When you use assisted reproductive technology to create your family, one of the issues that can be very stressful is, who do we tell? When do we share the decision to move forward with treatment, before or after, and what if it’s not a positive result and people call to ask about it? Are we letting them down? Have we failed?
As a couple or as an individual, fertility treatment can create many feelings including anxiety, sadness, anger, inadequacy and envy of others who have escaped this experience. Understanding these feelings and sharing them with your partner is the first step in deciding who to tell and how and when to safely share this information.
A single person choosing treatment faces some unique challenges in addition to those that a couple may have. A professional counselor and a support group for single intended parents are invaluable. Being part of a couple choosing treatment provides built in support and the ability to openly share with one’s partner as well as community support for following in esteemed, traditional roles. Not all communities offer the same support, validation, and respect for single men and women wishing to parent.
Who to tell can include or exclude your basic family, social and business networks. This is a hierarchy of groups that many of us use when deciding with whom we will share this important information about ourselves:
• The immediate family and closest friends
• Extended family, more casual friends
• Work colleagues, employers and business contacts
• Professional counselors, Support group members
• Internet support groups
• The hoped for child, himself or herself
It might feel safer at first to ‘tell no one’ as if a diagnosis of this kind would be shameful or embarrassing. Most couples don’t know that current data suggests that one in every six couples has seen a fertility specialist. Here are the main issues and some pros and cons to consider in deciding if and with whom to share.
Reasons to share and disclose:
SUPPORT and TRUST
Some people find that support for the demands of the treatment is invaluable. We trust that the people we tell will understand our strongest desires and support the decision to invest ourselves in medical protocols to create our families. Support can give strength when it feels like there isn’t any more left. Sometimes support feels like solid ground under our shaking legs, sometimes it is more like an umbrella to protect us.
Having confirmation from others of the correctness of our decision gives a great deal of peace of mind and lends courage when it is time to start, change or end treatment. We rely on validation from our partner when we are feeling discouraged or inadequate. Support says, I support your decisions…I may not agree, but I support you. Validation says, I agree that you are making the best choices for you.
Along with support and validation, understanding the unique stress fertility treatment brings shows an appreciation and consideration for this difficult situation. We look for understanding and compassion from those with whom we share. As many of us have learned, however, people sometimes say things that are meant to show compassion but they are misguided and hurtful. Discussing treatment can also invite unsolicited advice and opinions. At that point, it helps to be prepared by planning in advance your “party line,” which is an answer that you have practiced and rehearsed so you can be prepared to respond to comments that are intrusive or critical.
Some would say that sharing this means being prepared to educate people about the realities of the procedures and the emotional and physical demands. You can choose who you want to educate about this. Understanding means you may not want to talk about your treatment or results or future plans. Sharing with someone who is understanding also means that they understand you may not be in a place to hear and really share their joyful and happy news especially regarding new pregnancies and new births. Are you ready to ask for this understanding?
Keeping secrets from friends and family about where we are and what our days include is a heavy burden to carry. Hiding treatment means withdrawing from family and social activities and often fabricating activities or saying we are at work when it is a doctor’s appointment or egg retrieval or a period of bed rest. Being authentic can be freeing and ease the seemingly endless rounds of appointments and procedures. Especially during a mandatory period of bed rest, having guests or phone calls can be uplifting. Being honest about pursuing treatment doesn’t mean one must be honest with everyone that they know, however. They may choose to tell those they feel safest sharing with and choose to be silent with people who they feel will not understand or add censure. In addition, being honest in sharing treatment, does not mean you are obligated to be honest with every detail. Couples working with gamete donation may be honest about taking time to pursue treatment but are entitled to withhold their use of donor gametes if they wish.
Reasons not to disclose fertility treatment:
FEAR of CENSURE
Being prepared to share your treatment decisions means risking that you will be criticized for choosing this option. Friends, family or business colleagues who are critical usually have concerns that fall mainly under the physical, emotional-spiritual, or financial umbrella.
Physical. If you disclose some may state that you are putting your body in harm’s way and inviting many dire consequences. Be prepared with information to share by asking your physician for answers to the questions you expect. Your doctor can give you good information to share regarding your expectation for treatment and physical side effects.
Emotional-spiritual. You may be criticized for going against God's will, nature or a higher power. It may feel safer not to disclose to those who have faith based criticism, especially if it resonates with your own fears and you are working to be okay with a decision that feels scary to you too. People who you expect to criticize your plans for treatment may or may not be prepared to support your decision to pursue treatment. Sometimes this means conflict between a mom and dad who hold differing views or with different family members. Often, educating on this issue is helpful and asking for the understanding you need can turn out to be positive. Remember to continue to rely on your safest support system.
Financial. Sharing your choice of treatment may result in criticism for investing so much money on a treatment option which often does not offer a high rate of success. Parents, parents in-law, or older children from a previous relationship can be especially wary of this choice. Remember, you can briefly share your decision to have medical intervention without being obligated to disclose all of the financial nuts and bolts. A simple answer such as, “we have provided for this” can be enough. Sometimes, individuals are surprised when, after sharing, they receive an offer of financial help in the form of a loan or a gift. This is something to consider and decide upon based on your own needs and comfort with this option.
FEAR of FAILING
A major concern before “telling” is fear of failure and having to talk about it. This represents feeling like you have let people down, disappointing your partner and the people who have supported you. It also means questions and conversation that you may not want to invite by discussing treatment. Committing to medical treatment requires determination and focus. Please remember, the results of a cycle represent a lack of success on the part of the medical protocol, but not a personal failure.
Disappointment and sadness can shut down communication in a couple. If this happens, please call a counselor to arrange counseling to help with sharing and understanding difficult feelings. Fertility treatment is one of the most demanding challenges a couple or individual faces. It demands courage to follow through with it. Treatment can fail, but women and men wanting to be parents are not failures for pursuing treatment and not having successful results.
If you find yourself in the position of having to field intrusive questions , remember that a tried and true strategy is to always thank the person for their caring or concern right away. Once they feel acknowledged that you understand their intention, they may be ready to take your cue about how much you do or don’t want to discuss this. A prepared answer is best, and a stronger response can follow if you need that. Unsolicited advice can be responded to in any of the ways we’ve discussed here depending on the situation.
It is safe to tell people who know about an upcoming cycle that you will surely let them know when there is good news to share. No news from you on this matter means you have nothing you feel you can talk about.
FEAR of CAREER INTERRUPTION
Sharing your decision to pursue medical intervention at work means risking that you will not be included in decisions regarding promotions, plum assignments or salary increases. It can presuppose your seriousness about your work and career commitment.
Often, you may need to disclose privately to a supervisor, human resource manager or colleague who may need to take extra work assignments for you while you are absent for appointments or rest periods. Remember, sharing decisions with family and friends does not automatically include the work place. This can be a significant concern and disclosing may engage your anxiety but, hopefully, offer great relief if you can receive some support at work while going through treatment. You do not have to share the reason you are asking for time off typically, but the buzz around the office may start if you are mysterious or change the story that you tell. Be prepared to discuss your continued dedication to your work and your willingness to make up for lost time if you decide to share your plans. Also, know your company’s policy regarding this.
At a time when you believed that life would offer you what it offers the majority of people, going through fertility treatment can feel scarily out of control. Making babies and creating our family is supposed to happen for us as it does for our friends and family. Deciding who to tell is a major piece of this process. We make decisions based on maintaining self control and self esteem. If we hold on very tight, accusations come of being “micro managing” and “obsessive”. If we “go with the flow” as we are often encouraged to do, we may say things we cannot retract and have remorse later about what we have shared.
How do we decide what is the right amount of control and what we disclose and to whom? You, as a single individual or a couple, get to decide what and who and how to tell. It is important to decide together. This may be uncomfortable if, for example, you want your mom to know but not his mom, or your sister but not her brother. These disagreements can add unnecessary arguing for the couple. If you cannot resolve areas of conflict, please take some time with a professional who can help, or use other communication skills you have used successfully before. This is not the time to steamroll over your partner’s concerns.
After all of the considerations, losing the ability to become pregnant without intervention means making decisions about your treatment as best as you can. It also means that you are encouraged and entitled to evaluate and re-evaluate these disclosure issues as the process continues. It is important to remember that these decisions can be modified and altered as your own progress and feelings change.
Ellen Speyer, MFT, is a psychotherapist specializing in reproductive health and past Co-chair of the Education Committee of the Mental Health Professional Group of the American Society for Reproductive Medicine.
Revised and edited as of 8/20/15