Archive for March, 2011

Fear, failure and fertility: should we really continue to stay silent about these emotions?

March 28, 2011 | By:

I am getting over a pretty nasty bought of pneumonia.  And as a result, I have had a lot of time to think.

To think about everything that I should be doing in the office but can’t.  To think about everything that I need to be writing:  my e-book on egg donation is pretty much finished but I haven’t had time to input the final edits or to speak with my design and production team about getting it ready for the marketplace; I have an article on egg donation and surrogacy contracts that is due to the American Bar Association in a matter of days; I have to talk to my publisher about revising The Infertility Survival Handbook; I want to write a blog about a RESOLVE event I co-hosted on March 24th at Bis.Co.Latte Cafe in NYC regarding the legal issues egg and embryo donation; and oh yeah I am supposed to be teaching a class on third-party assisted reproduction at a law school and I have to prepare the syllabus (that one may not happen).

To think about all the contracts that I need to draft and edit for clients.

To think about the new series of blogs I am working on (perhaps it too will become an e-book?) on the mind-body connection in dealing with and resolving infertility.  Thanks to a Facebook friend, I discovered a wealth of information on something called “Conscious Conception.”  I have a ton of research to do on Conscious Conception, it is a seed germinating in my mind and something I very much want to talk about.   Just this morning I was staffing out work in the office and we got into a long conversation about how much I believe faith plays in people’s ability to deal with and overcome fertility.

And yet, all I am capable of on this gorgeous sunny day is to THINK about the overwhelming amount of things that are filling my proverbial plate.  I am utterly and completely without the ability to deal with any of it today.  For today my goal is to be able to breathe.  One of the fundamental things in life which I must attend to if I am going to get back to these things, yes?  Yet, instead of recognizing the very important need to take care of my own health, I have been beating myself up for my inability to do my work.  I feel like I am drowning, literally and figuratively.

It was only upon stumbling across an issue of the Wellesley Alumnae Magazine and its cover article about “When Life Doesn’t Measure Up” and reading about how, when and why so many of my fellow Wellesley sisters feel like failures, that I realized that I feel like a failure for having pneumonia and not being able to do my work.  And with that thought, I was off and running on a journey of self-analysis that of course brought me right back to the world of fertility and the feelings of failure that come with it.

Apparently, my college magazine conducted some kind of a poll asking graduates to discuss their feelings about their satisfaction with their life and feelings of inadequacy, failure, or success in a variety of different contexts.  I don’t recall receiving a questionnaire in the mail or an email like this — must have missed out on contributing my own thoughts to this very profound poll.  The reasons women gave for feeling like a failure were incredibly diverse.  And yet, despite the very diverse reasons or situations my Wellesley sisters gave when describing their own issues with failure, including dealing with chronic illness, the article did not mention infertility or an inability to have children (or the choice not to have children) as raising issues of failure.  Certainly, someone among the thousands of Wellesley graduates has experienced difficulties conceiving and must have felt like a failure.  I did.  I do.  Why didn’t someone else talk about it?  The Dixie Chicks talk about it in their song “So Hard” . . . a ballad that haunts me every time I hear it.  It’s all about the feelings of failure and loss we have when we can’t conceive.  One out of every 8 Americans is dealing with infertility.  Why didn’t the Wellesley College Alumnae Magazine talk about it?  Especially at an all women’s college, you would think that a topic like infertility and failure related to something so integral to being a woman would be recognized and not continue to be shrouded in secrecy. The article talked about the shame my sisters felt about their various failures, the secrecy that surrounded them but infertility was not among them.  What gives?

The secrecy and shame surrounding infertility is pervasive.  Just as for my sisters who are wrestling with their own failures of a different nature, the article pointed out that all of them felt better by talking openly in the article about failure and its impact on their self-perception.

Indeed, the magazine itself was often a cause for Wellesley alumnae to feel failure.  By hearing about the success stories profiled in the magazine many women admitted that they felt that they had let down the school or that they failed to measure up to the “Wellesley standard” of being or becoming another Hillary Clinton.  The article concluded with the following statement:

“But maybe what we don’t know is what failures happened to those women before they became household names that eventually brought them to the point of celebration.  And until we hear those stories, too, we can’t begin to make new templates for success that acknowledge the inclusion of failure as part of a life well-lived.”

And this leads me to the following conclusions:

Until we hear stories about our feelings of failure and inadequacy arising from our infertility, and our subsequent success at overcoming them, we cannot begin to make those new templates for success that acknowledge how much stronger or sensitive we have become as a result of our infertility.

Until we hear stories about our feelings of failure and inadequacy arising from our infertility, we cannot begin to find faith that our own journey will end in success.  We need to be inspired by the success of our sisters (and brothers) who have gone before us and achieved that which we long for — a baby — even if that success means embracing an alternate route to parenthood such as surrogacy, egg or embryo donation, or adoption.

It is, as my Wellesley sisters say, in embracing the loss in which we gain the faith to succeed.  I wish there was no stigma to being infertile but I must confess that the lack of mention of infertility in this article really drove home for me the sense of the overwhelming stigma with which we live.  I have a serious issue with the Wellesley Alumnae Magazine for not bringing to light a discussion of how failing at something as intrinsic as becoming a mother can be so devastating to our sense of self-esteem, to our marriages, and to our sense of failure as a woman.  (I cannot fathom that not one woman responded to that poll and didn’t mention infertility and if that was the case, I am even more troubled by the statement that makes regarding how much we hide about our infertility).

Learning from others who share their own shame or other sense of failure about something with which we are all supposed to be able to do — conceive, carry and give birth to our children — is what will carry us through.  For others it is not necessarily biological or medical failure but a sense of frustration at being unable to conceive because we lack the essential components — we are socially infertile.  And learning from others who find ways beyond our social infertility will give us ideas and strength for achieving that which our sexual orientation precludes us from obtaining.

And as the wheels started turning and hit overdrive as I considered the article and my own sense of failure because I have pneumonia and am unable to work (and am thus letting down my clients to whom I truly want nothing more than to help have a child), and considered once again the stigma with which we live, I couldn’t stay silent.  I pulled out my laptop and curled up in bed to “think through” this article and my situation and put together the pieces of this puzzle.  My blog will now not only be devoted to discussing the concepts behind Conscious Conception, but it will be devoted to de-stigmatizing this disease.  I know there is a Wellesley sister out there somewhere who is struggling to defeat the NOvary™ or endometriosis, to locate a birth mother, to navigate the increasingly complicated red tape of Ethiopian adoption, or to find a way to establish the fact that she and her partner are both the legal mothers of the child one of them delivered and which they intend to parent together.

So in my failure of having pneumonia, new ideas and inspiration have been born for my blog and thus my day has turned into one of celebration.  And I ask you to please not be silent.  I took the pledge with RESOLVE not to remain silent and today my failure in being human and having pneumonia has given me an idea of how I can fulfill my pledge to RESOLVE.  My blog is a safe place where I hope to support people walking with me on this path, and to provide the occasional nugget of legal or medical information to move us another step forward on the path to parenthood.  And thus I ask you to talk about your shame.  Talk about your sense of failure.  Talk about your frustration, your anger or confusion. (And if you are a Wellesley alumnae, help me convince them to let me write an article about infertility).  Share your story here wherever you may be in your journey.  And I will try and find people to share with you how they conquered the NOvary, endometriosis, found birth mothers, survived the red tape of Ethiopian adoptions, or proven their joint parentage.

Because I know that if we continue to be silent and give in to this crazy stigma, we will never know what failures happened to those women (and men) among us before they became mothers (and fathers), and that eventually brought them to the point of celebration.  And until we hear those stories we can’t begin to make new templates for success that acknowledge the inclusion of infertility as part of a life with children.

And now for some random FAQ’s and reminders:

Yes, you can establish your parentage if you are a same-sex couple and one of you has a baby.  Depending on where you live the mechanisms for doing this will vary.  In some states you can file a legal action to have your parental rights established, in other states you may need or want to adopt (even if you are not married).  In some States and in some circumstances you may need or want to do both.

If you have a functioning uterus, egg donation is perhaps the most successful route to pregnancy for women who have issues with the NOvary™.  At many clinics, with a properly screened egg donor, live birth rates per egg donation are in the 60% range.  Yes, you read that correctly, you could have a 60% chance of conceiving a baby using an egg donor.  And among those that conceive using an egg donor, the rate of twin conceptions is in the 40% range (making a strong case for single embryo transfer).

If you are considering adoption but have financial concerns or are worried about wait times, relinquishment risks, or red tape, embryo donation is a rapidly growing path to parenthood.  Using embryos donated from another family who has cryopreserved embryos which they no longer wish to use to build their own family, you may have a 40% chance of conceiving a child.  In addition to the affordability of embryo donation and the high success rates, you have the opportunity to carry the child, control the uterine environment, and may have the ability to conceive more than one child (this will depend on the type of embryo donation you enter into, as well as the number and quality of the embryos donated to you).

If you don’t have a functioning uterus, gestational surrogacy is another option for becoming a parent.  Using either your own gametes (genetic material), or an embryo created from egg or sperm donation (or sometimes both), another woman can carry a child for you and you will have all legal and parental rights upon that child’s birth.  Surrogacy laws vary by State, and it’s far from inexpensive, but when done correctly, surrogacy is a wonderful means of building a family.

And let’s not forget what is now almost considered boring: IVF.  If you have a viable uterus, eggs and/or sperm but for other reasons have difficulty conceiving on your own, with the assistance of In Vitro Fertilization, your chances of conceiving get better every day.  With the improvement of the culture medium used to nourish embryos, together with advances in reproductive medicine, some families will have as high as a 70% chance of conceiving.  Although the vast majority of families using IVF will need more than one attempt before conceiving, this is a technology that should not be ignored.

Other things to consider are:

PGD, (Preimplantation Genetic Diagnosis).  This enables you to select only those embryos that appear chromosomally normal for embryo transfer in an IVF cycle.  For older infertility patients, those with a family history of hereditary illness, or those with recurrent pregnancy loss, PGD can increase your chances of conceiving a healthy baby.

ICSI, (Intracytoplasmic sperm injection).  This is where doctors inject the sperm into the egg to help facilitate fertilization.  For families with male factor infertility this can help side-step problems with sperm that might prevent it from fertilizing an egg.

DNA Fragmentation Assay.  This is a test performed on sperm to determine whether the sperm are chromosomally normal.  Although there is a large range of “grey area” where it is unclear whether the sperm are going to cause problems with conception or pregnancy loss, this is proving to be a very important aspect in solving cases of recurrent pregnancy loss, IVF failure, or otherwise diagnosing “hidden” infertility issues.

Blood Clotting Disorders and other immune issues.  Do you have unexplained pregnancy loss or IVF failure (with an egg donor)?  Go get a work-up from a hematologist or other doctor specializing in diagnosing harder to find infertility issues.  Sadly many physicians routinely overlook or discredit the influence or impact of blood clotting and/or immune issues on the ability of an embryo to implant in the uterus, or to the ongoing development of a baby.

Are you going to stay silent, or are you going to talk with me here about what you are feeling, what you are trying to do to overcome your infertility, or what you did that helped you overcome it?  Speak.  If not here, then find somewhere.  Please.



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What You Need to Know About Birth Parent Relinquishment Laws and Revocation, and Why You Need to Know It!

March 3, 2011 | By:

Today is a day on which I usually hide under the covers.  Fortunately, I have the flu and have an excuse to hide from the world.  Although for the first time in many years I don’t think I really need or want to hide.  Progress and peace do come, although sometimes long after we experience a loss or a setback on our path to parenthood.

Today is the birthday of one of my children.  For privacy reasons I am going to call him James, but that isn’t the name we gave him.

On this day several years ago my husband and I, and our son, were racing in our car to meet a birth mother who was in labor.  I had been talking with this birth mother for many months and we had a solid and even loving relationship.  I felt a special bond with her and I was thrilled when she invited me to attend her baby’s birth.  Unfortunately, my husband and I just missed James’s birth, but we were there with his birth mother within hours of his arrival in this world.

While nurses frantically attended to James’s birth mother due to complications from his birth, my husband and I sat on a couch in the family area of the maternity center and held our new son.  Aware of my plans to breast feed James, a breast feeding specialist came by to help me get James settled and contentedly nursing.  Later that evening the social worker from our adoption agency arrived and after getting checked out by the attending pediatrician and approved for discharge, the social worker went in to sit with James’s birth mother and discuss whether she was ready to sign her relinquishment forms.

Every state law varies as to when a birth mother can sign these documents — most states require that birth parents have to wait a day or even more after the baby’s birth before the birth parents can sign the appropriate legal documents.  Under the laws of the state that was governing our adoption, James’s birth mother could sign her relinquishment papers at any time after he was born.  She had a relatively short period of time after signing them in which she could choose to parent and after that period of time her parental rights (and those of James’s birth father) would automatically be terminated.  She could also choose to appear in court before the time period had ended and relinquish her parental rights even earlier.  We had discussed it many times and she had decided to appear in court; she didn’t want to feel the pressure of waiting for the days to pass before the adoption was irrevocable.

After what seemed like an endless visit, our social worker came out and told us that James’s birth mother had signed the papers and we could go home with James that night!  We were told his birth father had already signed the papers earlier that day. Elated but still nervous, my husband packed up our things and collected our older son’s toys off of the floor where he was playing, while I finished breast feeding.  I visited with James’s birth mother and we said a very tearful goodbye.

Exhausted from a long drive and a very emotional day, we drove to our hotel now a family of four.  The next several days were a blur while we waited for ICPC approval to drive home.  When you adopt a child from a state that is different from where you live, The Interstate Compact on the Placement of Children (ICPC) requires that both the state in which the child is born and the state where you live approve the adoption; each state reviews all of the requisite paperwork to ensure that it complies with the law and once you have approval from both states you can travel home.  It seemed like we were in a state that had a very slow ICPC office.

Anyone who has gone through it knows that living in a hotel with a newborn while waiting for ICPC approval is excruciating.  We filled the days with a visit to a local pediatrician, introducing our older son (still an infant himself) to his new brother, meeting James’s birth grand parents, and with me learning to juggle breast feeding two babies.  Several days after bringing James home, while we were getting up in the morning and getting organized for another day of waiting for ICPC approval, the phone rang.  My husband and I both jumped for the phone assuming it was our social worker calling to tell us we had received approval to go home.  We were not so lucky.

She was instead calling to say that James’s birth mother had changed her mind and chosen to parent.  She wanted James.  His birth father still supported the adoption plan but wanted to support the mother of his son.  He thus advised our adoption agency that he too was choosing to parent.

Devastated and frightened, we spoke with the attorney from our adoption agency to review our legal options.  The good news was that the laws of the state governing our adoption were very favorable to adoptive parents.  Some states automatically return a baby to its birth mother or father when she/he chooses to parent and the adoptive parents face an uphill battle to regain custody and adopt the baby.  It was the reverse for us.  If we chose to fight to keep James, his birth parents were facing an uphill battle to prove that they would provide a safe and loving home for James.

After talking about it with our attorney and our social worker, and having a long heart to heart conversation, my husband and I agreed that we wanted to honor James’s birth mother’s decision.  Although we were heartbroken beyond measure, we knew in our hearts that this was what was best for James.  I packed up a small bag of things that James liked and that would smell familiar to him.  I breast fed him one last time and told him how much we loved him and that he would always be a part of my heart.  Crying, I tucked him into his car seat and my husband handed the bag and the car seat to our social worker.  She too was crying.

And James went back to his birth family.

No longer restricted by ICPC laws, we immediately packed up the car. The drive home seemed endless.   I sat in the back seat with our other son, unable to think.  The entire car ride I don’t think my husband or I said a word to each other.  We weren’t angry, we were just very, very sad.  I saved a small photo album of pictures of all of us, and a box with some of the clothes he wore when he was with us.  When I got home and walked through the front door carrying an empty car seat instead of two full car seats, it hit me and it hit me hard.  I started grieving at a depth I didn’t even know existed.  There were a few days that I don’t know how I survived.  I think that had we not already had a child I wouldn’t have been able to deal with the loss of James.  It didn’t matter that I knew we made the right decision, it still felt like he had died.  That is, and was, the only way I could deal with my feelings.  For me, James died several days after he was born and every year on his birthday and on the day “he went back” I have hidden under the covers and grieved.

A few years ago I accidentally found out through our adoption agency that “James” is doing well and is living with his birth mother.  But that wasn’t MY James.  It was someone else’s child they were talking about.  My husband asked me if it made me feel better to know that he was safe and loved, and to be honest, it didn’t.  It didn’t make it better.  Sure I was glad he was healthy and happy but it wasn’t MY child who was healthy and happy.  MY child had died.  Even though we never regretted our decision, it still felt like he had died; and a piece of me died with him.

This year, however, for reasons I am at a loss to explain, it isn’t as painful as it used to be.  I woke up knowing exactly what day it is but the grief was not overwhelming.  I didn’t want to hide under the covers.  In fact, I wanted to go straight into my office and help someone have a baby, TODAY.  People have been telling me for years that it would get easier and I never believed them.  But they were right, finally the day has come when it is easier to bear his loss.

I sent my husband a text message a little while ago wishing James a happy birthday and then I kissed my daughter and my other son.  And I went on with my day trying to help someone get closer to being a mother or father.

I did not know much about relinquishment and revocation rights when I started pursuing adoption with my husband.  I knew that there was always a risk a birth mother could choose to parent — and for what it is worth, I have since learned that more than 98% of birth mothers and fathers who choose to parent, do so before the adoptive parent takes the baby home.  But I didn’t know that then and it wouldn’t have stopped us from taking James home from the hospital.  At the time, his birth mother seemed resolute in her decision to place James for adoption and that is all that I thought mattered.

I also didn’t know the importance or nuances of the laws regarding revocation of consent.  I am glad our adoption agency found such a good attorney for us, one who advised us regarding the advantages of using the laws of the state where we lived to govern the adoption rather than the laws of the state where James was born.  Although the outcome would have been the same, we would not have had any choice to fight for James had we used the laws of the state where he was born.  (For reasons other than those surrounding relinquishment and revocation, James’s birth mother elected to use the laws of the state where we lived rather than where she planned on delivering. Typically it is the birth mother’s choice as to what law will apply to your adoption plan).

I never thought I would need to take advantage of those laws, but when faced with the enormous decision of whether or not to fight for James it was comforting and important for us to know that while prospective legal proceedings would be taking place, James would live with us (his birth mother and father would be given regular visitation), and unless they had a very compelling case we were told we had a very good chance that a  Judge would determine that James would stay with us, forever.

Do I recommend going into your adoption with a contingency plan for what would happen if you were in my shoes?  Absolutely not!  Statistics and my own experience as an adoption attorney all indicate that what happened to us won’t happen to the vast, vast majority of adoptive parents.  But I did do something stupid in not knowing more about adoption and how the laws in various states would impact potential adoption plans.  It is really important to know when and under what circumstances a birth family can choose to parent, when the adoption becomes irrevocable and even more important for many prospective adoptive parents, how long it is before a birth parent can even sign the documents necessary to relinquish their parental rights.  If you know this information in advance, you might choose not to advertise in a state where the laws require you to wait a longer period of time for the relinquishment documents to become irrevocable, or choose to advertise in a state where relinquishment documents are irrevocable upon signing.

Knowledge and information are power.  If you are pursuing a domestic newborn adoption, find out about the laws of the states in which you are advertising or those of the states in which you live and where the birth parents live.  Talk to your adoption professional about what your options are at various points in time and think about what you can handle emotionally.  For most prospective adoptive parents, there has already been a period of infertility treatment and loss that has taken place before their adoption journey starts.  You may need to factor in what you’ve already been through when you are thinking about this stuff.  And please keep in mind that sometimes you don’t have a choice and you have to use a particular state’s laws.  But most adoptive parents don’t think about this first and don’t know what their rights are or what they could be if they made certain decisions.

I am always saddened by stories I hear of people being involved in adoptions where they had no awareness of the legal issues presented by the location of the birth parents, or of the legal implications presented by a birth father situation or the existence of multiple potential birth fathers.  Do your research before you start out or while you are going through the process.  Initiate conversations with the adoption professionals you are using as you are making decisions and taking steps along the path toward adoptive parenthood.

My husband and I were very lucky that our agency had selected such a good attorney who made some very good and practical decisions that benefited both James’s birth mother and us as we embarked on our adoption plan together.  It probably wouldn’t have changed anything had we not been so well-informed but I am glad that we did have all the information to make an educated decision.

James is where he belongs, safe in my husband’s and my heart and a very special scrapbook.  And there is a very happy little boy somewhere celebrating his birthday with his mother, just as it was, and is meant to be.  Happy birthday baby!

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