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Bittersweet Joy: Post-Infertility Parenting

Laura Bencivenga gets livid when her husband grumbles about their toddler waking them in the night. "He'll mutter something under his breath, and I'll say, 'How can you say that? We worked so hard for this,'" she says. "I guess I don't feel we have the right to complain."

Infertility is a heartache shared by over five million couples in this country. Thanks to advances in technology, however, pregnancy and parenthood are now possible for more than half of these families.

Possible, perhaps, but seldom easy. Infertility treatment can involve years of powerful drugs, hormone injections, and an alphabet soup of such invasive procedures as IVF (in vitro fertilization), GIFT (gamete intrafallopian transfer), and ZIFT (zygote intrafallopian transfer). Many couples also grapple with difficult decisions about whether to use donor sperm or eggs, or even a surrogate mother.

These high tech routes to parenthood, collectively known as assisted reproductive technology (ART), often don't work, but they do result in more than 16,000 babies each year in the U.S. alone. Studies show that ART babies are as healthy as those conceived "the easy way." It's their parents who have the experts concerned.

"Infertility and years of aggressive treatment can leave wounds that don't entirely heal," says therapist Ellen Glazer, coauthor of Choosing Assisted Reproduction: Social, Emotional, and Ethical Considerations, and the mother of two daughters, 14 and 17, one through adoption and the other with the help of fertility treatments. "You make promises to yourself like, If I'm ever a parent, I'll never complain, I'll always be patient, I'll never take my child for granted."

Such unrealistic expectations aren't restricted to the previously infertile, of course; nor are separation anxiety or worries about a baby's health or one's competence as a parent. But years of fertility treatments can dramatically inflate not only expectations but also insecurities and fears.

Midnight grumblings aside, Barrett Bencivenga, of Short Hills, NJ, admits to a painfully intense protectiveness for his 2 1/2-year-old daughter, Caroline: "We're so lucky to have her, I feel I have to make sure nothing happens to her." When Caroline was learning to walk, Daddy became her shadow, his outstretched arms trying to keep gravity at bay. "At work, I find myself worrying about where she is and what she's doing," he says. Not just once in a while, but many times throughout the day. "I don't want to be stifling," he says. "I know she needs to explore her world."

Acknowledging such feelings can be tremendously helpful, according to infertility and adoption educator Patricia Irwin-Johnston, author of Taking Charge of Infertility. "Parents who have worked through the medical as well as emotional ramifications of infertility, and who understand how their losses can continue to play a role in their lives, are among the best parents I know," she says.

Contributing editor Jessica Snyder Sachs is a science and health writer and the former editor of Science Digest.

The Royal Treatment?

Six years ago, an article in The New York Times Magazine posed the question "What does it feel like being a $100,000 baby?" The assumption was that any child conceived at such great expense and effort was bound to be spoiled rotten and to fail the impossible task of justifying her cost in the eyes of her parents.

Michael and Pamela Stevinson, of Madera, CA, confess to giving their in vitro twins anything they want. "When their second birthday came around, our house had more toys than Toys 'R' Us," says their mom.

Adding fuel to the Stevinsons' overindulgence is the fact that they underwent a procedure called fetal reduction. Like hundreds of other couples who've used in vitro fertilization, they had agreed to the implantation of multiple embryos, four of which took. Eighteen weeks into the pregnancy, specialists urged reducing the pregnancy to twins to improve the odds of healthy births. (Quadruplets are more than 13 times likelier to die within the first year than single-birth children. Twins face five times the risk.) "Our joy came with a bittersweet reminder of those we lost," says Pamela. "How can we help but overindulge?"

Still, most experts say that the stereotype of the spoiled "test-tube baby" is inaccurate. "We just don't find the His-Majesty-the-Baby stuff among the families we've studied," says Dorothy Greenfeld, director of psychological services at the Yale Center for Reproductive Medicine. "As a group, these children aren't any more spoiled than others."

Part of the reason may be that the long ordeal of infertility treatment inspires many parents to invest extra effort in disciplining their kids. "All those years of waiting gave us plenty of time to see how we didn't want our children to behave," says Pat Kotsakis, of Palatine, IL, now the mother of a 5-, a 7-, and a 9-year-old. "It bothered us to see other kids acting bratty and spoiled."

Still, discipline can involve an inner struggle, according to Tom and Margaret Potter, of Bridgewater, NJ. "Sometimes I feel guilty after raising my voice to my older daughter," says Margaret. "I think, How could I? She's such an incredible gift!" The Potters' two children  -- Sarah, 4, and Brooke, 1 1/2  -- were born with the help of in vitro fertilization and a gestational surrogate. Margaret's uterus, but not her ovaries, had been removed due to cervical cancer.

Great Expectations

Sometimes the long, arduous course of infertility treatment and waiting can result in parents who become demanding, as if their children have some kind of debt to pay, says Diane Clapp, a counselor with RESOLVE, a national infertility support and advocacy group. But by expecting brilliance or perfect behavior all the time, they place an unfair burden on the kids. "Such parents need to remember that the infertility treatment was something they did themselves," she says. Children should never have to carry any burden because of the mechanics of their conception.

More common are the overblown expectations that once-infertile parents place on themselves. "It's as if they don't feel deserving if they're anything less than perfect," says Glazer. Laura Bencivenga, for example, recalls her extreme dismay at Caroline's first diaper rash, which developed two weeks after she was born. "I felt totally incompetent, like I couldn't even put on a diaper right," she says. Fortunately, Bencivenga's sister assured her that such ailments are common and are not a reflection of a person's ability to raise a child. Experts advise parents like Bencivenga to try to free themselves of self-imposed obligations to be superparents.

Also common is the assumption that child rearing will be nothing but a joy, says Clapp. Parents may fantasize about how perfect life will be when their baby finally arrives. Then, when the reality of midnight crying and endless diapers finally hits, normal feelings of resentment can stir up guilt.

Previously infertile parents need to give themselves permission occasionally to resent the day-to-day drudgery and strain of parenthood  -- and even to complain, the way other parents do, says Clapp.

"A" Is for Anxiety

Infertility can shake a person's self-confidence to the core. "Many of the couples I see had been very successful in their lives," says Judith Kottick, counseling coordinator for the department of reproductive medicine at Saint Barnabas Medical Center, in Livingston, NJ. "Then infertility hit them and shattered their rosy view. Many struggle with feelings that they're somehow incapable and that they were never meant to be parents." Admits Laura Bencivenga: "The experience of infertility has never left me. I still second-guess myself on everything that has to do with being a parent."

Some parents who've been through a series of infertility treatments become overanxious about their baby's health. Janet Moller (not her real name), of Boston, confesses to steering her 9-month-old son clear of playgroups and crowded restaurants, where germs may abound. "The prospect of anything happening to this baby is too terrible to imagine," she says. After eight years of trying, Moller and her husband had a child with the help of a surrogate, who donated her egg and also carried the baby to term. "It's as if years of miscarriages and failed attempts at pregnancy have robbed these parents of their naivete that things will be okay," says Judith Lewis, Ph.D., a nurse researcher at Virginia Commonwealth University. "They expect things to go wrong."

It may be no surprise, then, that midnight finds more than a few such parents checking to make sure their baby is still breathing. "I know all parents do it occasionally," says Margo Rush, of Shelton, CT. "But I do it a lot more than most." Rush's son, Jonathan (now 20 months), was born after five miscarriages and four years of infertility treatment. "I think it's still in the back of my mind that I might lose him, that this is too good to be true."

After two years of infertility treatment and a heart-wrenching experience with fetal reduction, Michael Stevinson found himself afraid to hold his newborn twins, Douglas and Michelle. "He never talked about it," says his wife, Pamela. "But I know he was scared to get attached, afraid that they might die too."

In a recent study of previously infertile mothers, Lewis found that 90 percent brought babies home to nurseries so sparsely furnished, some didn't even have a crib. She calls it "vulnerable parent syndrome." It's as if these parents fear they'd be tempting fate if they let themselves embrace the reality of pregnancy and birth.

In many cases, feelings of fear and denial begin to subside in the first days or weeks after birth. Occasionally, Lewis says, they linger longer.

For some, a feeling of impending doom magnifies separation anxiety. "Other parents tend to look back on their childless days with an easy fondness," says Glazer. "They look forward to having time to themselves again, if only for an occasional night out. But for infertile couples, revisiting the feeling of being 'without child' can be terribly painful."

Glazer encourages such parents to be patient with themselves. "There will be times when it will feel easier to let go and others when you'll need to hold on," she says. "It's part of a process that will go on for years."

Too Much Too Soon?

Infertile couples sometimes feel compelled to jump back on the treatment treadmill soon after their baby's arrival, before it's too late to conceive again. Within seven months of giving birth, Laura Bencivenga, then 41, was back on fertility drugs and preparing for another cycle of in vitro fertilization. She was almost relieved when her doctors told her that her ovaries were no longer responding. "I knew I didn't want to put my body and my family through this anymore," she says with resignation.

There are no easy answers to the question of when new parents should resume infertility treatment, but experts advise that they give themselves a hefty dose of compassion. "Realize that you may be emotionally exhausted from your first go-around with new parenthood," says Clapp. Parents should weigh the importance of rushing back into treatment against the need to savor their baby and recoup their inner strength. What can help: close friends and family, or even a secondary infertility support group through a local chapter of RESOLVE or an infertility clinic.

When Donor Makes Three

Over 300,000 children in this country have been born through donor insemination. And though not as common, babies born through egg donation are rapidly increasing in number, from a few hundred per year in the 1980s to several thousand annually today.

Since one parent will lack genetic ties to the child, counselors at fertility clinics urge prospective parents to carefully explore their feelings before pursuing this route to conception. Still, they shouldn't be surprised if certain issues resurface after birth, says Anne Bernstein, Ph.D., a psychologist in Berkeley, CA. Sometimes the parent without a genetic link ends up feeling less legitimate than the other, and retreats emotionally.

Many parents worry that a child born through the help of a donor may feel stigmatized or may someday reject them as "real" parents. For these and other reasons, parents may choose not to reveal that the conception was donor-aided, even to their own child.

But psychologists caution about the effects of such secrecy. "There will be times when the child will pick up that something is wrong," says Bernstein. "It may be a pinched expression when someone tells the parent, 'Oh, he looks just like you,' or an awkward silence when the pediatrician asks about family medical history."

Like many mental health workers, Bernstein urges parents to be open with their children. "The question is, do you want to spring this potentially mind-blowing information on a child when he's a teenager, or introduce it naturally, early on, as part of the story of his birth?"

For better or worse, secrecy isn't an option for the thousands of single women who become mothers through donor insemination. Linda Gerhart, of Plano, TX, is already anticipating the day when 9-month-old Brandon asks, "Where's Daddy?" Among the things that Gerhart will share with her son is an audiotape of his biological father, in which he talks about himself and the altruistic reasons that he chose to become a sperm donor.

"It would be dishonest to say that I didn't want my genes to be carried on, that I didn't want my children to look like me, be like me," admits Mark Sullivan (not his real name), of suburban Maryland. His and his wife's two children, 3 and 5, were conceived through donor insemination.

Sullivan feels comfortable as a father today, he says, because he acknowledged his loss. "There's a residue of sadness," he says. "But I know that I'm not less of a father." He and his wife have formed a support group for parents of children conceived with donor sperm or eggs. "Now, as we tell the kids the story of their birth, we can point out friends born in a similar way."

Janet Moller and her husband have chosen to stay in contact with the egg donor, who also carried their son to term. (Janet has legally adopted the child.) "He will know that he's special because he has two mommies who love him," she says. He will also know that he has a half-brother by his birth mom. "If and how a relationship evolves remains to be seen," she says.

Whatever the circumstances of their birth, what kids need most is a sense of confidence. "Both parents and children need to come to believe that they are entitled to and deserving of one another and that they belong together," says Irwin-Johnston. The biggest gift moms and dads can give their children, she adds, is to fully embrace their wonderful new role as parents.

"Where Did I Come From?"

Kids delight in hearing the story of their birth, but the telling can fluster a parent who has traveled the high-tech route to pregnancy.

Making the project easier are two helpful guidebooks: The Long Awaited Stork: A Guide to Parenting After Infertility, by therapist Ellen Glazer (Jossey-Bass); and Flight of the Stork: What Children Think (and When) About Sex and Family Building, by family psychologist Anne Bernstein (Perspectives Press).

IN THE BEGINNING
Around age 3 or 4, according to Bernstein, kids become curious about where they came from. Their questions are a natural opportunity to broach the subject, but parents need to be careful not to overwhelm their children with technical details. "When conception involves the mother's egg and father's sperm, I see no need to tell the child how that egg and sperm got together," says Bernstein. "After all, if your child was conceived in bed, you wouldn't discuss sexual positions."

EXTRA EXPLANATIONS
Kids born through sperm or egg donation need more information. Bernstein gives this example of what a parent might say:

"Babies grow in the mother's uterus. To start the baby, a woman's egg and a man's sperm must join together. But sometimes, when a woman and a man try to start a baby, a baby doesn't grow. There are lots of reasons why that can happen. Sometimes, the father's sperm/mother's egg isn't strong or healthy. If the man and woman really want to grow a baby, they may get sperm/eggs from a man/woman who wants to help."

CALMING WORDS
Some kids may need reassurance that the donor was not a parent who rejected them:

Child: "Why didn't the man/ woman who gave the sperm/eggs want to be my daddy/mommy?"

Parent: "This person didn't know you. He/she gave his sperm/ egg because he/she wanted to help, not because he/she was ready to be a daddy/mommy."

"The concepts take time for children to assimilate," says Bernstein. "Encourage questions, and let them know you're open to their concerns without making them feel like they're different."

Minding Your Marriage

Infertility treatment can take a terrible toll on a couple's sex life. Feelings of failure can taint the intimacy and passion between partners. Years of scheduled intercourse can wear down their sense of spontaneity and fun. And the stigma of infertility can warp a woman's image of herself, says Judith Lewis, Ph.D., of Virginia Commonwealth University's School of Nursing.

Men commonly suffer sexual dysfunction after infertility treatment. Though seldom required to undergo invasive surgical procedures, men can be affected by the cold, mechanical nature of supplying sperm for in vitro fertilization into a cup.

And the transition to parenthood - a stress on any marriage - can add further strain.

Experts emphasize that talking about your feelings is essential, giving each other some room to grumble, as well as lots of love and support.

Make an effort to revive dating too. "Within a few months after the birth, you need to get out, just the two of you," says Peter Kaplan, M.D., a clinical instructor of psychiatry at the New York University School of Medicine.

"Now that you're launched as a family," says therapist Ellen Glazer, "it's time to begin reexperiencing the pleasure and passion that were part of your relationship and inspired you to have a family."

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