Infertility Etiquette

I got this article from someone in my PCOS e-mail group. I believe it applies for infertility and fertility-challenges.

Infertility Etiquette
By Vita

Chances are, you know someone who is struggling with infertility. More
than five million people of childbearing age in the United States
experience infertility. Yet, as a society, we are woefully uninformed
about how to best provide emotional support for our loved ones during
this painful time.

Infertility is, indeed, a very painful struggle. The pain is similar to
the grief over losing a loved one, but it is unique because it is a
recurring grief. When a loved one dies, he isn't coming back. There is
no hope that he will come back from the dead. You must work through the
stages of grief, accept that you will never see this person again, and
move on with your life.

The grief of infertility is not so cut and dry. Infertile people grieve
the loss of the baby that they may never know. They grieve the loss of
that baby who would have had mommy's nose and daddy's eyes. But, each
month, there is the hope that maybe that baby will be conceived after
all. No matter how hard they try to prepare themselves for bad news,
they still hope that this month will be different. Then, the bad news
comes again, and the grief washes over the infertile couple anew. This
process happens month after month, year after year. It is like having a
deep cut that keeps getting opened right when it starts to heal.

As the couple moves into infertility treatments, the pain increases
while the bank account depletes. Most infertility treatments involve
using hormones, which alter the user's moods. (That statement is like
calling a lion a cat-my husband would tell you that the side effect is
insanity!) The tests are invasive and embarrassing to both parties, and
you feel like the doctor has taken over your bedroom. And for all of
this discomfort, you pay a lot of money. Infertility treatments are
expensive, and most insurance companies do not cover the costs. So, in
addition to the pain of not conceiving a baby each month, the couple
pays out anywhere from $300 to five figures, depending upon the
treatment used.

A couple will eventually resolve the infertility problem in one of three
ways:

They will eventually conceive a baby.
They will stop the infertility treatments and choose to live without
children.
They will find an alternative way to parent, such as by adopting a child
or becoming a foster parent.
Reaching a resolution can take years, so your infertile loved ones need
your emotional support during this journey. Most people don't know what
to say, so they wind up saying the wrong thing, which only makes the
journey so much harder for their loved ones. Knowing what not to say is
half of the battle to providing support.

Don't Tell Them to Relax

Everyone knows someone who had trouble conceiving but then finally
became pregnant once she "relaxed." Couples who are able to conceive
after a few months of "relaxing" are not infertile. By definition, a
couple is not diagnosed as "infertile" until they have tried
unsuccessfully to become pregnant for a full year. In fact, most
infertility specialists will not treat a couple for infertility until
they have tried to become pregnant for a year. This year weeds out the
people who aren't infertile but just need to "relax." Those that remain
are truly infertile.

Comments such as "just relax" or "try going on a cruise" create even
more stress for the infertile couple, particularly the woman. The woman
feels like she is doing something wrong when, in fact, there is a good
chance that there is a physical problem preventing her from becoming
pregnant.

These comments can also reach the point of absurdity. As a couple, my
husband and I underwent two surgeries, numerous inseminations, hormone
treatments, and four years of poking and prodding by doctors. Yet,
people still continued to say things like, "If you just relaxed on a
cruise . . ." Infertility is a diagnosable medical problem that must be
treated by a doctor, and even with treatment, many couples will NEVER
successfully conceive a child. Relaxation itself does not cure medical
infertility.

Don't Minimize the Problem

Failure to conceive a baby is a very painful journey. Infertile couples
are surrounded by families with children. These couples watch their
friends give birth to two or three children, and they watch those
children grow while the couple goes home to the silence of an empty
house. These couples see all of the joy that a child brings into
someone's life, and they feel the emptiness of not being able to
experience the same joy.

Comments like, "Just enjoy being able to sleep late . . . .travel . .
etc.," do not offer comfort. Instead, these comments make infertile
people feel like you are minimizing their pain. You wouldn't tell
somebody whose parent just died to be thankful that he no longer has to
buy Father's Day or Mother's Day cards. Losing that one obligation
doesn't even begin to compensate for the incredible loss of losing a
parent. In the same vein, being able to sleep late or travel does not
provide comfort to somebody who desperately wants a child.

Don't Say There Are Worse Things That Could Happen

Along the same lines, don't tell your friend that there are worse things
that she could be going through. Who is the final authority on what is
the "worst" thing that could happen to someone? Is it going through a
divorce? Watching a loved one die? Getting raped? Losing a job?

Different people react to different life experiences in different ways.
To someone who has trained his whole life for the Olympics, the "worst"
thing might be experiencing an injury the week before the event. To
someone who has walked away from her career to become a stay-at-home
wife for 40 years, watching her husband leave her for a younger woman
might be the "worst" thing. And, to a woman whose sole goal in life has
been to love and nurture a child, infertility may indeed be the "worst"
thing that could happen.

People wouldn't dream of telling someone whose parent just died, "It
could be worse: both of your parents could be dead." Such a comment
would be considered cruel rather than comforting. In the same vein,
don't tell your friend that she could be going through worse things than
infertility.

Don't Say They Aren't Meant to Be Parents

One of the cruelest things anyone ever said to me is, "Maybe God doesn't
intend for you to be a mother." How incredibly insensitive to imply that
I would be such a bad mother that God felt the need to divinely
sterilize me. If God were in the business of divinely sterilizing women,
don't you think he would prevent the pregnancies that end in abortions?
Or wouldn't he sterilize the women who wind up neglecting and abusing
their children? Even if you aren't religious, the "maybe it's not meant
to be" comments are not comforting. Infertility is a medical condition,
not a punishment from God or Mother Nature.

Don't Ask Why They Aren't Trying IVF

In vitro fertilization (IVF) is a method in which the woman harvests
multiple eggs, which are then combined with the man's sperm in a petri
dish. This is the method that can produce multiple births. People
frequently ask, "Why don't you just try IVF?" in the same casual tone
they would use to ask, "Why don't you try shopping at another store?"

There are many reasons why a couple would choose not to pursue this
option. Here are a few of them.
IVF is Expensive with Low Odds

One cycle of IVF is very expensive. With all of the hype in the news,
many people assume that IVF is a sure thing when, in fact, the odds of
success for each cycle are low. Most couples cannot afford to try for
one month, much less for multiple times. Considering that it also costs
a significant amount of money to adopt a baby, many couples opt for the
"sure thing" rather then risking their money on much lower odds.

IVF is Physically Taxing

Undergoing IVF treatments is very rigorous. The woman must inject shots
into her thigh daily to cause her ovaries to superovulate. The drugs
used are very taxing on the woman, and they can cause her to be become
extremely emotional.

IVF Raises Ethical Issues

Ironically, couples who undergo IVF to become parents may have to
selectively abort one or more fetuses if multiple eggs are fertilized.
Many couples cannot bring themselves to abort a baby when they have
worked so hard to become parents. If the couple chooses not to
selectively abort, they run the risk of multiple births.

Don't Offer Unsolicited Opinions If They Are Trying IVF

On the flip side of the coin, don't offer unsolicited advice to your
friends who do choose to try IVF. For many couples, IVF is the only way
they will ever give birth to a baby. This is a huge decision for them to
make, for all of the reasons I outlined above.

If the couple has resolved any ethical issues, don't muddy the waters.
IVF is a gray area in many ethical circles, and many of our moral
leaders don't yet know how to answer the ethical questions that have
arisen from this new technology. If the couple has resolved these issues
already, you only make it harder by raising the ethical questions again.
Respect their decision, and offer your support. If you can't offer your
support due to ethical differences of opinion, then say nothing.

A couple who chooses the IVF route has a hard, expensive road ahead, and
they need your support more than ever. The hormones are no cakewalk, and
the financial cost is enormous. Your friend would not be going this
route if there were an easier way, and the fact that she is willing to
endure so much is further proof of how much she truly wants to parent a
child. The hormones will make her more emotional, so offer her your
support and keep your questions to yourself.

Don't Play Doctor

Once your infertile friends are under a doctor's care, the doctor will
run them through numerous tests to determine why they aren't able to
conceive. There a numerous reasons that a couple may not be able to
conceive. Here are a few of them:

Blocked fallopian tubes
Cysts
Endometriosis
Male Factor
Thin uterine walls
Multiple Miscarriage
Implantation Issues
Ovulatory Disorders
Polycystic Ovarian Syndrome
Luteal Phase Defect
Premature Ovarian Faliure
Uterine Factors
There is nothing wrong about learning more about the subject of
infertility. Let your friends work with their doctor to diagnose and
treat the problem. Your friends probably already know more about the
causes and solutions of infertility than you will ever know.

You may feel like you are being helpful by reading up on infertility,
and there is nothing wrong with learning more about the subject. The
problem comes when you try to "play doctor" with your friends. They
already have a doctor with years of experience in diagnosing and
treating the problem. They need to work with and trust their doctor to
treat the problem. You only complicate the issue when you throw out
other ideas that you have read about. The doctor knows more about the
causes and solutions; let your friends work with their doctor to solve
the problem.

Don't Be Crude

It is appalling that I even have to include this paragraph, but some of
you need to hear this-Don't make crude jokes about your friend's
vulnerable position. Crude comments like "I'll donate the sperm" or
"Make sure the doctor uses your sperm for the insemination" are not
funny, and they only irritate your friends.

Don't Complain About Your Pregnancy

This message is for pregnant women-Just being around you is painful for
your infertile friends. Seeing your belly grow is a constant reminder of
what your infertile friend cannot have. Unless an infertile women plans
to spend her life in a cave, she has to find a way to interact with
pregnant women. However, there are things you can do as her friend to
make it easier.

The number one rule is DON'T COMPLAIN ABOUT YOUR PREGNANCY. I understand
from my friends that, when you are pregnant, your hormones are going
crazy and you experience a lot of discomfort, such as queasiness,
stretch marks, and fatigue. You have every right to vent about the
discomforts to any one else in your life, but don't put your infertile
friend in the position of comforting you.

Your infertile friend would give anything to experience the discomforts
you are enduring because those discomforts come from a baby growing
inside of you. When I heard a pregnant woman complain about morning
sickness, I would think, "I'd gladly throw up for nine straight months
if it meant I could have a baby." When a pregnant woman would complain
about her weight gain, I would think, "I would cut off my arm if I could
be in your shoes."

I managed to go to baby showers and hospitals to welcome my friends' new
babies, but it was hard. Without exception, it was hard. Stay sensitive
to your infertile friend's emotions, and give her the leeway that she
needs to be happy for you while she cries for herself. If she can't
bring herself to hold your new baby, give her time. She isn't rejecting
you or your new baby; she is just trying to work her way through her
pain to show sincere joy for you. The fact that she is willing to endure
such pain in order to celebrate your new baby with you speaks volumes
about how much your friendship means to her.

Don't Treat Them Like They Are Ignorant

For some reason, some people seem to think that infertility causes a
person to become unrealistic about the responsibilities of parenthood. I
don't follow the logic, but several people told me that I wouldn't ache
for a baby so much if I appreciated how much responsibility was involved
in parenting.

Let's face it-no one can fully appreciate the responsibilities involved
in parenting until they are, themselves, parents. That is true whether
you successfully conceived after one month or after 10 years. The length
of time you spend waiting for that baby does not factor in to your
appreciation of responsibility. If anything, people who have been trying
to become pregnant longer have had more time to think about those
responsibilities. They have also probably been around lots of babies as
their friends started their families.

Perhaps part of what fuels this perception is that infertile couples
have a longer time to "dream" about what being a parent will be like.
Like every other couple, we have our fantasies-my child will sleep
through the night, would never have a tantrum in public, and will always
eat his vegetables. Let us have our fantasies. Those fantasies are some
of the few parent-to-be perks that we have-let us have them. You can
give us your knowing looks when we discover the truth later.

Don't Gossip About Your Friend's Condition

Infertility treatments are very private and embarrassing, which is why
many couples choose to undergo these treatments in secret. Men
especially are very sensitive to letting people know about infertility
testing, such as sperm counts. Gossiping about infertility is not
usually done in a malicious manner. The gossipers are usually
well-meaning people who are only trying to find out more about
infertility so they can help their loved ones.

Regardless of why you are sharing this information with someone else, it
hurts and embarrasses your friend to find out that Madge the bank teller
knows what your husband's sperm count is and when your next period is
expected. Infertility is something that should be kept as private as
your friend wants to keep it. Respect your friend's privacy, and don't
share any information that your friend hasn't authorized.

Don't Push Adoption (Yet)

Adoption is a wonderful way for infertile people to become parents. (As
an adoptive parent, I can fully vouch for this!!) However, the couple
needs to work through many issues before they will be ready to make an
adoption decision. Before they can make the decision to love a
"stranger's baby," they must first grieve the loss of that baby with
Daddy's eyes and Mommy's nose. Adoption social workers recognize the
importance of the grieving process. When my husband and I went for our
initial adoption interview, we expected the first question to be, "Why
do you want to adopt a baby?" Instead, the question was, "Have you
grieved the loss of your biological child yet?" Our social worker
emphasized how important it is to shut one door before you open another.

You do, indeed, need to grieve this loss before you are ready to start
the adoption process. The adoption process is very long and expensive,
and it is not an easy road. So, the couple needs to be very sure that
they can let go of the hope of a biological child and that they can love
an adopted baby. This takes time, and some couples are never able to
reach this point. If your friend cannot love a baby that isn't her
"own," then adoption isn't the right decision for her, and it is
certainly not what is best for the baby.

Mentioning adoption in passing can be a comfort to some couples. (The
only words that ever offered me comfort were from my sister, who said,
"Whether through pregnancy or adoption, you will be a mother one day.")
However, "pushing" the issue can frustrate your friend. So, mention the
idea in passing if it seems appropriate, and then drop it. When your
friend is ready to talk about adoption, she will raise the issue
herself.

So, what can you say to your infertile friends? Unless you say "I am
giving you this baby," there is nothing you can say that will erase
their pain. So, take that pressure off of yourself. It isn't your job to
erase their pain, but there is a lot you can do to lesson the load. Here
are a few ideas.

Let Them Know That You Care

The best thing you can do is let your infertile friends know that you
care. Send them cards. Let them cry on your shoulder. If they are
religious, let them know you are praying for them. Offer the same
support you would offer a friend who has lost a loved one. Just knowing
they can count on you to be there for them lightens the load and lets
them know that they aren't going through this alone.

Remember Them on Mother's Day and Father's Day

With all of the activity on Mother's Day, (Father's Day) people tend to
forget about women who cannot become mothers. Mother's Day is an
incredibly painful time for infertile women. You cannot get away from
it-There are ads on the TV, posters at the stores, church sermons
devoted to celebrating motherhood, and all of the plans for celebrating
with your own mother and mother-in-law.

Mother's Day is an important celebration and one that I relish now that
I am a mother. However, it was very painful while I was waiting for my
baby. Remember your infertile friends on Mother's Day, and send them a
card to let them know you are thinking of them. They will appreciate
knowing that you haven't "forgotten" them.

Support Their Decision to Stop Treatments

No couple can endure infertility treatments forever. At some point, they
will stop. This is an agonizing decision to make, and it involves even
more grief. Even if the couple chooses to adopt a baby, they must still
first grieve the loss of that baby who would have had mommy's nose and
daddy's eyes.

Once the couple has made the decision to stop treatments, support their
decision. Don't encourage them to try again, and don't discourage them
from adopting, if that is their choice. Once the couple has reached
resolution (whether to live without children, adopt a child, or become
foster parents), they can finally put that chapter of their lives behind
them. Don't try to open that chapter again.