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What’s a guy to expect when she’s not expecting?

Marc Sedaka stood by while he and his wife endured endless rounds of drug therapies, 16 artificial inseminations, 10 in-vitro fertilizations, three miscarriages and, finally, a gestational surrogate who carried their twin girls to term. With the help of his own infertility doctor, Dr. Gregory Rosen, Sedaka has crafted the book “What He Can Expect When She’s Not Expecting: How to Support Your Wife, Save Your Marriage, and Conquer Infertility.” Here is an excerpt.

When to worry
So your wife just turned 35, you’ve been trying for six months, and all you’ve got to show for it is a drugstore’s worth of negative pregnancy tests. Is this really bad? Is it time to see a doctor? I’ll give you the answer that I heard most often when I was going through this. It’s the same answer I got when I was shopping for a house, choosing the right puppy, and yes, even deciding when to get married:

“You’ll just know.”

I realize that sounds kind of pat. At least that’s what I thought when I heard it. But it’s still no less true. There will come a day — maybe after three months, maybe after three years — when both you and your wife know, in your heart of hearts, that something is truly amiss. That’s the easy part. The hard part is actually doing something about it. Especially if your wife is reluctant to admit there’s a problem.

Dr. Rosen: As a general rule, no woman of child-bearing age should need more than three to four months to get pregnant. In fact, roughly 85 percent of people who are going to get pregnant in the first year do so within six months. Any longer than this, and it might be time to consider a specialist.

Doers vs. Avoiders
While there’s no telling how your wife will react to the sobering prospect of infertility, I can pretty much guarantee that she will fall into one of two very distinct categories — the Doers and the Avoiders — that roughly break down like this:

The Doers: These are the women who, as soon as they suspect there’s a problem, shift into high gear and make things happen. Books will be bought, lectures will be attended, appointments will be made. The Doers don’t waste time, and they don’t take s--- from nobody. My wife was a Doer. She was the ultimate Doer. She was a tornado.

The Avoiders: These are the women who believe that, so long as they don’t acknowledge there’s a problem, they don’t have a problem. They become detached, closed off, emotionless. In other words, very much like men.

Oddly enough, there’s no telling which one of these classifications your wife will fall into until she’s forced to make a choice. I’ve seen the most powerful, domineering women practically crawl into a shell when faced with fertility problems and, conversely, I’ve seen the most shy, passive women suddenly able to take on the world. Furthermore, there’s no telling if, and when, an Avoider will become a Doer and vice versa. It all comes down to how much they can take at any given point.

Here’s the bottom line: If you’ve honestly reached that point where you know there’s a problem, and your wife isn’t doing enough about it, then it is your duty and your obligation to pick up the slack. Fertility problems do not go away. They only get worse. With that being said, here are some simple, straightforward ways for you to take control of the situation and make things happen:

Communicate
It’s the most important thing you can do. It’s always the most important thing. Ask your wife if she’s concerned about going this long without getting pregnant. Does she think there might be a problem? Should you guys maybe take some action? The key here is to be as casual and non-confrontational as possible. My advice is to play dumb. It always works for me! In other words, you’re not telling her there’s a problem. You’re asking her — since she’s so much smarter than you with these sorts of things — if she thinks there might be one.

A fair warning: You are about to broach a subject that cuts to the very core of what it means to be a woman (at least as far as most wives are concerned). This is like trying to tap into a 50,000-watt electrical tower without shutting down the power first. One wrong move, and you’re fried. However, if times right and handled correctly, you will score some major brownie points for your extreme caring and concern.

EducateLet’s assume you had the talk, and, despite your wife’s admitting there’s a problem, she still won’t take any action. Now it’s time to start educating both of you on what your options might be. Surf the Internet, find a book or two on the subject, watch that biweekly “infertility” episode of Dr. Oz.

Remember, you can’t just rely solely on your wife for information. Sometimes you’ve got to take the bull by the horns and find things out for yourself.

SupportMany women choose to go at this process alone. My wife was one of those. Due partly to denial, and partly to embarrassment, she decided that it was best to handle this without the support of friends, family, or any outside organizations. In fact, when I suggested we attend an infertility support group, she scoffed at the very notion, claiming that she wasn’t one of “those women.” I still don’t know exactly who “those women” were, but I felt all too certain that she was, in fact, one of them.

In what might be my proudest early moment of this process, I took the brave initiative of contacting an online infertility support group and explaining our situation. At first my wife was uninterested in, even dismissive of, the responses. But as the many posts came in — and she saw, and felt, the support of so many other women like herself — it was as if a great weight was no longer being carried entirely by herself. There was help out there. And she was finally ready to accept it.

Dr. Rosen: What Marc is describing is really true in a majority of women. They initially want no one to know. A lot of infertile women treat infertility like a drug or drinking problem. They want to hide it from everyone, and the best thing you can do, as her partner in life, is get her to talk about it and help her find out that she is not alone.

A word of warning about the Internet: Like most online topics, the sheer number of infertility-related sites can be daunting, and there’s no guarantee that any one you click on is reputable. My advice is to start with Resolve.org or ReproductiveFacts.org. Here you’ll find all the information you need to get going.

The 10 things not to say to your fertility-challenged wife:
1. That’s OK. I didn’t want you to get fat anyway.2. No more condoms? Cool!3. Can’t we just invest all that money in a flat screen instead?4. Yes, but these doctors have yet to see my Super Sperm!5. So if your sister carries it, does that mean I can finally sleep with her?6. I don’t even want kids.7. Hey, did I tell you my ex-girlfriend’s pregnant?8. I discussed it with my mother, and she thinks ...9. Don’t worry. You’re still relatively young.10. But it’s not my fault, right?

Excerpted with permission from "What He Can Expect When She's Not Expecting" by Marc Sedaka with Dr. Gregory Rosen (Skyhorse Publishing, 2011). For more information, visit .

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