Article: The Right To Expect? The Demands & Disappointments of Infertility

The Right To Expect?
The Demands and Disappointments of Infertility
by
Jude Acosta, author The Next Osama (Jodere, 2006) and The Worst Is Over (Jodere, 2002)

First published in Women's News.

It is, or so we believed, our natural birthright. Birds did it. Bees did it. We did it. Just like that. In fact, most of the women visiting fertility specialists right now were afraid of getting pregnant and, for years, juggled IUD's, diaphragms, condoms, and pills to protect themselves from what they felt would be inevitable if they didn't cover themselves with creams and impermeable membranes.

The end of the twentieth century has had the last laugh, with hundreds of thousands of women finally throwing caution to the wind and finding out that caution was the last thing they needed. A whole generation of women that had felt so in control of their reproductive systems, found themselves at the mercy of forces so far out of control they could hardly be isolated at times.

"I was so prepared to be pregnant," one woman, L, said plaintively. "I dumped my pills in the toilet and waited the month you're supposed to wait. Then, I figured it would just happen. It's been 46 months-and no one knows precisely why-but I'm still waiting. And visiting doctors, and going through procedures. God, how I hate that word. If I never hear it again, it would be too soon."

Where there is expectation, there is disappointment.

And there is enormous disappointment in women who desperately want to have children and experience pregnancy, but for one reason or another cannot. The two combined lead, in turn, to the taking of extraordinary measures to make it happen.

L, like many others I see in my practice, had tried numerous in vitro fertilizations (IVFs), artificial insemination (AI), and high-tech assisted reproductive technologies (ARTs) after having suffered two miscarriages. The process has taken years and cost many tens of thousands of dollars.

The toll has been high for her and her husband not only in physical and financial terms, but in emotional and spiritual ones, as well, having been thrust into the deepest parts of their souls to determine who they are, what they truly value, what they are willing to do without, and what they are willing to give up in order to have a child. They have boarded a fast-moving train, running on bio-engineered tracks and roaring past the stations they thought were theirs.

Dag Hammarskjold wrote in his private journal, Markings:

Thus it was.
I am being driven forward
Into an unknown land.
The pass grows steeper,
The air colder and sharper.
A wind from my unknown goal
Stirs the strings
Of expectation.
Still the question:
Shall I ever get there?
There where life resounds,
A clear pure note
In the silence.

The women and men like L and her husband, who confront seemingly insurmountable reproductive difficulties, persevere. But many discover few answers and find themselves increasingly disconnected from one another on more ordinary planes: What to do with their free time, what to think about when they go to bed, and what to talk about over dinner-if it's not about getting pregnant.

One insightful patient, R, comments: "After so many years of such focus, such intensity of purpose, I would sit down with H and I didn't know what to say anymore. I had started seeing him as a semen donor and little more. I didn't know who I was without a baby, I didn't know him anymore as a husband, and I didn't know what we would be together if we were not going to be parents."

Striking A Balance
Persevering on the path is strength. To keep your center is to endure.
(Tao 33)

Women (and men) pursue fertility with a vengeance. Unfortunately, what they lose at times is their center-the knowledge that who they are does not need to depend on circumstance for definition, clarity, or peace.

"If I'm not a mother," laments one client, C, "who am I?"

Who, indeed. It was a matter that merited serious consideration and time for quite a few sessions.

Who are we if not all of it-our expectations, our dreams, our accomplishments, and our failures? Are we our circumstances-our jobs, our friends, our adventures and misadventures? Are we our holdings-our bank accounts, our Judith Lieber pocketbooks, our Kosta Boda crystal? Are our identities a function of family? Are we our images or the secrets we reveal to no one?

In our culture, we believe that every good act should be-indeed, must be-rewarded, and we expect immediate gratification from our doctors. When we don't get the expected reward, many people interpret that to mean that their lives have been "wrong" and that they are "no good," "failures," "losers." Self-esteem shatters and where before there was hope, now lays shame. How many times have women said to me, "What's the matter with me that I can't do what every other woman does?" I couldn't begin to count.

C, like so many other would-be mothers, works hard to find a balance-to stand comfortably with having and not having, between difficult and easy, letting high and low rest on one another, and learning that beginning and ending inevitably follow again and again.

The journey in fertility is only partially a technological and physical one. It is, in these and other women's struggles, more often than not revealed to be a spiritual one as shame turned to rage.

J started therapy because she was angry all the time. "Why can't I have a baby!" she clenched her fists and tried to hold back the tears. "I would make a good mother, give my baby a good home. And I look around and all there is are babies getting hurt, getting dumped, being thrown away. And some people get pregnant four or five times and have just as many abortions."

I waited. More was coming. The inevitable.

"What does God think He's doing!?"

The utter injustice of it to J was more than she could bear at times. As a result, the anger spilled over to other areas-and people-in her life. She found herself avoiding friends who had children, silently incensed and making up excuses. She stopped seeing family members with babies and toddlers. She snarled at women with children in the market and was surly on line at the bank if there was a pregnant woman anywhere in the vicinity.

The rage is most often the part that gets left unexpressed and boils inside to a seething brew. This is the politically incorrect indignation and fury at other women who have what they don't. They hold it inside, ashamed of the intensity of their anger and envy, feeling alone and punished, sadly not realizing how common the situation is and how much it is affecting them physically.

The Western Way of Fertility
Excessive striving leads to exhaustion. (Tao 55)
We live in nature, but can never possess it; we can guide and serve, but never control. This is the highest wisdom. (Tao 51)

Americans pursue fertility the same way we pursue everything else-with an unceasing doggedness and a confidence that borders on arrogance. This position of digging in the heels, clenching our feet, and railing against the universe is a familiar one in the Western World, particularly in the United States where, collectively stuck in an early stage of development, we believe in the eternal frontier-Badges, what badges? We don't need no stinking badges! Our generation grew up in resistance, on the edge, in defiance of established limits. We could conquer nature and send men to the moon. We could do it all and have it all. We could be mothers, CEOs, athletes, sex kittens, and tireless friends and confidants. And some of us have. But, at what cost? We have gotten ourselves so frightfully out of balance, we no longer recognize our own disequilibrium even as the blood rushes to the tops of our heads.

Is it possible this has become even more the case since women have been, like men had been before and continue to be, caught up in the solar-plexus life style of mastery, conquest, and control? Twenty-five centuries ago, Lao Tzu raised a few eyebrows and more than a few swords when he told the masculine warriors and leaders of the time to embrace yin, the female energy, the traditional way of women who knew instinctively the cycles of life and that all things could not be had, that there would be joys and sorrows, gains and losses, wounds and closures. However, a warrior does not want to hear that the battle could be lost and that, in the tao, it would be all right-that the loss could bring the greatest win of all. The warrior just wants to win, damn it.

Do we want to hear yet that we cannot have it all, yet have it right?

One 39 year-old patient, M, did.

"I had to make peace with that. I was losing my mind, my perspective. I had to. I didn't want to. Lord, the arguments I had with God, my husband, my pastor. My whole life was shaken upside down, my hopes for a family of my own dashed. But the worst part was that my faith in something bigger than myself was rocked. And, ironically, that was the piece I needed most. So, here I am. I'm humbler. I don't have what I want. And I'm okay. And getting better every day. I'm happy. I still want to get pregnant and still believe that one day I will-but only if it's meant to be. I do what I can and the rest...is the rest."

LD put the problem in a whole new context:
Even though it is a miracle to procreate, it's over in no time and then you've got a child for life. The pregnancy alone doesn't validate the real issue, which is parenting. Why not put the emphasis on being a parent instead of "having" a child. Men don't become pregnant but they're no less valid as parents. There are so many unwanted children and there are so many ways to parent in the world-adopting, fostering, teaching, befriending, mentoring, helping a single parent, coaching. I think if you want to be a parent, just be giving. Loving people are so needed in the world.

Too often, women and men on the march for pregnancy are so wrapped up in what they don't have, they forget to remember the gifts they do have and, more importantly, the gifts they can give.

Most of us get dragged kicking and screaming our way to Heaven, demanding that we want things thus and thus, in our time, in our way. We are a chronically impatient nation. But, it seems, that there is another Plan and perhaps, just perhaps, we don't always know what's really good for us. We know what we want. But is that enough? And is that always what's right and best?

A long time ago, an old man and his son had a ranch of beautiful stallions. And the townspeople said, not always without envy, "Oh, what wonderful luck to own so many beautiful stallions." One day, a thunderstorm spooked the horses and they broke through a fence, scattering to the fields below. "Oh," cried the townspeople, "such terrible luck. Such woe and misfortune." The old man and his son struggled to collect the horses. And, finally, they did. The townspeople rallied, "Oh, such incredible luck. Have you ever heard of a man with such good luck?"

As the son brought the last stallion in, another crack of lightning and another roll of thunder sent the horse wild. He threw the son and bolted for the stables. The son, landing badly, broke his leg and was unable to move. The doctor came and prescribed bed rest for two months.

"Have you ever heard of a man with such bad luck," the townspeople rubbed their foreheads with amazement.

That week, as the son, weary and aching, rested in bed to heal his leg, the Emperor declared war on the neighboring province and conscripted all able-bodied young men to serve in his army. The entire empire knew this would be a bloody battle, but, obediently, they sent off their sons. Except one.

Bad luck-good luck?

It is not always so easy to tell.

The Mind/Body Mystery
"When hard and rigid, we consort with death. When soft and flexible we affirm greater life." (Tao 76)

Gary Zukav, in his wonderful book, The Seat of the Soul, talks about the importance of acceptance. When we fight the way it is, when we deny reality, and resist the truth of our circumstances or feelings, he suggests that what we are doing is guaranteeing that we stay stuck. The truth shall set you free, he reminds us, and it is only by recognizing and accepting our reality that we can ultimately change it. On an Oprah show this past year, he told a woman, "If you want to be free of this problem, instead of saying, 'Why me?' ask, 'Now what?'" Acceptance does not mean passivity, he clarifies. It is the gateway for true, conscious action. Acceptance is a spiritual surrender to the way it is. Only from there can we make sound, productive decisions-whether to continue with fertility procedures or not, whether to pursue adoption or not, whether we want to be free to choose something entirely different or not.

In social work school, a colleague by the name of Rosemarie used to say, "When you resist, it persists." A novice and an oppositionalist at heart, I dismissed the idea. I believed, like so many others, that it was good and proper to resist. After all, we were a whole generation born on "fighting the good fight." If there was injustice, I argued with her, we were honor-bound to resist! But the years have taught me the real (non-political) wisdom of her words, the urgency of her message, and the secret magic behind it.

For there's an even more interesting sub-text to "coming to terms" and acceptance: For some reason, when women are able to relax into their life and relinquish some of the frenzy and struggle for control, they get pregnant.

According to Judith Prager, Ph.D., a hypnotherapist and author in Los Angeles, California, "We give our power away to anything we desire too much. And that desire has the effect of pushing things away from us by its very intensity."

One woman, LM, is now a single mother of an eight-year-old girl, something she never, ever expected to be:

They told me when I had P.I.D. that I would never conceive, to just forget about it. And, with time, I did. I forgot about it, until I missed two periods. It was not supposed to happen. I'm glad it did, but it's still a mystery.

Aerodynamically, bumble bees should not be able to fly. But they do.

What can possibly explain these "spontaneous" pregnancies? What happens to these women?

This more subtle aspect to fertility has less to do with biological parts and pieces than it does with spirit and attitude.

The mind/body is not, as many mistakenly conceive, two parts of us (like valves and crank shafts) in some form of linear communication with one another. The concept is more comprehensive and extraordinary than that. The mind/body is one, an entirety, a living, mutable, responsive organism. It is not an entirely new idea, for that matter. Before the reductionist scenario gained the dominant foothold in the medical schools, there was a school that believed in vitalistic medicine-that there was a vital force, a life essence, that was at work in us all. Samuel Hahnemann, the father of homeopathic medicine and the physician after whom the medical college in Philadelphia was named, refers to the wesen, the life force as the source of the human being and the place to aim the treatment of disease. "The totality of ... symptoms is the outwardly reflected image of the inner wesen of the disease, that is, of the suffering of the life force." (Organon of the Medical Art, ed., Wenda O'Reilly, Ph.D.)

In mind/body medicine and psychotherapy, the mind and body cannot be separated at all. What happens to one happens to the other. It is all connected in a fiber so fine, comprising a tapestry so complex, that if you pull one thread the whole picture changes.

For women struggling with fertility, this understanding can be both daunting and relieving. They have another option that can both enhance any further procedures that are medically indicated and, when procedures and technology have proved ineffective or when there are no biologically evident causes for the problem, can help facilitate conception itself.

Approximately 10 to 15 percent of all women experience fertility problems (Speroff, 1994) and, of those, 80 percent demonstrate a clear physiological cause. What about the remaining 20 percent? Without any clear cause, there is no clear course of treatment.

Most physicians today readily acknowledge the relationship between stress and fertility and research has documented the link since the 1980s. Mackett and Maden (Waxman, Ed., Medical & Dental Hypnosis, 3rd Edition) cite that stress, acting via the hypothalamus, can modify pituitary function and upset the finely-tuned hormonal balance necessary for fertilization to occur. They postulate that hypnotherapy is the ideal method for reducing stress because it specifically avoids negative drug interactions or effects. According to the MBS Institute in Central Pennsylvania, they are reporting a 70 percent success rate for conception with their patient population.

Reproduction is one of the most delicately balanced biological systems. It is one of the first systems to shut down when there is a perceived threat: persistent stress, malnutrition, illness. When our resources are needed elsewhere, reproduction takes a backseat to our own survival. If women lose too much body fat, they cease menstruating. Stress can do the same thing by increasing or inhibiting hypothalamic function, which in turns regulates the pituitary and adrenal glands. If our hormones do not flow properly, we do not conceive.

Infertility has also been linked to depression. Women with a history of depressive symptoms report twice the rate of subsequent infertility. (Psychosomatic Medicine, 1995, Vol. 57) However, according to the Journal of the American Medical Women's Association, (1999, Vol. 54) women treated appropriately and proactively for depression, showed a 60 percent viable pregnancy rate. When they were not treated, unfortunately, they showed a 24 percent success rate. That is almost three times less.

One study (Fertility Sterility, 1998, Vol. 37) went so far as to state that because mind/body programs are effective in the soothing of disturbing emotions that can impair IVF success, patients should routinely be offered such a program whenever they undergo IVF treatments.

The process is cyclical, for as much as depression interferes with fertility, continued infertility can cause depression and the effects can make conception even more elusive. Depression has been shown to ensue approximately three years into the infertility treatment process.

There is an option, however, according to one study in Reproductive Technology (April 2000, Vol. 73, issue 4). When women were treated prophylactically in their second year (before symptoms of depression were noted) through group counseling, it seemed to prevent the expected third year onset of depression and had significantly increased viable pregnancies.

Mind/Body Techniques to Increase Fertility Response
Stress Reduction/Relaxation

Experts in the field of fertility tend to agree that the more relaxed the individual, the greater the chances of conception. Relaxation techniques may include yoga and yogic breathing, tai chi or chi gong, aromatherapy, therapeutic massage such as Reiki, meditation and hypnosis.

For most of us, stress results when the world isn't doing what we want it to do. As a result, the environment makes a demand upon our systems. It could be by scaring us, physically hurting or exhausting us, frustrating us, angering us, or even giving us too much of a good time. Stress is unavoidable. It's a byproduct of breathing, loving, walking, feeling, working, not working

While pre-surgical anxiety improves recovery rate and small, temporary doses of fear can increase killer cell activity and boost our immune systems, too much generates the sort of imbalance that can prevent conception.

Hans Selye, M.D., who pioneered the concept of stress, also broached the concept of "strain." The notion is not new to Eastern mystics: circumstances may be chaotic, but we may remain calm. Stress is only partially the result of external forces. Much, it has been contended, is our response to those forces. When we are crawling in traffic with a mile left to go until the toll booths, do we rant, rave, pound on the steering wheel? Or, do we perhaps, notice the wildflowers we never saw before because we were moving too quickly?

A wonderful story told by the Sufis: On a dusty road lined with enormous, gnarled olive trees, a young man came upon a strange sight. An old man in robes sat cross-legged under one of the trees, meditating calmly. Right next to him was a whirling Dervish, spinning ecstatically, clucking, singing, trilling at the top of his lungs. The young man watched until, overcome with curiosity, he kneeled down next to the old man and asked, "How do you do it?" The old man looked at him. "How do you sit here and meditate so calmly while he's making suck a racket?" The old man smiled, "I let him spin."

While we may not be able to avoid stress, we most certainly can avoid strain by focusing on ourselves and our own responses, rather than trying (often in vain) to get a hold of circumstances beyond our control.
Express the Full Range of Emotions

Study after study has clearly indicated the negative impact of suppressing emotions. The quest for a pregnancy is rife with all sorts of emotions-anger, sadness, fatigue, fear, excitement, hope, discomfort, love, pain, envy, frustration, joy.

Many women mistakenly believe that they need to always be "nice," especially if they're trying to become mothers. It would be more accurate if they were able to appropriately express all their emotions, even the ones they feel are "unbecoming." What is suppressed festers.

Whether you find a support group, a religious community, a circle of friends, or a therapeutic relationship, the most important thing you can do is have someone you trust and that you can safely talk to about all your feelings.

Some pregnancies I've seen in my practice were initially blocked by unresolved trauma and/or interpersonal issues around a parent or a spouse. When those issues have been resolved, the women became pregnant.

Self-Talk
Charles Swindoll has said, "The longer I live, the more I realize the impact of attitude on my life...Life is 10% what happens to me and 90% how I react to it."

What we think about ourselves and what we say to ourselves forms the bulk of our response to the world. Our thoughts, our feelings, our attitudes affect our behavior and our biology.

What do you tell yourself? What do you hear deep in yourself, in the small dark spaces between heartbeats? Do you tell yourself how hopeless it is, how awful you are, how unfair your life has been? Or, do you remember your strengths, focus on the gifts you've received, and stay loving and open? Do you zoom in only on what has failed and frustrated you? Or do you pick up a wider angle lens to see all that is around you?

Dr. Bruce Lipton has claimed that over 4,000,000 bits of information careen into our nervous system every second. We are only able to consciously register 2,000.

Which 2,000 bits of information do you choose to see?

"Spreading through the nations, The Tao brings peace throughout the world. How do I know this? Because it begins with you and me." (Tao 54)

Judith K. Acosta, LCSW, CHT is the author of The Next Osama (Jodere, 2006) and The Worst is Over (Jodere, 2002 with Judith Prager). She is a licensed psychotherapist, hypnotherapist and crisis counselor with a private practice in New Mexico. Her areas of specialization include hypnosis and the treatment of trauma, fertility issues, anxiety disorders, depression. She has appeared on both television and radio and is a regular lecturer in the tri-state area.

She may be reached at:
www.wordsaremedicine.com