Days of waiting to ovulate or having your ovaries pumped up to produce multiple eggs. Sex on demand every other day for 10 or more days or the hCG shot and undergoing a retrieval and then transfer. Then the wait – you’re late – oh no, you got your period. The tears and the sadness and starting it all over again, DOES EVERYBODY FEEL THIS BAD?

What do you need to handle the infertility roller coaster?

Resilience, that’s the key to handling the ride with the fewest bumps and bruises. Resilience is the ability to recover from or adjust successfully to unexpected change or misfortune. It is what allows individuals to demonstrate strength in the face of adversity.

Challenge and disappointment are inevitable in life. Resilience provides you with the ability to bounce back from setbacks, learn from failures, be motivated by challenges, and believe in your own abilities to deal with the stresses and difficulties in life.

Don’t get me wrong. I am not saying that the losses of infertility don’t bring sadness to those going through it. Resilience is not going to prevent you from feeling pain, anger, anxiety, or sadness, nor should it, as these are normal, healthy human responses that are natural to experience.

However, when we are lacking in resilience, our human elasticity is lessened. Fortunately, while our bounce back may be diminished, the rubber band is not broken.

Developing resilience involves behaviors, thoughts, and actions that can help you cope with stressful events and restore balance in your life. Anyone can learn to be more resilient. Since individuals can use a variety of strategies to build resilience, here are eight suggested ways to build your own resilience strategies. I’ll discuss one each week over the next weeks, along with activities you can try to re-build your resilience.

1.  Make a Shift in Perspective. The capacity to reframe a crisis from an insurmountable problem to an opportunity to learn, make self-discoveries, and accept the very challenging experience which you are facing can create a difference in your reaction to the stressor. Acceptance certainly doesn’t mean that you like it. Nevertheless, seeing opportunities instead of danger, possibilities instead of only problems, can create a more resilient spirit in addressing the challenge.

Our thinking styles can be a major contributor to our resilience. An explanatory style that explains reasons for adversity as personal (my fault, my partner’s fault), permanent (will last forever and never change), and pervasive (everything about the experience and about me is bad), tend to be associated with a lack of resilience.

Fertility challenges present uncertainty about the future. The dream of the family you had envisioned and the child(ren) you had hoped to raise seems to be slipping away. The ambiguity of the unknown is often accompanied by great anxiety, as we can tend to equate future uncertainty with danger or disaster. To avoid automatically interpreting uncertainty as synonymous with danger or disaster it is important to remember that when an outcome is uncertain, it is truly unknown. It is not certain that you won’t wind up with just the right family for you. Acknowledge setbacks, but try to see them as an opportunity to grow, as well. Learning to react to setbacks with appropriate sadness, but also with dignity, humor over time, strength, and a positive outlook whenever possible is what resilience is all about.

Since hardships are inevitable when one experiences fertility challenges, see if you can face them with more open-mindedness. Questions you can ask yourself to avoid some of the thinking traps we can get caught in while experiencing infertility are:

Am I:

Jumping to conclusions (e.g., we’ll never be able to get pregnant or have a family)? Ask yourself, on what evidence have I based this conclusion? Am I certain or just guessing?

Prone to tunnel vision (e.g., since I lost one tube to an ectopic pregnancy, I can’t get pregnant)? Ask yourself, what’s the big picture? How important is this one aspect to the big picture?

Overgeneralizing (e.g., I’m a total failure because I haven’t gotten pregnant)? Ask yourself, is there a narrower explanation than the one I have assumed to be true (e.g., the technology failed me this cycle)? Is there anything more specific that explains this situation?

Magnifying of the negative and minimizing of the positive (e.g., our first IVF cycle was a complete failure)? Ask yourself, were there any good things that happened or anything that we learned from this experience (e.g., we learned that I responded well to the medications I was given, that my husband’s sperm could fertilize my eggs, that we could create many high quality embryos, that we could get through a cycle and remain supportive of each other …)?

Personalizing (i.e., it’s all my fault for wanting to succeed in my career before starting a family)? Remember your reasons for choosing to proceed as you did. Ask yourself, did anyone or anything else contribute to the situation?

Mind-reading (e.g., my partner must not care because he/she doesn’t initiate any conversations about our infertility)? Ask yourself, do I know with certainty that this is what he/she is thinking (e.g., wouldn’t it be easier for me to receive the understanding I am looking for from my partner if I just told him/her how I was feeling and what I needed from him/her)?

Using emotional reasoning (e.g., because I feel so awful, everything must be bad and will turn out horribly)? Ask yourself, can I separate my feelings from the actual facts? Have there been times when my feelings did not accurately reflect the facts of a situation? What questions must I ask to know the facts?

2.  Make Connections. Resilience is much more difficult outside of the protective influence of positive, close, and meaningful interpersonal relationships. In the past, we lived in larger groups with multi-generations and multiple people with whom we were interconnected. Current societies such as ours emphasize individualism and we have often lost these communities of support. Good relationships with close family members and friends that care about us can offer comfort, understanding, support, and a sense of belonging, and can strengthen our resilience. It may take some educating on your part to inform them of what is helpful to you and what is not (Ferre Institute published an excellent brochure some years ago entitled, Infertility: Helping Others Understand. If you can’t find it, let me know and I’ll gladly send you a copy [].) Find the people who listen and who give you strength and energy. Simply discussing the problem with others can help by putting your feelings into words, placing your trauma in a context, and giving it meaning.

In his book, The Wounded Storyteller, Arthur W. Frank describes the need of people who are sick to tell their stories in order to regain control of their relationships with their own bodies. While Frank wrote specifically of physical illness, his insights are easily applicable to emotional distress. He proposes three types of illness narratives: the restitution narrative (Yesterday I was healthy, today I am sick, tomorrow I will be healthy again.); the chaos narrative (Life is overwhelming and will never get better.); and the quest narrative (I accept that my life will never be the same. What can I learn from this?). Empathic listeners who honor our story rather than minimizing or dismissing it can often help us make meaning of adversity and transform our narrative into a quest narrative, reflective of a resilient perspective which envisions a positive, self-determined future.

Reaching out to others in a similar position can helps us feel less alone. Ralph Waldo Emerson once said, “It is one of the most beautiful compensations of life that no man can sincerely try to help another without helping himself.” CONSIDER JOINING A SUPPORT GROUP – THERE’S NOTHING LIKE IT TO REDUCE ISOLATION DURING YOUR INFERTILITY JOURNEY. Much psychological research shows that people who give of themselves to others feel more in control, more capable, and they cope more effectively with stressful situations. In addition, reaching out to others in need, knowing we can make a difference to somebody else, can be of enormous benefit to the helper by increasing your sense of self-worth, helping you recognize your value in the world, even if you have been unable to get pregnant thus far, and providing an incentive not to give up or to give in to despair.

3. Accept change and uncertainty as a part of living. In our attempt to make certainty out of uncertainty, we may also make thinking errors.  When we confront uncertainty, we may overestimate the probability that a bad outcome will occur. Mark Twain had once said, “I’ve had many catastrophes in my life, some of which actually happened.” For most of us, Twain concluded, not all of the catastrophes that we fear and predict will actually occur. When we accept circumstances that cannot be changed, we can turn our focus on those circumstances that can be altered and over which we have some control.               

The following bullet points will suggest helpful exercises for you:

• Mastery moment – create a success experience for yourself.
• Empathy – what would others feel if they were in my shoes?
• Build confidence in your ability to respond to uncertainty – experiment by challenging yourself. Take on something you have never done before and work to improve your skill, thus demonstrating your ability to cope with a challenge.
• Follow your curiosity, a quality that keeps you interested in life and the as yet unknown. When we combine curiosity with anxiety, in fact, the anxiety can actually have a positive benefit as it can be a springboard to action. Ask questions, find out as much as you are able, and pursue things about which you are curious beyond infertility, as well.

4.  Develop realistic goals. Just hoping will probably not make what you want happen. We must work towards reaching our goals, taking purposeful actions in incremental steps. Acquire knowledge about the situation you are confronting as this can help you make more informed decisions, as well as neutralize exaggerated fears which may stem from the unknown. Taking decisive actions rather than detaching completely or wishing a problem would go away is more likely to bring a satisfactory result. Nevertheless, with fertility challenges, we DO NOT HAVE TOTAL CONTROL over the outcome of our struggles, no matter how hard we work to achieve our goals. Thus, a more realistic goal under these circumstances may be, “I will follow the directives of my reproductive endocrinologist, take good care of my physical health before and during treatment, and be compassionate towards myself and my partner as we travel this journey.” The goal of becoming pregnant and carrying a pregnancy to term is not wholly under our control. Fortunately, self-esteem comes from achieving relative competence rather than absolute control in dealing with challenging situations.

• Think about one thing you can accomplish today that will help you move in the direction you want to go.

5.  Focus on the here and now. React to what is happening, not to the multiple what-ifs we can conjure up so as not to use up your valuable reserves of resilience with ruminations. Resilient individuals see it as a waste of time and energy to be preoccupied with regrets about the past (when those events or choices can’t be changed) or agitated about anticipated disappointments about future events which you can neither know nor control.

• Mindfulness. A mindfulness exercise puts you in the moment and helps you both concentrate and relax. It is an amazing tool that can be used at virtually any time and can quickly bring results. It involves cultivating an attitude of passive acceptance to that which is going on around you at this very moment in time. Virtually any activity can be a mindfulness exercise and you can bring mindfulness to virtually anything that you do. For example, you can eat mindfully by slowing down and noticing the flavor of something as you move it around the various taste buds in your mouth, noticing how it feels as it travels down your throat, etc. You can even do an every day chore mindfully, for example, cleaning your house or apartment mindfully (e.g.,  by de-cluttering your home, you may be able to benefit by having a cleaner living environment as well as symbolically letting go of things that no longer serve you. To bring mindfulness to cleaning, first view it as a positive experience promoting stress relief rather than merely a chore. Then, as you clean, focus on what you are doing as you are doing it and nothing else. Feel your muscle movement as you dust the house and reach for high places; experience the vibrations of the vacuum cleaner as you proceed across the floor; feel the warm, soapy water on your hands as you wash dishes; enjoy the warmth of the laundry as you fold it; feel the freedom and release of unneeded objects as you put them in a donations bag. While this may appear to you as silly, if you approach any task as an exercise in mindfulness, it can become one and you can reap more relaxing benefits from it.
• Float your worries away. Imagine placing your worries, one by one, on leaves that then proceed to continue floating down a river.
• Put your worries on paper, literally. Then place then in a paper bag and, in a safe environment, set them on fire. You have given them permission to disappear.
• If you are unable to let go of your constant onslaught of worried thoughts, consider taking control of your worries by putting some boundaries around them. Select a time each day in which you are going to think about your worries. Usually 30 minutes is adequate. Focus on your worries for that time slot, then pack the worries away again and emerge from your worry time. When worries come up at different times during the day, which they will, just remind yourself that this is NOT your time to worry, write the worry down if needed, and give yourself the opportunity during your next worry time to think about the worries that you are carrying. My clients have found it amazing how well this works to free them from worry during the day at times other than their designated worry time. And, as an added bonus, it allows them to feel more in control. 

6. Nurture a positive view of yourself and take care of yourself. Build the belief from your own personal life experience that you can cope with whatever comes. This provides you with such great confidence in yourself and your instincts that you no longer need fear about what the future may bring, as you know, from your past experience, that whatever happens, because of the confidence you have in your ability to solve problems, you will handle it and handle it as best you can, no matter how difficult.

• Maintain both your physical and mental health. This will keep your mind and body primed and ready to deal with situations that require resilience.
• Focus on your core strengths (find out what they are through the link, http://www.authentichappiness.sas.upenn.edu/questionnaires.aspx, scroll down to the VIA Strengths Questionnaire, an online measure of 24 character strengths. Find out your top five.).
• Engage in activities that you are good at and have enjoyed in the past and found relaxing or gratifying.
• Exercise regularly, albeit gently, if allowed. Yoga can be great, even if you never did it before.

7.  Maintain a hopeful outlook. Positivity is the heart of resilience. Try to cultivate realistic optimism, a positive outlook that does not deny reality. This enables you to expect good things will happen in your life. Try visualizing outcomes that you want rather than those that you fear. Appreciate the positive aspect(s) of a situation without ignoring the negative. Accept your need to persevere and work to pursue a goal.

People with high levels of resilience are likely to show lower levels of depression, even in the face of adversity. Research suggests that the positive emotions experienced by resilient people function as a protective factor to moderate the magnitude of their negative emotional reaction to adversity.

• When your world seems too bleak for hope and positivity, turn to loved ones, supportive friends, and cherished memories, and let them revive and renew you.
• Do your best to find the good within the bad. Take time to identify and appreciate positive things in your life. In every dark situation, there are moments of shining humanity. Try to open yourself up to see and treasure them.

8.  Keep things in perspective. To put things in perspective, ponder the following three questions: What is the best that can happen? What is the worst that can happen? What is the most likely to happen? Remind yourself that you may have been focusing on the worst and not the most likely outcome.

• When experiencing a crisis, try to remind yourself of all of the other aspects of your life that are going well. Think of past successes and give yourself credit for them.
• Recall a funny joke or comment, or turn to a friend, book, or film that always makes you laugh.
• How would you like to handle this fertility crisis? Is there anyone you admire who is reacting to this or a similar situation the way you would like to? How would someone you admire react right now?

Is there any fictional or mythic character who you would wish to be like, no matter how improbable? Be creative. Now skip forward in time and imagine telling someone about how you overcame this obstacle. See yourself as that strong, capable person who pulled through with courage, grace, and dignity.

While loss can weaken our belief in a basically safe and beneficent world and create a terrible sense of injustice, our trust in the world can be re-built. For example,

• Find one piece of evidence every day that there is still justice and goodness in the world.
When things have settled down, think about what you have learned and what you can take from this experience that may benefit you in the future. This can allow you to feel that something positive has come to you from adversity. Many have found that their relationship with their partner has been strengthened or that they have found new, understanding friends. .

In conclusion, by making it through tough times, character can be built. Life, unfortunately, can be like a backwards teacher. It sends us the test first and the lesson afterwards. So, whenever possible, learn from others’ mistakes and observe the ways they overcome difficulties. Looking back on tough times and seeing how you survived rather than focusing on how you suffered, is a critical factor in developing resilience. Having developed the skill of resilience, you will be able to transform hardship into challenge, hope, and meaning, thereby becoming even better than what you might have been otherwise. In fact, by turning lead into gold, lemons into lemonade, you, too, will be transformed.

References
American Psychological Association. The Road to Resilience. 
http://www.apahelpcenter.org/featuredtopics/feature.php?id=6
Frank, Arthur W. (1995) The Wounded Story Teller: Body, Illness,  and Ethics. Chicago:
University of Chicago Press.
Reivich, Karen and Shatte, Andrew (2002). The Resilience Factor: 7 Keys to Finding  
Your Strength and Overcoming Life’s Hurdles. NY Broadway Books.
Young-Eisendrath, Polly. (1996). The Resilient Spirit: Transforming Suffering into    
Insight and Renewal. Reading, MA: Addison-Wesley. 

Joann Paley Galst, Ph.D. is a psychologist in private practice specializing in a mind-body approach to reproductive health issues in New York City. She is currently Chair of the American Fertility Association (AFA) Mental Health Advisory Council, co-director of AFA Support Services, and is a past-chair of the Mental Health Professional Group of the American Society for Reproductive Medicine. Dr. Galst can be reached at her office at 212-759-2783.