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Information for Friends & Family
THIS IS AN OPEN LETTER WRITTEN BY PROFESSIONAL PSYCHOLOGISTS WITH BOTH PERSONAL AND PROFESSIONAL EXPERIENCE WITH INFERTILITY.

This information has been included here in the hopes that if just one person takes the time to read and understand the many and varied complex emotions surrounding infertility, then that person will hopefully be in a better position to understand some of the grief responses and other issues that they may at times encounter with the person in their lives who is experiencing difficulty conceiving or retaining a pregnancy.

This information includes many feelings that are possibly very confronting for your friend/relative to express to you, and in fact even put into words for herself.

Whilst its focus is primarily on an infertile woman, it also speaks to the challenges encountered by anyone still waiting for that elusive baby - be it the first or the third child so yearned for - which is equally as acutely painful, even when infertility is not an issue for the couple.

And if, after reading, that one person is better able to understand, then just like the 100th monkey theory (or indeed, lighting a rose-pink candle in our hearts to remind us), perhaps change will slowly take place in the various communities surrounding them, and still others who also have the weight of infertility on their shoulders might not feel so alone and inadequately supported (despite the best intentions of everyone around them).

About Fertility Issues
Some Facts About Fertility
Well-Meaning Advice
Why Not Having a Baby Is So Upsetting
What Modern Medicine Has to Offer the Infertile Couple
What Can You Do?
Problem Situations
The Bottom Line

About _______'s fertility issues:
__________ knows that you love her and want her to be happy, to be her "old self" again. But lately, she seems isolated, depressed and completely consumed with the idea of having a baby. You probably have difficulty understanding why getting pregnant has coloured virtually every aspect of her daily life. __________ hopes that by reading this letter, written by psychologists with both personal and professional experience with infertility, you will better understand the pain she is feeling. This letter also will tell you how you can help her.


Some facts about infertility

It may surprise you to know that one out of six couples who want to have a baby cannot conceive. There are many possible reasons for this dismal statistic: blocked fallopian tubes, ovarian failure, subtle hormonal imbalances that may not show up during testing, toxic exposure, immune difficiencies, husband's low sperm count, genetic abnormalities of embryo's, insufficient endometrium lining, subtle or obvious deformities of the cervix or uterus, just to name just a few.
Moreover, after a woman turns 35, it becomes difficult to have a baby primarily because many of the eggs she has left are defective.
All these barriers to pregnancy are physical or physiological, not psychological. Tubes don't become blocked because a woman is "trying too hard" to get pregnant. Antibodies that kill sperm will not disappear if a woman simply relaxes. And a man cannot make his sperm swim faster by developing a more optimistic outlook.


Well-meaning advice
When someone we care about has a problem, it is natural to try to help. If there's nothing specific that we can do, we try to give helpful advice. Often, we draw on our personal experiences or on anecdotes involving other people we know. Perhaps you recall a friend who had trouble getting pregnant until she and her husband went to a tropical island. So you suggest that __________ and her husband take a vacation, too: "Just go on a holiday and relax and don't think about it and you'll get pregnant!"
__________ appreciates your well-meaning intentions on giving the advice, but she cannot use the advice because of the physical nature of her problems. Not only can't she use your advice, the sound of it upsets her greatly. Indeed, she feels constantly bombarded with this sort of advice from well meaning friends and family at every turn.
Imagine how frustrating it must be for her to hear about other couples who "magically" become pregnant during a vacation simply by making love. Imagine how upsetting it is for __________ to hear that other
couples "magically" become pregnant once they decide to stop trying. Imagine how hard it is for her to hear that other couples "magically" become pregnant once they discontinue fertility treatments, or decide to adopt.
To __________, who is undergoing infertility treatment, making love and conceiving a child have very little to do with one another, now. You can't imagine how hard she's been trying to have this baby and how completely devastated she feels every month she learns that the attempt has failed again. It is a tumultuous rollercoaster of emotions to go through every month while trying infertility treatments. Your well-meaning advice is an attempt to transform an extremely complicated predicament into a simplistic little problem. By simplifying and minimising her problem in this manner, you've diminished the validity of her emotions, making her feel psychologically undervalued. Naturally, she will feel angry and upset with you under these circumstances. It is quite hurtful and feels demeaning to her when her struggles and experiences are minimised.
The truth is: There's practically nothing concrete you can do to help __________. The best help you can provide is to be understanding and supportive. It's easier to be supportive if you can appreciate how being unable to have a baby can be such a devastating blow.


Why not having a baby is so upsetting

Women are reared with the expectation that they will have a baby someday. They've thought about themselves in a motherhood role ever since they played with dolls. A woman may not even consider herself
part of the adult world unless she is a parent.
When __________ thinks she cannot have a baby, she may even feel "defective." She experiences isolation, and feels excluded as she is not part of the majority of the female adult world - as she is not a mother. This is very painful to experience. She has not shared the same experiences and has little in common with others.
Worse, __________ is not even certain that she will never have a baby. This is incredibly distressing. One of the cruellest things you can do to a person is give them hope and then not come through. Modern
medicine has created this double-edged sword. It offers hope where there previously was none -- but at the price of slim odds.


What modern medicine has to offer the infertile couple
In the past decade, reproductive medicine has made major breakthroughs that enable women, who in the past were unable to have children, to now conceive. The use of drugs such as Pergonal can increase the number and size of eggs that a woman produces thereby increasing her chances of fertilisation. In vitro fertilisation (IVF) techniques extract a woman's eggs and mix them with sperm in a "test tube" and allow them to fertilise in a laboratory. The embryo can then be transferred back to the woman's uterus. There are many other options, as well.
Despite the hope these technologies offer, it is a tough journey to take. Some high-tech procedures are offered only at a few places, which may force her to travel great distances. The patient must endure
repeated doctor's visits, take daily injections, shuffle work and social schedules to accommodate various procedures, and lay out considerable sums of money -- money that is not usually reimbursed by
insurance companies or health care plans. All of this is preceded by a battery of diagnostic tests that can be both embarrassing and extremely painful.
Infertility is a highly personal medical condition, one that __________ may feel uncomfortable discussing with anyone. And, she is faced with many family and friends and aquaintances asking intrusive, personal questions. Meanwhile, she is devoting considerable time and energy to managing her health, her treatments, and a mountain of forms and other paperwork required.
After every medical attempt at making her pregnant, __________ must play a waiting game that is peppered with spurts of optimism and pessimism. It is an emotional roller coaster. She doesn't know if her
swollen breasts are a sign of pregnancy or a side effect of the fertility drugs. If she sees a spot of blood on her underwear, she doesn't know if an embryo is trying to implant or her period is about to begin. If she is not pregnant after an IUI procedure, she may feel betrayed, not understanding how it could not have worked since everything went as planned, and nothing is medically wrong with her or her husband. If she is not pregnant after an IVF procedure, she may feel as though her baby died. How can a person grieve for a life that existed only as a chemical pregnancy, that did not implant in her uterus?
While trying to cope with this emotional turmoil, she gets invited to a baby shower or Christening, learns that a friend or family member or colleague is pregnant, or she reads about a one-day-old infant found abandoned in a dumpster. Can you just try to imagine her envy, her rage over the inequities in life? Given that infertility permeates practically every facet of her existence, is it any wonder why she is consumed with her quest for a baby?
Every month, ____________ wonders whether this will finally be her month. If it isn't, she wonders if she can she muster the energy and the hope to try again. Will she be able to afford another procedure? Is she willing to go through the hormonal rollercoaster? Is she able to withstand another month of daily painful injections and bruises?
How much longer will her husband be able to continue to try to be
supportive? Will they be forced to give up their dream?
So when you speak with ______________, try to empathise with the burdens on her mind and on her heart. Be aware of her struggles. Be compassionate and considerate of her feelings. She knows you care about her, and she may want to talk about her ordeal. But she knows that there is nothing you can say or do to make her pregnant. And she greatly fears that you will offer a suggestion that will trigger even more despair.


What can you do for ____________?
• You can give her support, and not criticise her for any steps she may or may not be taking -- such as not attending a baby shower -- to protect herself from emotional trauma.

• You can say something like this:

I care about you. After reading this letter, I have a better idea about how hard this must be for you. I wish I could help. I'm sorry for what you are going through. I'm here to listen to you and cry with you, if you feel like crying. I'm here to cheer you on when you feel as though there is no hope. You can talk to me. You can trust me. I will not judge you. I will not give you advice, since I have not experienced the struggle you have. I will only listen, I will hold you and hug you. I care.

The most important thing to remember is that ______________ is distraught and very worried.
• Listen to what she has to say, but do not judge. Do not belittle her feelings. Do not minimise her experience.
• Do not remind her of all the stories of others you know who "just became pregnant" after giving up. That is not reassuring to her, that is painful for her to hear, and just makes her feel like more of a failure.
• Don't try to pretend that everything will be OK.
• Don't try and sell her on fatalism with statements like, "What will be will be." If that were truly the case, what's the point of using medical technology to try to accomplish what nature cannot?
• Your willingness to listen and not judge and not try to 'fix it' can be of tremendously great help. Infertile women feel cut off from other people. They feel completely isolated, judged and alone.
• Your ability to listen and support her in the ways that she needs it will help her handle the stress she's experiencing.
Her infertility is one of the most difficult situations she will ever have to deal with.


Problem situations
Just as an ordinary room can be an obstacle course to a blind person, so can the everyday world be full of hazards for an infertile woman -- hazards which do not exist for women with children. These hazards are
painful and constant reminders to her about what she may never have. She goes to her in-law's house for Christmas. Children are running around everywhere. Her cousin is breast-feeding. Her sister in law is pregnant with baby #3. The men are watching the football game while the women talk about the problems with their kids. She feels left out, to say the least.
Christmas is an example of the many holidays that are particularly difficult for her. They mark the passage of time. She remembers what came to mind last Christmas -- that the next year, she would hopefully have a new son or daughter to show off to her family.
Each holiday presents its own unique burden to the infertile woman. Valentine's day reminds her of her romance, love, marriage -- and the family she may never be able to create out of that love. Easter time with extended family and easter egg hunts for the kids - reminds her of the experiences she may never get to enjoy as she may never have kids. Mother's Day and Father's Day? Their difficulties are obvious.
Grandparent's Day reminds her that she was never able to give her parents a grandbaby to spoil. Thanksgiving Day? Well of course she is thankful for the good in her life, but it's impossible to be thankful
for the painful struggle and emptiness that infertility presents.
Mundane activities like a walk down the street or going to the shopping mall are packed with land mines. Seeing women pushing baby carriages and strollers strikes a raw nerve. She is filled with envy and sadness. When she sees pregnant women - she is mentally beating herself up, thinking why can't that be me?
Why don't I deserve that? What is wrong with me?
While watching TV, ___________ is bombarded by commercials for diapers, baby food, and early pregnancy tests. She can't even read a magazine without seeing perfectly healthy pregnant women in ads for pregnancy or parent magazines, or cute babies in ads, or toddlers in clothing ads.

At a party or family get together, someone always asks when she is going to have kids. She feels like running out of the room screaming, but she can't.
If she talks about being infertile, she's likely to get well-intentioned advice -- just the thing she doesn't need: "Just relax. Don't worry. It will happen sooner or later," or
"You're lucky. I've had it with my kids. I wish I had your freedom," or
"Good for you - you don't have to go through labour," or
"just adopt," or
"maybe it's just meant to be," or
"well, it's God's plan, maybe you aren't meant to have children."

These are the kinds of comments that make her want to scream in anger and pull out her hair in frustration and curl up in a ball and cry.

Don't you think she tries to relax and not get stressed out?
Don't you think she wishes, prays, begs it to happen sooner or later?
Don't you think she'd give up her freedom and any and everything else in the world just to have a baby? Don't you think she would quite willingly and eagerly go through all the pain and suffering twice over if she could just experience pregnancy and labour and everything that goes with it?
Don't you think she's considered adoption, but maybe, just maybe she and her husband would like to
experience pregnancy and the birth of their own child?
Don't you think she feels condemned that it may be "meant to be"?

These are all the things she is wanting to scream at you when she is offered your well-intentioned advice.

Escape into work and career can be impossible. Watching her dream shatter on a monthly basis, she can have difficulty investing energy in maintaining or advancing her career. All around, her people are getting pregnant. Going to a baby shower is very painful -- but so is distancing herself from social occasions celebrated by her friends and family. What is even worse, is going to a baby shower and everyone ignoring her or treating her differently, as this reinforces to her that she is now an outsider because she is infertile. What is especially quite hurtful to her is when people keep things from her (like news of a pregnancy) - this excluding behavior demonstrates to __________ that she is being treated differently now that people know
she is infertile. If friends and family used to happily share the exciting news (before they knew of the infertility she experiences) and now they don't share the news, or keep it secret until it's obvious, _________ will feel that her family and friends intentionally excluded her, which is much more devestating and hurtful. She knows that she can be happy and excited for her family and friends with their great news, and sad because she has no announcement to share. This is normal for her to experience. But when
the news of a family or friend's pregnancy is kept secret from her, she feels betrayed and hurt that her loved ones would so obviously exclude her. She already knows she is 'different', not part of that group. And this obvious exclusion reinforces that for her.


The bottom line
Because she is infertile, life is extremely stressful for __________________. She's doing her best to cope. Please be understanding. Please be gentle and mindful with your words. Sometimes she will be depressed. Sometimes she will be angry. Sometimes she will be tearful. Sometimes she will be envious. Sometimes she will be physically exhausted. Sometimes she will be emotionally drained. Sometimes she will be scared. Sometimes she will feel hopeless. She's not going to be "the same old _______________" she used to be.
She has no idea when, or if, her problem will ever be solved. She's engaged in an emotionally (and financially) taxing venture with a low probability of success.
Overall, only about 11 percent of those people using special fertility treatments succeed in having a baby. The odds are even lower for women over 40. The longer she perseveres, however, the greater her chances of pregnancy become.
Maybe someday she will be successful. It may be soon or it may be years down the road. Maybe someday she will completely give up. Maybe someday she will turn to adoption, or come to terms with living a childless life. At present, though, she has no idea what will happen. At present, she is still wanting to try. It's all she can do to keep going from one day to the next. It's all she can do to keep trying, to keep hoping, to keep going. She does not know why this is her struggle. Nobody does. All she knows is the horrible anguish that she lives with every moment of every day.

Please care about her.
Please be sensitive to her situation.
Please offer her your support. She desperately needs it and truly wants it.

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