At any rate, if you are considering motherhood via a sex partner, it is essential to consult an attorney specializing in family law. The attorney will need to know family laws in more than one state if your partner lives elsewhere. With the proper information, personal and legal conversations, you can make an informed decision.
Donor Insemination
This procedure has an advantage in that the anonymity of the father is guaranteed and all parental rights are legally terminated. For this reason, women who want to ensure that the father will never try to see the child, become involved in his or her life, or sue for custody often choose this method. Other women are drawn to artificial insemination because it does not risk inadvertent coercion, or relationship confusion with the men in their life. If you are interested in artificial insemination, contact a women’s health clinic, a hospital obstetrics and gynecology clinic, or a private doctor.
There is an option called the “Yes” donor. These donors, like permanently anonymous donors, release parental rights at the time of donation but express a willingness to be contacted when their donor offspring reaches the age of eighteen. He may or may not agree to contact but is potentially open to the possibility. The advantage of a “Yes” donor is that there is the potential for some contact when the child is grown. However, there is no guarantee that the Yes donor will actually agree to the contact, and the child and mother could wind up disappointed. This outcome, or having a potentially unpleasant experience if there is a meeting, needs to be weighed against the advantage of the child’s potential satisfaction with meeting their donor. Similar to adoption searches, the child may feel a desire to find “the missing puzzle piece” as a part of coming of age. If you are planning to use donor insemination, your fertility clinic and sperm bank can provide you with more information.
Women who are understandably uncomfortable with the idea of an anonymous donor— “too impersonal,” “too clinical,” “like science fiction”—give more consideration to pregnancy with a man they know. This can occur with the man being screened at a fertility clinic and donating sperm, which are injected into the woman’s uterus at the clinic.
For some women, who prefer to bypass doctor’s offices, it is possible to inseminate themselves at home with their donor’s semen. If you want to do this, be sure to consult with a medical professional, e.g., a nurse or midwife at a community or alternative clinic. You will want to make sure that your donor has been fully screened for medical history and infections that could affect you and your baby. You will also benefit from the professional’s advice on timing of inseminations in light of your menstrual cycle.
Most women prefer to do their inseminations at a doctor’s office or clinic. There they have medical expertise, sterile conditions, and the neutrality of a clinical setting.
A few considerations: however the woman gets pregnant, it is important for the man to be screened for family and personal medical history and sexually transmitted diseases. If the woman is over thirty-five, it is useful to do some basic fertility testing for ovulation and hormone levels.
If you get pregnant by a man you know, there are legal and psychological considerations. Even if the man assures you he has no intention of parenting the child, he could change his mind and sue for visitation and custody. Even if you promise him never to ask for financial support, he could still be ordered to pay if you or a court demanded this. You can spell out your wishes in letters drawn up by lawyers, but these agreements are not always legally binding. If you are going to make such arrangements, it is wise to seek psychological counseling and legal advice. Be sure your attorney has experience with donor insemination and family law. S/he will know the laws in your state and any pending legislation.
Choosing a Biological Father
It is important to like and trust the man with whom you are considering having a child. If he is more in love with you, than you are with him, beware. He may be saying yes to win you over at the same time that you are viewing him merely as a friend helping you out.
It is important to talk about your and the biological father’s expectations. Does he want occasional or frequent visits with you and/or the child? What happens if life circumstances make him decide in the future that your child is the most important person in his life? What happens if you and the child are used to spending time with him and he marries or moves away, or decides he is no longer interested in the two of you?
Using anonymous donors for insemination is obviously less emotionally loaded than conceiving a child through intercourse. If you are ex-lovers, you and he may unwittingly regress to previous relationship patterns and expectations. If you are currently lovers and the man agrees to help you conceive but is uncertain whether to become a father or commit to you, there are myriad opportunities for misunderstandings, shifting expectations. The accompanying stress could put a damper on the pregnancy.
I know these questions can be daunting, and many men and women work out very satisfactory arrangements. I am simply offering points for consideration and conversation.
Adoption
It’s easier for single persons to adopt today than it was in the past. The policy began to change when agencies realized that a single parent was better than no parent at all for hard-to-place special needs or older children. Then they began to see how successful single adoptions could be. Now single men and women regardless of sexual orientation and gay couples adopt infants domestically, internationally and through foster care/special needs.
Under some circumstances, single people offer some advantages over two-parent adoptions. Children whose birth parents or previous foster parents quarreled constantly sometimes do better with just one parent, for instance. And a child who was abused by his father may adjust better to living with a single mother than he would to a mother-father combination. One loving happy parent is certainly better than two unhappy ones. And a single parent’s attention is not constantly divided between a partner and a child, so the child gets a lot of needed attention (see Chapter 11, “Adoption.”)
Because the websites resolve.org, resolvenewengland.org, creatingafamily.org and the patient blog of asrm.org (American Society of Reproductive Medicine) are goldmines of information on the causes and treatments for infertility and what to expect in a fertility workup for men and women, I am going to focus on the psychological aspects of coping and decision-making.
Early Stage
Wondering if you might have a problem? Infertility is defined as the inability to conceive or to carry to term in a twelve-month period if you are under thirty-five, and in a six-month period if you are over thirty-five. Because you will be eager to get pregnant and give birth once you’ve made the decision, you may jump to the conclusion that you have a fertility problem when you really just need a few more cycles for the egg and sperm to come together and for the embryo to implant. At this stage, you may want to talk to your OB-GYN about enhancing your fertility through ovulation monitoring, and the possibility of some hormonal blood tests. A man might consider having a semen analysis since it is non-invasive and might alert you to male-factor problems. Check and see if your insurance will cover these tests before you have waited the number of months required to be considered to have a fertility problem.
You may find it helpful to talk to a few friends, or see a therapist for support.
Pregnancy Loss
I prefer the phrase “pregnancy loss” to “miscarriage” because it acknowledges that your family has lost a potential child. This is not a minor event. After deciding to have a child, finding out that you’re pregnant makes it look as if you’re on a fast track to parenthood. Unfortunately, that path isn’t always smooth. You may have barely had the time to celebrate when cramps and a flow of blood send you crashing into despair. Although one-time losses are devastating, they are typically followed by successful pregnancies.
Self-Care after Pregnancy Loss
Although for many people the emotional pain of loss and anxiety about future pregnancy is foremo
st on you mind, let’s start with your medical needs.
Take care of yourself, and ask family and friends to do so as well.
If you have had an ectopic (tubal pregnancy that had to be surgically removed), if you had a D and C (dilation and curettage, scraping of the uterine lining) and/or have lost blood, follow your medical team’s instructions for healing. Don’t go back to work before you have been medically cleared and you are psychologically ready. Get lots of rest. Ask for lots of TLC from your partner, family and friends. This is not a time to tough it out.
Understand that your feelings are normal.
Some typical reactions include:
Anger, sadness, and disappointment.
Worry that you or your partner did something to cause the loss (this is rarely the case).
Shame, embarrassment, or a sense of failure.
Prepare yourself for hurtful, if well-intentioned, comments:
“Don’t worry. You’ll be pregnant in no time.”
“It wasn’t meant to be.”
“At least you know you can get pregnant.”
Your reality is that no matter how quickly you might get pregnant and no matter how many future children you might have the potential child you have just lost will never come again. If you went through infertility before getting pregnant, if this was a painstakingly high-tech conception, or if you have had previous losses, you know your next positive pregnancy would not end your worries or guarantee a birth.
Overcome isolation by talking to a trustworthy friend or family member. Choose someone who will honor your confidentiality. Other possibilities are a fertility counselor or support group referred by RESOLVE or other hospital or community resources. (see the Resources Appendix 2.) A hospital social worker can be a good referral source. A benefit of telling others is that you may learn that several friends and relatives, now happy parents, also suffered a loss. They are more common than we realize because people rarely talk about them.
What do you need for comfort? A massage from your spouse? Some TLC from a friend or parent? A weekend away someplace beautiful with your partner? A day home from work to cry and write in your journal followed by a friend delivering cookies and tea? You are not coddling yourself. You are taking care of the business of mourning your loss and healing your body so you can move on.
Logistics
Find out how soon you can start trying again and if there are any steps you need to take to prepare your body. If you were able to save any tissue that could be analyzed, you may get some information, but this is often not the case. Usually your medical team will not do any genetic testing unless you have a concerning family history since first losses are frequently followed by a successful pregnancy. (see Appendix 3 if you have genetic concerns.)
Evaluation and Diagnosis
Once you have reached the six or twelve-month mark based on your age, it makes sense to see a Reproductive Endocrinologist and begin a fertility workup.
Things to Keep in Mind
1. Having a workup doesn’t mean you have a serious problem. It just means you’re gathering information.
2. Having a workup is not a commitment to taking fertility drugs or undergoing another fertility treatment. The workup will enable your doctor to let you know of treatment possibilities, possibilities that you don’t have to act on. There are conservative, less invasive, more natural ways to proceed. You can accept or reject each possibility. You can also use RESOLVE, chat groups, and a second opinion reproductive endocrinologist to help you evaluate treatments you are considering.
3. It is important to work with a Reproductive Endocrinologist, a fully trained and licensed gynecologist who has done a number of years of training focused exclusively on fertility. Keep in mind that a brilliant, world-famous lecturer and medical school professor, someone you are comfortable with and trust (and would prefer to stay with) has to keep up with training, literature, and conducting or reading research in all aspects of obstetrics and gynecology. You can return to this doctor once you are pregnant. One of the biggest regrets I hear from infertility patients is not starting with a Reproductive Endocrinologist in the earliest years of treatment when they were younger and the treatment might have been successful sooner.
The Middle Stage
You may be embarking on fertility drugs, intrauterine inseminations with your partner’s or donor’s sperm at your doctor’s office, surgery for endometriosis or uterine fibroids or in-vitro fertilizations. While still hopeful in some ways, you may find these treatments exhausting, time-consuming, and if insurance doesn’t cover, extremely expensive. Be sure to check with your fertility clinic, resolve. org and creatingafamily.org to see if there are any lower-cost options.
At this point, you will need lots of emotional support. You may not feel comfortable or trusting enough to tell many/any family and friends. However, you need to talk to someone other than each other. This is a great time to contact RESOLVE if you haven’t already and attend a RESOLVE women’s or couple’s group. Doing shortterm work, just a few sessions, with a therapist specializing in fertility issues can release a lot of stress and improve your communication with your partner and/or anyone else in your support system. Stress management techniques such as meditation, yoga, and exercise can help you better tolerate the stress treatment and each sharply divided month: two weeks of trying, followed by two weeks of waiting anxiously to see if treatment worked.
Although the public has long assumed that stress causes infertility (hence the old wives’ tales of wine and candlelight dinners), frequently the truth is the reverse: the frustration of not getting pregnant, the fear of not getting to be a parent, and the biochemical changes of hormonal treatment cause stress in mentally healthy people whose lives have the ordinary amount of stress.
See Ali Domar’s Conquering Infertility for good stress management advice. Whether or not stress management techniques increase your odds of pregnancy, they do decrease depression and anxiety, increasing your sense of wellbeing as an individual and as a couple. They prepare you mind and body to tolerate the stress of treatment and the uncertainty of outcomes. Consider taking a yoga or meditation class or exercising with your partner. Acupuncture may relieve stress and depression and may positively affect your hormones.
If you haven’t already, you will probably also benefit from websites and blogs for those trying to conceive. Dawn Davenport’s Facebook group creatingafamily.org is an especially good one; she moderates it with wisdom, knowledge, and compassion. Keep in mind that if you are participating in chat groups, you can find yourself emotionally derailed by devastating unusual stories of bad luck/poor medical treatment or by disgruntled, not-so-emotionally stable people who will discourage your hopes. Just remember that when someone tells a horrible story, they may be grieving a new diagnosis or a pregnancy loss that just happened, and they could wind up parenting happily in the future.
Coping with a Pregnancy after Infertility or a Miscarriage
“Congratulations! You’re pregnant,” says your medical team. “Congratulations,” exclaim your family and friends. Now you can put infertility behind you and enjoy the pregnancy.
Enjoy the pregnancy? You listen. You smile. You try to get into the spirit, but you can’t. You’re on a different planet. In addition to the sinking feeling in your chest, you’re plagued by a sense of unreality. You may be asking yourself, “What is everybody so excited about? The lab probably made a mistake. And even if they didn’t, I’ll probably lose the pregnancy. I find it impossible to believe I’ll actually be holding a live baby in my arms in nine months.”
Your partner may be as scared as you, as much in disbelief. On the other hand, if he or she has crossed over the river of belief and is cheering along with the medical team and family and friends, you may not know what to make of him or her. On the one hand, you may hope your partner will boost your confidence, but on the other, you may feel lonely if you’re the only one who isn’t cheering yet.
If you’ve worked for a long
time with a fertility specialist or team that you know and trust, you may be terrified to switch to an obstetrician. Ask your fertility team for OB referrals to practitioners they personally know. This will make it easier to go to your first appointment. It is totally normal to secretly doubt that you are really pregnant despite all medical facts, despite your symptoms. Take your partner or a friend with you to your prenatal visits, at least the first few. Don’t be shy about having a list of questions. Consider interviewing more than one doctor or practice. Ask friends and doctors you trust for referrals.
Bill of Rights for Women Pregnant after Infertility
You have the right to:
be anxious without being told you’re neurotic, depressed, or pessimistic. It is the normal reaction of a mentally healthy woman in your circumstances to be afraid. You need support and compassion, not cheerleading.
work with a medical team that understands how precious this pregnancy is to you, who will allow you to come in for extra visits or call frequently if you have concerns. Many practices and clinics offer compassion as well as medical competence. Switch if you need to.
take your time before telling most people— the end of the first trimester is typical, but if you previously lost a baby at twelve weeks, you might wait until your middle trimester. Ideally, you will feel more trusting in the pregnancy when the fetus is moving and kicking.
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