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TODAY contributor
updated 7/30/2008 3:17:37 PM ET 2008-07-30T19:17:37

Q. My boyfriend, who I love dearly, has repeatedly asked me to marry him. He wants to have kids together and a happy life. We are such close friends that I do believe we would work as a married couple. However, he has a number of hereditary health conditions. The only thing keeping me from marrying him is the thought of having a child with the same health problems. I lost a child (from a previous marriage) to sudden infant death syndrome, and he is well aware of this.

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Emotionally, I would not be able to handle losing another child and I’m not sure how to explain my reasoning to my boyfriend. I love him and don’t want to hurt him over something he cannot control. How do I talk to him about this issue?

A. I am sorry to hear of your loss. Losing a child is terribly traumatic. It can leave you with the chronic fear that the same thing will happen again.

You don’t say what your boyfriend’s hereditary health conditions are, but he is alive and, presumably, well. Because of the trauma of your loss, it’s likely you have overestimated the risk to any future child. The fear of the traumatic loss you have suffered reoccurring may even be something a psychotherapist can help you with.

To start with, you need to get solid information about this medical problem. It would be useful to consult with a genetic counselor to ascertain what the risks really are. I am not a geneticist, but I cannot offhand think of a hereditary health condition in a person who made it to adulthood that would likely be passed on and cause the death of an infant.

You might want to have such a consultation privately. You needn’t take along your boyfriend if you don’t yet feel comfortable sharing your fears with him.

But if you are not comforted by the information you receive, then you simply must talk it out with him. Marrying him and then not having children, if you both want them, is unfair to both of you. Either you will make each other unhappy and resentful over this, or you will get divorced in several years, when it might be too late for you to have children with someone else.

So how do you talk about this issue? Honesty is the best policy. Your boyfriend has been honest with you about his health conditions and you have told him about the case of SIDS.

Because he lives with his conditions, it would be valuable for you to know how he feels about them, which would give you some clue about how a child of yours — if a child did inherit these conditions — would feel. He may also know whether blood relatives of his share his health problems or whether they proved fatal in the past to any of his relatives.

If he has repeatedly asked you to marry him, he must be wondering about your hesitation. So I suggest you broach the topic the next time the question of marriage arises. Let him know that the only thing stopping you is your fear over a future child’s health, assuming this is true.

You should also ask yourself if this is really the only thing keeping you from marrying this man. It might be that you are using it as an excuse for reasons you can’t quite put your finger on. If this health concern did not exist, would you be certain about moving forward? If not, what else is at issue here? If so, then you really owe it to both of you to have an honest exchange sooner rather than later.

Dr. Gail’s Bottom Line: If you have concerns about health conditions that could be passed to future children, find out the facts before concluding the worst-case scenario.

Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to TODAY. Her latest book is “Anatomy of a Secret Life: The Psychology of Living a Lie.” She is also the author of “Amazing You! Getting Smart About Your Private Parts,” which helps parents deal with preschoolers’ questions about sex and reproduction. Her first book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” was published in 2004 by Riverhead Books. It is now available in a paperback version. For more information, you can visit her Web site, www.drgailsaltz.com.

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