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Wednesday, August 16, 2006

At What Cost

I'm always curious and want to learn the process when I encounter a blog were the author states that they're stopping trying-to-conceive. They've either embraced living child-free or they're on-hold for an indefinite period of time while they consider options. It's always been the thing that scares me the most about trying-to-conceive with infertility. Talk about a ride Disney would never want to touch--the roller coaster with no off button.

Hello. My name is Melissa. I'm 32-years-old. And I'm a trying-to-conceive addict.

Because I'm not sure that I would ever have the courage and strength to say enough is enough. And that scares me. Because it all goes back to the idea of "at what cost." Yes, a baby is worth the hard work (physically and emotionally) of A.R.T. or adoption, but at what cost? A loss of health? The breakdown of a marriage? Financial ruin?

I am a huge fan of Ali Domar's book Conquering Infertility. It helped me get through many a negative beta. But I've always been bothered by a statement that brings other people so much peace. It's tagged as her "message of hope": You will be happy again. Life will become joyful again. And some how, some way, if you want to become a parent, you will.

Maybe it's really revealing that I'm a half-full (wait...half-empty. No, half-full. Which is the negative one?) person at heart. And my intention is not to ruin this statement for you or drag hope from your clenched fist. If you feel strongly about Domar's words, stop reading now and I won't be offended.

The first part certainly brings me hope because I can compare infertility to other times in my life when I have felt pain and I know that life changes. And I like being reminded that I will one day be happy when I am in the midst of great uncertainty and despair. It's the second part with which I find fault. And I'm not trying to be a buzz-kill, but the words just don't ring true to me because I've read a few blogs lately from people who have given IF their "all" but who are finishing their final post with a sayonara to trying-to-conceive.

And I think these words bother me because at the end of the day, they place blame with the person rather than the uterus, the sperm, the eggs. It's you in that sentence. Because the inverse is that if you don't become a parent, it's because you didn't try all the some ways and some hows. Which again begs the question: at what cost. Yes, there are certain "some ways" I could try, but the result of those "some ways" may be a child I can't afford to raise or a loss of overall health. And Domar's statement completely disregards the possibility of secondary infertility since they're already a parent and the pain that secondary infertility brings (the lack of respect for secondary IF is a whole different post...).

Which brings me back to the original question--when do you know that it's time to stop and how do you stop? Do you believe you can reach this space? Most people will luckily never need to actually put this into action, but it serves as an insurance plan. I shouldn't get on the ride not knowing how to get off.

Addtional thoughts added in the afternoon...

I just wanted to clarify (and become a bigger buzzkill because I don't think I've been enough of a downer today. Seriously, what is it with ovulation and my downer thoughts?)...

The reason I have concern with Domar's words are that they don't take into account anything but sheer will. Yes, if I'm willing to sacrifice everything, I can become a parent. Which takes us back to the idea "at what cost." In our current financial situation, adoption is difficult though not impossible. But for many people, adoption is impossible because financially it's impossible. So if they can't conceive naturally, and they've spent a lot of money on A.R.T. to no avail...then what? Even foster adoptions cost money. And I'm only worried that someone will take Domar's words to heart and feel like "I'm not doing enough--I'm not doing everything" and then self-blame. Because we take on enough guilt as is.

Which is not to say that finances don't change, circumstances in life don't change, and that what isn't possible today may be possible years from now. I guess I'm thinking about a small sliver of the IF community--but a sliver of the community nonetheless.

I'm scared for that sliver when I hear Domar's message of hope.

Because in the end, in MY situation, it is a message of hope because my husband and I are 100% on the same page (with our least). Which makes a huge difference. We all know that there are marriages that don't weather the storm. And I worry about that too when I hear those words. What if you want to adopt and your husband does not? Do you leave the husband in order to make yourself a parent? Do you stay in the marriage and feel like you didn't explore all the some hows and some ways? These are the difficult questions--and yes, it's a small sliver, but it's a sliver nonetheless.

So I can still hold onto those words as a beacon: I will become a parent again (even if I'm not really included in that statement anymore...I wish she would add some parentheses to make it applicable to people going through secondary IF or people who are step-parenting). But there are people who will not reach parenthood for whatever reason. And I don't want them beating themselves up because there were too many obstacles in their way and a cheerleader in their ear chanting: it will happen! Because I do want to have hope, I do want to have the cheerleaders, and I do need that support. But I also need the cheerleaders to step back with me and admit defeat if defeat happens. Which it hopefully won't. But I can't predict everything that life will throw my way. And regardless, even if it works for me, it doesn't mean that everyone else has the same resources and chances at their fingertips. And my heart aches about that.


Royalyne said...

I talked to my favorite cousin on the phone last night. I had good news about us finally buying a house, she had good news about being "unofficially" engaged (he feels like scum and won't let it be official until she has the gorgeous ring of her dreams on her finger). Guess what else she told me? That they are going to try to conceive ASAP after the wedding in June. She got very excited about the possibility of us being pregnant together, or even of me being too pregnant to fully participate in the wedding.

That's my cutoff, that's the place where it becomes too hard emotionally. I'm gonna keep trying until my cousin gets pregnant (or maybe until she has the baby, we'll see), but I don't know if I could keep going after that. We've always had that simmering rivalry (she's 1 year older), and this would be the hardest to get over. There have been so many "by then's" since we started trying: our first married holidays (Thanksgiving, Christmas, any holiday so I could say "see, I told you before the holidays were over"), our first anniversary, step-son's fertile mother's due date, second holidays, EDD of the baby we lost at 5w, another due date for step-son's wench-tastically fertile mother.

My cousin has so much hope, she just KNOWS we will be pregnant by then. I think it's my last "by then" for a while. Maybe not forever, but eventually I'll need to take a break, have another lap, let my body rest and try to keep the endo under control. After a break of no less than 2 years we can revisit the idea of having a baby, once I feel ready to handle the disappointment and resentment and guilt that IF puts on me. But I can't resent my cousin for having something I can't have, I can't be jealous of her like I was in elementary school. I love her too much. That conflict of emotions is beyond what I could handle. So when that conflict comes up, when I can't deal with another cycle beginning and still be happy for my cousin, that's when things end, that'll be the end of my journey.

mandolyn said...

Wow. I've never thought about it quite like that. I guess I didn't intentionally get on this IF ride, and I've been craning my neck to see the next dip or fun loop-de-loop that the thought of getting off the ride hasn't had a chance to occur to me.

I have a friend who just doesn't understand. She's not mean about it, she and I are just in very different places on "the whole baby thing." She's asked questions about infertility and my coping with it and what it would take to make me happy. What would it take? Um...a baby.

Well, maybe two. I don't know where it ends. I'm an addict as well. For now, I'm on the ride indefinitely...I guess I'll just hold on real tight.

Kay/Hanazono said...

I talk about this extensively on my blog since, as you know, we have decided not to try for a pregnancy any longer. My CNP told me when we first discovered my IF issues in Jan 2004 that we needed to have a plan because, as you say, IF treatment is addictive.

It took until this spring for us to actually make the plan, of course. But we had reached the point where both of us were feeling stretched beyond what we could bear and the emotional and financial costs were just too high to continue without a fixed end point.

So, I think the statement in Conquering Infertility is not that you'll get pregnant if you want to, but that you'll parent a child if you want to.

That is to say, I think she is trying to distinguish between those who will either get pregnant or build their families in other ways (some form of adoption, including DI/DE/TS, or fostering) and those who get to the end of the IF road and decide to live child-free.

My husband and I took a break last fall from fertility treatment specifically to consider child-free. We read Sweet Grapes and Adopting After Infertility, both of which discuss child-free. We felt like we couldn't honestly say that we were "choosing" more treatment until we had more than one alternative before us.

I think those books should be required reading even for people who don't think they are interested in adoption or child-free, simply because they help establish and reaffirm what is behind your desire to raise children or be pregnant. And because they really advocate for not just drifting, but having a plan.

The Town Criers said...

That was such an interesting perspective, Royalyne. Sort of a when-it-comes-between-me-and-someone-else? Someone I love?

Mandolyn--I warned you that it was a half-empty, pessimistic thought! Ovulation is getting me down...

Kay--I know she includes adoption in there, but not everyone will be able to adopt. Cost is a huge factor. My husband is on the same page as me and IF never really brought marital problems, but there are plenty of marriages that end in divorce due to IF. And one of those factors is wanting to take two different paths. I think Domar's statement is correct, but at what cost. Are you willing to lose the marriage to gain the child if one person wants to adopt and another doesn't? I think Domar's statement was quite applicable to me--most because my husband and I were on the same page 100%. But it's a dangerous statement for two people who are either both against certain paths to parenthood or one is against certain paths. Because then it goes back to the idea that it's your fault that you're not a parent--not the fault of finances, choices, your body, etc.

serenity said...

The cutoff - when is enough enough? - is tough. J and I have decided that we feel very strongly that we will be parents, no matter what we need to do to make it happen. Like kay/hanazono, we feel strongly that we need to ensure we have a choice here such that we do not get sucked into the treatment spiral.

In that way, we have started discussions about adoption. Since the both of us want to make sure that adoption is a full-on option for us instead of a last resort, we have arbitrarily set a date - the 2nd anniversary of the beginning of active TTC. If we are not pregnant by next February, we will pursue adoption.

I think Ali Domar's comment gets to this fact: it IS a choice we all have to become a parent or not. The toll IF takes on some people is very different than others. Whereas I know a woman who has been TTC for 11.5 years now and vows that she will never stop until she has a biological child, I also have a friend who decided that she would be child-free than go through another IVF cycles. (Adoption was not an option for she or her husband.)

And you know, my friend who chose to be child-less has a measure of peace about it. She is focusing on her volunteer work and other things in her life that make her happy. It's bittersweet, because she does have her IF scars, but she has peace.

And I think that is ultimately what Ali is trying to get at with her comment. Yes, the responsibility rests on us to find a decision in which we are comfortable. But she's giving us back the control by reminding us that we have options. We have choices in front of us.

Easy to intellectualize; harder to believe. But we DO have choices.

KE said...

As always, there are some thought provoking comments in your blog. When I read it the first time, I thought I didn't have a cutoff. But now I see that's not true.

I am not willing to sacrifice my marriage to IF. My husband is the most important person in my life - he's my very best friend and I couldn't ask for more love and support. He's helped me deal with every bump along this road and gives me more support than I can explain. I never have to worry about not having someone there for me.

The two of us always think "what if" when dealing with IF. What if IUI doesn't work? What if we move on to IVF and fail? I've brought up adoption (I'm adopted, so it's an interesting discussion) and he said he'd do it if it made me happy. Not exactly a ringing endorsement. :)

I don't plan on adopting unless I feel my husband is 100% behind the idea. So if we get to the end of possible IF treatments and have no baby, I think that's my cutoff. I can't sacrifice my relationship with my husband...part of the reason I want to have a baby is to share the experience with him.

Ellen K. said...

Thanks for your comments on my blog today. Funny how our posts were on the same topic.

I like what you had to say here about needing our cheerleaders to be able to step back and admit our defeat. That's one thing I definitely haven't gotten from most of my long-time TTC buddy groups, and the incessant "rah-rahs" can be disheartening.

Anonymous Infertile said...

I am a ttc adict but I would not continue if I thought that it would ruin my marriage. No matter how depressed I would be not to have a child, I would not be able to live without my husband.
We get stressed out about ttc and it sometimes ends in arguments but I think that they are more the type of arguments that help us to work through things rather than cause damage.
We have been ttc for 2 years and I am not ready to give up on a biological child and neither is my husband at this point. He genuinely believes that we will conceive a child of our own and his method of dealing with this is to not to talk about the 'what ifs.' That drives me crazy at times but his hope and faith are what get me through. If he were to tell me that he was ready to give up, I don't know if I could take it but I don't think that will ever come out of his mouth.
I guess to answer your question, I will keep trying until we are parents. At some point, if we do not conceive a child on our own (ok, with drugs that is so not really on our own), we will discuss adoption but not until we are both ready. And, on that note, I think that I will be ready to discuss that before he will be.


Lisa P. said...

Mel, I'm coming at this from a totally different perspective: one in ways you know (I'm in the "recurrent miscarriage" category) and the other that you may not: my husband wasn't sure he wanted kids at all until he finally agreed to start trying in October 2004. I had wanted to have kids for as long as I can remember, and so convincing him to do so was very important to me. We went through counseling, marriage retreats, arguments, discussions and heart-to-hearts before finally coming to an agreement that we'd try. Little did I know that my uterus was faulty from the day I was born; it may not have mattered if we'd gotten pregnant before we were married because my womb was not completely conducive to growing a healthy baby.

All that being said, of course I think about what happens if we don't get pregnant again on our own. Right now, I'm at the point where I feel like there would never be an endpoint, but I know that's not true, deep down. I just don't *want* to acknowledge it. I admire people who have reached that point and are comfortable in their decisions, but for now I feel this unrelenting urge to keep trying until something tells me to stop. I don't know that my husband would share my feelings -- I can recall an argument we had where he even said exactly what you use as your post title -- but for now, I try not to think much past one cycle at a time.

Andee said...

I am jealous of the couples that are of the same mind set on when to stop. I love my husband too- but there are days (many days) where it is hard not to be angry that he is done with treatments-while I think wistfully of the good ole days (those fun filled days where we hurried to time shots and drive "the boys" across town in a sterile container)

Add that to the fact that we are secondary infertility sufferers. We get the comments like- "wow- it must be so great that your daughter is old enough to take care of herself now"...ya-it's great, now we have an 8yo begging for a sibling- while she is brushing her own teeth- thank God for that!

My husband sat me down a year and a half ago and laid it on the line. He could no longer to watch me beat myself up emotionally, physically and financially. It was time to cut our losses-be thankful for the daughter we had (like at some point I had ever not been thankful)and let it happen if it was meant to be (yup- he said "meant to be" one of the worst phrases in the english language). and I got what he was saying- I really did. I was completly addicted- it might have well been heroin I was in so deep. God knows ~herion would have probably been cheaper!

I love what Royalyne said about "by then's"- we have had hundreds in our 6 year battle with IF. ~before our daughter was potty trained, before the edd of the baby we lost at 9 weeks, before we were done paying daycare bills, before I turned 35 (my personal favorite).

so- I've been lurking around here for months- and that is the question that drags me out of hiding...what do you do when only ONE of you is ready to throw in the towel? When one of you is ready to ride gracefully into the non-ttc sunset....while the other is kicking and screaming- while clutching a rx for clomid and a basal thermometer?

sube said...

I've always had that same issue with Domar's statement (and I love her book, just as you do). I've heard that sentiment from others and it rubs me the wrong way. Somehow there's judgement in it. Like if I don't become a parent it's becuase I didn't want it enough. Like I just didn't try hard enough. For someone who's always been an over-achiever, that's a hard thing to bear.

What I do take comfort in is Domar's assertion (I don't have the exact quote here) that infertility is a temporary state. That your life won't always be this way. That suggests a resolution without pressuming what form that resolution might take. Knowning there's an end to all this helps me even if I don't excatly know what that end is.

As for how to decide when we've reached the end? I'll let you know once we get there. :)

Piccinigirl said...

well I think it will come down to age with us. I get a tingly feeling (I don't know if it's good or bad) that no matter what , if we have a child now my husband will be over 40 when it happens. I wish I could say that is doesn't bother me, because I know it doesn't bother him, but in many ways it does. I too have had some many "by thens" since I got married 3 years ago that the disappointment is starting to become part of me. Yet, I can't give up. One (very big) part of me cannot give in yet , cannot admit that it MIGHT NOT happen. I believe it will.
I think it will be my cutoff when I turn 39 (in 2 1/2 yrs) and know that we have been trying since I was 33.
I can only hope that whatever happens my life will still be happy with Husband and dog. I can't imagine it will be, but through all of these 3 years of trying, I have had some very GOOD days, some very BAD days and some days in the middle. I can only hope for Middle days for the rest of the journey.

C said...

I have an addictive personality in general (hello, five Diet Cokes every day pre-IF diagnosis) and I worry about not being able to stop infertility treatments all the time. We haven't even done our first IUI yet, but I know myself, I know how I get when I want something badly enough, and I worry about the strain it could place on our marriage. The thing is, DH doesn't want to do IVF. He's not even crazy about IUI. He'd rather adopt than go through any infertility treatments, but I'm not ready to take that step yet.

How will I know when to stop? Will there come a time when I have to make the decision to either stop fertility treatments or sacrifice my marriage? I hope not. Do I know that it could happen? Yes, and it scares the shit out of me.

Dee said...

Now, all of this is going to sound a little hypocritical coming from someone who is currently waiting for a referral from China, but...

Even though we will, in all likelihood, have a child at the end of this neverending referral wait, this statement bugs me big time. Because it isn't alway true. It seems to say, "Just have faith, keep trying, there is an option that will work for you, there WILL be a happy ending" and you know what? Doesn't always happen.

We were there. In that place where there are no options left. And it really, really sucked. We had exhausted all of our possibilities with IF treatment (financially, not medically) and we'd achieved exactly one m/c. Insurance covered nothing, not even what little treatment we did, and we just plain didn't have the money to go any further. Needless to say, we also didn't have the money for an adoption, which we were both willing to pursue. I was on the verge of starting therapy (which we also couldn't really afford) because I had no idea how to come to terms with the idea of never having a child. It was just devasting. More so, maybe, because it was not a situation of my choosing. I didn't want to stop trying to have a child, that decision was made for me by circumstances beyond my control. And if this adoption (made financially possible, in part, by a death in the family) should fall through, if China should for some reason deem us unacceptable (which they've been doing more of lately) we'll be right back there, in the sucky place.

The Town Criers said...

Andee--I don't think there is an easy answer. And that's why Domar's statement is so terrible. Because it automatically assumes that the couple is on the same page. And not everyone is on the same page. With when to start or stop treatments, with how they feel about adoption or third-party reproduction. And I'm not even sure what is the norm--is the average couple on the same page or is one person usually the one who is willing to continue?

I'm sorry--and I know how much secondary IF sucks. There is a great James song that goes: now I've swung back down again / it's worse than it was before / if I hadn't seen such riches / I could live with being poor. And that's how it sometimes feels. Not to get all "poor me" because every single angle of IF sucks. Whether it's primary or secondary--how can you convince your heart that it doesn't want something when the need to have children is so primal, so coded into our DNA?

tbonegrl said...

I hear you. I love how Domar assumes everyone has all the means necessary to eventually be parents...not to mention the finances it takes after rounds of ART and then the cost of adopting. Emotionally, IF drains your bank SO much.

I found Domar's book to be good for me as far as teaching myself meditation techniques. I appreciate that she stayed positive. But she should slao stay realistic.

Thalia said...

I think you are spot on. I was reading someone's blog yesterday where they were beating themselves up for not trying hard enough, because they don't want to try IVF. It's so hard for people to know what's right for them, it's a shame that much of the writing on infertility doesn't recognise that there is a stopping point for some of us.