Excerpt: Don’t Tell Her to Relax

Excerpt: Don’t Tell Her to Relax

BMP- Don;t tell her to relax

By Zahie El Kouri

Chapter 3: Empathize with Your Infertile Loved One’s Sense of Urgency

While many women won’t want to discuss their infertility, some will eventually confide in close friends or relatives, and others will be open about their difficulties with getting pregnant from the first sign of trouble.

If you know your ILO is having trouble getting pregnant, whether she has told you or you just suspect, it may be very tempting to tell her to relax. You are not alone. As a society we seem to have decided that, “Just relax and you’ll get pregnant,” should be the automatic response to a confession of infertility.

Variations on the theme include, “If you go on a vacation, I just know you will get pregnant.”

Or, “If you start the adoption process, you will get pregnant.”

Or, “The minute you stop trying to get pregnant, you will get pregnant for sure.” All of these statements sound fine in the abstract.

It’s true that many women get pregnant while waiting to be placed with a child through adoption. It’s true that relaxation is key to good health, and good health is important for the reproductive system. It’s true that vacations are generally excellent, and your ILO probably deserves one.

But the reality is that true infertility is a medical condition, and relaxation will not cure any of the underlying physiological problems that cause it. Adoption is a long process, and some women will get pregnant while waiting to be placed with a child just because of how long it takes. But if your ILO has primary ovarian insufficiency (formerly known as premature ovarian failure), no amount of relaxation or adoption paperwork will help her conceive a child.

Even if your ILO knows you mean well, try to hold off from offering this kind of advice. It can sound flippant and smug, even if you don’t mean it that way. And even if relaxation would help, your directive will not help your ILO relax at all, and will probably make her feel as though you don’t understand her sense of urgency and panic about having a child, in turn making her feel less supported rather than more supported in her situation.

Takeaway Tip: Never say, “Just relax, and you’ll get pregnant.” Concentrate on other aspects of your relationship, or gently ask, “Do you want to talk about your fertility treatments?” You can always remind your ILO of the following: “I want you to know that I am not bringing up babies because I don’t want to be nosy, but if you ever want to talk about them, I’m here for you.”

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Author Q&A: Zahie El Kouri

Headshot Zahie El KouriWhat was your inspiration for writing Don’t Tell Her to Relax?

During my many years of struggling to get pregnant, I experienced a great deal of frustration with friends and relatives who really wanted to be helpful and compassionate, but who kept saying the wrong things. I was painfully aware that these people cared about me and would have said something less hurtful and more helpful if they knew what that might be. I imagined a sign I could carry around listing my top 5 requests for human communication during this time, and that imaginary sign turned into this book.

What was the hardest part to write?

It took a few drafts to sort out my feelings about interacting with people while wanting a child and not being able to get or stay pregnant. I really had to use my novelist’s brain to put myself in the shoes of all the nice people who meant well but who said things that I found hurtful and frustrating.

What was the greatest challenge in bringing the book to market?

The greatest challenge was my own attachment to the traditional publishing model. It was difficult for me to let go of the idea that someone else had to say the book was good enough to merit publication.

What do you hope the reader will take away from your book?

I hope readers will learn some simple, concrete actions they can take and meaningful, compassionate things they can say to be supportive of those who are experiencing infertility.

What book(s) had the greatest influence on you?

If I had to narrow the list down to three,

  1. Gish Jen, Typical American, for its portrayal of the immigrant family experience.
  2. The Unusual Life of Tristan Smith by Peter Carey, because Peter Carey is amazing.
  3. Mei Ling Hopgood , How Eskimos Keep Their Babies Warm, for its reminder that almost all parenting truths and methods are culturally constructed.

How do you balance writing and motherhood?

Now that I am a mother of infant twins in addition to a toddler, I am able to balance writing and motherhood with a lot of child-care help from my husband, my mother, and assorted babysitters. I also am really working on defining success both as a parent and as a writer on my own terms. Having worked so hard to have a child and being an older parent has made me both more comfortable with my current work-parenting balance (which currently involves more parenting than work), and more eager to get back the time I invested in fertility treatments and logistics.

What is your advice to mother writers?

Ask for the help that you need. Ask for the time that you need to do the things that will make you a balanced person and better parent.

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Adventures in Fertility and Mortality

Adventures in Fertility and Mortality

By Zahie El Kouri

spring2012_elkouri“Do you believe in an afterlife?” the doctor asks.

I’m lying on an examination table, wearing a sweater and socks, my feet in stirrups. A nurse has given me a folded, translucent square of paper, and I choose to leave it folded to cover my lap effectively rather than unfold it to cover more of my body while leaving nothing to the imagination. The doctor slides a special probe up what the truly educated are now calling the vajayjay. I am about to start my second round of in vitro fertilization, and the doctor is doing a baseline transvaginal ultrasound to see if we can go forward.

For some women, this kind of ultrasound is no big deal, but for me it is so uncomfortable it verges on the painful. I know I’ll be less uncomfortable if I relax, but I can’t do that because the doctor and I are talking about my father’s death.

My husband, John, is sitting by my side, and he squeezes my hand when he hears the doctor’s question. John is sad about my father’s death, sad that I have to go through all this medicalized stripping down, sad that sex has been taken out of our procreative equation. But he is also tired of being sad. That’s why minutes ago, before the doctor arrived, when I was crying while taking off my clothes, he tried to distract me by singing the tune of what he says is the music one finds in porn. Bam ba dah bam bah. Humor is the way he copes with stress and sadness, and the doctor has undone the moment of laughter John and I shared in his absence.

“So, how long has it been since your father died?” the doctor asks. He is looking from my vagina to the monitor and back again, and pushing buttons on a side panel. His glasses are smudged, and through a trick of the light, I can see my reflection in them, even though he isn’t looking at me.

“About six months,” I say, even though I know the answer down to the day.

“Was it a long illness?”

“No, just ten weeks. Pancreatic cancer.”

 *   *   *

In many ways I’m a typical fertility patient, if there is such a thing. I am thirty-six years old. I have been trying to get pregnant for three years. Seven months earlier I lost my first pregnancy, achieved through IVF, to miscarriage. Two weeks before this appointment, I started injecting myself with Lupron, which has put me into temporary chemical menopause, a condition that, ironically, will help me get pregnant through IVF, even though the associated mood swings and headache may also alienate everyone who has ever loved me.

Fertility and mortality are not the only things on my mind. Just a few months after my father’s death, John and I moved to this new city for his new job. My mother is staying with us because she is too sad to be alone, and my in-laws are visiting, and all the parental attention only highlights my father’s absence.

In many ways, I am alone in my grief, and in my mind having a baby has become all tied up with my father’s death. A grandchild was perhaps the thing he wanted most in life, and I feel like a failure for not finding the right person to marry earlier, for not having a baby before his death. I can blame the weepiness and the irritability on the chemical menopause (and I do), but I know that I am sad and desperate because I am still trying to redeem myself.

I want a baby—I have always wanted a baby—but the truth is that, without my father’s death, I might have chosen not to do all of this. I might have chosen adoption. The truth is that, yes, I do believe in an afterlife, in a religious sense, but that belief does not save me from my grief. It does not keep me from missing my father. The truth is that I am loath to start injecting myself with drugs that will hyperstimulate my ovaries. I am loath to go from chemical menopause to chemical super-fertility in ten seconds flat. But the most important truth is that right now, I am willing to do anything to preserve my father’s genetic legacy—other than my memories, the only piece of him I have left.

“Well, do you believe in an afterlife?” the doctor asks.

There is a long pause, and eventually, John answers the question for me.

“Yes,” he says. He takes my hand and squeezes it. “She does. Her priest really helped us through it.” John leans toward agnostic, but he, too, is transformed through this experience of death. He prefers humor, but he knows when to step in and be serious.

I cannot look at John without crying, and I don’t want to answer the doctor’s question, so instead, I spend my time coming up with all the possible reasons for the doctor to ask me this question at this particular moment. I come up with three:

1. The doctor may think that making any conversation will distract me from what is going on with my body, and therefore relax me (like a Caribbean vacation with no hurricanes).

2. The doctor is particularly curious about my unique presentation of the human condition. The doctor has lost a loved one, and has found solace in his belief in an afterlife.

3. The doctor is bored because he has seen too many vaginas.

I begin by considering reason #1. Maybe the doctor has had success with making small talk while doing transvaginal ultrasounds. Maybe, after dealing with thousands of women desperate for a child, he believes that having a conversation about something other than fertility will relax me, reduce stress, and increase my chances of getting pregnant. Maybe he sees himself as part therapist, and knows that I am in desperate need of some therapy before I should be allowed to get pregnant.

This may all be true, but I still rule out rule out reason #1, as it is unlikely that anyone would think that asking about a patient’s father’s illness and death would distract her from a penis-sized plastic probe up her vajajay.

I next consider reason #2. I vaguely remember this doctor mentioning losing his own parents. Maybe he struggles, as a man of science, with issues of faith and mortality. Maybe creating fertility miracles every day has given him the intellectual space to consider the possibility of an afterlife. Or maybe it is the opposite. Maybe he doesn’t believe in an afterlife, but he envies those who do?

If I were being rational, I might conclude that I can explain the doctor’s behavior with reason #1 or reason #2. He is a warm and friendly man. Like my husband, he’s sad for me. But I don’t want to dwell on these possibilities because they are just too painful, so I go with reason #3—the doctor has simply seen too many vaginas.

Now, to be clear, my doctor is a board-certified reproductive endocrinologist with an excellent record of successful IVF pregnancies, so he sees more vaginas than say, your average neurosurgeon. He probably also sees more vaginas than your average obstetrician/gynecologist, as your typical patient comes in once a year, takes off her panties, and that’s it. She might get pregnant, in which case, she would be coming in every now and then for exams, and then there would be the labor, where the doctor would see a whole lot of her vagina, but still, most women don’t go through labor more than once a year. Unless they have multiple uteruses, but that might present other issues that might also require a specialist.

It’s not that I think my vagina is anything special, or that I don’t appreciate the square of paper or the fact that my doctor will spend the extra ten minutes talking to me about my IVF cycle or inquiring as to my state of mind and grieving process. I respect the Swedish position on nudity and the time-honored tradition of skinny-dipping. It’s just that I miss the days when the only naked conversations I had about the afterlife were with my husband. I am tired of being physically and emotionally exposed. I don’t know how to talk about my feelings about death while trying to create new life.

*   *   *

In the next year and a half, I manage to get pregnant and miscarry twice more. I travel to another state for even more specialized medical treatment, coming back to the afterlife doctor for early-pregnancy monitoring when I get pregnant for the fourth time. In the appointments, he is still friendly, though he discusses work with John instead of discussing death with me. When I’m eight weeks pregnant, he sends me on to an obstetrician, wishing me the best.

That pregnancy took, and I gave birth to a healthy baby boy in June of that year. Soon after, I see this doctor again, as John and I leave the office of a lactation consultant who shares his waiting room. The doctor’s receptionist sees us walking by and sends him out to see us while we’re trying to get our crying baby into his car seat. The doctor approaches and greets us with a smile. After asking permission, he takes the baby and dances around with him. The baby stops crying and looks at his reflection in the doctor’s smudged glasses.

“How are you feeling?” he asks.

“I’m great,” I say. “Tired, but happy.”

“That’s good to hear,” he says. “Isn’t that good to hear?” he asks the baby in a sing-song voice.

John and I smile at each other.

“Who do you think he looks like?” the doctor asks, looking from the baby to my husband, and back to me. “I see bits of both of you.”

“He looks like Zahie’s father,” John says. I have never heard him say this before. “It’s nice.”

I stare at the baby with new eyes. I have been so sleep-deprived since his birth, so focused on the work of keeping him fed and clean and making sure he is still breathing, I haven’t really studied his features.

John is right—there are my father’s big brown eyes, his full lips, his round face. I hope to see my father in the afterlife, but I am happy to have these pieces of him here with me now.

*   *   *

Author’s Note: “Once infertile, always infertile.” That’s what my friend used to tell me when she was pregnant and I was still in the midst of my infertility struggle. At the time, I thought she was a little crazy, a little whacked out on pregnancy hormones, but now I know what she means. My ongoing mental state of infertility, which persists despite the presence of my vocal, playful baby, leads me to check the infertility message boards every day, and to pay special attention to any personal essays about infertility or fertility treatments. I’ve noticed a trend lately of comments on these essays saying that women who go through IVF to get a child instead of adopting are selfish. Was my desire to see my parents in my child selfish? I think about this question all the time. I wish more peace in this question for others, and I hope that this essay will give a sense of some of the emotions connected with wanting a child with a genetic link to you—and the ways in which those emotions are so much more complicated than the word selfish might ever contain.

Brain, Child (Spring 2012)

Zahie El Kouri writes about family, fertility, and immigrant culture. As the child of a Syrian/Lebanese/Palestinian father and an Italian mother, she has a special interest in the experience of second-generation immigrants, within the family and without. Her creative non-fiction has appeared in Memoir Journal, Brain, Child, Garbanzo Literary Journal, and Ars Medica. Her short fiction has appeared in Mizna, a Journal of Arab American Writing and the second edition of Dinarzad’s Children: an Anthology of Arab-American literature.  She holds an MFA in creative writing from New School University and lives in Austin, Texas with her husband, the novelist and legal theorist John Greenman, and their son. You can read more about Zahie at www.zahieelkouri.com.

The Girl with the Levantine Eyes

The Girl with the Levantine Eyes

By Zahie El Kouri

Two years ago on a rainy Tuesday in February, I spent several hours studying the Facebook profiles of female relatives who lived in Amman, Jordan, second cousins I had met only once ten years earlier. I was looking for a taller, sleeker, more symmetrical version of my physical self, someone who might consider being an egg donor.

When I joined Facebook, I had no idea it would be so useful in shopping for genetic material. Here, along with friends and acquaintances, were all the female relatives who liked me enough to “friend” me, conveniently displaying their photos in casual clothing, swimsuits, and formal wear, like a Miss Levantine Arab pageant in which they did not know they were competing.

As you might imagine, there are challenges involved in searching for an egg donor on Facebook. Just as I narrowed my cousins down to the two between the ages of 18 and 30 who were not married, I remembered that we had spent only a week together ten years earlier, and that I did not speak Arabic, and that I did not know how much medical English each of these young women spoke. I considered the logistical challenges involved in flying one of them to the United States for treatment, not to mention the dozens of transvaginal ultrasounds and needles involved, and I logged myself out of Facebook for the day.

I thought I had no intention of looking for an egg donor. I was sure that if IVF didn’t work out for me, I would turn to adoption. So why was I spending all this time trying to find my perfect genetic stand-in?

It all started with a well-meaning doctor. I had been through two rounds of IVF, one frozen transfer, and three miscarriages, and I was looking for a place to have either another frozen embryo transfer, or my third round of IVF. Three was all I could take, I had decided.

The doctor was a slight, young-looking Asian man who spent over an hour taking a thorough medical history, writing copious notes in blue pen on a stack of unlined white paper. When I described the last miscarriage, technically a chemical pregnancy, he nodded patiently, and said, “I see the problem.”

The doctor started a list on a fresh sheet of paper: the endometriosis, the miscarriages, the chemical pregnancy, and at the bottom of the list, he wrote the number 37, and next to it “Advanced Maternal Age.”

“As you get older, the percentage of aneuploid, or irregular, eggs increases,” he said, circling the number several times.

“So I would recommend doing genetic testing to see if you can gener- ate any normal embryos at all. Because if we do another round of IVF and we test the embryos, and because of your Advanced Maternal Age, none of them are normal, maybe you want to move to donor egg.”

“Actually,” I said. “I don’t want to do donor e-“

“No one wants to go to donor egg,” he said. “But it can be a really great option for someone of Advanced Maternal Age, particularly if you have a younger sister or cousin.”

I took a deep breath here. The doctor and I had just met, and he didn’t know my history. He didn’t know that, at this point in my life, whenever I heard the words Advanced Maternal Age and Donor Egg, I felt like the person using them was screaming YOU ARE A FAILURE. The doctor didn’t know that I dream of having my own sister or brother, someone who shares the common culture of my nuclear family, someone to mourn my father’s recent death along with me and my mother. He didn’t know that I was an only child, and, if I could have any children at all, would do almost anything to have more than one, so they could provide these things for each other. He didn’t know that during the first year after my infertility diagnosis, I was in a support group with several women who were trying to get pregnant using donor eggs. He didn’t know that I had already met with two adoption agencies and read several books on donor eggs and surrogacy. I knew that using donor eggs was an option, but I had already decided it wasn’t for me.

But that seemed like a lot to explain, so instead I said, “But I don’t have a younger sister, and I don’t have a cousin I would be comfortable asking.”

And the doctor said, “Are you sure? Because all women are worried about using a donor egg, but if you have a younger sister, you’d be surprised by how much DNA you share. My brother and I, for instance, are very similar, because we share so much DNA. It’s just a great way to preserve your genetics.”

He went on at some length about how lucky we were that modern science offered such a miracle as donor egg while I became progressively more despondent about my lack of a sibling who could donate an egg to me.

When I left the appointment, I told the doctor I would be in touch soon but I knew that I could not work with him. I cried all the way home, and then got under the covers with my puppy. This next round of IVF was my last chance to have a child who would be genetically linked to me, and, even more importantly, a child who would carry some of the genes of my father. But what was pushing me forward, since this path of assisted reproductive technology was so full of heartbreak? Was this drive to share genetics with my children a biological imperative? A complicated manifestation of love and belonging? I did not come to a conclusion in that moment. I could recover from the conversation with the doctor there, in my bed with my puppy, and I did not have to grieve my genetics yet. My next round of IVF could work, after all. But infertility and my father’s cancer had taught me to plan for the worst, and the doctor’s words were making me second- guess my decision about donor eggs.

I ran through the conversation with the doctor again. Was I sure I didn’t have a cousin who shared enough of my DNA to look like me? I thought through my family tree. I had lost touch with the first cousins on my father’s side who lived in the United States and couldn’t imagine reestablishing relations just for this purpose. I had lost track of my first cousins in Syria as well.

I turned to extended family, widening my search beyond the US I had one second-cousin in Italy who was hovering around 30, but there was no point in having her as an egg donor since she looked nothing like me, being blonde and button-nosed rather than dark- haired and Mediterranean-looking. I paused, peeking out from under the covers. Is that what was important to me? A child who was dark-haired and Mediterranean-looking? Well, if that was true, I knew where the good genes were. They were in Jordan, in the biology of the second cousins from the Palestinian-Lebanese side of the family, in the twelve or so female cousins who were the kind of women I might ask to play me in a movie.

It was that thought that sent me straight to my computer on that rainy day two years ago to spend the next few hours on Facebook looking at Jordanian cousins. I discovered that Facebooking relatives is the gateway drug of a donor egg search—when I decided that my relationship with my Jordanian cousins was too tenuous for me to ask one of them for such a gift, I found myself craving more and more donor profiles, and I soon found myself looking at donor egg websites.

Most of these are password-protected, and I wasn’t willing to admit to anyone that I was even investigating the possibility of considering using a donor egg in order to get a password, but I was able to find a few public sites with pho- tos of the young women interested in sharing their eggs. I did not immediately find a donor who looked like me among the featured profiles, which were mostly of women of Scandinavian or Anglo- Saxon origin, so I narrowed the search by ethnicity. I sorted for Middle Eastern and Arab women to reflect my father’s Syrian/Palestinian/Lebanese genes; I sorted for Italian women to reflect my mother’s genes; I sorted for Spanish women to reflect a possible combina- tion of the two. I expanded my search even further to include Persian women and Greek women, who did not look very much like me, but more like me than those of Scandinavian or Anglo-Saxon extraction.

I had no intention of actually going through with a donor egg cycle. Or did I? And if I did turn to an egg donor, did I want one who looked like me, or one who shared my ethnic or cultural heritage, since I was now assuming I couldn’t have both? Was there a rea- son I started my brief egg donor search with my beautiful Palestinian-Jordanian cousins? Did I secretly think that biol- ogy was a kind of golden ticket to being a part of the ethnic subcultures of the Middle East and Arab America? Do olive skin and dark eyes ensure the experience of dancing in a circle to the beat of the dirbekeh, of being a part of something?

My experience tells me no. Myprotean Mediterranean looks give me only a momentary sense of belonging to gatherings of Christian Levantine Arabs, of Greeks and Persians and Italians and Spaniard, but the sense of belonging does not last, since I am not really fully any of these, not raised immersed in any one language and cul- ture and set of traditions. Instead, what I have is an appreciation for the idea of belonging itself. So I don’t think my drive to have a genetically linked child is about being or looking Arab or Italian or Italo-Arab-American. Maybe it really is about the people who came before me, the people who made my parents and their parents and those beyond.

Every day I look in the mirror, and I look more and more like my father’s mother, the Syrian/Armenian woman who died long before I was born. I also look like my mother’s mother, who maybe had something Levantine mixed into her Venetian blood. There is some- thing powerful in this resemblance, in this connection to the past, a sense of history and belonging. Maybe it isn’t about intellect or rational thought, maybe it is about the visceral, the bio- logical drive for connection and continuity. Maybe having a child who looks like you satisfies this drive even if that child is not genetically linked to you. And maybe that is just as valid for those who need medical assistance in having a child as for those who do not.

A few months after my Facebook egg donor search, I got pregnant through my next round of IVF using my own eggs. My son’s looks change from minute to minute, but today, he has my Levantine eyes and my husband’s cupid bow mouth. Every day, I notice his beauty, and from time to time, I ask myself about it. Do I think he is beautiful because he looks like my husband? Do I think he is beautiful because he looks like me? Or do I think he is beautiful because I love him, because I am an attachment machine, because every day I wake up grateful that I no longer have to be sad about not having a child? I know the answer is the third of these options. I know that if we weren’t able to make him using my eggs, I would have grieved my genetics and moved on to adoption. I would have loved the child I adopted just as much as this child. I have no doubts about this. But I understand the drive to keep going past the third round of IVF, to make a child who looks like you and your partner and your parents. I understand the desire to move on to an egg donor instead of adoption, to have a child who looks like you even if that child does not share your genes. And I can easily imagine another version of myself, searching the internet late into the night, for months on end, looking for a girl with Levantine eyes, one who could act as bridge between the past and my future.

Double Take: Read another perspective on this topic: Matchsticks.

Author’s Note: I was inspired to write this essay by “Donor Agent Provocateur,” the April 8, 2012 Ethicist column in The New York Times. A couple wrote asking for advice about working with a fertility consultant to find an egg donor who matched some of the female partner’s diverse ethnic background, which was part ethnic Hawaiian. The consultant did not find a match, admitted that she did not search any Hawaiian donor agencies and refused to refund the retainer. The ethicist pronounced the behavior unethical but went on to give the couple a lecture about the ethics of looking for a racially similar egg donor. Perhaps the ethicist was trying to be kind and helpful, like the young doctor, like so many people who tell infertile women to “just relax,” but the idea that the couple who wrote to her hadn’t already thought about the complexities of race and donor eggs is the height of insult.

About the Author: Zahie El Kouri’s work has appeared in Mizna, a Journal of Arab American writing, Memoir Journal, Dinarzad’s Children: an Anthology of Arab-American literature, Brain, Child: the Magazine for Thinking Mothers, Garbanzo Literary Journal, Ars Medica, and Full Grown People. Her new e-book: Don’t Tell Her to Relax: 22 Ways to Support Your Infertile Loved One Through Diagnosis, Treatment, and Beyond, is available through Amazon, IBooks, Kobo, and Nook.


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