Sunday, November 13, 2005

Book review: Conquering infertility

The internet is a great source of information, but sometimes it's hard to find what you need and there are a lot of worthless pages to sift through. The noise to signal ratio is not good. So sometimes I like to be old fashioned and read a book. While on business in the U.S., I took the opportunity of visiting a large bookstore and going through the health section. I browsed through the books for a long time and selected two.

One of the books I bought is Conquering Infertility, A mind/body guide to enhancing fertility and coping with infertility, by Dr. Alice Domar (304 pages). In my opinion, this is a good book for 'new' infertiles. The tone of the book is pragmatic with a generous dose of empathy. I'm not at all convinced the book helps with enhancing fertility, but it has definitely helped me with coping. I first read this book at I time when I felt my emotions were running away with me, now I feel I have the means to manage my emotions better. Of course, getting the ART show on the road also had much to do with this.

(The rest of this post is all about the book, not about me.)

The first chapter is about infertility, stress and depression. The author gives some statistics about IF in the U.S. and explains the usual steps in diagnosis and treatment. Next she explains the vicious circle of IF and stress. Stress can cause a number of physical ailments, but research suggests that depression is far more likely to affect fertility than stress, writes dr. Domar.

The next chapter is all about coping skills, or more precisely, using techniques to elicit the relaxation response from your body in stead of the stressful fight-or-flight reaction.
The relaxation methods covered are: breath focus, body scan, progressive muscle relaxation, meditation and prayerful meditation, mindfulness, guided imagery, autogenic training, yoga.
Mini-relaxations are a variant to be used on the go and in emergencies (drive-by pregnancy announcements etc.). Cognitive restructuring is a way to drive out those recurring negative thoughts that keep popping up in your head. Journaling is also recommended (oddly enough, she doesn't mention blogging, or whatever it was called before 2002). Next comes self-nurturance (pamper yourself!) and seeking group support (still nothing about the IF blogging community, did it exist then?).

Chapter 3 talks about coping when everyone but you has a baby or dealing with the feelings jealousy, anger, resentfulness, hostility and bitterness. These feelings are normal, but it is important not to let these feelings rule your life. There are a number of things IF women can do to avoid the pain of being around pregnant women, without become socially isolated, writes dr. Domar.

  • Create a how-to-tell-me-plan: tell close friends and family how you prefer to hear about their pregnancies.

  • Draw up a coping list: what to do upon hearing others' good news?

  • Think about your thoughts: more cognitive restructuring.

  • Work to get over it: getting upset is normal, you just have to go through it. Remember that IF will not define you forever, regardless of how your journey ends.

Chapter 4 deals with the strain IF may put on the relationship with your husband. IF has an impact on your sex life and on your finances, the two top causes of marital strife. Depression is often a factor as well. To make things worse, men and women deal with IF differently. Dr. Domar suggests a number of things couples can do to better understand each other and strengthen their relationship.

Chapter 5 covers turning to family and friends for support. Deciding whether to tell or not to tell is a very personal decision, dr. Domar agrees. However, if your friends and family don't know what you're going to they can't support you or be sensitive of your feelings.
When you decide to tell, you will probably find that not everyone can give you the support you need. There are four key things you should do: educate about IF, communicate your needs, attach yourself to people that respond well, dodge the people who don't.
Many people are totally clueless about IF, because they have never had to deal with it before, first or second hand. This is where selective avoidance comes in, give yourself permission to steer clear of certain particularly painful social events (like baby showers).

Chapter 6 is about infertility and your career. The worries that come with IF and the treatments are a source of distraction, also your motivation may be compromised, writes dr. Domar. There is no research that suggests work stress is a factor in infertility and quiting to become a 'full-time infertile' is not a good idea for everyone. Deciding whether to tell colleagues and supervisors is a very tricky question. Dr. Domar explains how a number of the coping skills from chapter 3 can be used effectively at work.

Chapter 7 covers some special cases: secondary infertility and infertility in the unmarried woman. Women suffering from secondary IF often find it more difficult to find support, the fertile crowd doesn't see their problem and they don't fit in easily with the primary IF crowd either. Also, there is no avoiding all things child-related, as you already have one.
The part about unmarried women encompasses single women and lesbian's. Often these women have to face disapproval of their desire to have a child, let alone pursue IF treatment, from family, friends, and perhaps even the doctor.

Chapter 8 is called 'Why won't God give me a baby'. This chapter is intended to support women who struggle with their faith as a result of their IF.

Chapter 9 turns to the 'Nitty-Gritty of Infertility Treatment': financial and medical issues. Dr. Domar addresses questions like should you see an OB/Gyn or go to an RE immediately or how to prepare for your first visit with a specialist. She also writes how important it is to be your own health advocate and to speak up when you disagree with a certain course of action. The author also talks about dealing with stressful situations at the doctor's office and dealing with anxiety.

Chapter 10 is called 'When miracles don't happen: coping when treatment fails'. The author talks about having realistic expectations for treatments and coping with failures. Taking a break can be very beneficial in coping with IF. Next dr. Domar addresses surviving miscarriage and suggests a variety of coping strategies.
Next, the author talks about one of the hardest decisions of all, when to call it quits.

The final chapter covers other paths to parenthood. Are you ready to give up on having a biological child? Have you mourned the loss of having a biological child? The first thing to do is explore all the reasons you may have against adopting, and addressing them. Donation and surrogacy are discussed as well.
Finally, the alternative of choosing childlessness if covered.

In Appendix 1 'Lifestyle changes that enhance fertility' the author gives some facts and recommendations on a number of lifestyle changes (caffeine, smoking, weight, ...) as well as alternative/complementary remedies (herbs, acupuncture, vitamins, ...) often offered to IF women.

In Appendix 2: 'Resources' the author lists some (U.S.) organisations and treatment centres, as well as some books.

In short, there is no quick fix, but there are good coping skills you can learn.



At 13 November, 2005 15:46, Blogger zhl said...

Thanks for posting that. It reminded me that I probably need to go back and read some of the later chapters I never thought I would need.

And a refresher on coping would probably be good idea now.

At 14 November, 2005 20:47, Blogger Pamplemousse said...

The best coping skill would be a + hpt. Did the author of the book give that little gem? Probably not.

At 14 November, 2005 23:18, Blogger Lut C. said...

ROFL pamplemousse!

At 15 November, 2005 21:20, Blogger Pamplemousse said...

Sorry Lut! I was really PMS-ing yesterday and my inner snark was winning.

At 14 April, 2006 17:24, Anonymous Anonymous said...

Another great book is "Infertility to Family: One Man's Story" by Rocky De Lorenzo. It's located at

At 30 May, 2006 00:38, Anonymous Anonymous said...

You can control your body through Autogenic Training, here is a manual:

At 16 January, 2007 00:12, Anonymous Malky B. said...

we just interviewed Dr. Domar on our podcast. Check out episode # 11!


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