Unsung Lullabies PART I Reproductive Trauma: What Happens When Things Go Wrong? One This Isn''t How It Was Supposed to Be F or couples experiencing infertility, wanting a baby is a craving unlike any other. The intensity of your longing is matched only by the complexity of the emotional and medical maze you must navigate. When unexpectedly faced with the sting of infertility, would-be parents experience an unacknowledged trauma that leaves them feeling not only frustrated and angry, but sad, frightened, confused, guilty, overwhelmed, and out of control. You may feel as though you are losing your mind, as you''re caught up in a swirl of difficult feelings. This isn''t how it was supposed to be , you think. And you wonder, why is this happening to me? We, the authors, wondered this too, as we were going through infertility, and these are the first questions that many of the women and men we work with ask us. "It''s so hard to talk about this," said Emily, a thirty-six-year-old teacher. Makeup couldn''t erase the dark circles under her eyes.

"I never thought I would have problems getting pregnant--I''ve always been as regular as a clock. Everyone else seems to have no trouble. So what''s wrong with me? "It''s also embarrassing," she continued. "Everybody asks when we''re going to have kids and I never know what to say. I don''t feel like myself. I feel like such a loser." Emily and her husband Jack, a thirty-nine-year-old lawyer, have been trying for three years to conceive. Six months ago, their first in vitro fertilization (IVF) attempt failed; now they need to decide whether to try another cycle.

"We''ve been through so many tests, but nothing has worked," she cried. "I''m so tired of being poked and prodded and filled with hormones that make me feel awful. Financially, my parents said they could help out, but I don''t want to take their money. And what if it doesn''t work again? I don''t know if I can take another loss. And if it doesn''t work, then what do we do?" You, like Emily, may be experiencing the emotional turbulence of infertility and its treatment. Your mind races as all you think about is your infertility. Or you may feel vague and distracted, and have trouble concentrating or remembering things. You may not be able to sleep, or you may feel like sleeping all of the time.

You may cry at the drop of a hat; you may explode easily. You may worry that you are going crazy. You may feel like a failure. You obsess about what your body is doing now or the next step your doctor recommends. Faced with complicated decisions, often involving costly medical procedures, you may get frustrated by the lack of clear-cut solutions. You are devastated one moment, hopeful the next. You feel as if you''re on a roller coaster--careening from excitement to gloom, wishful thinking to devastating disappointment--only this ride isn''t at all thrilling; rather, the longer you''re on it, the more you feel as if your carload of emotions is about to go soaring off its tracks. You feel all these things because you are going through a reproductive trauma .

Being unable to have a baby as and when you had hoped is one of the most painful crises that couples confront. Clearly this is not how you thought it would be. What Is Reproductive Trauma? Often unrecognized as such, infertility truly is a trauma. A trauma is any event or feeling that goes beyond the range of usual human experience and is overwhelming either physically, emotionally, or both. It typically involves a threat to your physical integrity or that of a loved one. It may be the result of a single devastating event or a series of events that gradually build up and overwhelm you. As part of the mind''s attempt to master the catastrophic overload, the events may be re-experienced in flashbacks, which can be triggered by anything reminiscent of the original events. Sometimes a general hypersensitivity and irritability occurs, alternating paradoxically with a sense of numbness and withdrawal.

A traumatized person feels anxious, depressed, and has difficulty concentrating. What makes the experience of infertility a trauma? The diagnosis of infertility, and the medical interventions often needed to treat it, represent a threat to our physical integrity, our sense of being healthy and whole. One of the most fundamental aspects of our physical selves is our reproductive capability. When that does not function properly, we doubt everything else. Infertility is a trauma because it attacks both the physical and emotional sense of self, it presents us with multiple, complicated losses, it affects our most important relationships, and it shifts our sense of belonging in the world. When you are diagnosed with infertility, the world as you previouslyknew it crumbles. No matter where you are in your journey--trying the "old-fashioned way" to no avail, whether you have just been diagnosed, are using drugs to produce more eggs, undergoing surgery--your outlook on everything changes as you adjust to this crisis and what it means for your future and your dreams. The trauma of infertility is such that what you had taken for granted and expected is lost.

Moreover, like a soldier who must return to battle again and again, you face an accumulation of traumatic losses when, month after month, another menstrual cycle occurs, the procedure doesn''t work, or an intervention must be canceled. Infertile couples constantly re-experience their loss--and are consequently retraumatized--month after month. Not only do you react to one failed intervention, you react to the cumulative effect of all that you have undergone. The snowballing effect of all the treatment, all the trying, takes its toll. How do you get through a trauma like infertility? As you and your partner go through treatment, you may hear, "Keep a stiff upper lip" or "If you have a positive attitude and you relax, everything will go well." The implied message in this well-meaning advice is that you should hide your feelings and not dwell on the negative. It may seem counterintuitive to rehash the details of your experience--after all, wouldn''t it be better to forget all the bad things and move on? But this kind of trauma is ongoing and needs to be dealt with as you go through it. Talking about it helps.

Giving voice to your feelings gives you some relief from the trauma of infertility. Like an old-fashioned pressure cooker, it can help you let off steam by airing your worries, your distress, your sadness, your fears. If you can talk about what you are goingthrough, with someone who is not judgmental, but is understanding and safe, you will gain more control over the trauma and be able to move forward. The Emotional and Medical Roller Coaster "Not a day goes by when I don''t think about getting pregnant," said Kate, a thirty-five-year-old museum curator trying to conceive for four years. "I know I dwell on it too much, but I can''t control my thoughts. After I ovulate, it gets even worse. I start looking for symptoms. If my breasts get tender I calculate my due date.

I can''t help myself, even though it has always turned out to be PMS. When my period comes, I''m crushed." Not only did Kate''s emotions yo-yo through each month, going from high to low and back again, but she also ruminated about her activity during the month--wondering if she were to blame. She continued, "Then I begin to worry, and second-guess, and doubt myself. Should I have exercised as vigorously as I did? Did I do too much by carrying that heavy load of groceries? Did I forget to take my vitamins? Maybe I shouldn''t have had that glass of wine. I monitor every move I make, every month, every day. I know I obsess too much, but I can''t stop thinking, ''What have I done to deserve this?'' All I want is a baby; is that too much to ask?" Being preoccupied with pregnancy and consumed with wondering whether or not you are somehow to blame is typical of this kind of traumatic experience. There are emotional highs and lows inherent in infertility trauma.

Yet friends and family members, even your doctors, may not understand how upsetting all this is to you. Traumatic as well are the medical procedures to diagnose and treat infertility, which are physically and emotionally demanding,invasive, and painful. And the results may bring more questions than answers, causing even further distress. Having waited out the prescribed year of trying on their own, Marissa, a thirty-two-year-old wedding and event planner, and her husband Ken, a thirty-eight-year-old veterinarian, consulted a specialist for an infertility workup. The doctor recommended that Marissa undergo a hysterosalpingogram procedure. "The doctor stood on one side of the room, the technician on the other, and I lay there feeling helpless. They chatted about the Lakers while they were injecting the dye into me," she said. "The technician yelled: ''The right one is blocked!'' They seemed happy to find something wrong.

But I was devastated. It was all I could do to not start bawling on the table." Finding out her tube was blocked--that there was something physically wrong--shocked Marissa. It isn''t surprising that the tech''s announcement sounded so loud to her; the bad news distorted her perception, as if the news were echoing in her ears. Not only did she discover her body wasn''t functioning the way she expected it should, but what she wanted most--a baby--felt that much more unattainable. Now she was having trouble concentrating on work. "How can I be planning these happy parties," she asked, "whe.