No Baby Holiday Blues-- Alice Domar, PhD-- 12/11/03
By Alice Domar
Trying to get pregnant can certainly be a trying experience, especially when the holidays roll around. If depression, isolation, and even jealousy are clouding your quest for parenthood, see what Alice Domar, PhD, author of Conquering Infertility, had to say about beating the no-baby blues.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Dr. Domar. We have a large and vocal community of women trying to get pregnant here at WebMD, so I've seen that the level of emotional outpouring can be very high. Do you think most couples dealing with fertility issues are getting the emotional support they need?
Domar: Absolutely not. Only about half of the infertility clinics in this country have a mental health professional on site. In addition, many infertility patients are embarrassed or ashamed and so don't ask for emotional support.
Member question: Six months ago I suffered a miscarriage. I since have not been able to get pregnant. My periods are normal and my doctor says that I am ovulating. My family history is not good. My mother suffered a miscarriage and was unable to get pregnant after. She ended up having menopause at the age of 30. I am now very concerned that the same thing is happening to me and I am starting to stress about it. Could this stress be affecting my chances to conceive?
Domar: Excellent question. It's the most common question I've heard, and basically the answer is it depends. It's unlikely that anxiety is going to play a major role. Depressive symptoms however, may contribute to fertility problems, and there have now been three studies that suggest that if a woman is highly distressed when she gets pregnant she may face a higher risk of miscarriage. However, most cases of infertility and miscarriage have a physiological, not psychological cause.
That said, it doesn't feel pleasant to be stressed out, whether or not that stress plays a role in your infertility. I would recommend that you avail yourself of some stress management strategies, either through group therapy like a mind-body group, a support group, individual therapy, or even reading on your own. Learning such skills can help you feel immensely better very quickly.
Member question: How can we find therapists locally who know about infertility issues? My EAP program referred me to a local therapist who knew nothing of infertility issues, and I spent the three weeks I went to her educating her and then stopped going because she was the only one benefiting from our sessions (and I was paying her!).
Domar: What an awful situation for you. There are several ways to find a therapist in your area who is well versed in fertility issues. One way is to go ASRM.org and look under mental health professionals. Another way is to ask your infertility doctor. And a third way is to call your local Resolve chapter for a list of local therapists.
There is no reason why you should be put in that position and pay for educating your therapist. When I train healthcare professionals how to run infertility mind/body groups, I have a half day to teach them just the medical aspect and lingo of infertility. When you go to see a therapist about infertility, they need to know what an IUI is!
Member question: My family always gets together for the holidays. I have a cousin that was never able to have kids, and when ours are around, she makes comments like, "This is why I don't want any, and don't have any."" This never used to bother me until now, when I can't conceive naturally.
Domar: It sounds to me as if your cousin maybe being defensive and protective of herself. If she had chosen not to have children, that would a different story, but it sounds like she couldn't. The fact that infertility treatment was successful for you but wasn't for her may be very painful for her. And I think as opposed to getting mad at her for her comments perhaps see them as an expression of her pain.
Member question: We have been TTC for one year now (this month). We have made an appointment for next month with a fertility center. We initially wanted just my husband to get sperm checked, but they want to see us both. What should I expect at this appointment?
Domar: In addition to a semen analysis, they will want a medical history on both of you, a menstrual history from you, physical exam of either both of you or just you, and some basic lab tests. There are times where just from the initial visit an infertility specialist has excellent insight into what the problem is.
Member question: I have had a few surgeries recently, and when I tell my boss what is going on, he goes and tells everyone. He always comes back with some smart-aleck answers. How do I explain my fertility issues to him when I get ready to start the IVF procedures in another state? I don't want people approaching me about my fertility problems.
Domar: This seems to be much more than an infertility issue. There are some legal issues here as well. It is a violation of your privacy for you to share confidential information with your boss and have him leak that information. He is setting himself up for a lawsuit. But because you probably don't want to sue your boss and want keep your job, you may want to talk to someone in HR.
The other thing is infertility is considered to be part of the American With Disabilities Act, so you can ask for time off and divulge the reasons. You don't have to provide a medical diagnosis to take time off. I believe you just need a letter from a physician saying you need time off. You also may want to think of a few comeback lines, and zap him when he is insensitive to you.
Member question: I was unaware of the infertility being under the American Disability Act. Where can I find more information on this subject?
Domar: I don't know the exact details. I read it is one of the ASRM bulletins, so I would look under ASRM.org. The right to reproduce is considered a human right, so the lack thereof is a disability, if I remember correctly.
Member question: I enjoy working out, and when TCC I know I should cut back, but working out makes me very happy and when I don't work out I get very moody and out of the mood for BD. What can I do?
Domar: I actually agree that cutting back on your workout is a good idea when trying to conceive. But there are other stress management strategies that can help. Most popular exercise substitute for my patients is hatha yoga, which will keep you toned and fit but will not increase your heart rate. Yoga classes are offered all over the place, but make sure it's hatha yoga, not yoga such as power yoga.
Member question: I just found out that I would need IVF w/ICSI, due to male factor. How can I help my husband through the holidays with family asking us what the doctor found, etc., and what our plan of action is?
Domar: Good question. I think, again, coming up with some comeback lines ahead of time is the best defense and the two of you need to be consistent in your answers. So, for example, you both could agree to say, if someone asks, "We're not comfortable discussing a lot of the details but we wanted you to know they figured out what is wrong and we are about to embark on treatment which has excellent success rates, and we will keep you posted."
Member question: How do we help our partners? They are stressed also, and sometimes they aren't as understanding as we are. What can we do to make our partners feel better? How do we talk about it?
Domar: What most men would tell you is to talk about it less. One technique I teach my patients is called paired listening, where each one of you talks for a set period of time, such as four minutes, while the partner has to just listen. They cannot interrupt; they can't watch TV. They need to literally hang on to your every word. At the end of your set time, they get to speak for that amount of time while you listen to them, after which the two of you can discuss what was said.
This way both of you get a chance to be heard, so discussions about infertility don't take over your life.
Member question: Doctor, I find myself depressed a lot dealing with friends and family who don't have any fertility issues, when most of them don't want kids or don't need the five they have because they can't afford them. How do I get past this? I'm happy for them, but then I feel worse about myself not being pregnant. Any suggestions? Thanks.
Domar: No. 1, remember that you are so not alone. I hear this from my patients all the time. Another suggestion is to try to not be around your friends' kids more than you have to. If you want to see your friends, schedule adult events. You many want to come up with a couple of comebacks when they say something that is insensitive. The key here is to be protective of yourself.
Member question: Any tips for Christmas morning when we wake up and grieve for the little one we had hoped to have opening presents this year? I have been trying for six years now, and although the other Christmases have not been too tough, this year both my husband and I are having difficulties with the thought of Christmas morning.
Domar: A lot of infertility patients mark off Christmas' pain: "There is yet another Christmas without a baby." I have a couple of suggestions. Perhaps it's a good time to think about a Plan B. Maybe say to yourself, or you and your husband can say, "This is our last Christmas before we move on to Plan B." Six years is a long time to wait.
A second suggestion is to do something completely different on Christmas morning. So as opposed to mourning the lack of traditional morning with a child, plan something completely different. Maybe you can do a different activity that day. Are you able to go away? One of my patients is going on a cruise over Christmas because she and her husband don't want to face another childless Christmas.
Member: Unfortunately, family obligations are keeping me here; however, next Christmas, if there is no success, we were thinking about going away on a cruise.
Domar: That sounds great. But remember that you and your husband right now are a family of two, and perhaps you have some obligations to that family as well. Nurture yourself this season. You can try being really wild Christmas Eve and do something where you stay up so late you sleep through Christmas morning. Make some new traditions for the two of you.
Member: Thank you. You made me laugh with the wild Christmas Eve suggestion!
Domar: Bubbly is a good thing!
Member question: Why is the cost so astronomical for people who are trying to conceive? If the number of infertile couples is so great why do we have to pay so much?
Domar: It's not so much the cost of infertility treatment being so high. All medical treatment is expensive, but you normally don't have to deal with it, because insurance companies cover almost everything but infertility. When you have to pay out of pocket, you obviously notice the cost. Now that I'm working in an infertility center I see how truly labor-intensive infertility treatment is, but I don't believe infertility treatment is any more expensive than other comparable medical treatments. Be aware that many insurance policies cover more of infertility than you may have been led to believe. Read your insurance policy carefully.
Member question: Is there really a diagnosis called "secondary infertility?"" I have a 3-year-old daughter that was conceived in two months and now it's been 16 months of trying for number two and we've been unsuccessful so far. What are my options without going through extreme emotional and costly treatments?
Domar: Yes, there is such a thing as secondary infertility. It is when someone already has a biological child and cannot conceive another one. Until you have a diagnostic workup there is no way of knowing how expensive or intrusive treatment might be. For example, in women who don't ovulate a $40 dose of clomiphene can lead to a pregnancy.
Member question: Where do I go for financing help? My insurance doesn't cover procedures I would need to have done and I've been denied for two infertility health plans already.
Domar: A lot of infertility centers have sliding fee scales or financial packages. You can even ask if there are any ongoing studies you can participate in. For example, it was announced yesterday that 10 eligible patients would get a free IVF cycle, so make sure to ask your doctor if there is any such study he is doing.
There also are opportunities to get medications donated from patients who have leftover drugs after a pregnancy. Ask your doctor about that as well. Some of the drug companies will donate medication to patients who cannot afford them.
Member question: What are your thoughts on the use of acupuncture while trying to get pregnant?
Domar: There's been one study that showed that women who receive acupuncture just before and just after embryo transfer had higher pregnancy rates. But you cannot change clinical practice based on one study. The pro of acupuncture is that most people who receive it report feeling better. The con is that it's expensive and almost no insurance companies cover it. I tell my patients if they can afford it, and if they enjoy it or feel better from it, do it; but don't do it solely to get pregnant because the data is just not there yet.
I would say about one-third of my patient use acupuncture. I just trained an acupuncturist from Japan who said five years ago he saw his first infertility patient and now half his patient base is in infertility.
That said, if your tubes are blocked, you can do daily acupuncture for 20 years and it's not going to make a difference.
Member question: At what point would fertility testing be recommended for a 34 year old with one miscarriage?
Domar: The general rule of thumb if you're under 35 is after a year of unprotected regular intercourse, and if you're over 35, and/or you have a significant health concern (endometriosis, pelvic infection, your husband had a history of undescended testicles) you should go after six months.
The ideal is to see a reproduction endocrinologist who is an ob-gyn that has received extra years of training in infertility diagnosis and treatment.
Moderator: But having had one miscarriage does not count as a significant health issue, right?
Domar: I would say that since probably 20 to 30% of pregnancies end in miscarriage, it would not be considered a significant health issue. It can however, be a significant emotional hit.
Member question: My sister had her third child in October. I was happy for her, but sad for myself. We will be spending the holidays with them and I'm a little worried that I will embarrass myself by crying (which I do a lot) in front of her when I see the baby for the first time. To make matters worse, my husband won't discuss our situation at all. The last time we talked about it was the day the baby was born. Any suggestions for me to help me cope?
Domar: I'm so sorry that you are so unsupported during this crisis. I think being in a support group can be really beneficial for you. In terms of your sister, it depends on how open you want to be. You can always pretend they are tears of joy. Or you can email her ahead of time and say, "You know I'm really happy for you, but this is really hard for me. So I might cry, but remember it's my issue, not yours."
There is also nothing wrong with suddenly having wonderful plans for Christmas that don't involve seeing your family. That's okay, if it will be too tough for you.
Moderator: Do you have any final words for us, Dr. Domar?
Domar: I am busiest in terms of patient volume during the holiday season, because this time of year exacerbates infertility pain. This season is so focused on children, in both material and religious ways, and you need to do everything you can to nurture and protect yourself during this time. You officially have my permission to lie to people to make excuses for things you don't want to go to.
Think carefully before committing yourself to things that may upset you. It is a great time to establish traditions for your family of two, which hopefully will be expanded to a family of three or more. I wish you all the very best
Moderator: Thanks to Alice Domar, PhD, for being with us today. For more information on dealing with fertility issues, pick up a copy of Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping with Infertility.
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