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Surviving Mother’s Day and Father’s Day

Holidays, with their focus on family and children, can be emotionally challenging for individuals and couples experiencing fertility problems.  But Mother’s Day and Father’s Day are often especially difficult.  As celebrations of parenthood, they can be painful reminders of the child you yearn for.  For some, Mother’s Day and Father’s Day may also mark the passing of time – another year that’s gone by without being able to create a family.  The sense of isolation can often feel acute.  But a little preemptive planning can improve your ability to cope and make it through the day more easily.

 

Check-in With Yourself

Think about how you’re emotionally handling your fertility journey right now and realize that this may be different than how you felt a year ago.  If you think about a scale of “1” to “10,” with “1” representing “least distressed” and “10” representing “most distressed,” where are you on the emotional barometer specifically as it relates to your fertility journey?  If you’ve just started seeing a reproductive endocrinologist and are in the midst of your work-up, you might be feeling fairly hopeful.  However, if you’ve recently had an unsuccessful treatment cycle or a pregnancy loss, you may be experiencing more negative feelings and sensitivity; in this case, you want to be acutely aware of your emotional needs and care for yourself.  How you’re feeling helps determine how you should plan for Mother’s and Father’s Day.

 

Option 1: Honor Your Parents But Take Care of Yourself

Ask yourself if it’s important for you to acknowledge your own mother and father (as well as, mother-in-law and father-in-law).  If so, you may want to plan to celebrate on an alternative day, for example the day or even weekend before Mother’s or Father’s Day.  This allows you to avoid the restaurants filled with families and children, and those well-intentioned, yet sometimes unsupportive family members and friends asking intrusive questions.  If your parents are aware of your fertility problem, you may want to explain to them how difficult the day is for you and thus, the reason for celebrating early.

 

Once you’ve determined whether and how to honor your own parents, make an alternative plan for Mother’s and/or Father’s Day that involves an activity where you aren’t likely see other families.  This may involve a private day at home with just you and your spouse, inviting friends without children for lunch or dinner, attending a movie not made for family viewing, or taking a secluded hike.

 

Option 2:  Take Control of Your Family’s Plans for the Day

Hosting or organizing your family’s Mother’s or Father’s Day activities puts you in the driver’s seat; you determine when, where, and how your family celebrates and honors your parents.  For example, inviting family to your home for brunch or dinner allows you to create boundaries around the time spent together.  Planning and preparations for entertaining may also keep you busy and distracted in the weeks prior to Mother’s and Father’s Day when there is an onslaught of print advertisements and online and television commercials.  Having people to your home will also keep you busy on the actual day.

 

One More Tip…

Don’t be surprised if you’re suddenly blindsided by emotions.  This can often occur when you walk by the rows of Mother’s or Father’s Day cards in a store, or when you go to find a card for your own parent or in-law and have to read through the various options.  Stay away from the holiday card aisles.  Find a blank card or create a card and write your own heartfelt note to your parent.

 

Ultimately, being aware of your own needs and planning accordingly can help you survive Mother’s Day and Father’s Day.  And don’t forget to take pride in the fact that you were able to cope more effectively!

 

Dr. Erica Mindes is a Licensed Clinical Psychologist and an Associate with the psychotherapy practice of Covington & Hafkin, which specializes in reproductive health issues. She has an office in Richmond, Virginia where she provides counseling to individuals and couples struggling with infertility, pregnancy loss, and other areas of reproductive medical care. She has conducted research and written on the psychological responses to infertility and infertility treatment, and recently co-authored the chapter, “Counseling Known Participants in Third-Party Reproduction” for Fertility Counseling: Clinical Guide and Case Studies. Dr. Mindes is a member of the American Society for Reproductive Medicine Mental Health Professional Group (MHPG) and serves on the MHPG Executive Committee.

 

Strengthening the Support You Provide and Receive From Your Partner During Your Infertility Journey

Infertility and the accompanying treatment is emotionally, physically, and financially stressful and often experienced as a source of distress.  While individual responses vary, feelings of anger, sadness, guilt, shame, and anxiety are common.  Over time, self-esteem may plummet, social relationships can falter, and one’s sense of femininity or masculinity may be affected.  Yet infertility is not just an individual trauma, the strain on a couple’s relationship can be profound.  Although many couples ultimately feel their infertility journey has drawn them closer together, at times they still grapple with feeling alone and isolated in their desperation.  Because each member of the couple is dealing with this significant life crisis in her or his own way, they may not be aware of how to support their partner or meet their partner’s emotional needs.

Gender Differences in the Experience of Infertility

Women and men often experience infertility in distinct ways.  The question often arises, “do women suffer more than men?”  Studies confirm that women tend to experience greater levels of infertility-specific stress than men.  They also report more symptoms of depression, anxiety, and low self-esteem, irrespective of whether the diagnosis is female, male or a combined factor.  Contributing to a woman’s increased distress may be her monthly cycle, which serves as a physical reminder of what is missing and often facilitates a seemingly endless emotional roller coaster of hope followed by despair.  Women also usually undergo the majority of the medical work-up and procedures, which can be time consuming, invasive and sometimes physically painful.  In addition, we must acknowledge the societal and cultural norms about motherhood that shape women’s expectations of adult life.

Men also experience emotional struggles with infertility, although they express them differently than women.  Men commonly worry about aspects of the process, such as the stress of providing a sperm sample on demand in a medical office, and the costs associated with treatment.  They often feel the need to provide emotional support to their spouse and consequently, minimize their own feelings of sadness.  Overall, while research indicates men experience infertility-specific stress and distress, they are usually less emotionally affected than women.

 

Gender Differences in Coping

Men and women also tend to use different techniques to cope with infertility.  Women seek information, assistance and social support.  They turn to others for help and want to talk about their feelings, especially following an unsuccessful treatment cycle or pregnancy loss.  Men, however, utilize coping strategies that include distancing, minimization, and problem-solving.  They tend to remove themselves from the negative emotions associated with infertility by downplaying its significance.   They may become more involved in their work or other tasks as a way to feel productive and effective.  Men also often view their primary role as that of supporter or protector.  Thus, in an effort to shield their wife from increased emotional pain, they may be hesitant to express their own feelings.  When noting differences in the way men and women cope it is important to remember that difference does not indicate better or worse, it only means not the same.  It is also necessary to understand how your partner copes so you do not misinterpret his or her behavior.

 

Challenges in Communication

Unfortunately, what frequently happens is that spouses will misinterpret one another’s coping styles, emotional needs, and behaviors and get caught in a negative cycle of communication.  For example, a couple experiences an unsuccessful IVF cycle and the woman feels sad and discouraged.  She is looking for someone with whom she can share her sadness and feel emotional validation, support, and connection.  She naturally turns to her spouse and is looking for him to “just listen,” and to express empathy.  She would like him to be emotionally and physically present.  However, it is very difficult for a husband to see his wife in such emotional pain.  He loves her and wishes to help her; he wants to fix the problem.  He may talk about making the best out of the difficult situation, finding a silver lining, or offering solutions, such as proceeding with more fertility treatments as quickly as possible.  His well intentioned attempts at problem-solving backfire because ultimately, he cannot solve the couple’s fertility problem, or the feelings of sadness and grief they each feel.  The result is his wife feels alone and unsupported and he feels disappointed and ineffective.

While there are times when you and your spouse innately know the form of support one another needs, sometimes it is necessary to clarify the type of support you are seeking.  There are four types of support: emotional (listening, empathizing, hugs); esteem (expressing admiration or respect); informational (problem-solving, giving advice, gathering information); and tangible support (cleaning, planning a dinner, making doctor’s appointments).  If you are looking for emotional support and need your spouse to listen, empathize, and hold you, and you do not want them to problem-solve, then you need to state your preferences.  For example, “I need you to just listen for a while as I talk about how much I’m hurting.”  And what is “a while?”  Is it five minutes or a half-hour?  It is important to clearly identify your preferences.

When this occurs, the negative cycle of communication evolves into a positive cycle of connection.  Let us return to the previous example where a couple has had an unsuccessful IVF cycle.  The woman feels devastated and discouraged and explains to her partner her need for him to just listen and empathize.  The husband provides the emotional support his wife seeks.  She feels supported and he feels helpful.  They feel connected to one another as they continue on their journey through infertility.

 

Identify How You and Your Partner Cope

It can be constructive for you and your spouse to identify your preferred coping styles.  Think about how your ways of coping may impact your spouse and the relationship.  Do your coping techniques have a positive or negative effect on your partner and can this change based upon the situation?  You want to replace individual coping strategies that have a negative influence on the relationship with those that have a positive effect on the couple.

As I noted earlier, women tend to seek social support as a coping strategy, and this includes talking to their husbands about infertility.  While this can be an effective strategy to validate a woman’s feelings and help the couple feel more connected, at times it can negatively impact the relationship.  This occurs when talk of infertility begins to dominate a couple’s conversations.  While women find it helpful, men often note it increases their stress level (remember, men frequently cope by using distancing and minimizing techniques).  In response, men will often try to avoid infertility talk or disconnect from the conversation, which leads women to believe their spouse does not care.  One effective strategy is for the couple to limit infertility related talk to 20 minutes a day.  You might decide to schedule the 20 minutes for the same time every day or just see when the topic arises.  Some couples keep a general eye on the time, while others set a timer.  Either way, this is a strategy that allows women an opportunity to receive the emotional support they seek, while placing boundaries around the length of the discussion.

 

Take Away…

  • Infertility can create significant strain in a couple’s relationship.
  • Women and men often experience infertility in unique ways and tend to utilize different coping styles and strategies.
  • A coping style may be effective for an individual, but harmful for the relationship.
  • Identify and consider how each of your coping styles may effect the perceptions of the support you give and receive, and be aware that a change in your coping strategy may be necessary.

 

Dr. Erica Mindes is a Licensed Clinical Psychologist and an Associate with the psychotherapy practice of Covington & Hafkin, which specializes in reproductive health issues. She has an office in Richmond, Virginia where she provides counseling to individuals and couples struggling with infertility, pregnancy loss, and other areas of reproductive medical care. She has conducted research and written on the psychological responses to infertility and infertility treatment, and recently co-authored the chapter, “Counseling Known Participants in Third-Party Reproduction” for Fertility Counseling: Clinical Guide and Case Studies. Dr. Mindes is a member of the American Society for Reproductive Medicine Mental Health Professional Group (MHPG) and serves on the MHPG Executive Committee.

 

References:

Brock, R.L. & Lawrence, E. (2009).  Too much of a good thing: Underprovision versus overprovision of partner support. Journal of Family Psychology, 23(2), 181-192.

Greil, A.L., Slauson-Blevins, K., & McQuillan, J. (2010). The experience of infertility: A review of recent literature. Sociology of Health & Illness, 32(1), 140–162.

Jaffe, J. & Diamond, M.O. (2011). Reproductive Trauma. Washington, DC: American Psychological Association.

Peterson, B.D. (2015). Fertility counseling for couples. In: Covington, SN ed., Fertility Counseling: Clinical Guide and Case Studies. Cambridge, United Kingdom: Cambridge University Press.

Wichman, C.L., Ehlers, S.L., Wichman, S.E., Weaver, A.L. & Codington, C. (2011). Comparison of multiple psychological distress measures between men and women preparing for in vitro fertilization. Fertility and Sterility, 95(2), 717-721.

 

 

Coping With Inappropriate Comments, Questions, and Suggestions

Whether you’ve been open about your struggles with infertility or have only told a handful of close family members or friends, at some point you’ve likely received well-intentioned, but unsupportive comments or questions from others.  It may have happened when you were at a party having an otherwise enjoyable conversation with someone you hadn’t met before and they suddenly ask the question, “So, when are you planning to start a family?”  Perhaps you just confided in a friend about how long you’ve been trying to conceive and they responded, “Just relax and it will happen,” “Have you ever considered adoption,” or “At least you’re having fun trying.”  Maybe there’s a parent, sibling, or friend who you’ve always counted on to be supportive during other health or life crises, and it’s clear they change the topic whenever you bring up your fertility journey and never ask, “How are you doing,” or tell you, “I just want to let you know I’m thinking of you.”  These types of negative or unsupportive social interactions often result in feelings of anger, sadness, and isolation for those experiencing fertility problems.  Research has found that a majority of individuals who are diagnosed with a fertility problem have received negative, uncomfortable, or embarrassing responses from others, and these unsupportive social interactions are associated with increased psychological distress and decreased self-esteem.

 

Types of Unsupportive Social Interactions

There are generally four types of unsupportive or upsetting responses an individual may receive about their fertility problem:

  • bumbling, which represents comments that are awkward uncomfortable, intrusive, or inappropriately focused on trying to “fix” one’s fertility problem (e.g., “At least you’re having fun trying,” or “I have a friend who adopted and then was able to get pregnant on her own.”);
  • minimizing, which represents attempts to downplay the importance of a fertility problem (e.g., “Think about all the places you can travel without kids,” “You’ll never have to worry about college tuition,” or “Things could be worse.”);
  • distancing, which reflects behavioral or emotional disengagement (e.g., when you confide in someone about your infertility treatment and they seem uncomfortable, never want to talk with you about it, or don’t “check-in” to see how you’re feeling); and
  • blaming, which reflects criticism or fault finding (e.g., “You’re too stressed out – you just need to relax and let it happen,” or “You just need to think positively.”).

 

Don’t They Realize What They’re Saying or Doing Is Inappropriate?

Unfortunately, the answer to this question is usually, “no.”  It can be helpful to think of about these unsupportive and inappropriate responses as a type social ineptitude.  Some individuals simply lack a filter.  Others have poor boundaries – they disclose too much information about themselves and expect others to do the same.  Most commonly, though, the statements, questions, and actions of family members and friends are made with good intentions, but don’t consider the needs of individuals dealing with a fertility problem.  Although public awareness is increasing and infertility is a topic more frequently addressed in the media, as well as, in popular television shows, movies and books, a majority of people still don’t understand that infertility is a disease.

 

How Can I Cope With Others’ Comments, Questions, and Suggestions?

Next time someone asks, “When are you going to have kids,” or “Have you considered adoption,” or says, “Just relax,” there are a couple strategies you can try:

 

  • Take a couple of deep breaths. When someone asks that dreaded question or makes an inappropriate comment, it often feels like you’ve been punched hard in the stomach; it knocks the wind right out of you.  You don’t need reply immediately (or at all).  Taking a deep breath or two helps you regain your composure, and can give you some time to collect your thoughts and determine if and how you want to respond.
  • Silently acknowledge that the question, comment, or behavior is likely a reflection of the person’s social ineptitude. They may lack education and information, or don’t understand how to offer helpful support when someone is experiencing a fertility problem.
  • Prepare your response. Strategize how you or you and your spouse want to reply and come up with a few snappy comeback lines for common inappropriate questions and comments.  You may want to develop multiple responses to reflect the different situations in which the negative social interaction could occur, such as at a party, family event, or in the lunchroom at work.  For example, when someone asks, “When are you planning to start a family,“ you could say: “We’re working on it;” “We are a family;” “We’re way past the planning stage and already working with medical professionals;” “Sometime before we send out the birth announcement;” or just “Someday.”  You may also want to have a few general lines in mind for when you receive a question or comment you’ve never heard before.  These may include: “If you forgive me for not answering that, I’ll forgive you for asking it;” “I think you need to educate yourself more about infertility before you make comments that are inaccurate;” or “I don’t think you meant to say what you just said because I know you wouldn’t intend to hurt me like that.”  
  • Provide sources of education and information. This may be appropriate for family and friends in your close social network.  Providing education and accurate information can help them understand the scope of your fertility problem, as well as, the emotional experience of infertility.  The American Society for Reproductive Medicine has a patient website, reproductivefacts.org, which offers numerous fact sheets that provide information on all aspects of infertility and are written in easily understandable terms.  RESOLVE, the National Infertility Association, www.resolve.org, is also an excellent source for information.
  • Clarify your needs. You may have to specify to friends and family the types of support that would be most helpful for you.  For example: “I just need you to listen and let me say what’s on my mind. I don’t need reassurances or advice;” or “I feel very isolated.  It would mean so much if you would just check-in with me every week and ask me how I’m feeling.”

 

You can’t stop the occurrence of all inappropriate comments, questions, and suggestions, but you can change how you respond to these negative social interactions.  Ultimately, this may be enough to increase feelings of empowerment and regain a sense of control in your communications with others.

 

Dr. Erica Mindes is a Licensed Clinical Psychologist and an Associate with the psychotherapy practice of Covington & Hafkin, which specializes in reproductive health issues. She has an office in Richmond, Virginia where she provides counseling to individuals and couples struggling with infertility, pregnancy loss, and other areas of reproductive medical care. She has conducted research and written on the psychological responses to infertility and infertility treatment, and recently co-authored the chapter, “Counseling Known Participants in Third-Party Reproduction” for Fertility Counseling: Clinical Guide and Case Studies. Dr. Mindes is a member of the American Society for Reproductive Medicine Mental Health Professional Group (MHPG) and serves on the MHPG Executive Committee.

 

References:

Akizuki, Y. & Ichiro, K. (2008). Infertile Japanese women’s perception of positive and negative social interactions within their social networks. Human Reproduction, 23, 2737-2742.

Ingram, K.M., Betz, N.E., Mindes, E.J., Schmitt, M.M., & Smith, N.G. (2001). Unsupportive responses form others concerning a stressful life event: Development of the Unsupportive Social Interactions Inventory. Journal of Social and Clinical Psychology, 20, 174-208.

Mindes, E.J., Ingram, K.M., Kliewer, W., & James, C.A. (2003). Longitudinal analyses of the relationship between unsupportive social interactions and psychological adjustment among women with fertility problems. Social Science & Medicine, 56, 2165-2180.