Infertility and the Question “When Are You Going to Have Kids?”

Posted on January 2, 2019 by AHafkin

The holidays are a time of get togethers with family and friends. These can be fun, but also stressful. I recently posted a blog to address dealing with stress when you have anxiety. Infertile couples endure their own kind of anxiety: the pain of being childless during a season that focuses on children and family, and the fear that people will ask that very common question: “So, when are you two starting your family?”

People mean no harm when they ask. Some are sincerely interested in you, like your closest friends and loved ones. Others, people you may have recently met, may not be good at making small talk. Recognizing their intentions may help you consciously justify their question, but it does little to stop the visceral reaction of pain you feel when you hear it.

Part of this reaction is probably due to the tendency of couples to hide their struggles with infertility, even from those closest to them. Many couples feel shame or self-condemnation when dealing with this condition, and so they keep it secret. It’s so important to accept that there is no shame in infertility; it is not a reflection on you as a person, nor is it a sign from the heavens that you would be a terrible parent. It’s a biological condition and you are not alone.

How to Respond

There are several ways to cope with these questioners, both the well and not so well intentioned and it depends on their degree of closeness to you.

Consider sharing your struggle with those closest to you. Take time to think it through and discuss it as a couple, then share your situation and your feelings with your family and closest friends. Let them know you want them to be aware of your struggle but that you prefer they don’t ask about things unless you volunteer information. By doing so, not only do you avoid painful questions from them, you also develop a wider support team.  

For those people who are not as close to you but with whom you wish to maintain a positive relationship (co-workers or neighbors, for instance), give a vague answer and change the subject quickly.

    • “We’ll see what happens. How’s the guacamole?”
    • “It’s not something I’d really care to talk about. Let’s talk about your new job.”
  • “When it happens it happens. Let’s change the subject.”

For people whom you’ve recently met or you sense are just plain nosey, feel free to be a little more abrupt. It might prevent the person from hurting someone else in the future.

    • “That’s a very personal question and I don’t share that information”
    • “This is not something I would like to talk about?”
  • “It might be a good subject to stay away from don’t you think?”

You owe no one an answer. But those who are close to you could be a support system during a difficult time. I have helped many couples cope with the difficult emotional roller coaster of infertility. Please explore my blog for other articles on infertility and reach out to me if I can be of any help.

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Use These 3 Techniques to Cope with Anxiety During the Holidays

Posted on January 2, 2019 by AHafkin

The holidays are opportunities to celebrate, have time off from work, and spend extra time with family and friends. Unfortunately, holidays come with so much preparation and so many expectations that they can cause a great deal of stress for anyone, especially those dealing with anxiety.

Preparing for a party or holiday event can involve many anxiety-provoking aspects: shopping for the perfect gift for each person on your list while watching your budget; planning the perfect menu and shopping for food; cleaning the house and preparing for guests; and dealing with crowds and the family members who rub you the wrong way.

You feel pressure to do everything “right” while you may also feel underappreciated for all your efforts. You may feel obligated to attend certain parties or see certain people. And, of course, you worry about paying for everything when the bills come in.

If you struggle with anxiety, even just thinking about these things can cause you to feel unhinged. There are no easy answers, but there are certain steps you can take to help you not only cope with the upcoming holidays but actually enjoy them.

  1. Manage Expectations – Yours and Theirs

Know your limits and “just say no” to some things. Tell yourself firmly that you can’t do it all, and believe it. Choose several things that are important to you and focus on them. You will be pleased with the results of those few items that you had the time and the energy to do well.

You also need to communicate this plan clearly to others. Only the people who are important to you really matter. Tell them your plans and why – you want to be able to really enjoy the holidays like everyone else by managing the anxiety-provoking activities. This is what you are going to do, and these are the events you will be able to attend. Those who love you will support you.

  1. Take Care of Your Health – Physical and Mental

This is particularly difficult during the holidays, but there are a few things you can do. Try to maintain your routine, which calms the anxious feeling because you know what to expect. Maintain sleep and exercise habits, and eat as healthily as possible. Exercise is proven to reduce anxiety and depression, as are sleep and good nutrition.

Allow yourself time to step away and rejuvenate in the midst of get-togethers. Again, in order to do this, you need to communicate with your loved ones. Tell them that you’re not angry or upset with them and you aren’t being rude or snobby. You are rejuvenating because you love them and want to spend quality time with them. If you have to leave entirely, they should know that it’s not a reflection on them. You’re there because you love them and want to see them, but you have limits and need to get your sleep or your quiet time.

  1. Avoid These Common Pitfalls

Don’t set high expectations. People are people and they have their own personality quirks. Whatever a person’s quirk is, the holidays will amplify it. Try to have patience with them as you want them to have patience with you. Don’t self-medicate with drugs or alcohol. This makes anxiety worse and can trigger an anxiety attack. And finally, don’t isolate yourself. Being alone too much can also increase anxiety and depression.

If needed, I can help you develop the skills to prepare for and cope with the holidays, so don’t hesitate to reach out.

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Update on Infertility: Stress Has an Impact

Posted on October 10, 2018 by AHafkin

I recently posted a blog about how depression and anxiety are linked to infertility. Depression and anxiety are stressful in themselves, but stress can come without them. And “ordinary” stress itself can affect your fertility.

Stress has been on the rise for some time, and so has infertility, so it’s not a surprise that there is a connection. It’s a mistake to believe that stress is all in the mind and won’t affect your body. The brain, after all, is the control center that governs the function of every other system in the body: the nervous, endocrine, digestive, and circulatory systems­ all depend on the brain.

Many factors go into stress, and different people react to it differently. But it can’t be ruled out as a possible factor if you’re experiencing infertility, because stress affects both the body and our behaviors in several ways.

Hormones—The hypothalamus is a gland in the brain that regulates the emotions, the appetite, and the release of sex hormones. In both men and women, stress can cause a decrease in the release of GnRH, the chemical that controls the release of sex hormones. GnRH affects ovulation in women and the development of sperm in men.

Pregnancy rejection—Some evidence suggests that the body is more likely to reject implantation when the woman is under stress because pregnancy would further stress the body.

Behavioral changes—When under stress, we often cope with our emotions through changes in our behavior. Some people will smoke or drink more often, which decreases their physical health. Others may have decreased libido, so they just don’t feel “in the mood.” This complicates things even further when you’re trying to conceive, because you may be having sex for the purpose of conception alone, making the loving act seem less loving and more like a project. This can cause additional emotional stress.

Remember that not everyone is affected the same way by stress. But it’s important to reduce your stress, not just for your fertility, but for an overall improvement in your peaceful enjoyment of life and your partner.

Although you can easily find advice on “how to reduce stress,” the best methods for reducing your stress depend on your particular situation. We can work together to find the right way to help you reduce stress and improve your overall health and relationships.

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Are You Having an Emotional Affair?

Posted on October 10, 2018 by AHafkin

When people think of the phrase “having an affair,” they think of a person having a sexual relationship with someone other than his or her spouse. But one can also be guilty of “emotional infidelity.” This can be just as hurtful to your spouse and just as damaging to your relationship, even if you think you’re “just friends” with the other person.

Most affairs, physical or emotional, start out as benign friendships. But if there’s something lacking in a marriage, a person may be feeling vulnerable and needy, and without realizing it, may start looking elsewhere for relief.

Take a close look at your relationship with this other person and ask yourself if your friendship has any of these qualities.

Signs that it’s happening

  • Is there sexual chemistry between you? Do you find yourself fantasizing about the other person?
  • Are you sharing intimate conversations with this person that you’re not having with your spouse or significant other?
  • Are you contacting this person when you’re not together, maybe to share a funny comment or to say “just thinking of you,” particularly at odd times?
  • Is this person frequently on your mind?
  • Are you making an effort to find ways to be with this person, and you don’t want your spouse around?
  • Do you feel like this person “gets” you?
  • Are you starting to compare your spouse to this person, and your spouse comes out less favorably?
  • Are you keeping this a secret from your spouse? If your significant other walks in while you’re typing an email to this person, do you quickly hide the email and bring up a different page?

These are all signs that you are beginning to switch your emotional attachment onto another person from the person you’re actually committed to. This is extremely damaging to a relationship, because your emotional energy is being given to someone else and being taken away from the one who should be receiving it.

Your spouse, when he or she finds out, is going to be very hurt. Many people guilty of an emotional affair deny any wrongdoing and attack their spouse for being “too sensitive,” or reading something into the situation, or being controlling. This makes the hurt even worse.

What to do about it

What can you do if you suspect you’ve fallen into an emotional affair? First, you need to care more about your spouse’s pain than about your pleasure in this relationship. Next, you have to recognize that you’re only seeing the best side of this person. You have your spouse 24/7, warts and all. You’ve idealized the other person, but remember that person has warts, too, you just haven’t seen them. Finally, you have to recommit yourself to your spouse or significant other, and either adjust your relationship with this other person or end it completely.

Remember, you loved your spouse very much once, and you probably still do.  You should be putting your energy into nurturing your relationship at home, not elsewhere. If there is something that needs work in your relationship, commit to fixing it. If you need help, I’m here for you. I’ve helped many couples work through these kinds of problems and become closer and more in love afterwards than they were before. Sometimes, the exploration in to what is going on in the relationship can lead to a parting of ways. Which ever way your relationship goes, clarity and honest are the route to a more authentic life. With work and a renewed commitment to the relationship, love can grow and become deeper as you face your challenges together.

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Three Things that Can Get Better with Couples Therapy

Posted on August 29, 2018 by Alisa Hafkin

When couples come to me for help, they often start talking about a particular argument or issue they may be having at the time. However, therapy is not about solving whatever the current hot topic may be. Therapy is about getting to the roots—your core values, your world view, your baggage, your communication style. When we address these issues, we can usually reconstruct the relationship in a healthy way, so that the “hot topics” that seemed so formidable when you walked into my office have now shrunk to a manageable size.

This does not mean that creating and maintaining a healthy, happy relationship will suddenly be easy! Anything good takes work. You don’t expect to run a marathon when you first start running. You must learn certain principles then practice, practice, practice. If you stop practicing, your running skills will deteriorate.

If this is true for physical exercise, why would it to be any less true for the relationship with the most important person in your life?

So be ready to work. But the rewards will be worth it. You will come to know yourself better, you will come to know and appreciate your spouse better, and you will learn better communication skills. When these three core lessons are learned, everything else falls into place.

Don’t come to therapy thinking your partner needs to do all the changing, though. If I can get away with another analogy, imagine paddling a canoe. Each of you paddles on opposite sides, but if you don’t both pull the same weight, you’ll go around in circles. So it is with therapy.

Both of you need to be prepared to open up. Our experiences in life have shaped us, and often times, those experiences cause us to have trouble trusting, expressing ourselves in a healthy manner, or even feeling lovable. Sometimes it’s possible to pinpoint some behavior by your spouse that has damaged your trust in them, but sometimes the real culprits are past relationships that you or your spouse may be carrying over into your current relationship. By deeply examining your motivations and your past, you can both come to a better understanding of where you are coming from and where you both want to go.

This understanding improves your bond because you now see each other more clearly and can understand better why certain “hot buttons” trigger certain reactions. You can now work to create a system of communication that affirms each other and respects each other’s sensitivities.

There are many aspects that we address in therapy regarding improved communication. Communication is very complex, involving not only choice of words, but also tone and body language, and it changes depending on the situation. Listening is also part of communication; it is the other half of talking, and is perhaps even more important. But most of us listen to respond rather than listen to understand. Communication usually needs to be relearned when couples are having problems. The goal is to learn how to communicate in a way that assures each partner that he or she is loved and valued.

With couples therapy, you will grow to understand yourself and why you react the way you do. You will understand the same about your partner, and you will learn listening and communicating skills that will help you appreciate your partner more, affirm your love, and work towards a happy, healthy relationship.   

 

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Depression and Anxiety Associated with Fertility Problems

Posted on August 29, 2018 by Alisa Hafkin

In the United States, an estimated 1 in 8 couples struggle with fertility issues. The sadness that naturally occurs when people find out they may not be able to have a biological child is significant and may lead to anxiety and depression. One study found that half the women and 15% of men who seek infertility treatment experience depression. Another found that women with infertility suffer the same level of stress as those suffering from cancer. And when a man has a physiological problem causing the infertility, he may have similar experiences with depression and anxiety.

Depression and anxiety can complicate matters when dealing with infertility, as they can affect regular body processes. Therefore if physiological problems exist, depression can worsen the problem and decrease the possibility of successful treatment.

Unfortunately, while many couples reach out for medical intervention during this time, few get the psychological help that they need. Infertility causes the same grief cycle as with any loss. Couples need to be aware of the symptoms of anxiety and depression in order to intercept them and reaching out to a counselor or psychologist who understands the painful issues of infertility may be very helpful during this stressful time.

  • Signs that your sadness of infertility is actually depression or anxiety:
  • You’re thinking about having a baby throughout the day.
  • You feel ashamed, defective, worthless, or you blame yourself.
  • You experience on-going negative emotions: persistent sadness, nervousness or panic attacks, or are more easily angered.
  • You have trouble concentrating or remembering things.
  • You can’t sleep or you sleep too much. You can’t eat or you eat too much.
  • You lose interest in your hobbies.
  • Your relationships are suffering. You may feel isolated from others, or purposely isolate yourself—to avoid seeing mothers with their children or to avoid people asking hurtful questions or giving well-intentioned advice. Old friends no longer bring you happiness and you may lose interest in sex.
  • You self-medicate with alcohol or drugs.
  • You consider harming yourself.
  • Don’t wait to seek help

Sadness while experiencing infertility is natural. The symptoms listed above may be part of your experience but they can be mitigated with help. If you are experiencing any of these symptoms you need to talk to a mental health expert. You don’t have to feel this way. As a couple and as individuals, talking out your feelings and getting guidance on how to deal with them is crucial to strengthening your bond and renewing your joy in life.

Finding peace and purpose will help you before you reach the point of self-medication or self-harm. If you’ve reached that point already, do not delay. This is a dark road to walk alone. I counsel couples and individuals and try to help them find new meaning, to strengthen their relationships, and provide them with the tools they need as they navigate their path forward.

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How Men Cope with Infertility and How to Help Them

Posted on August 29, 2018 by AHafkin

Many couples come to me for therapy to help them cope with the stress of infertility. When struggling with this issue, society tends to focus on the woman’s feelings, while the man is often forgotten. This is likely because men usually share their feelings less than women do, and so it is assumed they are nott suffering as much. This is not true. Men suffer differently depending on whether the problem is with them or with their wives, but they suffer just as acutely.

How men experience infertility

When it is not male factor infertility, the husband also suffers while watching his wife go through treatments. There is also the internal struggle and sense of loss for men when realizing they may not be able to have a biological child. Traditionally, a man may feel like it is his job to take care of his family. Seeing a wife so sad may make a man feel helpless and like a failure. And because men generally try to “fix things,” he is likely to experience a rollercoaster of emotions around his sense of powerlessness. With each new treatment he may think, “This time it will work. This will fix it.” He has confidence in the science, and then the science fails him. Not only does he once again have his hopes of paternity dashed, he has to watch his wife go through her sorrow again.

When the husband is the one with the fertility problem, many more emotions come into play. The male self-identity is closely connected with a sense of virility. To have to admit that he cannot have biological children is a terrible blow to the male ego. And besides watching his wife suffer and not being able to help her, he now feels the terrible burden of guilt for being the cause of her pain. He also feels the cultural burden of “passing on the family genes” or “the family name” which he will now not be able to pass on to a biological child.

Men are generally less likely to talk about their emotions, but this tendency is heightened when dealing with infertility. A man usually feels like he has to “stay strong” so that he doesn’t add to the burden of pain his wife is enduring. And if he is the cause, he has the added perception that he’s not “man enough.”

How to help

Men need to address their emotions as much as women do, for their own mental health and for the health of their relationships. In counseling, I help couples find ways to draw closer together during this difficult time. But men need other outlets, as well. If you have a friend dealing with infertility, here’s what you can do:

  • Ask how he is doing. He may not tell you, but let him know you’re available. Eventually he might open up. Don’t offer advice, just listen.
  • Get him out exercising. It provides a healthy outlet for pent-up frustration and relieves stress. Excess stress can lead to depression, so getting out there and exercising might actually enable a man to cope better with his situation.
  • Help him stay involved in activities he enjoys and in which he feels some measure of control. This may help combat his feelings of helplessness.

Men suffer from infertility differently than women, but just as acutely. I’m here to help them with counseling, but as a culture, we need to become more aware of this fact and be ready to lend our emotional support.

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What Causes Depression?

Posted on August 29, 2018 by AHafkin

Depression is a complex problem and rarely caused by one single factor. The important thing for a person suffering from depression to realize is that it’s not your fault.

Both internal and external factors work together to affect our physical and mental health. Some causes of depression may be out of your control but can be managed with medical intervention or counseling. Others you may be able to manage on your own.

Causes outside your control

Genetics – Scientific studies and our own life experiences prove that depression can run in the family. There may not be a single gene for depression but rather a combination of conditions that contribute to the increased likelihood of experiencing depression.

Brain chemistry – This could be connected to genetics, or it may be unique to you. Certain neurotransmitters, which are the communication pipelines to different parts of the brain, can be out of balance, causing poor communication and possibly inhibiting proper function of crucial brain functions.

Serious illness, chronic pain, or menstrual cycles – Obviously, if you’re struggling with an ongoing condition, it is likely you could feel sad or frustrated, which could lead to depression. Hormonal imbalances from a woman’s natural cycle can also cause recurring bouts of depression.

Loss of loved one or major life change – Just as with a physical illness, a loss of a loved one will naturally make you sad. In some people, however, this natural sadness deepens into depression. Even a major life change can cause depression in some people. Loss of a job can create a sense of fear for the future or a sense of failure, but even positive events, like moving to a new house or getting married, can cause anxiety due to the dramatic changes that might be involved.

Causes that you may be able to control

Stress – If your stress is caused by your job or family situation, it may seem unavoidable, but often, how we respond to situations can determine the impact they have on you.

Diet, sleep, and exercise – Lack of certain nutrients can lead to imbalances in the body, leading to depression. A healthy, well-balanced diet with plenty of fruits and vegetables is important. Insufficient sleep is closely linked to depressed feelings. The amount of sleep a person needs can vary, so it is crucial to make sure you get the amount of sleep that you, personally need. Interestingly, exercise is one of the best natural anti-depressants. Exercise stimulates “happy hormones” in the brain, and if you’re out in the fresh air, you get the benefit of beauty and sunshine as well.

Drug and alcohol use – People who abuse drugs or drink heavily have an increased incidence of depression. However, certain prescription drugs can also cause depression. Look closely at the possible side effects and discuss alternatives with your doctor if you have a tendency toward depression.

Get help

Please remember this if you’re struggling with feelings of depression: You are not a bad person and you are not weak. You wouldn’t think you were a bad person if you broke your leg, so don’t think ill of yourself for feeling depressed.

There is help and there is hope. For serious depression, medical intervention may be necessary. But often, talking to a counselor can help you see things differently and work through your feelings. I’ve seen it in my own practice over and over. With good counseling, many people come out from the dark tunnel of depression back into the light. You can, too.

 

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Couples Activities

Posted on July 18, 2018 by Alisa Hafkin

I want to make my relationship stronger!  If you live and/or work in NYC, you know that it can be a busy place.  And when you are working and living in the hustle sometimes taking care of your relationship gets lost.  Sure, you may have the same home, kids and goals, but are you really connected?

Many of my clients come to therapy looking to build something into their relationship.  Maybe trust has been broken and they want it back.  Sometimes their marriage lacks intimacy, understanding or they just do not feel connected.  Some of my clients are struggling with infertility and want to ensure that their marriage does not collapse around the stress.  Or they may have already noticed that the tension they are feeling from not being able to conceive is causing strain.

When couples start therapy and talk about their relationship it is often the first time they are open and honest with each other.  The work we then do together is dependent on the hope that both stay committed to the process of slowly opening up and then building on the discoveries they make about each other.

Many couples ask me for ideas on what they can do outside of our sessions.  While I encourage clear and open communication it is often important to get out and have some fun.  What can you do in NYC to have some fun with your partner.

Well my first suggestion is don’t go out to dinner to talk! Engaging in new activities enables you to see your partner in a different light so go ahead, try something new. It is sometimes fun and interesting to visit old places that were significant to your relationship history.  This can include the spot where you met or a place that was very special.  You could even have lunch at the restaurant where you got married, visit the spot of your proposal, or the building stoop of your first apartment.

If you are able, try to get away for a vacation or give a cooking or dance class a go. Incorporate different ideas each week to add new dimensions to your life and to your communication.  Mixing it up and getting out of your normal routine and comfort zone can be great fun and recharge the energy that is running low in your relationship.

Volunteering together at a local charity here in the NYC area is a great way to bond.  You get to do something meaningful and make an impact while spending some time together as well.  You can work at a soup kitchen, build homes, collect items for a shelter, sort books at the library, or even visit a local college/high school for career day.  Giving back will help both of you sit in gratitude for all that you have as a couple.

Join a team – even if you have never played baseball, soccer, tennis or kickball you can find a team that will put the two of you on their roster.  Walk around Central Park, Chelsea Pier, or some of the other beautiful outdoor spaces in this city.  You would be amazed at how many sporting opportunities there are in the city.

The important part of this entire process is making sure the two of you bond.  It actually has nothing to do with specific activity you choose.  A simple walk around the block holding hands may do the trick to reignite the spark or at least ease some of the pain as we work through the tension you are experiencing in your lives.

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Sleep and Anxiety

Posted on July 18, 2018 by Alisa Hafkin

Trying to fall asleep when your mind is racing can be very difficult.  When you are dealing with problems in your life and you finally lie down in bed, your mind may drift towards those things that are causing you stress and you find you are unable to sleep.  Sleep is critical and provides necessary rest for our brains.  When you are already suffering from anxiety you might feel your heart or your thoughts start to race and suddenly you find you are wide awake.

So, what can you do when anxiety keeps you awake?  For my clients here in New York City we work together on a two pronged approach.  We begin by trying to uncover and then examine the issues.  We look at what is causing all the stress and axiety in your life.  Once we reveal the problem we strategize together on a plan to work through the issue.  It could be a problem at work, a financial crunch or even discord within your marriage. Many of my patients lie awake at night when they are going through infertility treatment and need assistance getting through the process.

Once we know what is causing the problem we can then work together on activities (and non-activities) that will create a bit more peace for you at bedtime.

  1. Brain dump – when you start to cycle through all the things you have to do the list can seem overwhelming, until you write it down.  Once you have all the stressful details out of your head you can then start to tackle the list.  And, sometimes, writing them down makes you feel as though you have begun the process of putting a plan in place.
  2. Exercise – under the direction of your doctor, starting an exercise program can be one of the most beneficial plans for you.  Physical fatigue will help your mind relax.  Make sure you do not exercise right before bed – leave a good hour or two before turning in.
  3. Wind down long before you go to bed.  Stop checking work emails and your bank accounts if these are things that are stressing you out.  Plan to do these activities at the beginning of your day.  If you and your spouse have stressful things to discuss then start those conversations long before you need to go to bed.
  4. Presleep activities:   You can read, meditate, listen to soothing music, anything to bring on sleep.  If these do not resonate with you then we will try to figure out the particular thing that calms you down.
  5. Go to bed at a reasonable time.  Sometimes the stress of knowing you are not going to get enough sleep is enough to cause you to lie awake at night and brings on further anxiety.
  6. Cut back on caffeine and alcohol long before it is time to turn in.  Both caffeine and alcohol can keep you awake and can cause disrupted sleep patterns.
  7. Limit your time in front of your computer, phone, and television.  These tend to stimulate your brain and interrupt normal sleep rhythms.

We can work together to tackle whatever is causing you to feel anxious and bring about more peace and balance into your life.  You will come to understand your triggers and with that, we will develop a plan to help you move forward, enabling you to cope with your anxiety and ultimately, get some sleep.

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