Most women are raised to expect that they'll become mothers some day. From baby dolls to baby showers, we're surrounded by images and expectations from parents, peers, religion, advertising, and the media. For many men, too, the hope of fatherhood is a fundamental part of their identity. The pressure to raise a family can be enormous, and the thought of not being able to can make many people feel something is wrong with them.

At Coastal Fertility Medical Center, we work very closely with Ellen Speyer, MFCC. Ellen is a licensed marriage and family therapist, with a specialty in Infertility and third party parenting. Ms. Speyer consults with individuals and couples to help with the difficult feelings of infertility while advancing their goals of creating new families.

Please read on for some suggestions for maintaining your sanity during this difficult time.

Recognize that Infertility is a crisis
Infertility may be one of the most difficult things you'll ever face. It can call into question the most basic expectations you have for yourself, your body, and your relationship. Allowing yourself to feel these powerful emotions can help you move beyond them.

Don't blame yourself
Once faced with infertility, don't be surprised if you start to second-guess yourself. Or if voices run in your head: I shouldn't have waited; I'm being punished for having that abortion; I should have lost more weight, or taken better care of my health; or I shouldn't have assumed that I could have children when I wanted. Self-doubt is a common but destructive pattern. Don't keep looking in the rearview mirror or you'll crash. Look forward.

Educate yourself about Infertility
Read, read, read and ask questions. This is solid advice when you face any problem, but it's especially important when dealing with infertility because the technology is complicated and changes so quickly.

Work as a team with your partner
Don't give in to the temptation to blame each other. Instead, help each other. This doesn't mean you need to feel the same thing at the same time (most experts say couples are often out of sync), but it does mean paying attention to what your partner is going through. Practical issues can also help you work with, not against, each other. If you're undergoing treatment, he can take care of the insurance papers. Or if he needs injected therapy, you can administer the shots. Work together to find ways to share the burden.

Establish "Talk Time" with your partner - The 10 Minute Rule.
Infertility presents extra strain and conflict for your relationship. Managing strong feelings and having to make important, difficult decisions together places pressure on each of you. Usually partners in a relationship handle their feelings differently. Typically, the woman trying to become pregnant is thinking about this all the time. Because her longing is deep, her desire to talk about the details of their treatment and all the what-ifs doesn't end. Typically, the husband would prefer not to talk about their situation all the time choosing instead to discuss it only at appointment times.

This discrepancy of needs usually results in some hurt and anger. To accommodate the needs of each person and to avoid an increase in ongoing tension counselors recommend the "ten minute rule". The rule is simple. Set aside twenty minutes. Use the oven or other timer. Each partner is allowed ten minutes to share all that he/she would like to share regarding their feelings. This is time to talk without being interrupted, criticized, corrected or overruled. Pure sharing of feelings is the exercise. When the buzzer rings, the other partner speaks his/her feelings without interruptions or criticisms.

Anything not shared in ten minutes is tabled for the next evening.

Now each person has insight and understanding into the thoughts and feelings of each other. For couples that commit to this exercise the reward is staying emotionally connected to their partner by using a time frame that protects each person and the relationship.

Say no to baby-focused activities
If certain gatherings or celebrations are too painful for you - all your siblings had babies two years ago, say, or you keep getting invited to baby showers - give yourself permission to avoid them when you're having a particularly tough time. Going would only be torture.

Get support from professionals or other Infertile couples
Because society often fails to recognize the grief caused by infertility, those denied parenthood tend to hide their sorrow, which only increases feelings of shame and isolation. So talk to others. Find a support group through RESOLVE, the national nonprofit established to help people cope with infertility, or check out our list of other resources. A recent study of women undergoing IVF found that those who openly discuss their emotions have a higher pregnancy rate than their more silent peers do.

Discuss limits with your partner: How long will you try?
For some people, that means getting off the treatment wagon before they get on. For others it just means setting limits of how many cycles they are willing to go through before deciding to move on to alternatives such as Coastal Fertility Medical Center's Donor Oocyte Program, Surrogacy, or even adoption.

Decide how much you're willing to pay
Coping with the anxiety caused by the high costs of treatment can be traumatic. Force yourself to face facts about your finances. In California, there is no mandate for Infertility coverage, and very few employer health plans cover infertility treatments, and even if you have adequate coverage your cash flow will likely suffer for a time. With the high cost of Infertility treatment, it's no wonder that couples often feel anxious about money, especially since some women need to go through multiple cycles before becoming pregnant.

Sit down together and develop a financial plan. Start with your insurance: Find out exactly what it does and doesn't cover. If it covers some of your treatments, decide whether you or your partner will monitor the paperwork and negotiate with the insurance company. Then look at all your assets and determine how much you can spend and on which treatments.

Balance optimism and realism
You need to be optimistic, but don't set yourself up for a huge fall with unrealistic hopes. By keeping up to date on the technology and your diagnosis, you can get a good handle on what chance of success you have with each treatment. Letting go of a dream is difficult, and the array of medical technologies available today leads many couples to keep trying month after month, year after year - that's the hopeful part. But nearly half of couples treated for infertility won't go on to have a biological child, and often they must make peace with that before they can move on with their lives. Trying to stay realistic about that can help you make smart choices as you work your way through the emotional roller coaster of infertility treatment.

Take care of yourself by pursuing other interests
While being treated for infertility can feel like a full- or at least part-time job, it's important to keep up with some of the activities or hobbies that bring you pleasure. This probably won't be easy, especially if you're coming into the office for a blood test on a regular basis, but look for ways to take care of yourself. Try to do things that can give you relief from the focus on infertility, such as getting a manicure, a massage, or going to a show… anything to get your mind on a different focus. If your old activities are painful - maybe all your friends are parents now - look for new diversions. If you've always wanted to learn guitar, do that. If hiking is your thing, make sure you do that. Or take a class - painting, dance, or something else that's always tempted you. And remember, laughter is one of the best healers. See a funny movie, head out to a comedy club, re-read your favorite funny novel.

Question: Can infertility cause depression?

Answer: Yes, absolutely. How could it not? After all, infertility interferes with your marriage, your sex life, your relationship with family and friends, as well as your job and financial situation. Infertile women are much more likely than fertile women to have symptoms of depression. In fact, infertile women have levels of anxiety and depression equivalent to women with cancer, heart disease, and HIV+ status.