Little girls often engage in the common childhood pastime of pretending to be pregnant, but it would be a rare individual indeed who would ever dress-rehearse infertility as a future problem. Unless individuals have pre-existing medical problems, they assume they will easily conceive a child. Not only do they expect that starting a family will be easy, but some also utilize birth control methods to make certain that a baby's arrival will be conveniently planned and timed. Thus, it comes as a shock -- and often a major life crisis -- for the one out of every six couples diagnosed with infertility.

Infertility is usually defined as the inability to conceive after at least one year of regular sexual relations without the use of contraception, or, alternatively, as the inability to carry pregnancies to a live birth. Most couples quickly seek medical advice, usually from an infertility specialist. Adoption after miscarriage or infertility is a great option for any couple to consider. While there was a time when adoption was virtually the only option for an infertile couple, today there are a myriad of choices, some of them low-tech, and others involving extraordinary medical interventions. Each individual differs in his or her willingness to undergo medical treatment and evaluation; there are many decisions to be made concerning medications, surgeries, and alternative reproductive procedures, and these decisions will be influenced by financial, emotional, and religious factors.

Ironically, while a significant portion of the population experiences infertility, couples who are in the throes of the problem often feel a sense of isolation. They sometimes experience their problem as unique and begin to view the world as peopled with a multitude of pregnant women and adorable babies. The isolation increases as avoiding behavior becomes more common; individuals are frequently depressed and steer clear of as many situations as possible involving children. For this reason, it is often helpful to have some counseling or therapy concomitant with the specialized medical treatment. Support groups are especially effective in countering the isolation and the notion that "I'm the only one with this problem." No matter how excellent the communication between husband and wife -- no matter how rich their emotional vocabulary -- even the strongest marriage will be tested by infertility and may benefit either from counseling or from at least brief participation in a support group. Most individuals later report that the infertility crisis either pulled the marriage apart or significantly strengthened the relationship. Infertility is never experienced as neutral.

During the course of an infertility work-up, one or both partners may begin to explore the infant adoption option, gradually realizing that medical treatments may not be successful. At the same time, some couples wonder if the fact that they first attempted to have a biological child means that they somehow devalue adoption. Here, one must distinguish the difference between viewing adoption as the "second choice" versus the "second best." In the natural order of things, most people first attempt to have a biological child; yet, while adoption was not their first choice, this does not mean that it is not equally as good as their first choice. Through discussion, reading, seminars, and the like, couples often grow to view adoption as an ideal way to connect children who need homes with adults who long to be parents.

Although couples may begin to explore adoption during infertility treatment, they seldom initiate an adoption home study until they reach a logical "break point" in the medical treatment. Proceeding simultaneously on two tracks is difficult. The financial and emotional investments are substantial in both the medical and the adoption routes. And some couples need time to grieve the loss of the potential or fantasized biological child; they need a pocket of space before changing courses. The fact that they choose to adopt does not mean that they will never again resume the biological quest or seek a more definitive diagnosis. Some may elect to do so if, for example, state-of-the-art treatment changes, or if their emotional needs change. But starting a home study usually signifies that for the present, they intend to devote their energies to the adoption process. At this juncture, it is common to hear couples express the view that they "feel good for the first time in many months," with a renewed sense of purpose and joy.

One often-debated issue is whether couples must have resolved their infertility before making application to adopt; the implication in the word "resolved" is that the situation is settled, and the feelings are laid to rest. Since society does not require parental-suitability assessments for biological parenting, prospective adoptive parents sometimes feel that they have to prove themselves in a way that biological parents do not. While accepting this difference in the two routes to parenthood, some become defensive and fearful of revealing important issues which could be addressed effectively in the home study. In front of the social worker, they do not want to parade what they fear might be viewed as weaknesses -- including lingering feelings of sadness around infertility. While it is a normal human desire to want to make a favorable impression, it is also true that future problems may arise if all expressions of grief go "underground." Thus it is important to locate an adoption agency which is hospitable to honest expression of feelings regarding infertility. There are a number of strategies for dealing with feelings of loss and sadness. The first is to acknowledge the feelings as normal; you are not being disloyal to your adopted children -- you are simply being human. When you understand and anticipate that you may be re-visited by such feelings, then you are not struck by surprise each time, and in some ways you feel more in control. Improved communication between husband and wife is also crucial. Finally, here are some markers for adoptive parents which may stimulate your further exploration and which may indicate that your infertility has been sufficiently resolved or worked through:

  • when you can acknowledge and embrace the differences between adoptive and biological parenting, particularly with recognition of the birth parents' place in the adoption "triad"
  • when you are willing and open to sharing your child's adoption story with him or her in the future, in age-appropriate ways
  • and when your life is primarily characterized by optimism and energy, rather than by pervasive feelings of sadness.

Perhaps no quote better captures the essence of dealing with infertility in a healthy manner than that of a participant in Barbara Eck Menning's classic study, Infertility, where infertility is poignantly personified as follows: "My infertility resides in my heart as an old friend. I do not hear from it for weeks at a time, and then, a moment, a thought, a baby announcement or some such thing, and I will feel the tug -- maybe even be sad or shed a few tears. And I think, 'There's my old friend.' It will always be a part of me ...."

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