ok to be a mess. It’s ok to cry there. It’s also ok if you don’t particularly like or connect with any of the moms; the social exposure for you and your baby is key. Some moms find wonderful support online through mothers’ groups and parenthood apps. This is a great way to feel understood by others, ask questions, and, most of all, laugh from reading and posting funny things about a mother’s day that others totally get.

Choose whatever path feels right to help you connect to others going through motherhood at your child’s stage. It can be so rewarding. I still remember the anxiety I felt going to the first mommy and me group. I teared up, and almost went home. Then I looked at my baby and thought, we got this. Some of those women still support me today, two years into motherhood. Find your tribe.  

Here are a couple of related articles:

The Loneliness of Motherhood

The Facebook Moms

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/
 

Pregnancy Reading List

I’m often asked about pregnancy books for expectant parents. Here are some helpful resources to check out. 

For Moms-to-Be:

Becoming a Calm Mom: How to Manage Stress & Enjoy the First Year of Motherhood
Deborah Roth Ledley PhD

Nurture: A Modern Guide to Pregnancy, Birth, Early Motherhood - and Trusting Yourself and Your Body
Erica Chidi Cohen

The Birth of a Mother
Daniel Stern and Nadia Bruschweiler-Stern

The Mindful Mom-To-Be: A Modern Doula’s Guide to Building a Healthy Foundation from Pregnancy Through Birth
Lori Bregman

Mindful Motherhood: Practical Tools for Staying Sane During Pregnancy and Your Child's First Year
Cassandra Vieten PhD

The Journey to Parenthood: Myths, Reality and What Really Matters
Diana Lynn Barnes

For Dads- and Partners-to-Be:

The Expectant Father: The Ultimate Guide for Dads-to-Be
Armin A. Brott and Jennifer Ash

Dad’s Expecting Too: Expectant fathers, expectant mothers, new dads and new moms share advice, tips and stories about all the surprises, questions and joys ahead
Harlan Cohen  

Mommies, Daddies, Donors, Surrogates: Answering Tough Questions and Building Strong Families
Diane Ehrensaft 

Confessions of the Other Mother: Non-Biological Lesbian Moms Tell All
Harlyn Aizley

Postpartum Wellness

Let’s focus on maternal mental health. There is much post-birth emphasis on newborn health, but a new mom’s own health is also a priority. Postpartum mood changes affect both biological and adoptive moms. You have to be able to take care of yourself in order to take care of a newborn.

It can be helpful to talk about what you are experiencing as a new mom.

How are you feeling emotionally? Physically?
Is your body healing from the birth?
Are you sleeping? How is your appetite? Are you getting outside?
Who helps at night when the baby wakes?
Are you having any breastfeeding, supply or latch difficulties?
How is your mood? Are you sad or tearful? Are you irritable or angry? Detached and numb?
Are you anxious? What are your worries? Are any of your thoughts scaring you?
How do you feel about your connection to your baby?
Your connection to your partner?
What worries you the most about the way you feel? Does your partner know how you’re feeling? Is there anything you’re holding back from telling others?
How are you taking care of yourself?
Who can you turn to for support?

Many women experience difficulties adjusting to new motherhood. It makes sense; you've never been a new mom caring for a newborn or infant before. New motherhood is filled with transitions, some expected, but also many, many surprises. And cumulative sleep deprivation can wreck havoc. Often moms report that something feels off, but they may not know how to express what they are feeling or worry they may be judged so stay silent.

How can you take care of yourself? Learn about postpartum mood changes and check in with yourself. Ideally during postpartum and pediatric checkups, you will spend some time focusing on your health as a new mom. If not, find friends, family members or a mental health professional who will check in with you. If you’re not feeling like yourself, tell someone. Remember, it’s essential to put on your own oxygen mask first. 

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.

What Holds Us Back from Change?

One of the primary obstacles for change is getting too comfortable with the way things are. We are creatures of habit, and our defenses can be difficult to break down, especially over time. Change is possible; neuroscience has shown through brain plasticity research that we do have the capacity to form new neural pathways that allow us to make changes in our way of being. Awareness is key – first we need to see that we are stuck in a problematic way of being in order to consider making a change.

How can you begin to shift things and make positive changes in your life?

We can learn ways to mindfully encourage change. It all starts with the understanding that we have the ability to make a conscious shift to do things differently. It’s about slowing down and noticing the patterns of our thoughts, feelings and behaviors. Awareness leads to insight.

What are you getting stuck on? Start by noticing when you’re thinking, feeling or doing the same things over and over. Track patterns and make a list of common triggers that lead to the same responses. Then begin challenging the old way of being and considering ways to change. Continually ask yourself, “Do I want to keep automatically reacting, or can I find a way to be present, pause and consciously respond?”

We can also benefit from giving up the narratives that keep us stuck. Letting go of core beliefs that hold us back (I’m not good enough, things will never be different, I’m always going to feel this way, etc.) can be terrifying, but doing so allows you to shift your way of being (I’m doing the best I can in this moment, things can be different, this feeling is temporary). Encourage openness and curiosity for the unknown, and a willingness to see what happens when you give up familiarity. With consistency, you will begin to notice that you are embracing change. Make sure to maintain this new way of being and continue to move forward in your personal growth. 

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