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MY SPECIALTIES |
Infertility What is meant by "infertility"? From a purely medical perspective, infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse or the inability to carry a pregnancy to live birth. This includes miscarriages and stillbirths. For most couples, infertility is more than just a physical condition; it represents losses that tax them financially and emotionally. The term "reproductive losses" encompasses the physical, financial, and emotional losses involved-including the distress involved in the treatment of infertility and any negative outcomes. Some people who initially experience reproductive loss are ultimately able to have a biological child, either naturally or with medical intervention. Why is the diagnosis of infertility so difficult emotionally? Nothing in your experience prepares you for the diagnosis of infertility or your response to reproductive losses. Most people assume they will be able to conceive and bear children, that it is their biological right. Unlike the anticipated loss of a parent or a job upon retirement, infertility is an unanticipated loss that is made more painful by the feeling that you have lost control over your hopes and dreams for your future. You may ask, "Why me?" You may wonder if infertility is a punishment for some wrongdoing, or you may feel personally assaulted by infertility. A critical turning point in coping comes when you can stop seeing reproductive loss as a predator and see it instead as a condition, predicament, or unfortunate situation that happened to befall you, out of no fault of your own. One of the biggest challenges in dealing with reproductive loss involves facing the losses associated with an infertility diagnosis. These may include, but are not limited to, the loss of the potential biological child, loss of the opportunity to parent, loss of the continuation of the genetic family line, and loss of status within family or your community of friends. My family and friends don't seem to understand why I'm so upset. They just want me to "get over it." Unfortunately, other people often do not know how to respond to your loss. Our culture fosters denial and encourages wishful thinking when we are faced with a difficult problem such as infertility. Well-meaning friends or family members, in an effort to make you or themselves feel better, may gloss over the truth and encourage you that "someday" it will all work out. It is easier to generate hope than face losses. Some may suggest that it is "God's plan" or that infertility has some meaning or lesson to be learned, even though such assurances are rarely comforting. Or they may imply that you should "get over it" or not feel the pain at all. Lack of support for or failure to proceed through the grieving process makes coping with the infertility diagnosis, treatment process, and negative outcomes even more difficult. How do people typically respond to a diagnosis of infertility? Responses to the diagnosis of infertility are complex. Some people endure the diagnosis with little turmoil, while others experience it as a profound blow to their life's dreams and to their self-concept. Men and women often respond differently. Our culture demands that males repress their true emotions, especially sadness or despair, and focus on finding solutions. As a result, many men react to the diagnosis of infertility with anger, which covers over their grief. They may adopt an aggressive problem-solving attitude or try to overcompensate in other areas of their life, for example, becoming more involved at work. Men often avoid discussing feelings about the diagnosis or the reproductive losses it entails. Women, on the other hand, struggle with a broad range of emotions and tend to carry the emotional burden for their partners and others, as well as for themselves. As a result, they often feel alone in their grief. Having to observe or even participate in the pregnancies of other women make the infertility diagnosis even harder. How each partner responds will affect the relationship, which is likely to experience some degree of turbulence, as most people are not prepared to find themselves in this situation. The reason for the infertility can also affect each partner's reactions. Statistics show that 40% of all cases of infertility are due to the combined problems of both partners. In 5 to 10% of couples, standardized testing indicates that nothing is "wrong" with either partner. In such cases, the diagnosis is "unexplained infertility." When the problem can be identified and is attributable to one partner, it is important that the partners refrain from blaming (oneself or the other person) and withdrawing from one another, but rather support one another without regard for what the individual medical issues are. How is infertility and reproductive loss treated in psychotherapy? An important first step in therapy is to identify, acknowledge, and validate the feelings associated with the condition of infertility and associated reproductive losses. This involves working through the grief, anger, and doubt that come as a result of the condition. Therapy should also help you and your partner sort through the alternatives to having a biological child-adoption, surrogacy, or the choice of child-free living. Reproductive losses often negatively affect a couple's sexual relationship, and a goal of therapy should be to restore a mutually satisfying sex life. Most importantly, therapy should help you integrate the condition of infertility into your self-identity and help you regain your sense of wholeness and integrity. What should I expect to get from psychotherapy for infertility and reproductive losses? Some benefits available from psychotherapy for infertility and reproductive losses are that you should be able to:
What if I am not necessarily infertile but am nonetheless childless? Many women have postponed marriage due to increased career options and an emphasis on self-development and career development. As a result, it may be more difficult to meet single men who are their intellectual equals or who are simply "right" for them. If marriage is seen as a prerequisite to having children (and for more and more women, it is not), a potentially fertile woman may be childless. In other cases, a career woman may be married but choose not to have children, only later, when the biological clock is about to run out, to reconsider her decision. In either case, how to resolve this situation may present emotional turmoil that can be helped by psychotherapy.
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Dr. Joyce Nash, PhD (650) 329-1000 |
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