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LFCA Latest Issue: Friday, September 25, 2009.

Latest Post on BlogHer: Parenting after Infertility.

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Tuesday, April 22, 2008

Barren Advice: One

Though I've kept One Smart Mama for almost a year, I've decided to integrate my advice column into my main blog and make it a weekly feature. Barren Advice is posted each Tuesday. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you're addressing if there are multiple questions in the post.

Dear Mel:

What did you find helped you through the uncertainty and seeming hopelessness that found you during your IVF cycles?

--Manda from
I Think I Hear Your Mother Calling

I can't speak specifically to IVF, but I can speak generally about hopelessness. I think we're programmed--probably for good reason--to always try to be moving towards happiness. This extends into people being uncomfortable around those who are not in a state of happiness (since we would rather deal with pleasant vs. unpleasant things) and it speaks to our own discomfort with non-happy emotions. No one wants to feel hopelessness and I'm certainly not saying that people should try to move in any direction other than happiness. But, I also believe that sometimes we need to sit in the state that we're in and experience it in order to move through it. There are obviously exceptions to this rule.

Which is a long way of telling you to feel what you're going to feel. Instead of trying to talk yourself out of it or brush it under the rug, allow yourself to feel uncertain and hopeless and not feel apologetic about being in that state. Of course, you are still programmed to move towards happiness so once you've acknowledged this state and felt the uncertainty and hopelessness, it is time to bid it adieu--at least until it creeps in again since each cycle is a roller coaster and the same emotions tend to come around the bend again and again.

Hopelessness is a strange state. Sadness looks backwards--it's a reaction to something in the past. Hopelessness looks forward--it's a belief that we can predict what will happen based on our past shitty experiences. Hope also looks forward and the same definition holds except that we base hope on our past good experiences. When you expect good things to happen, you walk into a situation with hope. When you expect bad things to happen, you walk in hopeless.

The way which we lean is hardwired, built from experience and the way we process the world. To believe anyone can change their hardwiring simply by making a choice to do so is simplifying human complexity. Those who walk with hope do so without probably knowing how they do so--attitude comes partly from experience but is also partly built long before we can control how we view the world. Just as you can't change your hair colour by simply wishing it a different colour, I don't believe you can change the way you view the world without some hardcore work--work that should probably be done under the guidance of a therapist.

Back to hopelessness: you do not and should not always exist in this state, but it means you should work with what you have rather than what you wish to be. If you are a sunny, positive person by nature, you probably don't have trouble getting yourself out of a bout of hopelessness. If you are someone like me, you sometimes need to acknowledge the doom and gloom and then push yourself out of it.

Accept that you feel hopeless or uncertain and own that. Keep it in check by taking out a pack of cards from time to time and trying to predict the next card you turn over simply based on your past experiences with poker. I give a lot of weight to intuition, but I've also been proven wrong in my predictions so many times that I have to embrace the beauty of chance. Without it, we'd never leap.

Dear Mel:

I have a what-to-tell-people dilemma. My husband and I have always told everyone that we didn't want to have children, because up until a couple of years ago that was true. When we did gradually change our minds and started TTC about a year ago, we kept it to ourselves in order to avoid pesky questions. So now we're dealing with IF. We're not pursuing very aggressive treatment options, so in terms of practicalities (finances, schedules, etc), it's not difficult to conceal. Between my husband and online communities, I feel like I have plenty of emotional
support. The difficulty is that I don't like lying, especially about something like this. Part of me thinks it would be better just to fess up and deal with the unwanted questions and advice. But even if I do decide to tell, how the heck do you start a conversation like that? "Hi Mom & Dad, you know how we said we didn't want kids? Well, we changed our minds but it turns out we probably can't anyway!" Any advice on what I should do, or suggestions on how to decide?

--Blogless Kate

Here's the strange thing about people--we are simultaneously nosy and so self-focused that we forget about anyone else's situation. Isn't that bizarre? We want to find out every detail of another person's life, and at the same, we don't notice half the things that they are experiencing right in front of our face.

I'm willing bet that family members and friends--those who would be affected by a child because it would be related to them or play with their children--are thinking about whether or not you are trying to conceive even if you expressed a lack of desire prior to this point. I'm also willing to bet that family members and friends--the same ones who might be thinking about your situation--are probably completely oblivious to your conception woes and aren't giving whether or not you're trying a thought.

If you have an overwhelming urge to tell--if it's something you think about while you're having a conversation with someone or you're trying to figure out a way to jump into having this conversation like an enormous game of Verbal Double Dutch--you should tell simply to have the telling behind you. Yes, you will probably have to deal with questions except if you haven't received them incessantly by this point, you probably have some pretty polite people in your life and it sounds like they could continue to do well with only a bit of gentle guidance: "you know, I've been having a hard time coming out and telling you this but we changed our minds about children and we've been trying for a while. We were recently diagnosed as infertile and we're trying some stuff now. I don't really want to talk about it, but I felt strange not telling you at all since it's a huge part of my life and you're a huge part of my life." Truthfully, I think it is something you can send in an email if you feel better doing that and think you won't be able to say it when a break in a conversation occurs.

If you don't have an overwhelming urge to tell and it feels more like something you should do rather than need to do for your own emotional wellbeing, I don't think you should tell. You have no obligation to inform everyone around you about each decision. You didn't call everyone to tell them when you started trying a year ago and you don't need to tell them now.

But they will probably appreciate being let in. Sometimes, people just sense that something is up and having words to put with what they're sensing goes a long way in building and maintaining relationships and clearing confusion.

Dear Mel:

What is the true shelf life of injectable meds? If the bottle says it has expired...has it really?

--Cali from Creating Motherhood

I had to consult with an expert and the quick answer is don't use them. I know, not the popular answer. The longer answer is that it depends on the drug and how quickly the drug's potency declines after the expiration date. Liquids degrade faster than solids that need to be mixed with sterile water and solids degrade faster than pills. Therefore, the injectible medications are probably degrading at a faster rate than those expired Tylenol that were tested by the FDA and military. The problem is that the studies on potency and the rate of degradation are not going to be accessible to the general public for most fertility drugs (which are often used off-label too!) therefore, while the drug may be good after the expiration date, you'll never know if it has lost 5% of its potency or 10% or 90% when it's a month after the date.

The longer answer includes your own emotional well-being. Regardless of the answer, how comfortable do you feel using the expired drugs? If the cycle works or goes well, you probably will have no qualms. If the cycle doesn't work, will you always wonder about the quality of the drugs you used? Will it become a stumbling block as you try to process emotions after a cycle? I always believe in removing any known what ifs so they don't come back to haunt you in the future. When the what ifs don't come to fruition, we sometimes forget how emotionally dangerous they can be. But in order to proceed without regrets, process how you would feel about the cycle if it were to be successful as well as unsuccessful.

One solution would be to go to a pharmacy and see if they can exchange the unused medications for ones with a later expiration date. Pharmacies close to fertility clinics that specialize in providing fertility drugs sometimes informally run programs where people can turn in unused medications after a cycle. You may look into this and see if you can exchange your medications there or at your fertility clinic--which is probably teaming with samples regardless.

Like what you read? Want to dispute some advice? Leave a comment in the reaction box below--only keep in mind that conflicting advice is embraced and rudeness is not. Make sure you indicate which advice you're addressing by numbering your comment with a 1, 2, or 3. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday's installment of Barren Advice.


Shinejil said...

This is awesome, Mel! I love that you're dealing with emotional and practical issues in the same space: They are so often interconnected...

sara said...

I love your question answer format...keep the good stuff coming. You do a great job!

Bee Cee said...

Loved it...thanks!

Carrie said...

Re: 3, expired meds

Ever since my neighbor went into a coma and almost died from taking an expired medication, I always look to see the expiration date on things and throw them away immediately so as to not accidentally take them.

Not worth it.
:) Carrie

Julia said...

RE:1. There is also a third way that some of us stumble into after being knocked down severely by huge things beyond our control-- we stop looking to the future. We live in immediate today and very few days or weeks ahead. This is how we get through the days, one at a time, because we have to, and without having to contemplate the hope or hopelessness. Because one has let us down severely and the other can swallow if we let it. So we walk the very fine line of "la-la-la-la."
It can be a logistical nightmare, when, for example, I don't realize until it is upon me that the week of my husband's business trip that has been on the calendar for months is NOW. But that is the price I am willing to pay for not having to struggle with the cognitive dissonance of disposition vs. experience.

Samantha said...

Great Q&A for you!

Q1: You remind me a lot of my therapist. She is telling me to sit with my unhappy feelings, because suppressing them doesn't actually help anything.

Pamela T. said...

I would like to add to your answer to the first question -- and point out that there are degrees of hopelessness that come with IF. There's the hopelessness that comes when the outcome of treatment isn't what we wanted and I agree with Mel that sometimes it's most useful to simply "be with it" rather than to fight it. It's very difficult to overcome but there's also a delayed reaction when the first fog clears that raises a different kind of hopelessness -- an okay what now? companion feeling that evokes a deep sense of futility. It's important to recognize that these feelings can play hide and seek but just know that you have it in your power to stay one step ahead.

Kathy V said...

I like the bare(barren advice). When I think of something to ask, I might even submit a question.

peesticksandstones said...

I'm such a sucker for Q&A's. This is fantastic! Keep it up... I can't wait to toss one at you (questions, that is -- though sure, you're welcome to one of my beers, too!).