The Moving Goalpost of Children
Did you originally envision a large family with your spouse, and at this point you would be happy with 1-2 children? Or perhaps you are single with advanced reproductive age, and you're thinking about having one child instead of more, like you originally envisioned. Or perhaps you're like me--an abrupt divorce changed your family building vision, and we all know that egg freezing is not a solution in and of itself.
On the fertility journey, there are all sorts of unanticipated forks in the road--pieces of new information which cause us to reevaluate and reconsider if the current path is going to lead us to our original goal.
In this episode, we discuss the following:
When expectations change
Discovering our deepest why
Making values-based, aligned decisions
Partner disagreements (if relevant)
Expanded approaches for family building
How to know which way to move forward
This episode is near and dear to my heart. If it resonates with you and your journey, book a consult call with me and we can help move your journey forward.
As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.
If you found this conversation valuable, book a consult call with me using this link:
https://calendly.com/loveandsciencefertility/discovery-call
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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.
In Gratitude,
Dr. Erica Bove
Transcript:
Hello, my loves, and welcome back to the Love and Science podcast.
Today's podcast is a bit heavy, and it's something that I talk about a lot in my coaching practice.
I wanted to talk about the moving goalpost of number of children.
And I think many of us meet our partners, we have an idea about how our ideal families will look, and say we go through the fertility journey, it's taking longer than we thought, or maybe we have secondary infertility, and what we thought would be a large bustling family, that vision becomes less likely. I think it's really important to talk about how to manage those situations. And so maybe you are that person who wanted a family of three or four children, and now that you're in your mental late 30s, you're seeing that you'd be lucky to have one child or one more child at this point. Maybe you didn't meet a partner like you thought you would, and now you're thinking about conceiving with donor sperm, or maybe even freezing eggs, and thinking about having a larger family, maybe even two children.
Now you start to think to yourself, well, geez, maybe I would be even happier with one. So I think in our coaching, we have tools to help us make values-based decisions. And I think sometimes it's really important to think about what to do when the data changes, what to do when the information that we're presented with may not necessarily be compatible with the original vision. And how do we bridge those two things? How do we bridge our expectations for what our ideal family looks like, and the reality of what our bodies may or may not be able to do in this moment in time moving forward?
So let's think about it. As we do with all things love and science, let's think about the emotional side of it. Let's talk about the scientific side of it. And I think the crux of it really is when the expectations change and how difficult that can be for all of us to say, okay, well, my identity was this certain way, and the reality is this other certain way. And so how can I look at my thoughts, look at my feelings, look at the ways in which I think it shouldn't be this way, or it should be this other way? And how can we look at that and make the best decisions we can and reduce the suffering in the meantime? So when I meet every single patient or client, truly, I really want to understand their deepest why. I don't want to just understand their medical history. I want to understand how long have you been with your partner, if there is a partner.
I want to understand how do you spend your free time? How do you spend your days and what sort of work have you chosen to do in the world? What size family do you envision? I think it's important at the outset to say, okay, well, is everybody on the same page here? Or is there an acceptable range? I'm amazed at how many people have actually never talked about this before. People sitting in my fertility office who really don't know, don't have a vision for how many children they'd like to have in their ideal family, which again, this is no judgment. It's an opportunity to look and say, huh, what do I really want? And for how long have I wanted this? And why do I want this particular version of a family?
And what's my own desires and what's society and maybe what's my family of origin? I think it's really one of the most important things we can do is to get clear on who we are and what we want and maybe what influences are affecting what we think we want, because sometimes what we most deeply want, we have to tune out those other voices and really connect with ourselves and our souls and really think about us and our purpose here without all those other influences. So how can we take that deepest why? Why are you here on the fertility journey? It's not always the first answer that comes. Some people say, well, because I've always pictured myself as a parent, okay, well, why is that? And then we get a layer deeper.
And why is that? And then we get another layer deeper. And why is that? And I'm amazed at the answers that come up, right? And the quote unquote, right answer, even though there's never a right answer, that sort of the resting answer, that deepest answer is usually the answer when the whole body relaxes. And it's like, we can exhale and we can say, yeah, that's it. That's my deepest why. It's amazing. I mean, some people have said, well, I had a miscarriage and I need to become whole again. I realized how much I wanted to be a parent in that loss. And this is what I really want. Other people say it's because I have this amazing partner and we have so much love to give, you know, for other people, it's other reasons. But I think the more that you can connect with that deepest why, and sometimes it really does take a guide to pull it out. The more of a foundation, the more grounding we have to start to then navigate some of these more difficult decisions.
So that's the first thing. And I also think that identifying our values is super important to this process because our decisions, you know, we can logic ourselves into a paper bag, right? We can, we can come to any conclusion that we decide to take based on our logic and our reasoning. I was a great books major in college. I took a logic class. It's like, if a then B, right? Our assumptions have to be correct, but there's all these different ways that our quote unquote reason can lead us to certain conclusions. And those are not always the conclusions that are heart centered or intuition centered. And so when we can identify what our values are, we can start to look at these situations through the filter of our values. So some people, one of my core values is actually joy.
Other people it's love or compassion or even beauty. We have a whole exercise we do at Love and Science to help us identify our top five values because those are really, when we can make values based decisions, that's when we are really living a life in alignment, right? So coming up with what are those deepest values, you know, where have I exercised those values in the past?
How are these values going to inform my future decisions? That is also really critical to the process because we can make decisions based on our reason or based on what other people think we should do or all other, what some Facebook board says we should do. Again, I'm not knocking any of those resources, but this is where we could have two couples on paper, two individuals on paper who have the exact same numbers, the exact similar situations, right? From a fertility standpoint.
But if they have different values and they have different visions, I'm going to think about those two individuals or couples entirely differently. Like I might recommend IVF in one scenario. I might recommend insemination in a different scenario. I might have different thoughts about even numbers of embryos to transfer. You know, I do follow the guidelines, but I also believe in patient autonomy.
So I think as we think about all these various things, like the values and the decisions and the perspectives, those all matter in terms of making these heart-centered intuitive decisions.
Okay. So then what happens when we hit a fork on the road that we may not expect?
Maybe our doctor comes back and says, "You know what? Everything mostly looks good, but unfortunately your antimularian hormone is 0.3." That's a very low number. Again, not a fertility test per se, but if somebody is sitting in front of me in my fertility office and their AMH is 0.3, I'm going to start to think that they may not respond as well to medications.
And we actually do see that quite frequently with low AMHs or maybe the FSH comes back very high.
Recent patient had an FSH of like 28, totally unexpected. She came in because she thought she had a sperm issue and lo and behold, the sperm were fine and her FSH was very high. And so I think sometimes taking the time to assimilate the new information, to come back to the deepest why and the values and then say, "Okay, how can I have this new information in the context of who I am, who we are, if that's appropriate, and what can we do with this?" Right? And so when I see somebody in a situation and I give them bad news, I usually explain what I'm seeing. I empathize because I know this is not what people wanted to hear. And then we talk about kind of what it means, but we don't usually make decisions that day. Usually decisions have to come later after that information has percolated, after people have had a chance to assimilate the information.
But then we have another visit where we say, "Okay, based on this new information, how do you want to proceed?" And oftentimes, especially if we're talking about low-eg reserve, we have a conversation about other ways to build a family. And again, this is not just about egg reserve issues. This might be after somebody's had several embryo transfers of high-quality embryos and things don't seem to be moving forward. Maybe the sperm have dramatically dropped off recently and we don't know why and the embryos aren't growing very well.
People always say, "Oh, your job must be so happy." And I actually look at them and I say, it's often not actually. Fertility, the fertility journey is usually a lot of bad news on the way to getting hopefully a successful outcome. So what I see as my role, both as a coach and a doctor in my job as a clinician, is to bridge people through the process, right? To be their champion, to be their doula, to hold their hands, to help them navigate the ups and the downs, because it's a journey.
And I don't think I've ever seen a single fertility journey that was a hundred percent good news. Usually there's some mix of both and many journeys, especially the longer ones, have quite a amount of bad news in the process. So how can we weather that storm and how can we think about that in the context of the desired family size and how can we be flexible when needed, not just in our actions, but in our mindset to try and have a more expansive view of who we are and what it means to have a family. And I do not mean that. I want to be clear.
I do not mean that in saying, oh, well, that just means choosing a different pathway than originally.
That might mean saying, I really wanted four children and I now have the opportunity for one healthy child and I'm going to take that opportunity and I'm going to make peace with it.
It doesn't always mean completely pivoting or thinking about other options. Nobody needs to make any decisions they're not comfortable with, but I think really asking that question, what does being a mother look like? What does motherhood mean? Does it need to be a person's DNA? Does it need to be that somebody carries that pregnancy? What is parenthood? Fundamentally, these are actually philosophical questions. And I think when we can wrestle with those questions, then the science piece of it can find its relative place in being a tool to help with those decisions, if that makes sense. So, I will say, I think of one family I helped now many years ago, actually, and my goodness, they made beautiful embryos. And this was also a friend of mine too. So she was a friend and a colleague and a patient all in one, which is always complicated. It's an honor and a pleasure, but it's always a deep challenge on many levels because you're connected in so many ways.
And so they always made good embryos. And then around five or six weeks, there was always the call bleeding and cramping. And these were tested embryos, by the way, you played embryos. And nothing seemed to stick. I did every single thing I knew how to do as an REI. I treated enemy tritis. I even resected maybe an argument uterus and maybe a small septum. I did every single thing I knew as a specialist to make this problem better. And I couldn't explain what was going on.
So we had a conversation and I said, well, this is a lot of heartbreak. What would you guys like to do? And we talked about all the options. And they said, and this is a couple that they always envisioned a big family, partially because my friend was from a big family, but that was their vision of their ideal life was living the dream. There were two positions, living the dream with wonderful careers and also a beautiful, bustling big family. So they said to me, after five or six, you played transfers. They were like, you know what? As much as we would love to proceed, as much as we know we have more embryos, I really think we need to take a different path. And I think we're going to adopt. And around the same time, there was a match and they adopted a beautiful baby boy.
And I'll never forget, she called me, you know, when her little one was maybe about a year old and was like, Hey, can you prescribe me lectures all? And this is a friend of mine, right? So I kind of jokingly said, well, you know, if I prescribe you lectures, all you're probably going to get twins after all that. And she's like, yeah, yeah, I know. Um, could I just have a lecture? And it was appropriate, right? Clinically, everything made sense. So I gave her lectures all, would you believe that she conceived twins and stayed pregnant with twins? And so she and her husband then delivered boy, girl twins. So she had a son was her adoptive son. And then boy, girl, boy, girl twins were next. And I mean, that was wonderful because their family was growing and everybody was happy and healthy. And then she called me a little bit later and said, you'll never believe what happened. We conceived on our own. And now we were on our way to a family of four.
And so, you know, it's, I love this story because number one, it's a true story. It's a story of tremendous heartbreak. It's also a story of opening the mind and saying, you know, maybe this strong plan A pathway that we're on is not the pathway to make us parents. Maybe there's a little soul who's meant to be ours that might come to us through a different avenue. Sometimes it's even a family member. You know, I've seen people whose family members had addiction and they stepped in and nurtured that and parented that little one, you know, all the way through. So there's not, this can unfold so many different ways. But what I saw was in the process of these people becoming parents in this way and, you know, probably calming the nervous system, getting out of a, you know, somewhat toxic work environment, all those things, they were able to then go on to build their family in a different way, right? A way that they hadn't expected, but now they have a beautiful family and one that is actually somewhat in alignment with their original vision.
So I love that story. And I think it shows the power of persistence, but also the power of flexibility and open-mindedness and that we will all find our way, right? I also wanted to share another story of a patient of mine and she, I swear I thought she was going to need a gestational carrier, like similar recurrent miscarriages. You played embryos at least six losses. I probably took her back to the OR four or five times for retained products and conception, you know, and she was all set to have a gestational carrier, full RPL evaluation, reproductive immunology, like the whole work she had done it all. And she called me up and she was like, Oh my goodness, I'm actually pregnant. And we weren't intending to get pregnant because this wasn't IVF, but we just stopped protecting and I'm pregnant.
So kind of held my breath and, and, you know, deep in my heart, I was really praying that she didn't have another miscarriage because that tended to be what happened, you know, with her and the pregnancy kept going and kept going, kept going. And all of a sudden she didn't need her gestational carrier anymore because she then delivered a healthy baby boy. And then similarly, again, she called me up after that and was like, Hey, you'll never believe it, but we can see it again outside of any assistance. And now we have our beautiful son. And so again, this is a couple that was completely open to shifting gears, had completely even signed all the paperwork for gestational carrier, but being open to other options, there was a different, there was a different pathway intended for her.
So she had fully committed to switching gears. And then something said, no, actually, this is not how you're going to build your family. And so, you know, I also know many people who switch gears and they stay that course and that's how it works out for them. But I just wanted to say that families are made many different ways. It's a beautiful thing when an individual or a couple can build a family.
Sometimes people use double donor egg, double donor embryos, which is made from donor egg and donor sperm. Sometimes people need a gestational carrier to carry the pregnancy. Sometimes, you know, I have a another person in my world whose husband was paralyzed, being a cop, and they need a donor sperm. And that's how they build their family. Like, I think that sometimes it's useful to really question, you know, what is, what is a family? You know, is my strong plan? I the only way forward or might there be other ways to build my family? And that's really important to do.
Donor egg, donor sperm, embryo donation, adoption, foster care, you know, all beautiful ways to build a family. And doesn't always mean that that's the only way the children are going to come either.
You know, like I said, in these situations, I have so many examples in my own world of somebody who is committed to one way, maybe even, you know, had a child through their not strong plan A approach, right? And then somehow, a little soul entered and they became, you know, parents in the original way that they had intended or maybe slightly differently, but they were able to build their family. So that's not entirely what this is about. But I think just talking about like, how do we when we get bad news, how do we really question what does parenthood mean to me?
What kind of a family do we envision? What pathways would actually lead us there?
You know, I do think and I'll reference another episode I did before, I think sometimes it's really challenging when two people are not on the same page. And so I think some of this does require a little bit of recalibration, both individually and collectively, you know, and my experience is that sometimes, especially in a heterosexual couple, the man will just be like, this is too much suffering, I think we should just stop, we'll have a rich life without children.
You know, and I think that it is really, really important, again, to zoom out to come back to the deepest why, to think about why people want to have children in the first place, and to really look at those things. But you know, maybe by having one child, one healthy child, you know, that's going to be a beautiful family for you. And, you know, maybe all those ideas that people have, you know, I've heard from so many people, oh, but they're going to be lonely, oh, but they're going to be an only child. And I don't even know what that's like, because I have four siblings, all those things, like stripping those cultural messages away and be like, we have so much love to give.
This is the little soul that the universe is providing for us to love and to grow and to develop. And this is our responsibility. This is our legacy. And so pouring our hearts into that, I think can be really important. So how do we then know what the right answer is, is if there is a right answer, right, we always challenge that notion. How do we know what to do when we're faced with new information that makes our original vision less likely to happen? And I see this, you know, I actually just finished Ruthie Ackerman's memoir called The Mother Code.
So fascinating. I had no idea that when I signed up for this writing conference, that she had just published her own memoir about her fertility journey. And she talks about going from freezing her eggs as a married woman, when she and her partner were maybe on different pages. She talks about going back to try to use those eggs later. She talks about going through IVF. I will not spoil it for you, but I think a lot of the things in this memoir are going to be very, very relevant as you look at your own journey and the moving goalposts.
And, you know, even thinking about relationships, I help a lot of people who are in relationships where they really do want to be a parent and maybe their partner doesn't. And I actually even do see relationships end over this, not infrequently because people are on different pages and they actually are headed in different directions. But I bring this up because how do we know what to do when the information that we're getting is different than what we'd hoped for and maybe even incompatible with our original goals?
We will never know with 100% certainty, but I think the science would say, okay, if you keep trying in this way, there's maybe a low single digit percentage that it's going to work out. Or, you know, if you do this this way, you know, you're going to spend this much more money with this low chance of it working. And so I think that's where the statistics can be helpful to try and shape our decisions because we have to think about the finances. We have to think about the emotional reserves. Sometimes insurance coverage plays into these things as well.
And even age, you know, at some point it's like, okay, well, you know, if you were on the older side and you would always envision five children, maybe there are different ways to make that happen, but it might not be the strong plan A, right? So at what point do we change paths and think about donor agave? Yeah. At which point do we say my own uterus doesn't seem to be holding up? I think I might consider a decisional carrier. All these things have phases. I've never met anybody who just heard of one of these ideas and said, oh yeah, that's my next step. That's what I'm going to do.
But I think Ruthie has a really beautiful way in her memoir of like looking at that uncertainty and being in that uncertainty and making her best choices based on the evidence and, you know, a trusted doctor who seemed to really understand her and her situation. And so we're going to read it in our support group. So if you're curious, you know, inquire about our support groups, it's in October, so I'm really excited about this opportunity.
She's even going to join us for Book Club, which is fantastic. And if you know anything about me, you know, I love books and I love conversations about books and I love fertility. So it's kind of combining all the things I love, including support groups. And so, but I think that, you know, what it really does involve in terms of you making the most empowered choices for you. The bottom line is we need to carve out time. As female positions, we can just be very machine-like and we can even use our work to drown out our intuition.
I'm raising my hand here, even if you can't see me, because I'm guilty as charged. I do this not infrequently when I have a tough decision to make, when I am maybe uncomfortable, when I need to have a hard conversation. Work is always there. You know, you work a little harder, you work on a project, write a few more notes. Like it's very predictable. You can kind of drown out the uncertainty temporarily. In coaching, we call this actually a form of buffering.
But even if, you know, some people say, you know, Erica, I just want the summer not to think about this. And I say, well, that's fantastic. However, you know, you're going to be thinking about it on some level. If you're sort of resisting thinking about it, it's going to come out in strange ways. And I don't know about you, but for me, I'd rather say, okay, I'm going to journal about this for two hours on a Saturday.
And then it's going to be over rather than I'm just subconsciously like feeling irritated or weird or, you know, uncomfortable in a way that I can't quite articulate. So the point is to carve out time to listen to your body. So your body knows, okay, there's time for the feelings we can process doesn't mean it's not going to come up at other times because grief is strange and it's non-linear.
And it just does that. But I think if we can proactively say like, this is the time I'm going to carve out to feel my feelings, maybe you can't get into the mode without music. That's one of my biggest sort of tricks. If I'll use that word, trick tactics is to use music that I know will draw me into a certain mode to be able to access my feelings. But I think that unless we carve out time to listen to our bodies, our minds are going to run the show. Our reason is going to run the show. And like I said, that's just going to be like a predetermined conversation because our brains are literally machines, but our bodies have wisdom. Our bodies have intuition.
Our bodies actually know what we want. We just were not trained to listen to them. Actually, we were trained to do the opposite. We were trained to squash out any internal wisdom. We were taught not to pee when we had to pee, to fight to the fatigue of 28, 30 hour shifts. We were taught not to eat when we were hungry. And that's sort of the sign of this like superhero position. This is the opposite. And the older I get, the more that I learn that what we actually need is not always learning, but it's actually unlearning. So how can we unlearn the things that are not helpful to us?
And how can we figure out what our body is actually trying to tell us in terms of what we want and need?
Now, if there's a partner involved, it can also get complicated because what they want and what they need that might not always line up. But I think if we can truly dig in and understand our identity, our values, our deepest why, that can make the moving goalposts of children a little bit easier to bear. Because if we know that we're making decisions that are in alignment with our values, we're not going to have that cognitive dissonance.
We're not going to have to tell ourselves stories. We're not going to have to resist reality. We can start to accept a different reality, maybe even open our minds to considering other family building options, or accepting what is, which perhaps is one of the most difficult things that we can ever do, is to say, okay, well, this is the way that it is. And my resistance to this reality is actually increasing my suffering tremendously. So how can I take what is and embrace it and make the best of it and make my best choices based on who I am and what I value and who I want to be?
So, you know, I hope this has been helpful. You know, we talked about the original vision of family, you know, when expectations change, often due to new information, new diagnostic information, maybe new information that we get as we are undergoing treatments and they're not working.
These are all very, very, very difficult parts of the journey. And I think ones that we don't talk enough about at the outset, you know, I try to be a realist and I say to my patients and my clients, hey, we're in this for the long haul. So I want to get to know you, you need to get to know me, we need to trust each other ideally so that we can have the best journey together, right?
Because that's what it is. It's a journey together. But I think a lot of people are really surprised at how much harder it is than it seemed at the outset, or how many nuances and how many decisions and how many sort of terms there are that are outside of the comfort zone.
So my goal as a coach is to really keep people out of the rabbit hole. My goal is to empower and educate and help people sort these things out. So when people are feeling like they have analysis paralysis, when they are feeling so hopeless and alone, I bring it back to the deepest why, to the values, to the values based decisions, to help even couples, you know, sometimes they coach couples to help couples get back on the same page when, you know, it seems like the fertility journey is more of a wedge in the relationship than something that brings people together. It is actually possible to use this for us and for closeness, rather than as a divider, but we have to have the tools to be able to do that. And sometimes, you know, a coach is able to bridge that divide and help people turn towards each other instead of away from each other.
And lastly, I think it's really important to learn the skill of how to know what's best in a particular situation. You know, how many times do you try IVF with your own body? Do you even try IVF in the first place? There are other options, you know, calling you right outside of IVF. And so all these things are very nuanced. Like I said, there's no two people's journeys that are exactly the same. That's why I love what I do. Wonders never cease. It never gets old. But I'm really passionate about helping each person and each couple navigate this journey, full, intact, supported. We bring in fun things like vision boards and book clubs and other resources outside of ourselves to bring in art and music and literature to nourish us on this journey, because I think our left-sided brains get going so often.
And that doesn't always serve us. And so let's balance things out. Let's maybe even have a little joy along in the process, a little art and, you know, even some humor as well. So if you are like, oh my goodness, this is me, you know, I originally wanted four or five children. Now it's looking like I'd be lucky to have one. And that's really distressing to you. Call me up. I'd love to have a conversation with you. We can do a consult call. I can review everything, provide my perspective. I think one of the best things we can do is really learn how to assimilate new information and then make empowered aligned choices. And most of us are not taught how to do that. So thankfully, from all my experience, both in my own personal life, navigating difficult life circumstances, and also being a fertility doctor for over a decade, it is one of my life's greatest honors to be able to do this. So book a consult call, send me a DM.
I'd love to hear from you. And like I said, we do this in community and we are truly stronger together. So with that, let us honor that it is hard when the moving goalpost changes, but it's not the final answer. There are other avenues. We just need to figure out what is right for each individual in each couple, if that's appropriate. So, you know, I love you and let me know what you think of this episode. Like I said, it's near and dear to my heart until the next time. Bye.
