Control, Loss and Dreams: Searching for a Solution to Infertility
An Interview with Pat Johnston

Interview By Allison Martin

Pat Johnston is a well regarded publisher and prolific author and speaker on infertility and adoption. In this exclusive interview she discusses a thoughtful approach to coping with infertility. Prospective parents who are struggling with infertility will also enjoy her exemplary book, Adopting: Sound Choices, Strong Families.

In your book, you state that adoption satisfies some needs for infertile people, but not all. What can adoption do, and what does it not resolve?

In 1978 Barbara Eck Menning, the founder of Resolve, was the first person to begin talking about infertility as having an emotional component rather than just talking about the medical aspects. She saw infertility as the loss of a dream child, and many of us in the early days of Resolve saw that as really helpful and comforting. But as I began to work with more and more infertile people as a Resolve volunteer, it became clear to me that there were really multiple losses that accompanied the experience of infertility, and that depending upon the individual (and, ultimately, the couple's ability to compromise) how important each of several losses might be could rule certain options in or out for them.

I see six major losses (and attached sub-losses) related to infertility. From my perspective those losses are

1. The loss of control (over multiple aspects of life that most post-birth-control generation folks take completely for granted)
2. The loss of genetic connection and continuity (carrying our family's genes into the future)
3. The loss of a child conceived jointly with a beloved partner
4. The loss of the physical, sexual aspects of impregnating and being pregnant
5. The loss of the emotional expectantions we have about the pregnancy and birth experience
6. The loss of the opportunity to parent.

Adoption "solves" or "prevents" just one of these losses. By adopting, we prevent the loss of the opportunity to parent. So, for couples who find that what they wanted most out of their attempts to conceive a child was the opportunity to parent, adoption is a healing experience.

How are other choices for resolving infertility similar to adoption, in this sense? What common issues may arise with these options?

Well, let's look at some examples. When a woman wants more than anything to experience pregnancy, often she can if she uses donor eggs or adopts an embryo. If her husband is infertile, using donated sperm will achieve that pregnancy. When a man feels a need for a genetic connection but his wife is unable to conceive, using a surrogate or a gestational carrier will give him what he needs.

Those who feel most deeply the sense of lost control are the ones who are most "put off" by the adoption experience with its "interference" by agencies and lawyers and a need to prove oneself to a pregnant woman unable or unwilling to parent. Sometimes those who most deeply feel the loss of control find that reaching positively toward a childFREE lifestyle rather than to remain childLESS gives them back a sense of control.

What is important to consider when searching for a solution to infertility?

I believe that for couples, the most important thing to consider is the endurance of the partnership. The two of you may not rank or weight those losses in the same way. So what looks like an obvious solution to one (say, using donor sperm to achieve a pregnancy for the wife) may feel absolutely wrong for the other (say, an infertile husband whose main issues are genetic connection and control.) When are losses are not the same, we are going to need to reach for compromise--or, even better, a solution that offers synergy. Neither may get their optimal dream, but in sharing loss and choosing an option that gives both most of what they want, you nourish the partnership, and, as a result, the family.

What resources do you consider helpful in coping with infertility, and moving toward building a family?

It's important first to get a full and comprehensive diagnosis, includings second opinions in many cases. Once people fully understand the extent of the medical problem and can be realistic about their statistical odds of treatment success, they are better able to explore all family building options. This doesn't mean that they should try all the treatments available before moving on. I think that the next step is to gather a lot of information. I think that internet support listservs and sites can be very helpful to some, but face-to-face education and support, though not as "convenient" are ess likely to result in misinformation or misinterpretation that often are byproducts of the "shorthand" that is core to internet communication.

In Adopting: Sound Choices, Strong Families I offer a step-by-step plan for decision making that culminates in a retreat weekend where all of our self exploration and fact gathering comes together to help us talk about feelings and fears and wants and needs. First step is self examination. What is REALLY important to you, to your partner? Take an inventory of your financial, emotional, physical and age and time related resources. The next step is gather data about all of the options available. Reading is important of course, and attending conferences, but I think that most couples need more than "just the facts." With facts in hand, sharing honestly with one another in a milieu that is free from distractions and the pull of things that we "need to do" very often results in a mutually satisfactory plan for what to do next.

Often this is enough to help couples feel that they are on the same page. But sometimes the couple can benefit from sitting down with a completely objective third party. Not a doctor or infertility nurse or adoption worker, all of whom are a slanted perspective, but a therapist or a mediator whose objectivity can help each really "hear" what the other is having difficulty expressing. Those professionals are out there, and often three or four sessions are all that are needed for clarity.

© Copyright 2008 Allison Martin