Preconception

The Infertility Squeeze
by Sandra Gordon

If you’re among the roughly 1.5 million of whom Americans of childbearing age estimated to be affected by secondary infertility (infertility following the birth of one or more children), you’re no doubt exhausted by it all. From the blood tests and sonograms to the do-it-yourself hormone shots and strategically-planned doctor’s appointments to the actual procedure--whether it’s as low-tech as intrauterine insemination or one as advanced and invasive as in-vitro fertilization (IVF)--hang on to your flimsy doctor’s gown. As you’re probably well aware, the world of infertility is an emotional and physical wild ride. And that’s even before you’ve waited for and received that phone call, telling you whether treatment was successful—or not (or simply gotten your period).

Besides the psychological and physical toll infertility treatments can take—appointments for blood tests, sonograms and related procedures can cumulatively consume hours, days and weeks of your working life.

“Some women in infertility treatment go part-time if their job is very stressful. But for the majority, it’s learning how to do a balancing act between treatments and working full-time,” says Harriette Rovner-Ferguson, CSW, co-author of Experiencing Infertility (WW Norton) and a support group leader for RESOLVE, a national infertility organization. Meanwhile, you’ve also got a marriage to maintain and one or more children at home to tend to. Whew! Talk about multitasking.

But as all-consuming as it is, infertility treatment doesn’t have to disrupt your entire life. Here, sanity-saving strategies for managing work, the medical quagmire and family responsibilities during this particularly challenging time.

1. Seek support

With secondary infertility, you may be less inclined to confide in others about your situation than if you were trying to conceive for the first time. And for good reason. “Secondary people often don’t get the understanding they need from coworkers, friends and relatives. The sense is, ‘what are you complaining about? You already have a child,’” says Rovner-Ferguson. But as a result, you’re apt to walk around feeling even more disenfranchised than those with primary infertility, which can slow the resolution process and keep you in the medical system longer than might be advisable because nobody’s counseling you, says Rovner-Ferguson.

“I didn’t tell my coworkers because I have two kids already and I felt like no one would understand,” says Christy Kutz, a 30-year-old fifth grade teacher in Fort Meyers, Florida, who has been undergoing infertility treatments for a year to conceive her third child. But getting others’ understanding and empathy, especially through a secondary infertility support group of those going through a similar experience, can be helpful.

In fact, studies show that the emotional support they provide may even improve pregnancy rates in infertile women. (To find a support group in your area, preferably one that specializes in secondary infertility, visit www.resolve.org).

But thanks to the Internet, you don’t even need to leave your home (or office) to find fellow infertility compatriots. “Online message boards and chat rooms have been a blessing for me,” says Kutz, who regularly logs onto the secondary infertility message board at www.parentsplace.com. (Other sites to check out include www.babytwo.com, www.fertilethoughts.com and www.childofmydreams.com.)
“Some online communities will even form cycle buddies, where you pair up with someone who is in the exact part of treatment you are,” says Shelli Fidell, a licensed clinical social worker at the Women’s Healthcare Partnership in St. Louis. One caveat: If your online supporters meet with success before you do—and inevitably some will—you can be hit with a bad case of ‘why not me?’ in which case, you may want to sign to log off to that particular support group for a while and find one that’s more collectively in line with your stage of treatment. Or, you may wish to seek individual psychological counseling, especially if you’re depressed because of your infertility or if it’s creating marital conflicts and other deeply personal problems a support group can’t really address, says Linda D. Applegarth, Ed.D., director of psychological services at the Center for Reproductive Medicine and Infertility in New York City.

2. Choose a doctor with job-friendly office hours

If you travel for business, it’s tough. Your whole month can be ruined if you’re away when you need to be at the doctor’s office for baseline hormone tests and other procedures, such as ultrasound exams to monitor ovarian follicle development—not to mention the actual infertility procedure, all of which track with your menstrual cycle. In which case, the best you can do is to coordinate your business travel schedule with your cycle, if possible. Otherwise, try to seek an infertility specialist with office hours before or after the traditional workday.

Of course, depending on where you live, finding an obliging doc isn’t always possible. Kutz, the Florida fifth-grade teacher, is actually changing jobs to better accommodate her infertility treatments because her preferred physician doesn’t see patients before 7:30 AM, which is when her workday starts. “When you teach fifth grade, you can’t take an extended lunch hour to go to a doctor’s appointment. So I’m switching to teaching high school science because it offers a more flexible schedule that will allow me to go to the doctor without using sick days,” Kutz says.

3. Maintain a business-as-usual attitude

Many couples undergo treatment for several years. During that time, you’re apt not to focus on your career as much as you would otherwise. In fact, you may park yourself in a job you’ve outgrown just because it’s flexible enough to accommodate your treatment schedule. Promotions may come your way and you may wonder if you should take them.

Should you? It depends. Like every jobseeker, “you’ve got to weigh the stress of the new job against the opportunity,” says executive career coach Laura Berman Fortgang, president of InterCoach, Inc. and author of Living Your Best Life (Putman). Still, putting your working life on hold due to your infertility can be emotionally risky.

“Infertility can make you feel stuck. And if your career is stagnating too, you can feel even more stuck,” says Resolve support group leader Harriette Rovner-Ferguson. Her advice: Forge ahead, if at all possible.

Psychologist Linda Applegarth agrees. “To give up a promotion and not become pregnant or resolved about your infertility leads to further feelings of loss and resentment,” she says. “That’s why I encourage my patients to live in the now and make decisions based on the realities they have at hand.”

That strategy worked for Mary Ann Wilmarth, a 41-year-old physical therapist in Andover, Massachusetts who became the manager of her office while also juggling a patient load and undergoing IVF. “I knew the management position would involve a lot of time but I didn’t want to be what I considered losing on both fronts: not being able to start a family and not being able to progress with my work,” Wilmarth says. Ultimately, Wilmarth succeeded on both counts: She underwent two cyles of IVF, which resulted in twins and two years later, a single child, and started her own physical therapy clinic. In retrospect, however, “the juggling was difficult,” Wilmarth concedes.

4. Confide in colleagues—selectively

At work, keeping your infertility a secret can jeopardize your career. Unexplained frequent absences, for example, can make your boss think you’re out job hunting. But the other extreme--using your boss and colleagues as a sounding board--can also backfire. Besides risking not getting the empathy you need, “coworkers can grow weary of hearing about your treatment and become resentful of the fact you’re out so much,” says career coach Berman Fortgang, especially if treatment drags on for more than a year.

Or perhaps even worse, your coworkers may start tracking your treatment cycle, and know exactly when you should be pregnant, which can feel eerily invasive, especially when treatment isn’t successful. “They’ve done the math and they know that the month is up, and that you should know by now whether or not you’re pregnant,” says Joanne Constantine, 36, a communications manager in Chicago who made the mistake of confiding in coworkers during her first IVF cycle. (She’s currently undergoing round two--quietly.)

Your best bet: Don’t give your coworkers the play-by-play, but do brief your supervisor on why you’ll need to be out the office frequently (unless, of course, your medical appointments don’t interfere with your workday). If they do eek into company time, emphasize that you’ll stay late, work through your lunch hour or take work home, if necessary, to get your job done.

“My immediate manager knows I’ve been trying to get pregnant and I have many medical appointments during work hours. But I work from home and work late in the office to make sure I catch up,” says Maria Biancaville, a thirty-five-old bank vice president in New York City and mother of a 2-year-old son, who has been dealing with secondary infertility for two years.

Still, if you’re worried about being taken less seriously because of your infertility or you simply don’t feel comfortable mentioning your treatments to your supervisor, you don’t need to disclose even that much. “To legitimize your absences, you can just say ‘I’m having female troubles--that catch phrase buys you a lot of privacy,’” says MaryCasey Jacob, Ph.D., associate professor of psychiatry and obstetrics and gynecology at the Center for Advanced Reproductive Services in Farmington, Connecticut. Then go on to say something like, “it requires treatment and it’s hard to predict because it’s based on my menstrual cycle. I’m going to have to pop in and out of the doctor’s office for a while and I’ll do my best to keep you informed. How can we work this out?” suggests Casey Jacob.

The cloaked approach worked for Alicia Lindhurst (not her real name), a 34-year-old human resources vice president in Lafayette Hill, Pennsylvania, who went through three unsuccessful rounds of IVF to conceive a second time. “I just told my boss I had a medial issue,” Lindhurst says.

5. Know your baby limits

When undergoing infertility treatments, let’s face it: You’re sensitive to anything baby. “Seeing pregnant women or babies, or holding babies can make me depressed,” admits Donna Williamson, 33, a legal administrative assistant in Louisville, Kentucky who is currently undergoing treatment to conceive a child with her second husband. (Williamson has two daughters from her first marriage.) “And going into the baby department is a big no-no,” she says. Which brings up the issue of office baby showers, which can be particularly painful during this precarious time.

Whether or not to attend can depend on what’s best for you that day, says Rovner-Ferguson. (The same applies to visiting friends and relatives with babies and anything else in your life in which babies are involved.) If, for example, you’re feeling hopeful because you’ve just had a procedure, such as IVF or an intrauterine insemination, you may feel like going. But if the timing’s not right—say you just found out you’re not pregnant, a baby shower is probably the last place you want to be. But unfortunately, you can’t just blow it off. “If you ignore these things, you’ll leave a lot of dead relationships in your path,” says psychologist Casey Jacob. What to do? “If it’s somebody you want to maintain a good relationship with, you either need to just pop into the shower briefly or privately take her a gift and say congratulations,” says Casey Jacob. Meanwhile, as long as you’re shopping, buy five gifts at once and put them in a drawer to save yourself the agony of returning to the baby department any time soon.

6. Polish your comeback

Throughout the infertility process, you’re bound to get your share of intrusive, albeit innocent questions and comments, such as “You only have one child? Oh, I’ve got three. You’ve got to catch up.” Or, “Do you want more children? Are you trying?” Even, “You should just be happy with one (or the number of children you already have).” Grrr! To keep from losing your cool, develop an arsenal of short answers that curtail the topic.
When are you going to have another child? “Well, gosh, I wish I knew” or “Still practicing.” Do you want more children? A simple, “Yes we do,” is sufficient. “Role play how you’re going to handle these questions because they’ll come from people in the supermarket, in the workforce and your relatives,” says Fidell, who speaks from experience. She has been in treatment to conceive her second child for the past four years and is currently pursuing adoption.

7. Keep a journal

8. Give back to your body

Because infertility treatments can be so physically demanding—need we mention the hormonally-induced emotional ups and downs you endure due to the drugs involved as well as the invasive diagnostic tests and procedures--it’s important to pamper yourself throughout the process. Manicures, facials or pedicures and/or stress management techniques, such as meditation, exercise and yoga--can also give you a much-needed emotional boost.

“When I was going through in-vitro, I had to give myself injections of progesterone, which made my muscles sore. So I gave myself permission to get massages during that part of the in-vitro cycle, even though it felt extravagant. But the massages really helped my muscles,” says Fidell, “and the fact that I was taking care of myself helped me get through it.”