When You're Not Expecting Part 2

54.Emotional Overload: Staying Together through Infertility Staying Together through Infertility The husband says: The husband says: "I don't even care anymore if we have a baby. I just want her to be happy again." "I don't even care anymore if we have a baby. I just want her to be happy again."

The wives say: "I can't believe that after all these years of infertility treatment, he's ready to give up! I know that in the beginning we both desperately wanted to have a baby. And I've been the one who has had to adjust the most to the medical interventions - the toll on my body and moods, the interruptions in my work schedule, the inability to plan ahead. I've tried hard to choose the right doctors, the right clinics, the right procedures. And now he wants to throw all that away? It seems as if he is saying that he wants to have me happy again so that our marriage can get back on track, and I'm saying that I want to have a baby so that our marriage can get back on track."

"Not only has infertility changed me, it has changed our entire view of what it is to be a couple. I had always thought that being a couple came first, and building a family came next. Chad had agreed with that perspective, but somewhere along the line he began to question whether the struggle to build a family was worth the toll it was taking on me and on our relationship. We really felt stuck in a cycle of two weeks of waiting to see if I got my period and then two more weeks of hoping that I'd be able to conceive this time this time I ovulated. Finally we began asking ourselves whether the quest for a baby was robbing us of our pleasure in life. So now we are sitting down to decide whether we could be happy going through life without children. If the answer to that question is 'no,' then I think we may be ready to ask ourselves whether adopting a baby would be a different pathway to our happiness as a family. I don't know where these 55 I ovulated. Finally we began asking ourselves whether the quest for a baby was robbing us of our pleasure in life. So now we are sitting down to decide whether we could be happy going through life without children. If the answer to that question is 'no,' then I think we may be ready to ask ourselves whether adopting a baby would be a different pathway to our happiness as a family. I don't know where these 55conversations will land, but it feels better to have them than to be stuck."

"When my husband began to question whether or not we should continue our infertility treatment, which had proved so emotionally exhausting for both of us, we decided to take a three-month 'vacation.' That was a really difficult decision to reach, because we'd lose precious months. But we had to know how it felt to have our lives back without infertility being on our minds every minute. So we notified the clinic that we would consider resuming treatment in three months, we told our therapist that we would call her if we needed her, and we planned some time out of town so we could be away from all the familiar reminders of our infertility struggle - including well-meaning friends and family. We needed to see if we could get our lives back. I guess we also needed to see if we still felt complete as a couple, since so much of our time in the past few years had been spent talking about how we would feel complete once we had a baby."

This final statement by the husband speaks poignantly to the toll that infertility can take, and to the sad recognition that the relationship will never again be the same. This husband clearly feels that the quest for parenthood has exacted too great a cost - he wants to preserve what he can of the marriage and, once again, he is looking for a way to "fix" his wife's sadness. Since men in North American society are not socialized toward parenthood in the same way that women are, it is easier for some of them to look to other rewarding life choices that do not include parenthood. However, a husband's willingness to forgo parenthood will probably offer little consolation to his wife. The two of them need to find 56 Emotional Overload: Staying Together through Infertility Staying Together through Infertility ways of reintroducing some pleasure into their lives, and ultimately they need to decide how long and to what ends they will pursue their efforts to become parents. ways of reintroducing some pleasure into their lives, and ultimately they need to decide how long and to what ends they will pursue their efforts to become parents.

Lesbian Partners If you are in a lesbian relationship, you know that many factors have shaped your decision to seek a.s.sistance in conceiving a baby.

Chances are that you both have given careful consideration to which of you will try to become pregnant first, and you hope you can conceive quickly!

Lesbians enter the path to parenthood with what has been called social factor infertility social factor infertility, whereby their choice of a female partner prevents them from conceiving without a sperm donor. Some lesbians will conceive through intercourse, some will self-inseminate with sperm from a known donor, and many will seek the a.s.sistance of a physician who is supportive of their desire to conceive. Others will use the services of an infertility clinic, with a.s.surance that advanced technology will be available and that clinic hours on weekends and holidays will allow them to be inseminated at the time of ovulation.

Lesbian couples who have trouble conceiving will experience many of the same issues as heteros.e.xual couples. Impatience, frustration, and sadness accompany the hope and antic.i.p.ation of any couple using a.s.sisted reproductive technology. However, lesbians also face unique challenges when seeking medical help to conceive. First, some health-care professionals will behave awkwardly when accepting a lesbian as an infertility patient.

Second, many clinic questionnaires are designed on the a.s.sumption the patient is in a heteros.e.xual relationship, so that may feel off-putting. And finally, as you may already have experienced, 57clinic staff may be confused about your relationship (sisters? best friends?). Only you can decide whether the convenience and quality of medical care make it worthwhile to stay in a clinic that is not gay-friendly. And even though the power relationship between patients and physicians can deter you from being openly critical, you may be able to encourage your physician to sensitize the clinic staff so all patients feel welcome.

These medical barriers mean that lesbians must select physicians and infertility clinics that appreciate the unique circ.u.mstances of lesbians hoping to conceive. And as a lesbian couple hopes for a successful pregnancy, their antic.i.p.ation is tempered by the reality that the partner of the birth mother will not be legally accepted as a mother, but will need to go through the legal formality of adopting the baby.

The following statements demonstrate some of the unique challenges facing lesbian couples, with examples of how each partner might react: The non-birthing partner says: "Once we decided we wanted to have a baby, our next decision was 'which of us will try to become pregnant?' " "Once we decided we wanted to have a baby, our next decision was 'which of us will try to become pregnant?' "

The birthing partners say: "This was an interesting challenge, since both of us are in good health and both of us felt really positive at the prospect of being pregnant. Ultimately we resolved the question by reminding ourselves that our long-term plans were to have more than one child, so hopefully each of us would have the opportunity to be a birth mother. We decided for baby number one that I would try to become pregnant, in part because I have better health insurance and I have more flexibility to work from home."

58.Emotional Overload: Staying Together through Infertility Staying Together through Infertility "We asked at our clinic whether I could pursue IVF, using donor sperm and my partner's eggs. In that way I would be the gestational surrogate of my partner's baby, and both of us would feel that we were sharing conception in a very special way. The clinic agreed, so that's our solution to pursuing motherhood!"

"Since my partner has several health problems that would be aggravated by becoming pregnant, we both hoped that I would be successful in conceiving. We decided that she would be the stay-at-home mom after I delivered, so in that way both of us would have important experiences in parenting our baby."

"I always have wanted to be pregnant and to nurse a baby. Jan is open to the idea of being a birth mother, but she was really very willing for me to try first to conceive.We agreed that if I didn't get pregnant after a year, she would be glad to try to conceive.

Our real priority has always been on becoming parents, and who carries the pregnancy is not especially important."

Once the couple reaches the decision to pursue parenthood, lesbians face both the questions of "who?" or "who first?" and also the fortunate opportunity for the other partner to try to conceive if the first partner's attempts are not successful.They both will share in the suspense of whether or when a pregnancy will occur, but there are a variety of creative answers to the question of who will be the birth mother.

The non-birthing partner says: "How are we going to arrange for you to get pregnant?" "How are we going to arrange for you to get pregnant?"

The birthing partners say: "I would like for us to choose someone we know to be the sperm donor. We've both talked with several of our guy friends, and 59once we narrow it down we'll decide on the details. I'm not interested in having intercourse, so once one of our friends agrees to donate his sperm, I'll just use a turkey baster, which worked fine for several lesbian couples we know. I know it sounds weird, but it allows me to bypa.s.s the whole clinic insemination routine."

"My partner hopes that her brother would be willing to donate his sperm, so when I conceive at least some of her family DNA will be in our baby. That's fine with me, since I know her brother and think of him as a really fine person. I'd like to inseminate myself, but if that doesn't work, I'd consider having intercourse once we pinpoint my most fertile time of the month."

"I have decided to ask my gynecologist to perform intrauterine insemination (IUI) using donor sperm from a sperm bank. Since my partner and I hope eventually to have more than one child, we plan to arrange for some of this donor's sperm to remain frozen so we can use it again when we try to conceive our first baby's siblings."

For lesbian couples planning to use sperm from a known donor, it will be important to be clear about whether, or to what extent, the donor will relate to the baby after its birth.

Just as the non-birthing mother will need legally to adopt the baby of her partner, both mothers should seek legal clarification and doc.u.mentation about the role the sperm donor will have in their lives and the life of the baby. Some families are eager to have the donor very involved; others prefer that the donor remain a family friend, and still others want to be sure that he understands his role with their family has been strictly as a donor - nothing more. And for those women using frozen 60 Emotional Overload: Staying Together through Infertility Staying Together through Infertility sperm from a sperm bank there is the opportunity to select a donor with characteristics that have a special appeal to the prospective mothers. sperm from a sperm bank there is the opportunity to select a donor with characteristics that have a special appeal to the prospective mothers.

The non-birthing partner says: "It has been a whole new experience facing the non-gay-friendly environment of the infertility clinic." "It has been a whole new experience facing the non-gay-friendly environment of the infertility clinic."

The birthing partners say: "After filling out all the forms asking for 'husband's name,' 'husband's urologist,' and various other questions, I just took a red pen and crossed through those questions. When a staff member asked me why I hadn't answered, I explained that I have a female partner and the questions do not relate to us. She said 'oh,' and disappeared. So when I saw the doctor, I mentioned how the intake form seemed inappropriate for same s.e.x couples and, to my surprise, he asked if I would be willing to revise the form so it was more user friendly to all patients, including single women. Since I'm sure I'm going to be spending lots of hours in their waiting rooms, I said I'd give it a try. But, honestly, I feel pretty good about his recognition of the problem I posed and his willingness to consider a solution."

"When I was called into the exam room, the attendant asked me if my husband would be available to talk to the doctor after the exam. I asked if she had read my records, and when she said she had not, I told her that I have a lesbian partner who is in the waiting room and who would like to be in the examining room with me. She looked a bit fl.u.s.tered, said she would check, and disappeared. When the doctor arrived, I explained that I had asked the nurse if my partner could be present during my exam, but I hadn't received an answer. The doctor consulted 61the chart, asked if my partner's name was Cheryl Sutton, and when the nurse arrived a moment later, asked her to show my partner into the room. I then said to the doctor how nice it would be if clinic staff could be alerted that not all patients are heteros.e.xual, and asked what the clinic does to help its staff be sensitive to diversity in its patients. He paused, said he hadn't given it much thought, but he agreed that it would be worth raising at a staff meeting. Cheryl was shown into the room at that point, only to hear me offering to make a presentation at any staff meeting where the topic was on the agenda! If I don't get an invitation in a month or two, I think I'll repeat my offer and see if I can make any headway."

"Once again I find myself frustrated and angry to be in a clinic where I'm a.s.sumed to be heteros.e.xual. Not only did an intake worker ask me if my husband's urologist had forwarded his records, but the look of awkward confusion at my answer convinced me that I'm probably the first lesbian she has knowingly met."

These and other examples demonstrate that some infertility clinics have staff who are unfamiliar with how to make same s.e.x couples feel comfortable and accepted in an environment that for so many years offered its services to married couples. For those patients who choose to be a.s.sertive, there is always the possibility that their offers to help will be solicited or accepted. For those patients who encounter inappropriate or rude behavior, a written complaint to the personnel office would be a logical response. If the clinic has a psychologist or a social worker on staff, it would be reasonable to meet with them to discuss your concerns about the lack of respect you feel in the clinic, and what has contributed to that feeling. Those helping professionals, who often see themselves as patient advocates, may be in 62 Emotional Overload: Staying Together through Infertility Staying Together through Infertility the best position to address your concerns from the inside of the organization. However, if you find yourself clenching your teeth in silence, rather than drawing attention to slights or rude treatment, you probably are in the throes of a power imbalance. the best position to address your concerns from the inside of the organization. However, if you find yourself clenching your teeth in silence, rather than drawing attention to slights or rude treatment, you probably are in the throes of a power imbalance.

Not only are you depending on the staff to help you get pregnant, but you also would like that to happen as cooperatively as possible. For you, an anonymous letter to the personnel department or a counselor on staff may be the closest you want to come to making a complaint. And that is understandable, given that you really want the focus to be on a successful pregnancy. It is always a challenge to weigh the roles we a.s.sume in various settings, and you have a right to decide where you want your focus to be as you concentrate on your efforts to conceive. Just keep in mind that, over time, different options may seem more plausible as you become more familiar with the clinic, its staff, and the best ways of requesting flexibility in behavior.

The non-birthing partner says: "Whenever I get my period, which is no big deal, I worry that maybe this month Chris will get her period too, and that will be a sad time and another lost month for us." "Whenever I get my period, which is no big deal, I worry that maybe this month Chris will get her period too, and that will be a sad time and another lost month for us."

The birthing partners say: "Getting my period was bad enough before I began intrauterine insemination. The week or so of PMS, the cramps, and the general discomfort were no picnic. But now my period has such a symbolic meaning of loss. Kelly can sense my PMS almost before I do, and we both begin to have a premonition that this is not the month to celebrate a pregnancy. It is really a comfort to have someone who is so in tune with my biological rhythms. I only hope that she can share those rhythms in a different way when I get pregnant."

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"It's so strange to be so aware of my period. Since Jan is the one who has cramps and mood swings, we would both be on high alert when she got her period because she felt so rotten. Now we both feel rotten when we get our periods, since mine represents the non-pregnancy. We've decided to indulge ourselves when we get our periods, just as a way of not letting them get us down too much. So the first day of a period is now an excuse to go out for dinner or a nice dessert, or maybe to pick up a colorful bouquet at the florist. We both know we're trying to get past the sadness for me and the discomfort for her, but so far it's working pretty well."

Unlike the experience of heteros.e.xual couples, there's no question about a lesbian partner being unable to understand the meaning of her partner getting her period! The significance of another month pa.s.sing without a pregnancy is heightened for females who are so in tune with one another's biological rhythms.

The non-birthing partner says: "It has been strange to face the reaction of our families to the news that Sharon is trying to get pregnant." "It has been strange to face the reaction of our families to the news that Sharon is trying to get pregnant."

The birthing partners say: "Our families' reactions were directly parallel to their acceptance of us as lesbians. Marilyn's parents have welcomed me from the start and have been clear that they cherish me because I make their daughter happy. So it was no surprise to hear their happiness when we announced our plans to conceive their grandchild.

No fuss from them about the fact that the baby would have none of their genes - just hopes for a healthy pregnancy and a healthy birth. They've even offered to help with the costs of 64 Emotional Overload: Staying Together through Infertility Staying Together through Infertility the inseminations. My parents, on the other hand, have always believed that I would 'come to my senses' someday, and they've avoided references to my lifestyle as much as possible. They're clearly uncomfortable around Marilyn, and she and I keep any visits with my parents to a minimum. So our announcement to them about wanting to become parents was received as the last nail in the coffin. Clearly if I have a baby with Marilyn, there's little possibility that I'll 'come to my senses.'" the inseminations. My parents, on the other hand, have always believed that I would 'come to my senses' someday, and they've avoided references to my lifestyle as much as possible. They're clearly uncomfortable around Marilyn, and she and I keep any visits with my parents to a minimum. So our announcement to them about wanting to become parents was received as the last nail in the coffin. Clearly if I have a baby with Marilyn, there's little possibility that I'll 'come to my senses.'"

"Most of the members of our families received our news with good wishes. But one of my sisters and one of hers both waited a few months and then raised their issue: what are they supposed to tell their children about how our baby is being conceived?

My guess is that they'll wait until the conception has occurred, just to avoid the awkwardness of it with our nieces and nephews. Sarah and I agree it isn't our problem, but we're trying to figure out whether this is a genuine request for help or whether it is a message that, once again, we're the black sheep in the family."

"One of my sisters has been going through infertility treatment for the past year. Her reaction was mixed. On the one hand she was glad to know that someone else in the family was having to work at conceiving a pregnancy; on the other hand, it seems to me that if I conceive before she does it will remind her of her reproductive failure. But now I'm worried that our efforts to get pregnant may take on a compet.i.tive edge in her mind.

One thought I've had is to send her some of the lesbian literature that frames efforts at conception away from reproductive failure and toward the positive wish to bring a child into the world. I love my sister dearly and would hate for my pregnancy to drive us apart."

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Families are important during any developmental stage, but there is a special poignancy when everyone is poised, waiting for the announcement of a much-wanted pregnancy. Lesbian partners already have had ample experience with their families'

reactions to their s.e.xual orientation. And, yet, families have many members, each of whom may have a unique relationship with its lesbian siblings, offspring, nieces, aunts, or cousins. So lesbian partners, always trying to antic.i.p.ate family reactions, probably will not be taken by surprise as they share with relatives their hopes for a baby. But negative reactions are sure to take a toll on them as they decide whom to tell, how to ask for support, and as they answer awkwardly posed questions from various family members. So not only do they bear the suspense of whether or not their method of conception will be successful, they also may endure family lack of emotional support at the very time it would be most appreciated. Many lesbians find comfort in creating their own non-kin families, chosen out of love and compa.s.sion, who can be counted on for strong and solid validation.

The non-birthing partner says: "Although we arrived together at the decision of who would try first to get pregnant, I'm worried that while she's learning how to nurse I'll have to be preoccupied with the legalities of adoption." "Although we arrived together at the decision of who would try first to get pregnant, I'm worried that while she's learning how to nurse I'll have to be preoccupied with the legalities of adoption."

The birthing partners say: "Both of us are unhappy and angry that the legal system makes it so complex for a baby to be recognized as having two lesbian parents. It feels intrusive to have to pay for and to go through a home study and all of the legal paperwork a.s.sociated with an adoption, when both of us know that this baby will be ours ours.

66.Emotional Overload: Staying Together through Infertility Staying Together through Infertility It's partly the cost, it's partly the a.s.sumption that we can't be committed parents without a legal doc.u.ment for one of us, and it's very much the legal intrusion on our time and energy just when we're bonding as a family." It's partly the cost, it's partly the a.s.sumption that we can't be committed parents without a legal doc.u.ment for one of us, and it's very much the legal intrusion on our time and energy just when we're bonding as a family."

"The adoption aggravates both of us. Not only would it be unnecessary if we were a married heteros.e.xual couple, but it sends a message that the non-birthing parent can't be committed to parenthood unless there are legal doc.u.ments. Of course we're seeking the legal doc.u.ments so that if, heaven forbid, something terrible should happen to me, Jenna would retain custody of our child. But it's an extra cost, an extra set of appointments on the calendar, and a very real reminder that there's an imbalance in our ent.i.tlement to parenthood unless the legal system is involved."

Certainly at the very time a couple is involved in Lamaze cla.s.ses, furnishing the nursery, making more frequent pre-natal visits, deciding on possible names, and contemplating the changes that a baby will bring in their lives, the prospect of a home study and a legal adoption feels very out-of-place. And this is one of those issues that will not go away. Even if you are legally married and therefore should not need to adopt a child born from this marriage, you probably will go through with the adoption, just to be on the safe side. Depending on what region of the country you may be traveling in, even an adoption may not be recognized as valid, so same s.e.x couples are in a real double bind: d.a.m.ned if they do (because it feels so wrong to have to adopt the child you know to be yours yours), and d.a.m.ned if you don't (in case you're caught in legal limbo somewhere and your parentage is called into question). So the frustration of adopting must be taken in stride with the joy of a new baby in the family.

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Therapeutic Tips The challenge you face as a couple is to accept that your difficulty in conceiving places a unique stress on your relationship. It isn't a stress easily shared with others, because of the privacy many people place around personal issues like s.e.x and reproduction.

It isn't a stress that health-care providers are likely to ask about. It isn't a stress that parents or siblings are likely to understand.

And it isn't a stress that you and your partner ever antic.i.p.ated or experienced before.

However, as time moves forward, frustrations mount, schedules are disrupted, and savings accounts are depleted, it is normal and expectable for your emotional resilience to wear thin. Your challenge is not only hoping and planning for parenthood; it is also knowing how to keep your relationship in enough balance so you as a couple can empathize with one another and move forward on a common path. This may be new territory for you, so don't be shy about seeking out resources that can offer new coping skills, open up channels of communication, and bolster your emotional resilience. Here are a few ways you can find additional support: * Join a support group so that you feel less isolated socially and better connected to couples whose experiences may mirror yours.

* Inquire about whether your infertility clinic provides a therapist with whom you and your partner can discuss the impact of infertility on your relationship. Also inquire whether the clinic provides a support group for couples.

* Become a member of the Infertility Awareness a.s.sociation of Canada (IAAC) or RESOLVE (the national US infertility a.s.sociation) and learn how other couples address the challenges you and your partner are facing.

68.Emotional Overload: Staying Together through Infertility Staying Together through Infertility * Use Internet chat rooms and resources suggested by IAAC or RESOLVE to find creative resolutions to managing anger and sadness.

* Seek out a therapist who has expertise in couple therapy so the channels of communication with your partner can be rejuvenated and you can feel less stuck.

* Keep some boundaries around your sadness and your frustrations. Agree with your partner on setting time limits on regular discussions about conceiving.

* Weigh the option of taking a vacation from infertility treatment, both to get a rest from the side effects of hormone treatments and to a.s.sess with your partner what next steps you are ready to consider.

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Four.

The Waiting Game: When Life Is on Hold Treating infertility is a time-consuming process, and it is predictable that you will feel as if your life is being held hostage.

More than likely you and your partner will be subjected to a variety of medical tests and possibly medical interventions. You may need to take pills, have injections, monitor hormone levels, have surgery, and recover from that surgery. You will spend a lot of time waiting, all the while unable to move forward in your career, take on new challenges, or build up your financial security because of the possible high cost of treatments.

This is a time when many women feel helpless, swept along by the tests and procedures, and as the months progress, far from confident that they will get pregnant. This also is a time when you, like many women, feel dependent on your health-care providers. You find that you wince at impersonal communications, grind your teeth at unreturned telephone calls, and silently chafe at the inflexibility of the scheduling process that rules your life.

But because you are so dependent on the medical staff, it feels Chapter Four too risky to vent your feelings. Your life is moving at a sluggish pace, with the tantalizing hope of pregnancy dangling just out of reach.

Feeling stuck, whether by infertility itself, or by others in your life who are unable to support your decisions, can be discouraging and exhausting. As the women in this chapter relate, infertility has catapulted them into a mora.s.s of decisions they never envisioned when they first began their efforts to conceive.

Most people find that if they can agree on how to proceed, the opinions of employers, parents, in-laws, and other loved ones matter less. Further, most women can find role models in their new communities of infertile women and couples. Support groups, clinic waiting-room conversations, counselors, friends of friends, and chat rooms are all resources that women may want to consult as they try to get "unstuck" and open new doors.

And especially as you experience the frustrations of infertility, you will want to find ways to lift your spirits, distract yourself from disappointing news, consider new options, and nurture your relationships. Finding balance in your life becomes more of a conscious effort now that you are in the midst of medical procedures. Remember that just as you are spending considerable energy engaged in medical treatment, you can soothe some of this stress by identifying and connecting with personal and community resources.

Waiting Once you begin diagnosis and treatment, there is an initial hopefulness that you're on a new path with pregnancy as a hoped-for outcome. But, as the remarks of the women in this chapter reveal, that hopefulness begins to fade as time marches on and 72 The Waiting Game: When Life Is on Hold When Life Is on Hold still no pregnancy occurs. Impatience, frustration, sadness, and dependence on health-care providers are familiar responses as month after month pa.s.s, with your calendar and your bank account constantly adjusting to clinic procedures. It isn't unusual to feel "stuck," and some couples use this treatment time as an opportunity to seek counseling, both for their own peace of mind and also to open the door a crack to consider other options they might be willing to pursue: still no pregnancy occurs. Impatience, frustration, sadness, and dependence on health-care providers are familiar responses as month after month pa.s.s, with your calendar and your bank account constantly adjusting to clinic procedures. It isn't unusual to feel "stuck," and some couples use this treatment time as an opportunity to seek counseling, both for their own peace of mind and also to open the door a crack to consider other options they might be willing to pursue: "Once we began to be seen at the clinic, I felt as if the treatment regimen was so much more organized than what I had experienced with my local physician. But, looking back, I had no idea how the variety of tests and treatments would take up so much time. So we grind along, first doing a certain number of months of one procedure. Then when that doesn't result in a pregnancy, we try another couple months of the next procedure on the list. Getting negative test results each month has felt like nails being pounded into our family coffin. Neither my husband nor I want to go through IVF [in vitro fertilization] if we can avoid it, but we're beginning to run out of options."

"It's getting to the point where I'm afraid to call the lab for results when I'm at work, because if my hormone levels aren't up, then I know this is one more lost month. If I'm at work that means I land in the restroom and have a good cry, and my colleagues only need to see my bloodshot eyes to know the news this month isn't good. But if I wait until I get home, often the clinic is closed and then if I'm lucky there's a message on our answering machine. Sometimes I ask Tom to listen to the voice message because I'm tired of always being the first to hear bad news. I recently counted how many months we've 73been trying to get pregnant - it's been over 30. My friends and family are holding out hope, but I don't know how much longer I can. I'm reaching the point where Tom and I need to look at where we want to go from here. That way, at least, we could ask ourselves the hard questions we've avoided so far - about whether we should seek out a new clinic or begin to consider adoption or surrogacy."

"One of the worst aspects of having my life divided into 'before treatment' and 'waiting for results' is that my emotions are being badly affected by the medication and the failure to get pregnant. There's no longer even a 'good' time of the month. All the days are colored by the hormones I'm taking, and of course everything comes crashing down when the nurse calls with bad news. I've never been a very patient person, and I do well when I'm in control of my life. So now, I feel both out of control and impatient. But each month is more than just a month without a pregnancy. Each month is time spent, money spent, my body being subjected to medications, and my schedule being turned upside down to accommodate medical appointments. I'm even too exhausted to distract myself with friends, hobbies, or a good book. The magazine articles on trying to conceive always end up with the parents cuddling a darling newborn. When will it be my turn? Haven't I waited long enough? One of my infertile friends is seeing a counselor she thinks is very good and, much as I dread adding yet another appointment to my calendar, I'm beginning to think that some counseling sessions might be my best chance at breaking loose from feeling so trapped."

"When Jack and I were first diagnosed as having infertility problems, an infertile friend of ours gave us a book that had more wisdom than I realized at the time. Dr. Seuss's book Oh, The Oh, The 74 74 The Waiting Game: When Life Is on Hold When Life Is on Hold Places You'll Go! Places You'll Go! captures the path we have traveled to infertility. captures the path we have traveled to infertility.

Right now we're in the place that the book calls 'The Waiting Place,' where no matter what you do you're still stuck. I've faced frustrations in my life, but I've always felt as if there were new doors I could open. Jack and I aren't ready to consider adoption yet, so here we are, dependent on medical professionals to do the best they can to help me conceive. In my wildest dreams I never imagined this pathway to parenthood."

Not Taking On New Challenges In addition to feeling stuck waiting for a positive pregnancy test, you may feel unable to move ahead with other aspects of your life: career choices, promotions, further education, or moving.

These decisions and others are closely tied to whether or when you will become parents, and it seems difficult to move in new directions until the certainty of parenthood has been made clear.

The following stories explore how some women feel about their own inability to move forward: "Our plan was to have two children, and once they were in school I would go back to university to get my master's in education.

An advanced degree would open up better-paying career opportunities and also give me more flexibility to be off during the summer months for family time. If I had known a couple of years ago that I'd be getting treated for infertility for four years, I would have gotten my degree earlier. The way things are going now, I don't dare enroll in a graduate program, because what if I get pregnant? But the longer I stay out of school the less professionally productive I feel. And, frankly, if I don't get pregnant, I don't know whether I want to enter a profession that focuses on working with other people's children."

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"Last year my boss said to me that he wanted to groom me to take over the position of someone in the company who is due to retire. That person has a lot of responsibility, works long hours, and has made the company the center of his life. So I explained to my boss that once I have children I doubt that I could commit to the additional hours and the travel schedule that would be expected of me. I said it in the throes of lots of medical procedures that had to be carefully timed, so a part of me was aware that I couldn't meet the challenges of the position if I were still being treated for infertility. So here I am stuck in my current work position, without the joy of a baby to take the monotony out of my life."

"I have the perfect job for a parent - I get summers off, I have good vacation and sick-leave benefits, and I can do some work from home. It's not nearly as stimulating as other jobs I could have, but I took it because I wanted to be able to balance work and family responsibilities. But as the months drag on, I realize that this job isn't good for me now now. I have very few coworkers, the work is fairly repet.i.tive, and there's no social life at lunchtime or after work. So these days it feels lonely, isolating, and boring, just when I need to have some distractions from the disappointments of my infertility treatment. I know I stay in this job as a way of saying to myself that maybe I will will be a parent soon. But maybe I need to start listening to Mike when he encourages me to get out of the house with him for a quick morning walk, to meet friends for lunch, or to take that evening cooking cla.s.s at the community college." be a parent soon. But maybe I need to start listening to Mike when he encourages me to get out of the house with him for a quick morning walk, to meet friends for lunch, or to take that evening cooking cla.s.s at the community college."

"Last month Janice was offered a transfer to a branch of her company that is in another city. This transfer carried a promotion 76 The Waiting Game: When Life Is on Hold When Life Is on Hold with it, and the only reason she didn't take it is that we feel so fortunate to be in the same city as the infertility clinic where I'm being treated. If we move, the nearest infertility clinic would be four hours round trip, which would have been exhausting and disruptive for me. I suppose there may be other opportunities for her later, but it was hard for both of us that she had to pa.s.s up this promotion because I haven't become pregnant yet." with it, and the only reason she didn't take it is that we feel so fortunate to be in the same city as the infertility clinic where I'm being treated. If we move, the nearest infertility clinic would be four hours round trip, which would have been exhausting and disruptive for me. I suppose there may be other opportunities for her later, but it was hard for both of us that she had to pa.s.s up this promotion because I haven't become pregnant yet."

"As a single woman, I've had to plan pretty carefully for the support system that I can count on if I'm lucky enough to have a baby. When my boss offered to pay for my education if I would work in a distant city after I got my master's degree, she seemed totally puzzled when I turned her down. I explained that I was trying to get pregnant, and her response was that she was sure I could manage my education along with parenthood. Well, perhaps I could, if I'm lucky enough to get pregnant in the next year or so, but she seemed completely unable to grasp that my support network is here here, and I can't very well pick that up and move it to another city."

Infertility and Your Job Another aspect of feeling that your life is on hold may occur as you realize that your work and infertility do not mix. Perhaps it is the inflexibility of your job, the insensitivity of your coworkers, or that infants and children are an integral part of your work at a time when you are yearning to nurture a baby in your own home. The dilemma becomes whether you are prepared to tough out the months of infertility treatment in a job that causes you stress, whether you will seek another kind of work, or whether you will leave the workforce altogether. These women 77speak about their challenges of juggling infertility treatment and work, which may be the same as your own: "Initially my boss was reasonably understanding when I told him that I would need to take some sick time for infertility treatments. But I think he believed it would be only at convenient times. Well, now it seems that no time is convenient. And although I'm legally ent.i.tled to take sick time, I don't always know from day to day when I'll be scheduled to go in for procedures, and he is getting less and less accepting of my absences.

I know I have the union on my side, but the work environment is getting downright unpleasant. I feel as if infertility treatment has become a second job, and of course I have to give it priority. So, given my boss's negative att.i.tude, I'm trying to decide whether I should look for a new job or if we could afford to use Jack's medical benefits, which aren't as good as mine, and just have me quit work until we know if the infertility treatments are going to be successful."

"I've always been proud to be a child welfare worker, and I know my work has made an important difference in the lives of lots of families. But over the past year I've been feeling more and more anger toward the parents who abuse and neglect their children. I used to be able to appreciate the life circ.u.mstances that might cause someone to put a child at risk, and I was good about being able to intervene, to set clear limits, and to advocate for the children involved. Lots of people I worked with were able to turn their lives around and become better parents. Now I am consumed with anger toward these parents who treat helpless children with so little love and concern, and when I encounter abusive situations it's all I can do to resist taking the children home myself! I know that my infertility is what has made me 78 The Waiting Game: When Life Is on Hold When Life Is on Hold react personally rather than professionally. So now I'm struggling with how to take the focus of my work away from children, at least until I'm successful in becoming a parent myself." react personally rather than professionally. So now I'm struggling with how to take the focus of my work away from children, at least until I'm successful in becoming a parent myself."

"I'm a midwife. My greatest joy is in working with couples during the woman's pregnancy and then delivering healthy children into this world. But I'm realizing that after five years of being treated for infertility, I am feeling jealous of my patients, envious of their abilities to plan their lives so carefully, and downright weepy when I place a newborn into its parent's arms. I worked my whole adult life to be a great midwife, and now infertility is robbing me of being able to take joy in my work. I'm considering taking a leave of absence - maybe to teach students midwifery, which would be less direct contact with pregnant women and infants. Somehow, I need to find a new path to follow while I'm trying to cope with my infertility."

The Financial Crunch Before you were faced with infertility, you probably had many financial goals and dreams that you wanted to achieve, such as owning a home, saving for retirement, or taking an exciting vacation. However, now that you have new financial challenges to deal with, you might feel like your financial plans are at a standstill and you're not sure how to organize your funds.

In addition, like many infertile women, you probably have become an expert on how to distract yourself on bad days, nurture yourself, and try new experiences at the very time when the one experience you really want eludes you. And the reality is that it usually costs money to cushion yourself against the pain of infertility. And coping with infertility costs money. So you may be stuck between saving money for future infertility or 79adoption expenses versus spending it on yourself. Perhaps you can gain insight from the stories of these women who coped creatively with the financial challenges of infertility: "We've been trying hard to watch our savings, since we've decided to pursue adoption if I don't get pregnant in two years.

But we know that two years of infertility treatment can be costly, especially when it involves missing days from work, so we're tucking away every spare dollar and that means no new clothes, no vacations, very few dinners out, and modest gifts on birthdays and holidays. Mack and I decided to begin doing some things that would increase our feeling of togetherness and reduce the stress that infertility is causing. He thought I was being dramatic when I said that I planned to meditate twice a day, but after hearing from me about how I felt more able to cope, he is setting aside time for meditation each day too. We both find that it allows us to move through the stress more constructively.

Then, since we have to eat at home more, and neither of us is very handy in the kitchen, we decided to make weekend projects of cooking different ethnic foods. If a dish turns out really well, we celebrate by inviting friends over to share it with us.

And, just because it is sometimes hard to face the day, we now get up 30 minutes early and take a quick walk together before we have breakfast and leave for work. It lets us feel connected and gets our blood circulating so we have energy for whatever the day brings. I find it really has helped to focus on low-cost activities that bring us closer together."

"Ron and I love the outdoors, and before infertility became such a concern, we used to take vacations all over the country. Now we just can't afford it, so instead we take camping trips that get us into the wilderness, allow us to appreciate the beauty of nature, 80 The Waiting Game: When Life Is on Hold When Life Is on Hold and challenge us to handle rain, rodents, and rough terrain. We take pride in being able to economize, and it's actually fun to spend weekends in winter planning camping trips for warmer weather. We're thinking of borrowing some cross-country skis and using that as a way of getting outdoors, while avoiding the expenses that go along with downhill skiing." and challenge us to handle rain, rodents, and rough terrain. We take pride in being able to economize, and it's actually fun to spend weekends in winter planning camping trips for warmer weather. We're thinking of borrowing some cross-country skis and using that as a way of getting outdoors, while avoiding the expenses that go along with downhill skiing."

"As we try to adopt a frugal lifestyle, the people who are becoming our friends are empty-nesters who are paying for their kids'

college expenses. We don't end up worrying about conversation moving in the direction of pregnancies and babies, and these friends in their forties and fifties are pretty mellow and easy to be with. Some of them have been in our community much longer than we have, so they often suggest activities that we hadn't thought about. One of the women volunteers in a local soup kitchen, and when I went with her one evening, I decided that this kind of volunteer work was just what I needed to get my mind off my own sadness. Everything is relative, and although I don't have a baby, at least I have a roof over my head, a partner who loves me, and enough nourishing food each day."

Considering Adoption or Surrogacy Many couples begin their infertility experience with every confidence that they will conceive and have a healthy birth.