Framed baby-photo collages line the purple halls of the Chicago fertility clinic where Marie Davidson, PhD, works. But the psychologist isn't sure how healthy the pictures--intended as a symbol of hope--are for her clients. After all, these women are willing to spend tens of thousands of dollars to become pregnant; they probably don't need to be reminded of their most fervent wish.
"I call it 'walking the baby gauntlet,'" says Davidson. "Almost every fertility clinic has baby pictures all over the place."
However, the photos remain because Davidson knows she can't insulate her clients and their partners from the daily reminders of the joys of parenthood. For instance, a woman might go to a drug store to pick up hormones for in vitro fertilizationand see a father and daughter shopping for back-to-school supplies. At a family Thanksgiving dinner, a young couple might get peppered with questions about when they plan to add to the gaggle of cousins. Add to that the physical, emotional and financial cost of going through cycles of fertility treatment, and any couple can begin to feel unhinged, says Davidson.
"This experience is demanding, and it doesn't have a certain outcome," she notes. "It is about something that strikes into the very core of who we are."
As the staff psychologist at the Fertility Centers of Illinois, it's Davidson's job to help people handle the strain of infertility and decide how to realize their baby dreams. Most often, she serves as a sounding board for people at a crossroads--couples deciding whether to use donor eggs or sperm, women contemplating adopting. Davidson--who typically sees clients between one and three times--helps fertility patients gather their thoughts and links them with resources such as books, yoga classes and support groups. When a couple is having a particularly difficult time, she refers them to an outside mental health professional for longer-term therapy. Often, however, fertility patientsonly need a session or two plus a few follow-up phone consultations to stay on a mentally healthy path, Davidson says.
Such fertility-related counseling is a growing practice niche for psychologists, psychiatrists and social workers, says Margot Weinshel, membership chair of the Mental Health Professional Group of the American Society of Reproductive Medicine. In fact, her group's membership expanded by more than 30 percent just last year.
"It is a fairly new field," says Weinshel. "Thirty years ago...not much was known about what women go through."
According to Weinshel, psychologists and other mental health professionals began consulting with clinics in the 1980s. However, in recent years they've broadened their role, advising patients throughout treatment. In some cases psychologists are part of clinic staff; in other instances, mental health professionals counsel infertile couples as part of their private practice.
The more such psychologists know about fertility treatments, the better they can help patients, Weinshel notes. Fifteen-year veterans like Davidson can tell women what to expect physically and psychologically as they undergo procedures like in vitro fertilization. But what patients often find most comforting, says Davidson, is when she shares her personal experience with infertility.
Twenty-five years ago, Davidson tried for more than three years to get pregnant. Her anxiety peaking, she went to a reproductive endocrinologist to see what was wrong. Months of tests followed, some involving blood draws. Another involved injecting radioactive ink to see if pathways to her fallopian tubes were blocked. Finally, Davidson had a laparoscopy--a surgical procedure where a small camera is inserted into a woman's abdomen to search for abnormalities. Test results indicated she was not ovulating, so she went on a medication to induce the process. Luckily, the procedure worked.
"I had it easy compared to many of the people I see," says Davidson. "Still, it wasn't fun."
Many of Davidson's patients can't treat their infertility with medication alone, so they opt for in vitro fertilization (IVF). The month before the operation, they self-inject egg-stimulating hormones with an enormous needle every day. They endure frequent blood tests to see if the medications are working. And, worst of all, they have to live with the fear that, despite all their best efforts, the process may not work.
"Fertility patients are often in their 30s. They are successful. They have good jobs. They've toed the mark," says Davidson. "And now they have arrived at a place where, no matter what they do, there is no guarantee of success. It is very frustrating and very hard to accept."
Davidson's client Kate Farrell (not her real name) felt just that frustration. Farrell, an architect, came to Davidson after she had tried IVF multiple times and finally discovered that her eggs were probably not viable.
"I kept thinking: It can't be happening to me, not me," says Farrell. "I wanted a family, and I was very driven. My whole life I believe if I worked hard I could achieve anything I wanted to."
Talking with Davidson helped Farrell accept that luck plays a maddening role in fertility treatment. After working through her disappointment, Farrell decided to try again--one last time--with donor sperm and eggs. And this time she got lucky. Her daughter will turn 5 in November.
"Marie was so good to talk to because she could tell you what to expect," says Farrell. "She could tell you the roller coaster ride you'd be on."
Davidson keeps herself informed of the particular twists and turns of that roller coaster ride by staying abreast of fertility technology through conference attendance and lab visits.
"I can explain some of the medical techniques to our patients in a way that is easier for them to digest because it is coming from a nonmedical person," says Davidson.
Patients often leave her office with an armload of reading material--brochures on medical procedures, photocopied articles with advice on handling relatives' questions, listings of local support groups. And Davidson often distributes information on adopting--a service that Laurence Jacobs, MD, a clinic physician,appreciates. Patients sometimes feel they are letting down their physicians if they opt out of fertility treatments, he says. Having a psychologist on staff gives them an unbiased person to talk with about their many options, including surrogacy, adoption or even embracing the freedom of childlessness.
"Marie Davidson certainly makes my job a lot easier," Jacobs says.