The Emotional Crisis of Infertility

from the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.

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Sir William Osler, a famous physician, once said that human beings have two basic desires - to get and to beget. To have your own family is a universal dream . This dream can become a nightmare for the infertile couple and learning that you have an infertility problem can cause painful and difficult emotions. Infertility is like a chronic illness that uses up a large amount of a couples' resources - emotional and financial - and involves the expenditure of a considerable amount of time, money, physical and emotional energy.

Everyone's response to infertility is different depending on individual situations, emotional strengths, coping methods and personality. You will be confronted with the emotional impact of infertility before, during, and after treatment. It is better to prepare yourself for these difficult periods, so that with emotional support and mental preparation, you can successfully reduce the potential pain of infertility.

Discovering that you have an infertility problem

Although you may have friends who have experienced infertility and you're aware that it is a common disorder, the news is almost always unexpected. As you examine the issues surrounding infertility, you may find yourself experiencing some uncomfortable emotions. Some of the most common ones are:

Shock: In most cases, infertility is not diagnosed until after one year of unsuccessfully trying to conceive. Because of this, you may suspect that you have a problem before finding out for sure. For many couples, infertility is very difficult to accept. Most couples initially respond with feelings of shock and disbelief. After planning for years to have a child "one day", you may feel that your life's plan has been put on hold. These feelings generally only last a short while and are not emotionally harmful when you recognize and address them.

Denial: Another part of the emotional process is often denial. You and your partner may find yourselves saying "it can't be happening to us," and rather than confronting infertility, you may choose to deny the problem. However, this phase serves an important purpose and allows you to adjust to an overwhelming situation at your own pace as you work at resolving your infertility. Denial is only unhealthy if it lasts for a prolonged period and prevents you from accepting the reality of infertility.

Fantasizing: For some women, denial also leads to fantasizing - and they dream of what life would be like with a child. They feel that all their problems would be solved if they got pregnant . They lose touch with reality and everytime they start treatment, they think they are going to conceive . They find it difficult to cope when it fails.

Guilt: Guilt is an unfortunate but common response to infertility. In an attempt to determine why you are infertile, you may wonder if past behavior caused the problem. Some individuals may feel that they are being punished for past sexual activities or an elective abortion. Often infertile partners may feel that they are depriving fertile partners of the opportunity to have children. The inability to produce a baby may also make you feel you have let your family down because you have not been able to fulfill what is expected of you - especially so if you (or your husband) are the only son or daughter of your parents. In large joint families, this stress can be stifling - and fertile daughters-in-law are given special privileges from which infertile women are excluded.

Bargaining: This is a common response - especially if you believe in God. You promise to fast ; offer penance ; offer money; and to be good for the rest of your life if He gives you a pregnancy. Many infertile patients have visited an endless number of temples and "holy men" - and done "yagnas" and "tapasya" - in order to conceive, often at considerable expense.

Blame: You may blame one another for your inability to conceive, especially when only one member is infertile. Also, you may respond differently to the emotional aspects of infertility. For example, one of you may find that the other is less concerned about having a child. As a result of these differences, one partner may grow resentful because the other is not experiencing the same emotions on an equal level.

Sadness and Depression: The number of losses associated with infertility makes depression a very common response. In addition to the loss of a baby, infertility represents the loss of fulfilling a dream and the loss of a relationship that you might have had with a child. What you are mourning for is the absence of experience - and this type of sadness can be especially hard to deal with. You and your partner may have even more difficulty dealing with these losses because friends and family often underestimate the emotional impact of infertility - and you have no one to talk to . The nature of infertility is such that you may never know definitely whether you are able to conceive or what is causing the problem. Your grief therefore has nothing to focus on - and there is the continual hope that "this will be the time" which can leave your emotions painfully suspended, creating a continual "hoping against hope" attitude. When someone dies, the death brings family and friends together to grieve the loss - and this helps in healing . In contrast, infertility is a very private form of grief - you grieve alone without social support because the loss is hidden.

Hopelessness: Hopelessness is related to depression and usually results from the up and down cycle of emotions produced by infertility and its treatment. Most likely, you'll feel hopeful during mid-cycle when you've been treated and are looking to success. But if the cycle is unsuccessful, hopelessness can occur, and you may feel that you'll never become pregnant. Starting over again each month can make dealing with infertility especially tough. After the disappointment of several unsuccessful cycles, you may find it difficult to maintain a positive attitude. You may think that it gets easier with time - but it never does - and every time it fails, old wounds ( which you hoped had healed ) open again. After all, every time you start a treatment ( especially when it is a new type of therapy you have never tried before; or treatment with a new doctor), you always do it with the hope that "this" time it's going to work for you. If you didn't have this hope, no matter how small, no one would ever start treatment at all!

Loss of Control: You and your partner have probably planned your lives so that you'll begin a family at the most favorable time. Many of us think everything is possible if we work hard enough - and not being able to have a baby is often the first time you experience failure against forces at work which are beyond your control, no matter how hard you try. You may have practiced birth control for years and waited until your careers were established before trying to have a baby. Discovering that you are infertile removes these feelings of control over your own life. During treatment, you may find yourself putting other parts of your lives on hold. This might include postponing moving to a new home, continuing your education, changing jobs, or establishing new relationships. The more you give up, the less in control you're likely to feel. Each treatment cycle can become a roller coaster of emotions with its ups and downs - the hopes of success and the frustration of failure.

Anger: Anger arises from having to confront a great deal of stress and many losses, including the loss of control. It is not unusual to resent pregnant women, and friends and family who do not seem to understand the emotional tension associated with infertility. Often the anger is directed towards doctors - and this is one of the reasons why so many infertile patients change doctors so frequently.

Isolation: Feeling alone is a common experience among infertile couples and coping even more difficult. Most people cannot comprehend and complex feelings associated with infertility. Insensitive remarks, such as "relax and you'll get pregnant," or "after you adopt you'll have a child of your own," are not based on fact and can cause a great deal of pain. It is not unusual for relationships to change if friends and family are unable to understand and empathize with your feelings. Let your friends know that what you need is not their advice, but their support.

Infertility is an experience that continually fluctuates in intensity and direction, so that at different times you may have different needs and experience different emotions. There are no set "stages" in this experience, and, while, at one time, your emotions can be mystifying and frighteningly intense, at another time, you may simply feel numb. There may be moments when the fact of being infertile dictates every facet of your life. The way you learn to deal with the experience of infertility will also be different at different times. One day a particular strategy may help you a lot, but later on you may find it useless. At times you may find that the pain you experience is very destructive, but at others you may find it a useful motivating force in your life. It is important to acknowledge that emotional responses to infertility vary greatly, as do different people's methods of coping with them. Each person has to find his or her own way of coping with the infertility situation, and sometimes might need help to accomplish this.

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