The American Fertility Association

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The American Fertility Association’s Monthly Newsletter

October 30, 2007

Jennifer J. Bute, Ph.D.

Disclosing a Fertility Problem
By Jennifer J. Bute, Ph.D.

The millions of women in the United States facing reproductive obstacles, often find themselves blindsided by another painful issue: disclosure.

Figuring out whether or not to reveal this intimate part of life is hard enough. Then comes the onslaught of necessary subsequent questions: Who to tell; how much detail to share; when to begin this complicated conversation with others.

On the one hand, talking about the situation can provide an outlet for expressing feelings like frustration, failure, and sorrow. On the other hand, disclosing infertility can open up a can of worms. What if friends and family members don’t respond as hoped? It’s especially complicated when this information follows the joyful announcement of the decision to begin building a family in the first place.

Over the years, I’ve watched close friends and family members struggle with infertility and grapple with these very issues. So when I began a doctoral program in communication at University of Illinois, I decided to focus on the complex array of issues women face when it comes to talking about a fertility problem. I was already interested in how health concerns affect communication and relationships. But I decided to look at infertility because no other communication scholars had studied this subject, and I wanted to draw attention to it as a socially significant issue.

During my final dissertation project, I talked to 23 women who had experienced a fertility problem at some point in the five years prior to our meeting. All the women I talked to were married, and all but one woman had sought some form of medical treatment for infertility. The women I spoke with represented varied experiences. Some had given birth to children after successful treatment, some had chosen to adopt, and other women were still trying to get pregnant at the time of the interview. A few women were having trouble getting pregnant with a second child after achieving pregnancy with relative ease the first time around. And a few had resolved their infertility by choosing not to have children.

For the purposes of my study, I was interested in how women talked to family members, friends, coworkers, and acquaintances (rather than their husbands). My interview questions focused on those conversations. During our meetings, these 23 women were incredibly generous. We talked about whether they disclosed their fertility problem, how they disclosed, and how people responded when women did open up.

Women recalled memorable conversations in great detail, describing who said what and how they said it. Some of these conversations were painful for women to relive as they described them to me, but women also recalled conversations in which they found relief and support.

Here are some of the prominent themes that emerged in my interviews:

Disclosure can be risky
Many women described talking about infertility as being incredibly difficult. In some cases, disclosing a fertility problem can mean admitting a “failure” to get pregnant, which can be especially painful for women in the midst of invasive and often unsuccessful treatments. Women also described situations in which talking about infertility was awkward for everyone involved. Disclosing infertility might lead to talk about personal topics like sexual intercourse and bodily functions. Some women expressed their own and others’ discomfort in discussing these subjects. Finally, friends and family sometimes responded to disclosure in unexpectedly insensitive ways. Some women said that people trivialized the problem or made unhelpful comments like, “You’re just trying too hard. Maybe you need to relax.”

Both disclosure and avoidance can be beneficial
In contrast, women also described helpful conversations in which they received important advice or emotional support from loved ones after disclosing infertility. Some women chose to tell others to let people know that they wanted to have children and were trying to get pregnant. In some instances, however, women chose not to tell certain others, which allowed them to avoid unintentionally hurtful responses and to maintain control over this personal information.

Managing information is complicated
Almost one of the women described some people in her network of family and friends who knew all the intimate details, some people who knew just bits and pieces, and others who knew nothing at all. Just keeping track of who knew what was a complicated task for women already coping with a challenging and volatile situation.

Dealing with questions is a prominent aspect of the infertility experience
The vast majority of women I interviewed discussed situations in which people asked them questions about their childbearing decisions, inquired as to whether or not they were pregnant yet, or requested specific details about the nature of the fertility problem. Although some women appreciated questions that provided an easy way to broach the topic of infertility, other women found questions like “Why don’t you have children?” “Are you pregnant yet?” and “Is it you or is it him?” hurtful, invasive, frustrating, and annoying. As one woman said, “It’s one of the most private things in the world, but nobody thinks twice about asking.”

In future articles, I will expand on some of the key themes identified by the women I interviewed. I hope that reading about their experiences will be helpful to all of those people managing their way through reproductive disorders.

Brief biography:
Jennifer Bute recently completed her Ph.D. in Speech Communication at University of Illinois at Urbana-Champaign. She is now an assistant professor in the School of Communication Studies at Ohio University in Athens, Ohio. She can be reached at bute@ohio.edu.

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Carolyn Berger, LCSW

Adoption Agencies: The Choice Is Yours
By Carolyn Berger, LCSW

Remember how carefully you chose your infertility doctor? You probably asked people for recommendations, checked various doctors’ credentials, went for consultations, and attended conferences where doctors explained cutting- edge technologies designed to coax Mother Nature to let you have a baby.

For whatever reason, though, Science and Mother Nature did not cooperate and you are now hell-bent on finding a baby to adopt. Possibly, because you have already worked so hard to create a baby, you are hoping to find an agency that will do all the hard work this time around. You may discover that you are drawn to ads about agencies that display beautiful couples embracing perfect babies in pastel settings. You, too, want that happy ending. Who wouldn’t?

And the truth is there are many, many happy endings to adoption stories. What the ads don’t tell you is that you will probably have to work hard to get there.

Kathy Brodsky, LCSW, who is the Director of The Ametz Adoption Program/JCCA, in New York City, an agency that helps people decide which type of adoption to pursue and how to navigate the
process, says, “Choosing an agency is a pivotal part of the process. Your agency will be your guide, advocate, and, occasionally, a shoulder to lean on.” Brodsky and her staff spend time getting to know their clients, and they consider many factors before a personalized adoption plan emerges.

Factor This

Before you ink your name on an agreement with an adoption agency, consider all the factors listed below.

First, decide whether you want to do a domestic or international adoption. If you’re certain you want a newborn, domestic adoption is the route. Babies adopted internationally are often a year if not older. Do you feel most comfortable working with a local or a national adoption resource. For some, the idea of speaking with agency staff in person is absolutely essential. Others want to deal with an agency in a different time zone because this allows them to talk with staff before or after their own business hours.

Your finances are important to consider, too, when choosing an agency. Ask yourself: How much can you spend? How much does an agency that appeals to you charge for its services and how is its fee structure set up? Beware of agencies that charge large sums of money up front. And if someone tells you they know an agency that can get you a baby much faster but whose fees are considerably higher, run for the hills! This agency is preying on people’s desperation, and a call to the Better Business Bureau is likely to yield complaints against it.

Straight Talk

Talking with various adoption agency representatives at adoption conferences is a good way to find an agency that could be right the right fit. Pay careful attention to how forthcoming they are, how extensive their answers to your questions are, how easy they are to engage in more detailed conversation. If they put you on the defensive for seeking information, consider it a big red flag.

Undoubtedly, you’ll have lots of questions throughout the adoption process or need to talk over issues that almost inevitably come up. You need to feel confident that your queries are dealt with respectfully.

This is also a good way to test the waters regarding the agency’s ability to be there for you emotionally. While you are not marrying your adoption agency, it will be a part of your life long after your adoption is complete. In domestic adoptions your agency may well be the conduit between you and your child’s birth parents. In international adoption your agency will continue to be a resource connecting you to your child’s birth country.

For a list of adoption events in your area as well as a directory of domestic and intercountry adoption agencies, go to the Adoptive Families magazine’s website: www.adoptivefamilies.com, an excellent resource as you begin your search.

Compare and Contrast

Once you have developed a list of potential agencies, compare agency track records.

Check out how long each agency has been in business and how many children it places each year. Find out exactly what services the agency provide. Determine if there are requirements regarding age, sexual orientation, or religion.

In a domestic adoption will the agency do all the advertising for a pregnant woman who wants to place her child, or are you expected to search on your own as well? How do they choose which birthmothers will see your portfolio? And how do they handle situations that fall through? (In that case, you should not have to pay additional fees.)

Diane, 47, and her husband Steve, 45, went to the Internet in search of a domestic adoption agency. They were dismayed by the sheer number of agencies and had no way of knowing which agencies were good and which were scams. They turned to an adoption attorney in their state and asked him for recommendations. The first agency he recommended was a large, well- established agency. They contacted the agency and learned there was a 10-month wait just to attend one of their introductory talks. The second agency recommended by their lawyer was a small agency in New England.

Steve and Diane attended a “get acquainted” weekend there and were impressed by the forthright way this agency handled participants’ concerns about birthmothers changing their minds. An adoptive parent spoke with them about having to return a baby whose birthfather had stepped forward, how she dealt with her disappointment, and her ultimate joy when she finally adopted her daughter. Steve and Diane felt comfortable with this agency because it felt personal—not “corporate or high-pressured.” They endured some false starts—with birthmothers deciding to parent their children-- but brought their son Justin home two months ago. Next summer they will be attending their agency’s annual picnic, which brings children, their adoptive parents and their birthparents together. Their relationship with their agency continues to sustain them as new parents.

Felicia and Dan, both 47, knew they wanted to adopt from China. They split up the task of speaking to agencies at conferences and going to introductory meetings. One agency they considered proved to be “restrictive” and “judgmental”—Felicia says the agency told them that since Felicia was still trying to conceive through IVF, they were not eligible to sign on—after the agency had accepted their fee for an initial consultation.

Later, Dan attended a meeting at a large, national agency with a small China adoption program. They were impressed by the program director, who was Chinese and had a good relationship with CCAA (China Center of Adoption Affairs). He also had relationships with the agency’s adoption facilitators in China, the people who walk parents through the process when they go to pick up their child. Moreover, Felicia found this agency’s personnel were flexible—it was fine with them that they were still trying to conceive. And, although people at the agency were knowledgeable, they were not patronizing. They were honest about the changing timeline for adoptions from China and let them know when it changed from 8 months to 12 months then to 18 months. While the couple was waiting to get their referral matching them with a child, they were able to meet other adoptive parents at agency events and Chinese holiday celebrations. Two months ago, Felicia and Dan went to China, along with their two daughters by birth, and picked up Beatrice who is now 14 months old.

Checking out agencies can be a little like going on a series of blind dates. You gather the facts, get to know them as well as you can, and then follow your gut. After all, you are entering into a relationship that should last a lifetime.

Carolyn Berger, LCSW, is AFA’s Adoption Coordinator. She has two sons, one biological and one who came to her family through adoption.

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Support Line: 888-917-3777. Fax: 718-601-7722. www.afafamilymatters.com