By Anne Malavé, Ph.D.

This post is in recognition of National Infertility Awareness Week (NIAW), April 21-27.

“I feel damaged,” she said, “…this is the worst thing that has ever happened to me!...Infertility is something I wouldn’t wish on my worst enemy.” This is a typical, heartfelt and heartbreaking, refrain that I hear in my consulting room.  As a clinical psychologist-psychoanalyst specializing in infertility, I witness, up-close, the pain it causes and the toll it can take on people’s lives and relationships. But I also find, despite the despair, some people find opportunities for growth.

Infertility is a disease of the reproductive system that impairs the body's ability to perform this basic function.  Infertility affects one in eight couples of childbearing age within the United States--7.3 million women in the U.S. and their partners, which constitutes approximately 12% of the reproductive-age population.  Women and men are equally affected: one third of infertility cases can be attributed to female factors, one third to male factors, and one third a combination of female and male factors or unexplained.

Reproductive medicine provides an ever increasing array of assisted reproductive technologies (ART) such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) as well as third party reproduction options (egg, sperm, and embryo donation, and gestational carrier/surrogacy) which help many people achieve parenthood.

Fertility treatments bring hope for the successful and despair for those who fail. For those without access to care and those who are unsuccessful, the psychological consequences can be profoundly painful.  While adoption and third party options make parenting possible, this does not erase the heartbreak of infertility.  And while some can embrace being childfree, many remain painfully and involuntarily childless.  The legacy of infertility can remain present over the course of the lifetime.

Infertility affects people physically, socially, psychologically, and interpersonally.  It is one of the most distressing life crises experienced by couples. Research shows that women and men handle infertility differently: women talk about their feelings, while men tend to internalize their difficulties.  This difference can lead to a division within the couple. Additionally the challenges of medical decisions and the uncertainties that infertility brings can wreak emotional havoc.  Typical reactions to infertility include feeling out of control, isolated, and anxious and depressed.

Fertility is taken for granted as a given, even as a human right.  We are wired psychologically and socially to reproduce.  The experience of wanting to have a child may take many forms, from a deeply felt, internal desire to a social imperative which, depending on the cultural context, can result in the individual quite literally being cast out if a child is not created. 

Infertility is frequently misunderstood.  The now outdated “psychogenic infertility theory” blamed the woman—infertility was supposedly caused by her “unconscious conflicts” about becoming a mother.  Barbara Eck Menning, the nurse who helped found RESOLVE in 1974, was one of the first to reverse this line of causality, to consider the possibility that infertility is the cause of stress.  However, many women still blame themselves and men still often attribute infertility to women’s distress.

Infertility creates an existential crisis.  Who am I if I do not have a child? Who will remember me after I have gone?  Some women feel they are being punished for perceived or imagined transgressions. Some feel invaded and persecuted; the world can turn hostile.  Passing a pregnant woman on the street or hearing a baby cry on the subway can inflict great pain.  Loved ones may seek to comfort, but this can end up feeling like being told to “stop being upset.”  Suggestions such as “just adopt” feel intrusive and dismissive. Modern technology teases with its unpredictable outcomes. Shame and distance creep in. 

Infertility is like trying to find your children. The child, the imagined and expected child whose presence is palpable yet missing, feels near.  It feels like searching for a lost child--you keep looking and searching around every corner.  To stop trying can feel like an abandonment of an actual baby, of “my/our own baby.”

But infertility can also present opportunities for radical change and growth. While almost all psychosocial research on infertility has focused on its negative aspects, one study, in which I had the privilege of participating as part of the research team, has provided evidence of Posttraumatic Growthin people who have experienced infertility, suggesting that people can turn this crisis into personal and interpersonal growth.

Although typical statements of study participants were: “…this experience has been the hardest, most demanding disheartening and most stressful and depressing experience of my life,” they also reported growth: “I have found out that I am much stronger than I thought,” “Support from family and friends has been one of the most important factors in dealing with my infertility;” and “With the love of my husband and a few good girlfriends I have done well.”

“Infertility changed me”, said a woman who eventually used a form of third party reproduction. “When I look back on those six years when I was lost in the isolation and the hopelessness I thought the pain would never end.  I thought I would never stop crying and grieving…[but] in the end infertility helped me become a better person…. my marriage is now extremely strong… I feel we could face anything together…I am also more compassionate…I now realize that you cannot tell from the outside what internal struggles a person may be going through…the child I have is the child I was meant to have.”

The processing, integration, and transformation of painful experience into growth is at the very heart of psychoanalysis.  As an interpersonal psychoanalyst working in reproductive medicine, I have the privilege of witnessing the pain and courage of suffering people who are working hard to move forward.  Disruptions need repair.  Disintegrations become reintegrations.  Torment turns into transformation.

Life must and can go on.

Anne Malavé, Ph.D. is affiliated with the William Alanson White Institute, RESOLVE, The MHPG Mentoring and Training in Infertility Committee, Reproductive Specialists of New York (RSNY), Adoptive Parents Committee (APC), and Ametz. She is in private practice with offices in New York City, Long Island, and Dutchess County, NY.  You can hear Dr. Malavé on Wednesday, April 24 at BlogTalkRadio.

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