When You're Not Expecting Part 6

"Finally I am showing, and I love it! Now the whole world knows that I'm pregnant, and I'm relishing the questions, the happy wishes, and the attention. And lots of my friends who have children are now much more comfortable being with me than when I was infertile and they were feeling awkward or guilty.

Now they are offering me hand-me-downs for the baby's early months and all sorts of pregnancy advice."

"Now that I'm beginning to wear maternity clothes, I'm also getting questions - some from friends who know I will be raising this baby as a single parent, and others from people who are just trying to make conversation. But I certainly feel a little 170 Achieving Pregnancy: An Emotional Roller Coaster An Emotional Roller Coaster awkward when they ask things like 'And does your husband want a boy?' or 'Be sure to get your husband to do his share of the housework now, so it's not a shock when he needs to pitch in after the baby is born.' But so far I find that a vague smile is all that anyone seems to expect." awkward when they ask things like 'And does your husband want a boy?' or 'Be sure to get your husband to do his share of the housework now, so it's not a shock when he needs to pitch in after the baby is born.' But so far I find that a vague smile is all that anyone seems to expect."

"Wearing maternity clothes has brought out some interesting reactions in people who know that I'm in a lesbian relationship.

Some are clearly confused and avoid the subject of my pregnancy altogether. Others are curious and open up the subject by congratulating me on my pregnancy and asking about the due date, while clearly hoping I'll offer more information about how I'm going to parent this baby. And then, happily, there are friends who have known all along how carefully we've been trying to conceive and who celebrate this healthy pregnancy with great joy and antic.i.p.ation."

"Steve and I must just be nervous people. When we were being treated for infertility, we were worried all the time - about test results, side effects, and the lack of control over our lives. I thought the worrying would end with my pregnancy, but it has just shifted focus. In the first trimester we worried about whether the pregnancy might miscarry. Now that I'm in the second trimester, we've begun to worry about what could go wrong with the delivery. Somehow it seems that we don't feel ent.i.tled to enjoy this pregnancy until we have a healthy baby in our arms."

"I'm having such fun buying maternity clothes - I can remember my years of infertility when I actually wouldn't even go to the place in the mall where the maternity shop is located. I couldn't bear to see the pregnant women shopping there, knowing that I might never be able to. Now my maternity clothes are a real symbol of my victory over infertility."

171."Joe and I are thrilled with how the pregnancy is progressing, so that's a real relief. But we also realize we were so caught up in our infertility treatment that we hadn't fully appreciated some of the challenges parenthood would bring. So now, at the same time that we're feeling so happy, we are looking at our bank account to decide how we can support the additional expenses of a baby, whether we'll both need to work full time, whether our apartment is going to be big enough, and all sorts of other practical questions."

Emotions in the Third Trimester By the third trimester the focus shifts once again to delivery and parenthood. Unless there have been complications in the pregnancy, the third trimester becomes a time of eager antic.i.p.ation, with some apprehensions about the delivery. These apprehensions are fueled by your earlier experiences with medical procedures focused on your reproductive health. Since the outcome of some of those procedures was not what you hoped for, you probably still carry with you a heightened sensitivity that the outcome of your baby's delivery carries risks. For now, however, you're focused on keeping healthy in this last trimester, as each week of pregnancy confirms that the baby is developing well.

The energy in earlier months that focused on hopefulness is now channeled in more concrete ways. You and your partner discuss names, make more frequent visits to the obstetrician or midwife, furnish the nursery, attend childbirth cla.s.ses, read books on delivery and nursing and infant care, select a pediatrician, and make final plans for the trip to the hospital and help at home after the baby's arrival. In many ways, the endless planning of this period is in direct contrast to the feelings of being out of control that characterized your months of infertility.

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Achieving Pregnancy: An Emotional Roller Coaster An Emotional Roller Coaster You now try to structure the most ideal situation as you antic.i.p.ate parenthood. You now try to structure the most ideal situation as you antic.i.p.ate parenthood.

Perhaps you can identify with some of these scenarios of the third trimester and its impact as you and your partner antic.i.p.ate the amazing changes that a baby will bring into your lives: "In some ways I feel as busy as I did during our infertility when we were rushing from the clinic to the therapist to the drugstore and trying to fit it all into our work and personal lives. But this is so much more fun! I love the decisions that we're making - colors for the nursery, names, which stroller to buy . . . I feel as if I'm in a dream world and all it will take to complete the dream is to wake up with our baby in my arms."

"Frankly, as thrilled as I am to be pregnant, I'm finding myself irritated at the way some of our family members are suddenly intruding on our lives.When we were infertile, it's like we had an invisible disease - no one wanted to talk about it or about how upsetting it was for us. Now that we're expecting and the pregnancy has progressed to the third trimester, all of a sudden everyone wants to get in on the act, suggesting names, offering hand-me-downs, and talking incessantly about their labors and deliveries. I guess I find it upsetting that it takes a pregnancy for me to be embraced by my family again."

"This third trimester is a time when my partner Jennifer is antic.i.p.ating all the legal work involved in preparing to adopt our baby after it is born. On the one hand, it makes us both angry that she needs to go through legal steps that no one would require of a married couple. And certainly the idea that a case worker will do a home study to evaluate her as an adequate parent is just downright insulting. But, on the other hand, now that we are so close to becoming parents, this trimester also is a time 173to celebrate with our friends and family who have been so supportive of our decision to become parents."

"During introductions at our first childbirth cla.s.s, Joan introduced herself as my sister-in-law, and I could see the puzzled looks on the faces of the other couples. I wasn't sure how to present myself as an enthusiastic single mother-to-be and, sure enough, a good number of couples in the cla.s.s initially a.s.sumed that this was an unplanned pregnancy. But I decided to be clear that I had conceived this baby with lots of reproductive a.s.sistance, and eventually everyone just included Joan and me in the informal conversation before and after the cla.s.s. But I do feel that I stand out as a 'different' mother in a group, and I guess I'd better figure out a comfortable way of conveying my happiness at my choice to be a single mother."

"When I was a teenager I did a lot of babysitting, so I have a pretty good idea of how to diaper and burp and soothe crying infants. In spite of his pa.s.sion about becoming a father, Steve hasn't even held a baby before, let alone become familiar with its daily functions! I've told him that I'm going to need to learn about breast-feeding, but that I know he's perfectly capable of learning how to bathe and change a baby, and these are experiences that I really hope he'll take on to feel closer to the baby.

He seems hesitant, but willing to give it a try. He's even agreed to take lessons from my brother, who has volunteered his infant for supervised bathing and diapering!"

"After all the infertility procedures I've undergone, I'm feeling pretty apprehensive about the delivery. So much can go wrong, and my body has never been something I could count on when it comes to making babies. I guess I worry that it may let me down during the delivery too. As much as I like our obstetrician, 174 Achieving Pregnancy: An Emotional Roller Coaster An Emotional Roller Coaster the whole idea of having a doctor involved again brings back the memories of all the surgeries when I was infertile." the whole idea of having a doctor involved again brings back the memories of all the surgeries when I was infertile."

Unantic.i.p.ated Complications For women who have pregnancy complications, the earlier feelings of being out of control resurface. Once again you must depend on health-care professionals. Once again you are reminded that your body is not handling its reproductive capacities smoothly. Once again you feel the fear in the pit of your stomach that perhaps, even now, this pregnancy is going to defy your every effort to have a healthy outcome.

Having sustained the pregnancy until the third trimester is a measured victory. Yet, with the fear of premature labor looming, it is possible that your obstetrician has told you to curtail your activity or to be on strict bed rest, either at home or the maternity ward, where your pregnancy can be closely monitored.

The hospital environment forces you to confront the constant reminders of your body's unpredictability, even as you observe with envy the parents on the ward who are learning to care for their newborns. This is a trying time for you and your partner, as you are reminded once again that having a baby is not an experience to take for granted. Whether your bed rest is at home or in the hospital, this forced period of dependency keeps you and your partner from having the kind of mutual pre-parenting experiences that most other couples enjoy. However, with your focus being on day-to-day successes, you are eternally hopeful that the end of this trimester will be a smooth delivery and a healthy baby, as these women's stories demonstrate: "The minute the doctor ordered me to bed I knew I was going to be robbed of feeling fully joyful about this pregnancy. Now I'm 175so tuned in to every movement the baby makes, to every twinge of my uterus, and to every fear I could imagine about a premature delivery. Earlier in the pregnancy I had all sorts of things to distract me - now it's just me in this bed feeling funky, unproductive, and obsessed with wanting this pregnancy to be healthy."

"With the doctor saying that I needed to begin my maternity leave two months earlier than I had expected, I'm at loose ends.

I sort of feel as if I'm under house arrest, since I can't drive either.

Now I appreciate how the structure of work and being involved with the outside world was such a vital part of my life. I was a miserable infertility patient, and I can feel lots of those reactions resurfacing, even when a different doctor is calling the shots. I just have to keep in mind that things are really more hopeful now that I'm pregnant - I just hope the baby stays put until closer to my delivery date."

"Being in the hospital so much earlier than I had expected is tough.

I feel guilty about going on maternity leave weeks earlier than I'd planned, and now Tim is left with getting the nursery in order - and I'd really looked forward to doing that with him! With all these worries about the baby's health, there is a part of me that wants to tell him to wait until the baby is born before finishing the nursery - is that morbid or what? But I've had so much sadness with our infertility that these last complications are just another reminder that being pregnant is no guarantee of a healthy baby."

Post-birth Concerns Pregnancy and a healthy birth represent the dreams that you have nourished throughout your pregnancy. Will any ghosts of infertility lurk in the corners once you have a healthy baby 176 Achieving Pregnancy: An Emotional Roller Coaster An Emotional Roller Coaster sleeping in the nursery? I will mention a few, not to preoccupy you, but to rea.s.sure you that it is normal for these ghosts to float in and out of your consciousness as a new parent: sleeping in the nursery? I will mention a few, not to preoccupy you, but to rea.s.sure you that it is normal for these ghosts to float in and out of your consciousness as a new parent: * Being overprotective Being overprotective is both expected and common for previously infertile couples. This baby is especially precious, and you are aware that it may be your only birth child. So it is not surprising that you want to do everything possible to keep it safe and healthy in every way. Just be careful if you find yourself being overly vigilant or reluctant to let your growing child take in new experiences. is both expected and common for previously infertile couples. This baby is especially precious, and you are aware that it may be your only birth child. So it is not surprising that you want to do everything possible to keep it safe and healthy in every way. Just be careful if you find yourself being overly vigilant or reluctant to let your growing child take in new experiences.

* Being stoic Being stoic, which you may have been during your pregnancy as you refused to acknowledge the misery of nausea and fatigue, may resurface. This time your stoicism may kick in as you endure sleep deprivation, the boredom (or hectic aspects) of your daily routine, the lack of down time, and the juggling of your new roles and responsibilities that may not be going as smoothly as you had hoped. Just be aware that it is emotionally healthier for you to communicate your frustrations than to keep them bottled up. Only by letting others know what you need can you make a plan that will reduce your exhaustion or feelings of being overwhelmed.

* Striving for perfectionism Striving for perfectionism, whether it is keeping up with the laundry or being ready for your baby's next developmental phase, is a temptation for all parents. Now that your baby is such a significant focus in your life, you want to create the best environment possible. But don't be too hard on yourself (or on your partner) when you must adjust carefully laid plans. Or, more likely, when you lack the time and energy even to plan more than a few hours ahead! Focus on the joys and pleasures of parenthood and partnership, and try to take the ups and downs in stride.

177.* Feeling guilty Feeling guilty, which is especially unproductive, can be triggered by a variety of circ.u.mstances: ambivalence about parenthood, fatigue, difficulty juggling family responsibilities smoothly, challenges of renegotiating familiar relationships, doubt about day-care arrangements, and myriad other day-to-day irritations. If you can, try to talk to other new mothers about their experiences with parenthood. You'll find some guilt is universal, but some new mothers will carry fewer emotional burdens than others, and their perspectives may be useful to consider as you realign your priorities. After all, parenthood is an evolving process, and being open to new ways of coping is a real plus.

* Experiencing depression Experiencing depression, possibly a familiar feeling from infertile days, may now be related to the changes in your hormones following your delivery. It may be exacerbated by fatigue, the feeling that your body will never get its shape back, the monotony of changing diapers, frequent feedings, and a squalling infant. For most women, depression pa.s.ses as they begin to establish a routine that enables them to get more rest and more partic.i.p.ation from their partner. However, if you are among the women whose depression does not lift, or if you have thoughts of doing harm to yourself or to your baby, you may be experiencing postpartum depression postpartum depression. If so, it is time to share this information with your ob-gyn and identify a mental health professional who can immediately a.s.sess how best to help you. If you are not sure how to begin this process, you can contact your community's mental health society. Other sources include the social worker at the hospital where you delivered your baby, your ob-gyn, your clergy, or the Resources section at the end of this book.

The sooner you reach out for help, the more quickly you will experience relief from the weight of this depression.

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Achieving Pregnancy: An Emotional Roller Coaster An Emotional Roller Coaster Therapeutic Tips Therapeutic Tips Once you have a positive pregnancy test, you know how precious this pregnancy is. As you try to balance your feelings of apprehension and hope, you are keenly aware that your infertility continues to influence the ways you and your partner view this pregnancy and your preparation for your new roles as parents. Pregnancy books are not likely to include any of the tips below, which are especially timely for you as you hope for a healthy pregnancy and safe delivery: * You may be tempted to stop going to your support group or seeing your counselor once you hear the welcome news of a positive pregnancy test. However, don't be so hasty to take up membership in The Club that you distance yourself prematurely from your support system! During this pregnancy you are likely to experience periodic feelings of anxiety that can be best a.s.suaged by empathic friends or a familiar therapist who has traveled the infertility pathway with you. If your infertility support group does not allow pregnant couples, see whether your infertility clinic or a nearby chapter of the Infertility Awareness a.s.sociation of Canada (IAAC) or RESOLVE has a support group that feels right for you. You may not need to meet with your therapist as frequently as during your infertile months, but it is a good idea to schedule regular meetings to check in - you'll be surprised at how infertility has conditioned you to see this pregnancy uniquely.

* You may be trying to decide with your partner how soon to share the news of your pregnancy. Although you may be tempted to wait until after the first trimester, when the risk of a miscarriage diminishes, it is important to ask yourselves 179why you are waiting. Most couples wait because they fear a miscarriage or a negative outcome of prenatal testing. But if (heaven forbid) that happens, won't you want to gather around you the love and support of family and friends who know how much this pregnancy has meant to you? An early loss, even before you look pregnant, is still a very real loss to mourn, and you absolutely deserve to have the support of loved ones at such a difficult emotional time. How much information to disclose is up to you, but do be aware that people who love you can more easily offer their comfort and support if they have known about the pregnancy from the earliest weeks.

* You are undoubtedly relishing the fun experiences in which you could not indulge during your months or years of trying to conceive: buying maternity clothes, looking at baby furniture, knitting or crocheting blankets or baby garments.

But also unspoken during those childless years were some practical decisions that you and your partner now need to discuss: finances, child-care arrangements, ch.o.r.es, and parenting responsibilities. Take your time, but be aware that enlarging your family means changes to physical s.p.a.ce, bank accounts, leisure time, family responsibilities, and work-life balance (although the word balance balance may disappear from your vocabulary for months at a time!). The more you agree on these practical issues before the baby's birth, the easier it will be to renegotiate new arrangements as the baby grows. may disappear from your vocabulary for months at a time!). The more you agree on these practical issues before the baby's birth, the easier it will be to renegotiate new arrangements as the baby grows.

* You and your partner may consider setting boundaries with families and loved ones. This will differ with every family.

Single parents and lesbians will very likely create families from loved ones and close friends who may not be blood relatives.

Married couples will also need to decide how to negotiate 180 Achieving Pregnancy: An Emotional Roller Coaster An Emotional Roller Coaster relationships with existing family members, who often feel especially ent.i.tled to offer advice, make demands, and be involved in your life now that you, too, are parents. Only you know the parties involved, with their unique strengths and limitations. The guiding considerations to keep in mind are whether the preferences of family are contributing to your strengths as partners and parents; whether they are in the best interest of the health and safety of your child; and whether they allow for reciprocity in a comfortable way across the generations. Often the reactions and behaviors of family members during your difficult years of trying to conceive have left their mark, either positive or negative. Pay attention to their behaviors now to see how your new relationship might evolve as you take on your roles as parents. relationships with existing family members, who often feel especially ent.i.tled to offer advice, make demands, and be involved in your life now that you, too, are parents. Only you know the parties involved, with their unique strengths and limitations. The guiding considerations to keep in mind are whether the preferences of family are contributing to your strengths as partners and parents; whether they are in the best interest of the health and safety of your child; and whether they allow for reciprocity in a comfortable way across the generations. Often the reactions and behaviors of family members during your difficult years of trying to conceive have left their mark, either positive or negative. Pay attention to their behaviors now to see how your new relationship might evolve as you take on your roles as parents.

You and your partner are entering uncharted territory as parents, which can be both exciting and daunting. You both may have idealized this period of your lives as you looked with antic.i.p.ation to having your dreams fulfilled. The reality of disrupted sleep, piles of laundry, a curtailed social life, and a to-do list that never ends will require cooperation and humor from both of you. If you are a single parent, now is the time to draw on the goodwill of relatives, friends, and neighbors to let them know how they can provide much-needed support - there is nothing like a new baby to bring out solicitous offers of help!

In the midst of it all, you will have no difficulty recalling the much darker days as you were trying to conceive, which make most challenges of new parenthood pale by comparison! So get as much rest as you can, share the errands, be patient with yourself, breathe deeply, and relish how the meaning of family has taken on new and unexpected dimensions.

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Ten.

Ending Treatment: When Enough Is Enough The decision to let go of your quest for a birth child comes in stages, in ebbs and flows of emotion that are laced with grief and ambivalence. On the one hand is the tremendous amount of energy you have devoted to overcoming your infertility. This energy has consumed you, altered your relationships, diminished your financial resources, put your life on hold, and ultimately changed the person you are and the way you view the world.

On the other hand, at the very time you have been investing energy in overcoming your infertility, you have yearned for some stability, predictability, and control over your life and the decisions that you face. You ask yourself how much longer you can keep this up, and wonder about other options besides being a birth parent that could bring you happiness. If you let go of your dream child, could you live happily in a world full of infants, children, and pregnant women?

Many couples wish that their physicians would simply tell them there is no hope and, indeed, some physicians do. But far Chapter Ten more common are the messages that "one more try," "another approach," or "a few more cycles" might lead to a healthy pregnancy, and it is in the midst of these seductive messages that couples realize they are the ones who ultimately will need to call a halt. At a time when medical advances once seemed so promising, what factors will you consider as you make the decision to stop infertility treatment? In this chapter, I will explore some of these practical factors that you and your partner will need to discuss, including finances, time disruptions, clinic accessibility, work performance, statistical odds, and emotional issues.

Finances Most individuals begin diagnosis and treatment full of hope. But it isn't long before the costly realities become a factor in how long you believe you can continue treatment. These realities include limits of insurance coverage, time away from work, and housing accommodations if your clinic is in a distant city. It isn't only that your bank account is depleted - you may also need to antic.i.p.ate costs a.s.sociated with later choices to pursue adoption or surrogacy. You may want to consider putting a limit on how low you are willing to draw your savings account, so that if you do not become pregnant you still will have some savings set aside to pursue other options.

"We have spent our life's savings trying to have a baby. The idea of giving up now makes me feel as if we've just thrown all that money, time, and hope down the drain - and all for what? For the sadness of not being a parent?"

"Frankly, we just don't have any more money that we can devote to this. We have no savings, we've borrowed from both sets of 184 Ending Treatment: When Enough Is Enough When Enough Is Enough parents, and if we continue at this rate we'll be in hock up to our ears. If the doctors could offer any encouragement I might be willing to continue, but with no optimism from them that I can get pregnant, we just have to cut our losses." parents, and if we continue at this rate we'll be in hock up to our ears. If the doctors could offer any encouragement I might be willing to continue, but with no optimism from them that I can get pregnant, we just have to cut our losses."

"Even though we've been lucky that our insurance has covered a number of procedures, it won't continue to finance our treatments indefinitely or even to be a resource if we move into a more high-tech set of treatments. And, since our clinic is very far away, we have to bear the expenses of hotel costs and time lost from work, and those costs are beginning to mount up."

"We sat down the other night to talk about our bank account.

Jim asked whether I wanted to spend thousands of dollars on treatments with no promises of success or whether we might consider taking the money we have left and pursuing adoption, which he thinks will offer more possibilities of bringing a child into our family."

Time Disruptions The loss of other opportunities while you pursue treatment feels like a dark cloud hanging over you. Remembering that you began infertility treatment with high hopes, it is important to re-evaluate those hopes and other life goals every six months or so. Your physician, a support group, or a counselor can help you think through whether (or for how long) you want to sacrifice your other goals to the quest for a pregnancy.

"You know, the money has been a very concrete loss in all of this.

But another loss has been my devoting three years of my life to trying to conquer infertility, when I could have been using those years to get more education, to get ahead in a career, or 185just to enjoy life. I feel like I've wasted this time and I'll never get it back."

"We have given years to this quest for parenthood. When we began, we were thinking in terms of months. This period of sadness in our life together is becoming too long."

"I haven't taken a vacation in three years, because we need to be near the clinic for various procedures and treatments, and I haven't wanted to lose so much as a month. I can't imagine trying to enjoy myself on vacation, while wondering the whole time if this might have been the month I could have conceived."

Clinic Accessibility Access to quality clinic services may involve a lengthy and costly commute. Ask the counselor at your clinic what their other patients do to reduce the cost and disruption of a commute.

Explore whether some of your tests and blood draws can be performed locally and the results faxed to the clinic. If you are in a support group, ask its members if they have found creative solutions to this dilemma. In some cases you may be able to find a nearby reproductive endocrinologist or urologist in private practice who could perform most of the diagnostic and treatment interventions that you need. If so, consider working with a reproductive specialist whose office is much more accessible than your clinic.

"Even though my partner and I live near a good infertility clinic in the US, we are not eligible for services there because they insist their patients be married. As lesbians we don't have that option where we live. As much as I'd like to challenge the clinic's policy as discriminatory, I've decided to put my energies into a 186 Ending Treatment: When Enough Is Enough When Enough Is Enough much longer commute to a different clinic. But it is exhausting, time consuming, and expensive to go that extra distance." much longer commute to a different clinic. But it is exhausting, time consuming, and expensive to go that extra distance."

"The closest clinic to our home is about a three-hour drive. We decided that I'll simply rent a little apartment in that city and stay there whenever I need to, since I'm the one who has to undergo the most time-consuming procedures. We're lucky that money isn't a big issue. But the separation from Tom, especially while I'm waiting for test results, is just agonizing."

"We have a farm, and whenever we both need to travel to the clinic, which is 300 miles away, it means that we need to hire people to do the farm work - after all, the cows need to be milked whether it's convenient for us or not! But all of this travel to a high-quality clinic is a real disruption and also a big expense."

Work Performance Pride in your work may be especially significant when you are feeling unproductive in your efforts to become pregnant. You will not know the medical demands on your time until you have been in treatment for some time. Initially you may have communicated to your supervisor and coworkers what you believed would be the impact of your periodic absences. But, as that changes, it is relevant to offer some updated information about why your schedule must adapt to medical routines. You have a few choices: asking to be a.s.signed a workload that you believe is flexible enough for you to manage (perhaps including some work from a distance), putting an "end point" to your treatments, and deciding to explore other options for parenthood that are not as work-disruptive, or leaving (permanently or with a 187sabbatical) your current place of employment, if you can afford to, so that the stress of your infertility is not compounded by the stress of performing below par in the workplace.

"I cannot tell you how awful it is to choose between having good continuity in my work at the office and fitting in the clinic appointments. I love my work, and doing less than my best makes me feel that I could lose my professional life just as I'm having to accept that I may never get pregnant."

"Although we were overjoyed to find a clinic within a two hour drive that offers infertility treatment, we had no real understanding of what it would mean to have to go there regularly.

My absences, some of which are more than just a day when we figure in the travel time, are affecting the quality of my work at the office. And I feel guilty to have my coworkers picking up the work I'm not there to do."

Statistical Odds or a Poor Medical Prognosis The scenarios in this section are heartbreaking, but they also are a reminder that not everyone is going to be a promising patient for infertility treatment. If you know that your statistics are not hopeful, it is important to combine consultation with your physician and counseling with a therapist as ways of bringing together information and insight about why you are continuing with infertility treatment when the odds are against success.

"When I began treatment I was in my late thirties. Now I am in my early forties, and even if I'm able to conceive, I worry about the age of my eggs and whether or not I could have a healthy baby. Frankly, I don't think I could bear a miscarriage, and the 188 Ending Treatment: When Enough Is Enough When Enough Is Enough possibility that there might be a problematic prenatal diagnosis is more than I can contemplate." possibility that there might be a problematic prenatal diagnosis is more than I can contemplate."

"After five years of treatment with every procedure my doctor could offer, I still haven't had even one pregnancy. It seems to me, my husband, and the doctor that trying longer isn't likely to lead to a healthy pregnancy."

"Although my infertility treatment has resulted in four pregnancies, it has also resulted in four miscarriages. No one knows why I am unable to have a healthy pregnancy, but the odds of another pregnancy being successful are not promising."

Emotional Issues In addition to the rational issues, there are also the emotional issues that are part of any decision to discontinue treatment.

Couples may be influenced by their beliefs about genetic continuity; by the woman's visceral yearning for pregnancy, childbirth, and breast-feeding; by issues of "success"; or by a wish not to confront the necessary mourning that will accompany the end of a medical quest for a birth child.

Genetic continuity may be important to one or both partners, and it also may be an issue for parents or in-laws: "In my family we've always made a big deal of family connections.

Whether it has been the jokes about who resembles whom, or the admiration for talents that appear in each generation, there's no question that family genes are important to us."

"My fantasy baby is a mix of Alan's red hair and freckles and my slim build and musical talent. I know it's possible that we could give birth to a chubby, tone-deaf brunette, but even in a baby 189who's different from what I imagine, I would love to see some genetic resemblances."

"My father-in-law has been so sad about our infertility. And he is clear that Mitch, as his only child, is the person in the family that will bring the next generation into this world. Accepting an adopted grandchild would be very difficult for him. And when the doctors asked Mitch and me how we felt about using donor sperm, we both ended up discussing his father's att.i.tudes."

"Both sides of our family place a premium on being bright and going to college. I know that it is possible that we could have a birth child who is not college material, but I think I could accept that more easily if I knew we both had given him our genes and it just didn't work out. To accept a baby into our lives without those genes would cause us to blame ourselves if that child didn't end up being bright and inquisitive."

Many women a.s.sociate parenthood with the joys of seeing their bodies change to nourish a pregnancy, to deliver a healthy baby, and to breast-feed an infant: "Ending infertility treatment is the end of my dream of being pregnant. Everyone I see around me is pregnant, and it seems so unfair to be deprived of that joyful nine months. After all these years of infertility, I just wanted to present myself pregnant to the world and watch my belly grow and feel little baby kicks!"

"When I have imagined having a baby, I have imagined showing pictures in our family sc.r.a.pbook of me growing more and more pregnant, of me holding a baby in the delivery room, and of me nursing the little darling. The idea that I'll never have any of these experiences is really emotional for me."

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Ending Treatment: When Enough Is Enough When Enough Is Enough "After all this time of having my body be the focus of infertility treatments, I kept holding out the hope that the ultimate reward would be a baby growing inside me. I wouldn't mind the morning sickness or the stretch marks. The loss of this experience is immeasurable."

"There's something magical to me about giving birth. In spite of my worry about the pain, I found myself fantasizing about the magic of delivering a baby into this world, nursing it, and cuddling it. It's just tragic that my body has betrayed me and denied me this experience. Giving up on treatment means I can never have this special bond with a baby."

For women who take joy in successes, who are compet.i.tive, or who believe that hard work is rewarded, the thought of stopping treatment can feel like failing. For someone with that perspective, infertility has been perceived as a barrier to be overcome, and the incapacity to do so can be bitter and can contribute to ambivalence about ending treatment: "At heart I'm a pretty compet.i.tive person. When I put my mind to something, I usually get what I want. My att.i.tude is that if I try my best, I should be able to achieve my goal. But infertility has been a real wake-up call. This is one game I finally have to admit I'm not going to win. Not by sheer determination, not by seeking out the best doctors, not by tolerating the most awful side effects, not even by praying. I guess it's a comfort to know that I've done all I can do, but the question is still out there: what if I had hung on just a couple of months longer?"

"For my whole life I've been admired and complimented for the successes I've had. I've worked for every one of them and I've 191always believed that hard work is rewarded. Now, when a baby is really the only thing I want, I feel like a miserable failure. It seems that there's nothing I can do to have the one success that matters more than all of the others combined."

The incapacity to experience a healthy pregnancy despite medical treatment calls forth a range of emotions. Every woman is familiar with the sadness, the disappointment, the rage, the frustration, and the helplessness brought on by infertility. For some women it is easier to experience those emotions month after month than to confront the feelings of loss that accompany the decision to end treatment: "I think I held off ending my infertility treatments until now because if I'm not going to be a mother, I really don't see a future for myself. Ever since we've been married my view of my future has included children. In my wildest nightmares, I never envisioned that infertility would take me so far off track. So now that I'm letting go of my dreams of being a birth mother, it's pretty scary to see this big world looming out in front of me."

"I am so worn out emotionally from the mood swings, from the sadness of getting my period month after month, and from the realization that I am running out of options. But I feel as if giving up now would just be another huge emotional burden to bear - it feels somehow more hopeful to keep on trying, even though I know there's so little chance."

"Pursuing infertility treatment has been a huge project, complete with research, scheduling, and learning about procedures and results. It has kept me completely preoccupied. Frankly, I'm exhausted and I'm upset at the amount of energy I had to devote to something that had no joyful outcome. If we decide 192 Ending Treatment: When Enough Is Enough When Enough Is Enough to adopt, I don't know if I'll have the energy to begin all over again with the research, the paperwork, and the interminable waiting." to adopt, I don't know if I'll have the energy to begin all over again with the research, the paperwork, and the interminable waiting."

"By ending my treatments, I feel as if I'm moving from having very few choices to suddenly having too many choices. I can't choose to be a birth mother, which is what I really want. But once I accept that that door is closed, I feel as if I'm in a corridor of lots of other doors of life choices. The challenge is going to be what choices can make Cory and me happy."

Letting Go Letting go inevitably involves mourning. You will mourn the dream child that you cannot give birth to, and you will relinquish the dreams of any other children you had hoped would complete your family. You will mourn the loss of your role as a birth mother and all of the hopes you a.s.sociate with this role: a joyful pregnancy, an uncomplicated labor, a victorious delivery, peaceful breast-feeding, and the rewards and challenges of parenting. Unless you decide to pursue other ways of building your family, you will mourn the loss of those things you had antic.i.p.ated sharing with your partner: parenting, rejoicing in your child's successes, enjoying family leisure and vacations through a child's eyes, and planning for a child-centered future. And, at some level, you will mourn that you are the last generation. That when you and your partner die no one will carry on the family genes, the family stories, the family jokes, and whatever legacy you would have shared with a birth child.

This is a lot to mourn. Making the decision to stop infertility treatments can feel like several deaths. And in North American 193culture, where even real death is but briefly ritualized, there is no ritual for accepting your lifelong infertility and all the losses it involves. As you are well aware, only people who have experienced infertility can appreciate how much pain and sorrow are involved in the unsuccessful pursuit of a healthy pregnancy.

And, sympathetic as loved ones may be about your decision to let go, they also are likely to be relieved that now you can get on with your life. Women who decide to let go will confront the situation in different ways: "My mother was so relieved when we told her that we were giving up on medical treatments. 'Now you can get your life back,'

she said to me. But how do you just walk away from the dreams of a baby who will never come to life? How do you take joy in going to work every day when you still sit down at the family dinner table with just one other person? How do you fill your life with activities that have meaning?"

"After we decided not to pursue treatment any longer, I took some vacation time and gathered up all the reminders of our baby who was not to be: an empty baby sc.r.a.pbook, a baby name book, a couple of cute maternity dresses, and some children's books I had picked up at a library sale. One of our neighbors just announced that she is due in six months, so I asked her if she wanted them, and she was thrilled. I needed to give them a good home, since I took so much care in choosing them."

"Jake never had been as emotionally attached as I was to the hope of a baby. All along he was more concerned with my mood swings, with my feelings of desperation, and with my fixation that we had had to have a baby. So when the doctors made it clear that they had run out of options, I think Jake was relieved that we could get our lives back. But it was really 194 to have a baby. So when the doctors made it clear that they had run out of options, I think Jake was relieved that we could get our lives back. But it was really 194 Ending Treatment: When Enough Is Enough When Enough Is Enough important for me to tell him that I needed his emotional support as I came to terms with the knowledge that I would never become pregnant or bear our child. He would have preferred to distract me from my sadness, but once I made it clear that I needed time to heal emotionally, he took his signals from me." important for me to tell him that I needed his emotional support as I came to terms with the knowledge that I would never become pregnant or bear our child. He would have preferred to distract me from my sadness, but once I made it clear that I needed time to heal emotionally, he took his signals from me."

"As much as I maintained that the sadness of infertility was greater for me than it was for my husband, I think this was just because I couldn't bear his grief on top of my own. When we decided that there really was no point in continuing treatment, we talked a lot about what that decision meant for each of us. Our parents and siblings haven't been especially understanding during this time, but our pastor has been. We asked if he would pray with us to help us let go of our baby dreams and open our hearts to the new possibilities that life has to offer. He was eloquent and caring. We are so fortunate to have been able to lean on him, both during our years of treatment and especially as we ended that part of our lives."