What are some of the stresses of infertility and how can patients and couples cope. Why is the grief of infertility unique? We talk with two therapists who specialize in reproductive medicine: Bette Galen and Joey Miller.
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What are some of the stresses of infertility and how can patients and couples cope. Why is the grief of infertility unique? We talk with two therapists who specialize in reproductive medicine: Bette Galen and Joey Miller.
Please leave us a rating or review RateThisPodcast.com/creatingafamily
* Note that this is an automatic transcription, please forgive the errors.
Speaker 2:Welcome everyone to creating a family talk about infertility. Do us a favor and let your friends know about this podcast. Most people find out about podcasting in general and about this specific podcast from their friends, so do us a favor. If you've got somebody in your life who either you want to educate about infertility or are they are also in their own infertility struggle or journey, please let them know about this podcast.
Speaker 3:Today we're going to be talking about coping with the stress of infertility with Joey Miller. She is a licensed clinical social worker with over 18 years of experience in women's reproductive health. She is in private practice in Chicago at wellsprings health associates and her first book on the unique challenges of subsequent pregnancy after a loss is targeted for release in spring 2020 we will also be talking with Betty Galen. She is a licensed clinical social worker working in the field of reproductive medicine since 2005 she is licensed in both New Jersey and Florida having worked for Reproductive Medicine Associates of New Jersey for 11 years before relocating to south Florida or she continues in her private practice. Welcome Betty and Joey to creating a family. We are so happy to have you here. Thank you so much. Happy to be.
Speaker 1:Thank you. It's wonderful to join.
Speaker 3:Well, you know, I think that um, for a lot of our audience, quite frankly this next question they're going to roll their eyes at. Um, but for those in case there are some fortunate few who are listening who have never experienced infertility, let's start by saying, you know, why, why is their fertility so stressful? I mean, you know, you're not getting pregnant, but you know, why is that in particular? So Special Joe, you want to start with that one?
Speaker 1:Sure. I'd be happy to. I think that the deal where this has gradually been increasing, that infertility is a medical issue and a medical challenge. But I think what is not quite as obvious is that it's also very significantly a mental health challenge that women and couples often times are going through this and in silence because they greatly desire privacy and because they don't necessarily know what the outcome of this journey will look like. So there's often times depression, anxiety and also secrecy, like layered on top of that, sometimes by choice, but that can also isolate women and couples from their social support networks.
Speaker 3:You know, you're right. And, and, and the secrecy and the, the privacy I think is somewhat tied into the fact that it's all connected to sex. I mean, you know, and, and, and, and it's, uh, so I mean, I don't know how, and we one would think with Earth a bunch of adults that we would not still be connected. I mean, not still be concerned about that, but it is a private matter and not usually one that you discussed. So
Speaker 1:and one that oftentimes is a very intimate process, but oftentimes not that when a couple is not able to have unprotected sex very straightforwardly or spontaneously and conceive and oftentimes a reproductive endocrinologist or a whole team of providers then becomes included, that the intimacy kind of goes out the window. And so oftentimes women and also scramble to hold on to that sense of intimacy and privacy as they go through this
Speaker 3:or give up on intimacy and give up on the fact that sex is supposed to be an enjoyable aspect of life. And then that also adds to the stress, particularly if that has been a way that couples have had been able to come together and literally and figuratively, um, in the past, you know, that it makes it that it's a huge loss. Uh, yeah, I'm, I'm glad you actually mentioned that. That's not one that I had thought of
Speaker 1:and so many different levels. A loss, um, in terms of identity, in terms of spontaneity, in terms of control, in terms of on so many different levels. It's a loss.
Speaker 3:Yeah, it is. And, and you know, in the, there are so many potential greys griefs that we are, or losses that we are, um, anticipating our, our, our having to process Betty, one of which is the, the whole concept of, I mean, the whole reason we're trying to get pregnant is because we want to be a parent. Right. Um, so let's talk some about the, the loss associated with that.
Speaker 4:Well, you know, I think, uh, women particularly, we're socialized when we're really young to think about being mommies because we get baby dolls and we'd play house and we do that, which is a little bit different than boys right there shooting up and doing all kinds of other things. But it is changing a little bit. But still we are, you know, even women who don't want to Ha, you know, think about, um, having children, that happens a lot later. We don't grow up saying I'm not going to have a baby unless there's a physical sin. They were not able bodied or something like that. But I think that's really difficult. You know, that there's an expectation. It's a transition from a coupling to family. So I think it's really hard for people to think about not having a child the way everybody else does
Speaker 3:well. And yes. And, and then the, the, the growing a fear that either you won't be able to have a child, right. Uh, and, or you won't have a genetic connection to your child and, uh, and, and that comes with it's own loss. Right. Uh, you know, the, the, the, you know, we always imagined the perfect combination of our partner and our self. Uh, you know, and not that of course we never really imagined the imperfect combination where they get, you know, your big feet and his big nose, but we always imagined that it's going to be just the perfect, uh, uh, uh, flourishing of, of who we are as a couple too. And there's that loss. Yeah.
Speaker 4:It's the natural way, right? That you get married, you know, you date, you get married, you have a baby or isle and that, that is changing. You know, now we'd have a, we date, we have babies and then we get married. So, but it's really kind of the natural order of things. And when all your friends are, are in that position and they're succeeding and you are not, yeah, really hard, you know, and these many, many women, you know, have never not succeeded at anything that they've done.
Speaker 3:You know, I'm so glad you mentioned the sense of failure. Uh, Joey, can you talk further about that? Because that's something that's seldom discussed, but there's an underlying current of I am failing, my body is failing. Uh, you know, and, and, and like Betty said, and I'm used to succeeding, you know, cause yeah, I'm, you know, I've, I usually, if I put my, you know, my heart, you know, pull myself up by the bootstraps, work hard, do all the right things, I could succeed. And yet I can't. Yeah.
Speaker 1:And we're, we're socialized to believe that. And we buy in to that thinking that if we work hard enough, we can have anything that we want the classic dream. And for many women, it's not for a lack of trying that many women who struggled with infertility are trying for weeks and months and sometimes years. Yeah. Pursuits of greatly desired parenthood and who are pregnant, whether that includes loss or that doesn't even get to the point of a conception. The loss telly continues to grow and, and so yes, you're correct that women do feel that their bodies have failed oftentimes that the medical system has failed them. We know a lot of medical providers thinking if I present to[inaudible] clinic, if I work with a team of providers, it's not always a guarantee. And so in many different ways, the sense of of a woman's identity. And, and you mentioned before from a cultural standpoint, in many ways motherhood defines women, whether or not the individual buys into that or not. And so on so many different levels, feeling I have failed as a woman, I have failed as a partner. I have failed as a daughter to provide my own parents with a greatly desired and anticipated baby. And I think this idea of failure, you know, it ties into even the words that we use when we're expecting, or I'm sorry, when we're pregnant, I'm expecting, yes, I'm expecting I can have unprotected sex with a partner. I'm expecting that nine months later, happily ever after. And then fertility goes counter to all of it.
Speaker 3:Yeah. And it's a, and it challenges your, your dreams and your life expectations. So let's talk some about[inaudible]. Uh, was glad you mentioned the fact that it challenges your, uh, your expectations, but it also challenges your identity as a a woman are as a man, Betty. Let's, and I, I, I often feel that the men have it harder, um, that, that masculinity in some ways is, is more tied, although I guess femininity, femininity is equally tied to motherhood. So maybe I'm, maybe I'm wrong there. Uh, do you think it's harder, are equally as hard for men and women from their sense of who they are as a man or a woman?
Speaker 4:I think it's equal. I think women talk about it more than men talk about it. That's fair. And I think the bottom line question that a lot of people say is, why me? And of course there's no answer to that. Why me? You know, there may be a medical question, but then you go into all the psychological whatever, um, whatever, uh, core values they have about themselves, why me can all bring up, you know, it all comes up when we're going through fertility. So we have a lot of, um, critics that come up and I think that, you know, men have, don't have as many places to go to talk about it. They did a, there's, I think, um, I found one male, uh, one, um, support group online for men and women have lots of places where they can go and amendment men are just, um, and they don't talk to their friends and they're coping in different ways, you know, men avoid women talk. Yeah,
Speaker 3:yeah. And yeah, and, and yeah, I think you're, you're absolutely right on the lack of, of talking from men standpoint, you know, another, uh, lost that first for some women is that even when there are other options for becoming a parent through adoption or through surrogacy, there is still the loss of pregnancy and experiencing that. And Joey, I think that that comes as a surprise to a lot of women, that that actually is important to them. Um, that, uh, I mean there's not a lot of people who say, Gosh, I just really can't wait to go through labor. And yet being able to share in the communal, uh, sharing of labor stories, you know, when a group of new moms get together, all of that is, is it is a loss as well. Maybe, you know, the, just even the physical aspects.
Speaker 1:Yes. I think it's a loss. And I think sometimes it comes as a surprise to some women, but also many of the people who surround them. So if someone is able to parent, you know, and become a foster parent or through adoption or through a search, many people who surround the woman think now you, now you really have what you want it. And in many ways, yes, a woman does have a child to parents, but on some levels it's, that's not exactly what and who she wanted. And so the of adjustment
Speaker 3:and acclimation can take significantly longer sometimes than the process to parent. Well. Yeah, I mean, what we try to tell people oftentimes is that there are many losses associated with infertility. The loss of having a genetic connection to your child, the loss of experiencing the physical aspects, uh, the loss of, uh, of, of, uh, of n a n n a complicated way of, of being able to reproduce as well as the loss of the ability to parent non-genetic parenting only. Well, surrogacy and adoption only take care or depending on how you, you become a parent through circusy, let's just say adoption only takes care of the loss of the inability to parent. It doesn't deal with all the other losses. And if we don't acknowledge that those losses are there, it can, uh, they will find a way to raise their head in your parenting journey and it doesn't reflect the love you feel for your child.
Speaker 4:Right. And I think that it also, it, um, the relationship changes if you don't talk about it, you know, there sometimes women are holding lots of emotions that they're not feeling comfortable talking about, whether it's to their friends, family, husband, you know, it can be really difficult. You know, there, um, I remember going to a twin group and I was saying how difficult it was and people were so mad at me did, I was saying how difficult it was because the, you know, I should be, I should have been thankful that I have twins and um, even, and they have twins, but I was complaining that it's so hard and how dare I. So there's a lot of shame that can go along in many different ways, many different aspects of it.
Speaker 3:Yeah. And after the fact, after you, what you're raising is, is so true after you finally get your long awaited child, uh, heaven forbid that you would complain. Right. Um, you know, and that's another loss and the inability to kvetch with your friends about, yeah. Yeah. Yeah. And the other thing you brought up that I was thankful is the feeling of, of, uh, of guilt that, let's talk some about how guilt plays in. Uh, let's see, Betty, go ahead.
Speaker 4:Well, I think there's guilt in many, you know, many, right? From the beginning. You're not, you're not a good goodwill. You're not a real woman. You're not giving your hug has been to your partner a baby guilt in parenting guilt and thinking, oh my God, I waited this long and now it's really hard and now I'm saying something. Um, it's just latent and, and motherhood in general. Motherhood, muddy mother, mothering twins. How do you give each kid the, um, attention? So there's, you know, um, and everybody
Speaker 3:and breastfeeding and it goes on, it goes on and it goes on. The inability to give your partner a child. We hear so often when of course it's a female, we hear it from a women and if it's male, we hear it from men. Right. And the feeling that, you know, you'd be better off. I mean, leave me, go find somebody else. Yeah. That feeling right. Younger person. Go get it. My husband should go get a younger woman. Yeah, yeah, exactly. That I'm only worth it if I am, if I am fertile. Yeah. Yeah, exactly. And the guilt that if, especially if you have waited the guilt that you have brought this on yourself. Joey, is that a common feeling as well?
Speaker 1:Yes. These are things that I hear with great regularity and oftentimes I challenged the patients I'm working with in terms of a broader perspective because oftentimes women will hone in on one factor. So for example, you know their reproductive ability saying again, I'm a failure to my partner and I, I engage very directly with my patients saying, you know, when you decided to make a commitment to your partner, was it contingent on this one individual factor saying, you know, we're going to have a contract that we're going to have two children by this timeframe. That in general, you know, even though couples have, many of them have discussed their desire to focus on family growth at some point. There are many, many, many other qualities and factors that bring two people together. And I encourage people to have, you know, the pursuit of fertility or family growth be a part of their lives instead of becoming their lives. And I focus on that with regard to their relationship as well. Saying fertility or family grew up can be a part of your relationship. But I have yet to meet one couple who is not, who, who doesn't have additional reasons why they chose each other to be life partners.
Speaker 3:Yeah. And I'm glad you were. We were in a circle back to talk about, um, some of the impacts, uh, of the stress of infertility on the couple because
Speaker 2:let me pause to let you know that this show is brought to you through the support of organizations that believe in our mission of providing unbiased, medically accurate information. And these are organizations that put their money behind their beliefs and we truly thanked them. Oh, one such organization is Cooper surgical fertility genomic solutions. They are global leaders in IVF and reproductive genetics. They offer p, g t a P G T N P G T S R n e r p. S. M. A. That's a individual receptivity testing both for individuals and couples, Cooper genomics and who for surgical is proud to provide comprehensive genetic counseling to their patients. And I will add
Speaker 3:that, uh, it is so important to have, uh, the genetic counseling to go along with the genetic testing. Another central organization is cryos international sperm. And Egg Bank. They are dedicated to providing a wide selection of high quality, extensively screened, frozen donor sperm and egg. And they cover all races, ethnicities and phenotypes. And they also can provide for both home insemination as well as fertility treatments. Cryos international is the world's largest sperm bank and the first freestanding independent egg bank in the United States. Another, uh, source of stress and anxiety is honestly for a lot of people, uh, the, some of the medical interventions, um, it's easy to kind of snicker a little at people who, who really disliked shots. But if you really dislike shots, it's a very real feeling and you know, you're screwed because there's a lot of shots. Um, as you progress through infertility treatment, so, um, medical anxiety, how does that play out? Uh, Betty in your experience?
Speaker 4:Well, the, you know, there's, there's, for men, I'm giving a sample in it, in a clinic can be very traumatic, you know, and, or having sex on demand, we have to do that. That breaks. That's a difficulty between the husband and the[inaudible] or the partners. Um, I find a lot of anxiety, you know, if I'm, I'm 34 and when I turned 35, that's it. You know, there's that kind of debt. It's, it's really, it's like at that you're going to hit 35 and then it's going to be all over it. And so people are really high anxiety through this whole, um, process. And it's really hard to maintain a life, you know, the anxiety about giving yourself shots, about how many doctor's appointments am I going to go to? How do I get out of work? I'm a teacher, get out of work and there somebody's going to find out it's laden with anxiety.
Speaker 3:Yeah. Such a good point about them. Just the sheer number of how do you fit these appointments into your work life? Uh, yeah, that's a, that's a real issue. That's it. That's another,
Speaker 1:and also this is, this is Joey, just adding onto this, excuse me to interrupt, but also lack of predictability that if someone is going in for a baseline ultrasound or a blood draw on day three of her cycle, that tends to be something that's anticipated. But as someone who's going through a stem preparing for a retrieval, it's very difficult to plan because everyone's body is literally different.
Speaker 3:Yes. And, and, and yet our works demand a certain amount of predictability because we need to ask for time off. Yeah. Yeah, exactly. And who's going to cover for me during this time? Yeah. You know, and, and like it or not, I always say this, that in most discussions about infertility, we have to bring up money and, and, and that is a, another source of great anxiety for not everyone. Some people have the money and it's simply not an issue or are they've got good insurance coverage. Um, and that's certainly our goal to get all, all couples there. But until then, how the heck do you pay for it, Betty? Where, what? Let's talk about the, uh, uh, the numbers aspect. The money aspect is, you know, people, um, mortgage take out mortgages on their house. They borrow money from their parents. They're just, I mean, it's, they go in debt for two just to have to have a baby because it's so, um, difficult to think about living life without doing this, you know, how could they not try? Um, and Tara big anxiety and hopefully we'll have more states that are mandated fertility coverage on insurance. I mean that would be really wonderful. Yes, yes. Uh, yeah, we are a part working to help promote that in a resolve a certainly a doing a lot along those lines as well. Um, yeah, that is certainly our goal. So there, there's so many different aspects of stress and grief and loss in the whole infertility journey in general. And in many ways I think that the stress of infertility is unique. I'm sure there are other that, you know, all pain is, you know, all unhappy families are uniquer and all, you know. So I'm sure that it could be said that there are definitely other forms of, of stressing that people go through that has its own unique characteristics. But let's just talk about some of the union. Some of the ways that the infertility, stress and losses are unique to other, to other stresses. Joey,
Speaker 1:again, as women go through this, it quickly becomes apparent that the, that infertility is more than a full time job. That it is every single second of every single hour of every single day, including evenings, weekends, and holidays that any of these women have decided that they wanted a baby a long time ago and may have changed things like their diet. You know, thinking, I'm not going to have that glass of wine or those few glasses of wine or I'm not going to have soft cheese or I'm not, you know, in anticipation of having a child. And so in terms of how they're living, sleeping, eating, breathing, their focus is on conception and pregnancy and having a baby. And so monitoring their cycles, you know, if they use the washroom, you know, is there any discharge? Am I looking for, you know, Mucus today?[inaudible] have I started bleeding? Um, and so again, there's, there's no off button. And so going back in the podcast, just a moment when you had talked before about some of the differences between men and women are, you know, potentially making a suggestion that men have it harder. I would argue that the challenges are simply very different. That and do get to go to work or you know, get to have other distractions where they're not having to think on every single level 24, seven, but in some ways that makes them more in the dark. Um, and they're not only concerned about their desire for pregnancy parenthood, but also likely being very concerned about their, their partners and not necessarily being able to do anything to necessarily help make this easier or better at some times better sometimes. So often times partners feeling incredible sense of helplessness.
Speaker 3:Um, it also seems to me that part of that we talked earlier about people not talking about, uh, their infertility sometimes even with those very close to them in their family. Um, but, and, and very often not talking about it with friends, so that this allows, one of the ways it's unique is that it's being, uh, suffered in silence and in solitude, but even when women and men as well, uh, even if those who are struggling with infertility share, there's so much misunderstanding, um, and lack of quite frankly, compassion, um, that, that, that they face if they do share, uh, Betty, I'm assuming you have, you also have seen this.
Speaker 4:Oh my goodness. I, you know, I have, we have, I have been doing support groups for, I don't know, eight or nine years now. And the people continually tell me, we call it stupid things that people say. And I'm always amazed at how many things it's, it's, it's mind boggling how people will, what they will say to people. And, um, without even thinking that perhaps that might hurt somebody. So, you know, it's, it's about being able to, um, you know, puts people back in the closet that they don't want to talk. So from something benign, like, when are you gonna have another, when are you having a baby? Can somebody really hard when they're right in the middle of, um, all their treatments or they ha I had somebody said, um, you know, um, they had somebody had twins and some person said, well, maybe that they can give you one of the babies. I, I tried really hard to understand. So it's, um,
Speaker 3:the one that really gets me the most, and I think that it is so common. Uh, you know, maybe this is maybe you weren't meant to be a mother, right? Maybe. Pardon? It's God's plan. Yeah. It's God's plan, you know, uh, you know, not everybody met or you can be a good aunt, you know. Uh, yeah. I mean, we've, we just hear it so often, um,
Speaker 4:discounting somebody's feelings saying that, oh, or I'll let you, I'll let you know. Why don't you take my kids, which is[inaudible] or, or[inaudible]
Speaker 3:this is, you know, another gym. Uh, you know, it could be worse. You could have lost a child, you know, and it's like we're in the pain Olympics that we are going to. Yeah. Terrible. Yeah. And, and, and because, and that drives, as you say, people back into the closet. It, uh, it makes it when they share, which can be good for them, um, in an emotional level, so other people know and could support them, they have to anticipate that they're not always going to, it's not always going to be understood. Uh, so they have to make that choice and, and that, that's a, that's a tough choice to make
Speaker 4:cause you're depending on these people who you think are friends and it's terrible for somebody when they say something who's a really good to something, somebody who's a really good friend and it gets, um, the comment they get back just doesn't sit well. Just, yeah. That's a real hurt to the friendship and where she is in her life.
Speaker 3:Yeah. And, and it is not uncommon for people for, uh, for a number of reasons to end up shifting friend sets. Um, partly because as, as I think it was Joey, every, all your other friends are all now parents and, and quite frankly, you do have less in common and, and less flexibility and things such as that. Um, and their interest of shifts. So you've, you've lost that, but also loss of friendships, um, based on the, your friends inability to understand what you're going through. Yeah, that's a hard one. Um, we've talked about, uh, talked around this. Um, but uh, not always, but often. Uh, it is, uh, a couple that is going through the infertility together and uh, the reality is, uh, the couple is the infertile entity in a sense because it doesn't really matter if it's the man or the woman. It's the couple that is not able to get pregnant. And yet it is not at all uncommon for couples to grief separately and cope with the stress of infertility, uh, differently. Uh, and as much as I hate the, you know, men are from Mars and remember if women are from Venus or maybe it's the reverse, but I, you know, have the over generalizations about gender types. Um, I do think that there are probably some generalizations that we can make. Joey, in your experience in your practice, um, how do men and women cope with the stress and, and process the stress of infertility differently?
Speaker 1:I definitely think that there are gender differences that quickly become apparent to any couple, but I also think that that's true no matter which two people we take a sample size of, if we're looking at two women going through fertility treatments that we all deal with things differently, whether that's grief, whether that's loss, whether that's stress. Um, in general, I find that women do tend to be more outwardly visible with their grief reactions or with their stress reactions. Ideally wanting to be able to talk more frequently for longer periods of time, and to express more of those emotions, assuming that they have a safe place, you know, to be able to have some of those conversations. In general, men tend to be a bit more concrete and tend to focus on the moment in terms of if there's nothing I can do right now in this moment, I'm going to lean into work or focus on something where I can feel needed and productive. And again, that's just in general. But I do think that communication is one of the keys here for couples, but also for women who are interfacing with their support networks to be able to, and this goes back just a few minutes to be able to help empower women and patients to say, I'm looking to just have you listened right now and not give me unsolicited advice or commentary or what happened to your friend's neighbor who had a success story. It's helpful just to listen. Um, and I think in between or you know, interpersonally as well with a couple to say, I need more privacy or I need to be at home or I need to be more social, or it's more helpful for me to be distracted at work that instead of making judgments or assessments, it's working to better accept some of these inevitable differences. It doesn't mean that one is struggling more or less. It simply means that we have different reactions
Speaker 3:and yes, and it doesn't necessarily, it's not necessarily indicative of the degree of grief that your partner, male or female is experiencing. But I also think that those of us who process through talking, um, need to understand that perhaps our partners shouldn't be the only one we are processing with that, that that's a burden that, uh, in and of itself that we're, we're dumping on our partner.
Speaker 4:You know, you know, I talked to my clients about the 20 minute rule, which is when you walk in the door, when your husband walks in the door or your partner walks in the door, that you don't bombard them and you set aside a certain amount of time that you're going to talk fertility. And that may I just call 20 minute, but maybe
Speaker 3:it's an hour for the couple who knows, it's whatever feels right for them so that they, they, they talk about it and then they can move on to other aspects of their relationship. You know, I'm, I'm, that's a great segue because I wanted to talk about the impact of, of infertility on relationships. And in this case, I mean the, the marital or the romantic relationship. We've talked some about how it can impact friendships. Um, but it is, it's hard. Yeah. If, if all of a sudden your life becomes in fertility and that's the only thing you talk about, uh, it makes it tough. On the other hand, it's hard because if that's first in the forefront of your mind, I mean that's, that's tough advice Joey. I'm thinking, I dunno, what would you suggest at that point? I mean that's all the woman's says. That's all I can think about.
Speaker 1:No, I couldn't agree with you more in just to clarify, when I'm talking about communicating, I'm not certainly not suggesting talking about fertility 24, seven Betty, I think your idea's great and I likewise, you know, counsel, my patients, I'm simply suggesting when we do talk about fertility that we talk about it and me mean what we say and say what we mean. So instead of holding grudges because someone needs or wants to be more social, it's working to better accept my partner might need to go out with friends if it's more helpful for me to stay back behind. But I think the reminder here is that we are all multidimensional women and human beings. And so it's being able to access other parts of ourselves even if they don't feel as important or as pressing as the fertility piece because ultimately with regard to pregnancy or parenthood or if, unfortunately no, either, either way, there's going to be more loss if this time is not used wisely and that if it's exclusively focused on fertility, um, there's going to be even more grief down the road. And in the event there is a pregnancy that will be important to model as a parent, that it's not just one interest, that there are other interests and activities. Even if they're not embraced with the same excitement, they can still be practiced with regularity.
Speaker 3:Yeah. And, and, uh, one of you had mentioned it, I think it was you, Joey, at the beginning. Another impact of very common impact of infertility on a, on a marriage or a couple is impact on their intimacy, on their sex life. And it is so seldom talked about. Uh, it's, it's a, it's the, you know, people and believe in joke about it. Say, Oh, you must be having fun trying and you think you clearly have never had to try. If you think that it is fun, you know, it's fun the first month, uh, the, well actually that's not true as long as, as long as you are thinking that it's going to happen anytime now. Yeah, that could be fun. But once, uh, once that, those thoughts are gone, it's tough and it's tough to have sex on, on demand and it's very common to have, uh, sexual dysfunction, um, male and female, uh, through this and, and also just wanting nothing to do with sex cause sex became, is not fun anymore. It's not fun. And it's also associated with failure. Right,
Speaker 4:right. Yeah.
Speaker 1:Just, you know, focusing on the exhaustion factor, you know, when someone is undergoing fertility treatments and maybe doesn't feel terribly sexy or like herself, but also just get them the emotional exhaustion and the cumulative toll depending on how long this process takes.
Speaker 3:Okay. So what is often suggested, and we're going to talk about coping techniques in, in and in a bit, but it's often suggested that, uh, taking a tea, taking time off from, uh, infertility for awhile, uh, so that you can fall back in love, remember why you married this person or why you're partner with this person to begin with and to take the pressure off so that hopefully some of the joy, uh, that you, uh, have experienced in the past with your intimate relationship would come back. But that flies in the face of everything you're hearing constantly, which is, you know, time is not on your side. You know, we jokingly talked about 35 being a cliff, but you know, in, in fact, of course it really isn't a cliff. It's more of a slow decline but declining nonetheless. So, so how do we, how do we reconcile the fact that yeah, our sex life might improve and our relationship might improve if we take a break. But, you know, Time's not on our side. We're not getting any younger thoughts on that one, Betty.
Speaker 4:Well, I think that depends on the age of the woman. And I think it depends on the her conversation that she has with her, her, um, doctor. And if the doctor says, you know, if you take the two, uh, two months off, it's not going to change your fertility. So yeah, go ahead and do it. So I think it did, and it depends on, sometimes there's women who say, I can't stop because if I stopped doing something, I'm going to feel like I'm doing nothing. And that's about working with them to be able to, you know, see what's realistic and what's not realistic. Cause sometimes it's just that, that, that doing is really important for them. And what else can they do? How do they build resiliency? That's, I think it's really important to talk about, you know, what can they do to make, make it through this marathon because it's oftentimes a marathon and not a sprint. And how to be able to keep your energy up as a couple and as an individual, each one.[inaudible].
Speaker 3:And that goes back to what Joey was saying, which is communicating with your partner, uh, for and being able to say what you, um, but also being able to listen to what she or he needs, uh, and then compromise and figure out a way, uh, ultimately you want to end this however it ends with each other still. Uh, so keeping that in mind that it often takes give and take. Uh, I think Joey at the beginning you mentioned something about cultural differences in how uh, cultural, if we don't think of fertility in general and oftentimes in cultural sense we think of, you know, um, and we do know that infertility is a, you know, is, uh, it, it hits irrespective of of your race or your culture. Although I do think there are differences. I think there are cultures who do perhaps make it either easier or harder to be in fertile. Some thoughts on that one, Joey?
Speaker 1:Yes, I do think that infertility can cross across the cup, Cross all cultural lines and also all socioeconomic lines. You know, there is not a face to infertility. There are many, many, many faces in situations. And I think independent of, you know, a woman's unique situation, she is a part of a community at large and a part of it, you know, a family, a community, a society and the world and many women do define themselves by motherhood. And something so basic as procreating, um, is something that we see all the time. And so for women to constantly not eat, be flooded with visuals of pregnant women, um, pregnant animals. Um, I had a conversation with a patient who was going through years and years of infertility and decided to take a break and go whitewater rafting with her husband and she was so distracted because she kept seeing these dragonflies mate above harassed by it, thinking, you know, I can't get away from this so many different levels. Um, this is something that surrounds women and they're not able to, to always walk that visual.
Speaker 3:Yeah. Yeah. Go ahead, Betty.
Speaker 4:And I think in the, there are a couple of cultures that come to mind. One is the Orthodox Jewish community where family is. So having children is so, so central. Um, I've worked with a lot of, um, Orthodox women who are harassed that they're going through this and there's a lot of proscription about what they can do and they can't do. Um, I think that that community has a, has a lot of difficulty with, with infertility based on what the rabbi say they can do, where they can't do. And I'm, and I'm new to Florida and I find that the Latin cultures, which I had not had a lot of, um, experience with in New Jersey, but I find that the Latin cultures are also very quiet about what's happening for them. It's hard. Uh, men particularly, there's a, they don't want to talk about it. And um, and the women too have a really hard time coming out and actually admitting some that they're going through something with, with girlfriends.
Speaker 1:Excuse me. Just to add on to that, I also want to add the element of religion that there are some cultures and some religions where fertility treatments are more supported, understood and permissible than others. And so for many people there are cultural limitations and additional stress layers and levels on top of this, but also potentially from a religious standpoint where if a woman or a couple decides to proceed and may have a very strong faith base, may feel an additional layer of guilt and, or a grief
Speaker 3:or man go forward. Yeah. And secrecy, right. If they do decide to go forward. And, and I would throw out also certain cultures and religions where really large families are the norm that uh, the inability to conceive makes you feel like you are standing out even all the more then in are less than. Exactly. Yeah. And you know, I will, uh, we did a show a couple of years ago on um, uh, infertility in the African American community. And one of the, uh, comments I think are good we received from one of our audience members was that as a black woman, she said, you know, the, the joke is, and, and, and the societal joke is that that, uh, black men are hyper sterile and black women are hyper fertile, not sterile, hyper. Both of both black men and women are hyper fertile. And so to be suffering with infertility is flying in the face of, of, of what is a stereotype in it actually a very negative stereotype to begin with. But it's still one that they're flying in the face of. And it's almost as if people were saying, if you're black, you can't be infertile when in fact that is absolutely not the case. Yeah. Yeah. And it makes it harder for black women and black men, um, to be facing infertility, I think. Yeah. Yes. And, and, and, and before we leave religion, there are certainly some religions that have a more dogmatic approach to that, uh, you are being punished by, uh, your infertility is deserved because that's how God works and that religion. And I think those, those people really struggle as well. Yeah.
Speaker 1:[inaudible] self esteem and self confidence and identity just continues in in many ways.
Speaker 3:Yeah, absolutely. All right, so now we've talked a lot about all the ways that infertility is hard. Let's talk about ways, uh, techniques that people can use for coping. Um, uh, they are infertile and they want to get through this with their mental health and tech, uh, and hopefully with a child. But, uh, but, uh, there are guarantees. So let's talk about some coping techniques that, uh, that, uh, couples and women and men can employ. Uh, let's start with you, Betty.
Speaker 4:Well, I think what most the clients that I see, their coping mechanism is getting research. And unfortunately I find that a lot of times they're not going to, um, places, you know, um, uh, reputable places to get research and they're, you know, going to start a pineapple core diet soon because they read the signup of course, helped their fertility. Um, good research is great if you're going to the places that we know that there's good information. Um,
Speaker 3:well let me just add that creating a family exist. That's really was why we found it a way back in what, 2007, that was the core of why we began, right. Was as a place or medically accurate information because I couldn't agree with you more that a wonderful coping technique is getting information. Information is power. Right? So I interrupted. So keep talking, but I just want to hear. And then other, you know, what can you do,
Speaker 4:do, so there's, you know, there's some information about acupuncture. There is some information about changing diets. There is information about, you know, one of the things that I think, uh, helps people is, um, getting out of themselves. Meaning is there something you can do to volunteer? Usually we know that women and men stop doing the things that they liked the most as they're going through fertility because there's just not enough time in the day. And I always recommend if they can bring some joy back into their life. Something that they've dropped. You know, they're no longer scrapbooking, they're no longer going to the movies. Whatever it is. Distraction is a wonderful coping strategy, you know? Yeah. Watching silly movies or something where they can laugh. Um, you know, it's almost an hour by hour. How can you cope? What are you gonna do this hour to be able to keep yourself level headed and to take care of yourself. And so there's, you know, many find your support group, find a therapist, do something that um, meditate, listen to music. There's all kinds of things that find what what makes you, um, gives you a little bit of happiness during this long difficult journey.
Speaker 3:Okay. Excellent. Bring joy back. I, I love that. Um, okay Joey, some other thoughts on things that people can do to cope with the mini stresses of infertility.
Speaker 1:I think it can be helpful to identify and or confirm your support group. So if historically leaning into your best friend and having long phone conversations or text exchanges was really helpful and your best friend is pregnant, she may or may not be the person who is going to be one of your greatest supports right now. And that may be the case, but I think it might be some reorganizations of friendships in terms of who is going to truly be the most supportive and or available. And it's some giving women permission to step back a bit from some friendships that may not be as reciprocal during this time. And this is very challenging because again, many people feel isolated already as they're going through this. And I'm not suggesting getting rid of all of your friends or family members, but instead being very selective and discretionary about who those truest supports really are. And again, really locking them into place. And it may be proactively saying, my husband and I are anticipating, you know, that this is not going to be as straight forward. Maybe sharing some information with a trusted source doesn't mean you have to disclose everything. But I think really, again, identifying and or confirming or clarifying who those true supports are going to be to have that team in place around you.
Speaker 3:[inaudible] yeah, yeah. That's a, and giving your h I um, over rephrase what you said a slightly different way cause I really liked it. It's okay to be self-protective. Yes. Yeah. Yes.
Speaker 4:And so this is Betty and speaking of self-protection, we're coming up to a holiday season and I think this is a time to really be self-protective. You know, there's um, you know, during the year we have lots of baby showers, which I always tell people if you can't, if you don't want to go, don't go. I take care of yourself. But in the holiday days, which is always about kids, right? Christmas and Hanukkah and all that. So work with your partner, work with your partner and decide what can you attend? What can you not attend? Should you take a trip this time, not be there for Christmas. What is it that you can do that you can, um, take care of yourself as we get to the holiday season? How to sneak out politely, show up late and leave early.
Speaker 1:This is Joey again. I think also gently challenging some historic traditions and ex expectation that if every single year it's been 30 or 40 family members, a woman's social anxiety might be too high to comfortably be able to attend or participate in. So it may be deciding we will see family for Thanksgiving, but we won't for other celebrations. That again, it's being very, very selective, discretionary, assertive, but also really self focused on what's going to be most helpful for the woman when she's got depleted reserves and limited reserves that she's going to need for the rest of this journey.
Speaker 3:One of the, um, very creative solutions, uh, uh, a couple in our support group, both were in the medical, uh, profession and they, uh, decided that over the holidays, and let me just throw out that Thanksgiving is also, uh, stressful because, uh, the talk tends to be very focused on children and grandchildren to the table. And then, you know, other holidays such as, uh, Halloween, oh my gosh, your, your, your Facebook feed is going to be full of, of, you know, uh, princesses and superheroes and even Easter we hear about, uh, and then of course, mother's Day and father's day and things like that. Anyway, this couple, as I said, we're both in the medical profession and what they did was they decided that they needed to just not be that, that it was just going to be too stressful. So they both volunteered and they were extremely popular, as you might imagine, because they're always looking for volunteers to work over the holiday. And it was the perfect excuse. And then when they, uh, they said the added benefit was, and it took them a couple of years to, to successfully become parents. And when they were parents, they didn't work a holiday for a long time because they had already paid in advance. Uh, and so I thought that was amazingly, uh, creative. And you know, there's always, there's a lot of organizations, homeless shelters, soup kitchen, things like that, that they really struggled to find volunteers over the holidays. So just a thought as well, yes. Of, of, of what people can do to, to, to be proactive for the holidays. And the one thing I would also add is, uh, sit down and do assess what about the holidays? Bring you joy and don't, don't let infertility steal that from you. You know, if it is getting together with, you know, seeing your siblings, well then go out to dinner with them, uh, without their kids. If, if indeed the presence of your nieces and nephews is, is stressful for you, uh, or getting together with your parents, uh, you know, is, is find a way to incorporate that. Or maybe it's midnight mass or whatever, incorporate the parts of the holidays that bring you joy and don't, don't let that go in. You're in, you're in, unless you absolutely have to because it's the only way you can self protect. Yeah. Yeah. Great idea. All right, so, uh, we've talked about some of the coping techniques and, and, but we, we should certainly mentioned that therapy is a, is a very effective coping technique. Uh, how would people go about finding a therapist that specializes or at least understands, uh, the infertility and the complications that infertility can add? Betty,
Speaker 4:um, I think that, uh, going to asrs m d s um, American society of reproductive medicine and looking up a professional is a great way to find somebody who, uh, is, uh, steeped in the knowledge of infertility. Um, there's also other registries where you can go online and you look up the, um, by category. You could say somebody who's interested in somebody who's well versed in infertility. And I do think that that's often one of, again, one of those frustrations for women going through and for infertility is when they have a therapist who doesn't understand what it all the terms, there's so much medical jargon and if she's sitting across from somebody that says, tell me what an IUI is, tell me what that, what does that mean? You know, it just, hey, it takes the air out of being able to just talk and have somebody really understand. So I think it's really important to find somebody who gets what you're talking about.
Speaker 3:And I will say that, uh, one way I, yeah. Go Way, there is a list of mental health professionals or mental health professional committee. I think it's called the committee at a, at ASR m. And so those members is, is a great source. But you know, honestly, even if, if you aren't at a clinic calling your clinic and asking who they may have a counselor, uh, and if they don't, chances are good. They can recommend one. Yeah. Um, Joey, what questions, if you're, if you're looking for a therapist, uh, what questions should you ask to, to help you winnow out those that have more or versus less experience in I guess you're winnowing out? So it'd be less experienced, uh, in, uh, in, uh, in fertility.
Speaker 1:I think this is, um, this is a really important, um, point to focus on because we are very lucky that with, you know, ASR em but also with the national numbers organization that many people are able to access a specific, um, and well experienced mental health provider. But there are many, many, many areas still unfortunately where there is not a specialized provider. And so I think it is wonderful if a patient can ask somebody who is well versed and has the knowledge and experience. But I also think from a personality standpoint, there are many therapists who are well versed in women's mental health issues who can focus on some of the challenges of depression or anxiety, navigating couples communication. Um, and so I think being able to say when someone presents for therapy, this is not just in fertility that I'm dealing with, but are you well versed to help me, you know, well well versed in equip to help me focus on marital communication, you know, relationships in general and navigating a lot of social anxiety as well.
Speaker 4:Okay.
Speaker 3:Yeah. Yeah. And I think those are, uh, you're right, it doesn't actually have to be, uh, a counselor that exclusively, uh, yeah, fo focuses on it. Yeah.
Speaker 2:Let me remind everyone that this show is underwritten with the support of varying pharmaceutical. They'd want you to know, and this is totally irrelevant to the topic that we're talking about today. There is an app out there called to call. It is an app that was developed by Dr Ali Domar and Dr Liz girl who are both reproductive psychologists. And it is designed to help women cope with the mini daily challenging emotional situations that arrive when you are struggling with infertility. You can get more information about the photo calm app and actually download it, uh, at their website further calm app.com. That's F, e r t, I, C, a l m a P p.com. And, and let me also mention that the app is free and it,
Speaker 3:so, so it is at least now at least to share it is free. So, uh, we recommend that you get over there as quickly as possible and get it while it's still is free
Speaker 4:and also done. Can I just include that? Um, there's also for males, there's 30 strong absolutely. Right? Yeah. And for men for women can give it to their husbands if they're not listening in to let them know that there is a place to go for information.
Speaker 3:Yes. Thank you for saying that. And in fact, I would, I'm going to add that in my experience from talking with people, most of the men are finding the first strong app for women. And that, of course, it's not surprising in the least. Now is it? All right. Thank you so much for being with us today, uh, to talk to about this really important topic. You know, coping with the, the, the stress. We, we thank you, Betty Galen and Joey Miller for being here. Uh, Joey, if people want more information about you, uh, where would they get it?
Speaker 1:Perhaps the easiest way is through my website. It's www dot Joey Miller, m s w dot.com. That's j o e y m, I, L L E R m s w.com.
Speaker 3:Perfect. And Betty Galen, if people want more information about you and your
Speaker 4:private practice, how would they get it? And that's on my website, www Betty, which is B e t t Galen, G A, l e n, a MSW, lcsw.com[inaudible].
Speaker 2:And let me remind everyone that views expressed in this show are those of the guests and do not necessarily reflect the position of creating family, our partners for our underwriters. Keep in mind that the information given in this interview is general advice to understand about how it applies to your specific situation.
Speaker 4:You need to work with your infertility professional. Thank you guys for being here today and I will see you all next week.