"My Baby, Not a Baby"

Let me tell you a story. It's about me earlier in my life - an obstetrician and gynecologist who delivered thousands of babies in her career.

It's also a story about me now - a psychotherapist who counsels women who are having difficulty getting pregnant. My psychotherapy practice focuses on women in their late 30s and early 40s with infertility issues who are undergoing IVF to become pregnant. Many of these women go to the reproductive endocrinologist for IVF late in their reproductive life and, by the time these women present to me for psychotherapy, they have often undergone several failed cycles of IVF. Needless to say, they are devastated.

Yes, this story is about me, but it is also about Mary. She is a 45 year old woman who came to see me for counseling after four cycles of failed IVF. As you can imagine, she was shattered by these failures. Her doctor had recommended that she use donor eggs for IVF, that is, eggs from a younger woman, as Mary's own eggs were just too old. But Mary told me that she wanted "my baby, not a baby." She wanted a baby who shares her genes. She wanted a child who shared her smile, her personality, and her endearing quirkiness.

Let me tell you more about Mary. She was born and raised in rural Alabama where she lived with her mother, father, and two younger brothers. Mary was very close to her siblings during childhood and, as the oldest, felt protective of them. And at a very young age, she began a pattern of behavior of putting her own needs on hold in deference to the needs of others, such as her siblings and parents.

Mary's childhood was far from idyllic, mostly marred by her father's illegal drug use. As a consequence of his illness, the family struggled financially, so she took odd jobs after school, rather than playing with friends, to bring more money into the household. She often cared for her siblings when her mother was too exhausted to do so and, according to Mary, her mother was often exhausted. In addition, Mary took care of her father while he was using, while harboring the fantasy that she could keep his drug abuse a secret from her brothers.

Mary always enjoyed school as a refuge from the chaos at home and did well academically. During her freshman year in college, her father died of an overdose. She reluctantly left school to be with her mother and her siblings and had little time to process these losses. For the first time, she noticed resentment towards her mother and her mother's choice of partner that led to her needing to leave school. She and her mother kept the family financially solvent. Mary woke up early to work at a coffee shop and to help her siblings get ready for the school day while her mother worked at a local grocery store. Together, they were able to provide the financial resources to keep the younger siblings in school and the family financially stable. Over time, Mary recognized that she was sacrificing herself to keep her family together. As her siblings began attending college, participating in the social life of dating and partying, Mary's frustrations and resentment towards her situation grew. Several years later, as her siblings were completing their education, Mary enrolled at an Ivy League college and majored in economics.

She is currently employed as a data analyst by a health-related Fortune 500 company in New York City.

Mary had always felt a desire to have children of her own. She dated occasionally when she was in her 30s and early 40s, but did not find a life partner. This saddened Mary as her current situation was far from her reproductive story. Most people have what psychologists call a reproductive story, i.e., a story, a fantasy, or a wish that people tell themselves when they are children or adolescents about the family they desire when they become adults. How many children will I have? A boy first and then a girl? Will they look like me? Mary had a reproductive story in her teens: she told herself that she would marry a man she met in college and raise a large family with him.

In her late 30s, Mary began to consider having a child as a single mom. This was a difficult choice for Mary, and it took time to make this decision as it conflicted with her reproductive story. By age 43, she had made the decision to pursue this path, and she began treatment with a reproductive endocrinologist. She ordered donor sperm from a sperm bank.

And then she came to talk with me. She was 44 years old and had already undergone four cycles of in vitro fertilization using her own eggs. The first three cycles failed to produce a pregnancy. The last cycle of in vitro fertilization produced a pregnancy which, unfortunately, miscarried at seven weeks. 

After the first failed cycle of in vitro fertilization, a few years back, her reproductive endocrinologist recommended that Mary consider egg donation as her eggs were just too old. Mary hesitated, frozen by fear to not be able to have a child that shared her genes, especially in light of the fact that she would be utilizing donor sperm.

So how could psychotherapy help Mary? She and I met weekly to focus on this hesitancy. Our work together helped her to understand not only her past delay in seeking reproductive technologies and coming to the reproductive endocrinologist late in her reproductive life, but also her current hesitancy to accept donor eggs. Mary was angry at herself for beginning fertility treatment so late in her reproductive life, as she felt that her employment in analytic business data should have made her aware of the data on how maternal age affects reproduction and pregnancy rates and the data's implications for her situation. She wondered how she could have ignored the meaning and significance of the data and, in the process, undermined her own fertility. Mary and I worked through this anger.

Much time in psychotherapy with Mary was spent understanding what I call the concept of "my baby, not a baby" and her hesitancy to carry and raise a baby that did not share her genes ("a baby, not my baby"). Our discussion revolved around her understanding of what it means to give birth and to raise a child not biologically related to her. We wondered together what it would be like if the child did not share her eyes or her smile or her personality. Would she see glimpses of herself reflected in her child? Mary was also worried about how to explain her choice to become a single mother to her child. Would the child be resentful in the same way that Mary's mothers' single parenting after the death of her father made Mary resentful? For Mary, the concept of "am I enough?" emerged as she recognized that her choice to become a single mother necessitated her assuming the role and the workload of two parents. Could she be a good enough mother if her eggs were too old and not good enough?

As Mary's psychotherapist, I tried hard to understand these concerns. But as a retired obstetrician and gynecologist, I would have liked Mary to have begun fertility treatment in her 30s, as I am well versed with the medical literature on the decline in pregnancy rates as women age and time goes by. I was acutely aware with each passing month of treatment that Mary had once again missed a cycle of reproductive opportunity. Each round of in vitro fertilization was filled with futile procedures using her own old and worn out eggs because she could not move forward with an egg donation.

And what was I feeling? My own maternal identity is also central to me and I desire that everyone who wants children should have them. I worked through both my strong desire for Mary to be a mom in my own personal psychotherapy, as well as the anxiety in me that was created as time passed in my 45-year-old fertility patient. I identified my longing that we would resolve problems quickly and rapidly work through issues. I had to check my desire to encourage her to find embryo donors, as well as my fantasy that we would search through donor catalogs together. I felt the rapidity of the passage of time in my work with Mary, as well as my desire to get ahead of it by moving psychotherapy forward quickly.

But I also knew that the slow unfolding of psychotherapy, like fertility, is constrained by the reality of time. You just can't push it forward too quickly. I came to understand that psychotherapy had to proceed at Mary's pace, not at mine. I adjusted my expectations, as I became aware that my own desire to move Mary forward too quickly would leave us little time in psychotherapy to wonder, to work through, or to process.

Over time, as we worked together, Mary finally accepted 14 donor eggs from a 22-year-old donor. At the time of this writing, she is eleven weeks pregnant. She tells me that she is "holding her breath" to hold things steady, hoping not to lose this pregnancy. Remember I told you that this story is also about me? I think I am holding my breath for her, too.