The secret: marriage, infertility and infidelity

I have a secret.  But it’s not my secret to tell.  I didn’t want to know this secret, but somehow I have ended up the keeper of this secret.  Let’s just say this world is way too small for my liking.

Let’s start with marriage and infertility.  Infertility puts a huge strain on any couple’s relationship, whether you are married or not, it’s makes you question everything about you and the way your partner are together.  And sometimes your relationship is questioned through no fault of its own.  Infertility does that to you.  It tests your relationship in many ways that other couples could never understand.  The burden of infertility on each of the couple is heavy and yet we are expected to support each other throughout the grueling journey.  And yet each of us infertiles will experience the impact on our relationships in different ways, whether it is positive or negative.  Our journeys are different, our relationships are different.  But what I am 99% sure of, is that what is common, is that infertility WILL strain your relationship to the point of almost breakage.

When I typed into Google…”Infertility effects….” the top search entries that came up were:

  1. Infertility effects on marriage
  2. Infertility effects on family
  3. Infertility psychological effects
  4. Infertility side effects

That’s pretty damming (because google is always right of course).

I will do a separate blog post one day about my internet research into infertility and marriage someday, but for now, let’s just say….research shows that infertility does impact our relationships. (No shit Sherlock!!!).

But what about infertility and infidelity?  It may be argued from an evolutionary view that a failure to produce offspring may cause the failure of a monogamous relationship and increase the likelihood for infidelity to occur.  Well, I couldn’t find any research on this theory at all, despite it sounding like a pretty sound theory.  But I did find research on Zebra finches which are animals that are socially monogamous.  A failure for mummy bird to successfully hatch her eggs made zero difference to their monogamous relationship.  Daddy bird did not cheat on her,or vice versa, she didn’t go looking for another mate.  And apparently there is no convincing evidence to suggest that this is the case in any other monogamous species either.

So, I really thought that may be infertility could increase the chance for infidelity to occur in a marriage.  Turns out I am just paranoid.

For me, Chris and I have definitely had a few moments where we just could not understand each other, we thought may be we were on different paths, may be our marriage was in jeopardy.  But despite the rockiness of our emotional and physical relationship, I have never been tempted to cheat.  In fact any attention from another man was definitely unwanted.  No matter the times we argued.  I would not have it in my heart to cheat on him.  I feel like our relationship has solidified in crazy ways I cannot explain unless you have lived it.  My relationship with Chris is phenomenally strong, I never want that to go away.

I can understand however for some that infidelity may be an escape.  An escape from all the problems we face in our struggles to conceive what many do so easily and readily.

And so back to my secret.  I have a friend who is going through infertility who has cheated.  And none of the three parties involved know that I know.  I don’t want to know.  But I do.  I feel so so sad about this situation.  There is never a worse time to cheat on your partner.  But I also understand escapism and that some relationships do just simply fail under the weight of infertility.  So it is my secret to keep and not to tell. But it kills me at the same time.

What would you do?

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Survivor’s Guilt

I have a broad understanding of Post Traumatic Stress Disorder (PTSD) I’ve read a lot about it…so much so that even my Instagram advertises about PTSD charities on my feed (weird).

PTSD

this advert about PTSD came up on my Instagram feed

 

There is one thing that I suffer from and that is Survivor’s Guilt.  This is when someone believes they have done wrong by surviving a traumatic event when others did not.  In my case I have double the effect.  Why?  Because I survived a horrifying terrorist attack and second, I survived infertility…all within weeks of each other.

I did not know anyone personally who died in the Brussels terror attacks.  But I saw people who were dead or dying being carried out on stretchers, left alone on the side of the road as I helplessly watched.  At the time I wanted to help, but of course I couldn’t, I was (sensibly) being pushed further and further away from the airport.  I have these images burned into my head of a man with his body broken, dusty, bloody, head with loose bandages wrapped around his head, face indistinguishable and arm hanging out, quietly moaning.  All alone.  But I was behind glass some 20 metres away watching this happen in front of my eyes as more as more people were stretchered out.

I get it.  They have a system of triage, there were only so many first responders who were there in the first 20 minutes after the explosions.  The cordon was set up to protect people.  After all, there was a third bomb in there.  We know tactics of terrorists are to create mass effect by targeting the first responders.  But that boundary, the distance was so close, but so far.  I heard people were saying – I’m a first aider…I’m a nurse…I can help.  But they weren’t allowed to.  I can’t get my head around those very short moments.

I feel guilty for surviving, for not being able to help.  Sometimes my mind is heavy with these thoughts.  This doesn’t outwardly appear to affect me overall.  Well, I don’t think it does.  But I do have some bad dreams (to be expected), not regularly, but perhaps it does affect my sleep.  I wake up very early some days, I tend to put it down to my jet lag, but actually, it could be a symptom of PTSD.  I don’t have problems falling asleep, and I’m not afraid to fall asleep, so I don’t feel like it is an issue.

Then there is my pregnancy.  I am overjoyed we finally achieved our dream, we fought hard to get here!  But along the way, I have made friends with some very lovely women who have struggled with infertility too.  And the feelings I have are that of guilt.  Guilt that I have left them behind.  Similar to survivor’s guilt, and in some ways could be classified as such.  Infertility is traumatic.  I feel like I took the last life boat and rowed away from the desert island leaving you all behind in uncertain conditions.  So some days I haven’t been able to open and read blog updates, Instagram is hard to scroll through.

For those of you who are reading this and now worrying about me (my mum probably!!!) It’s OK, I’m OK.  I am sensitive to my levels of anxiety and sadness, and how that impacts my daily life…and I am OK.  Writing this down is kind of a release to me, and re-reading my writing makes me see things more objectively.  And that helps.

I found some words that are helpful (I think) on strategies to cope with survivor’s guilt:

“Rather than focus on the burden of guilt, remind yourself that you and your loved ones have been given a gift — the gift of your survival. Embrace your will to survive and fight the forces that challenge your way of being.”

Reading these words make me feel happy because deep down I know they are true, I just need to remind myself of this when I start to feel sad or guilty.

Not forgetting Huckleberry

Speaking of not forgetting….this week my app ‘Glow’ I use(d) to track my periods told me that my period was due in 2 days!  Well that was a strange thing to say because I had marked “I am pregnant” on the app.  So I decided to open it up and see what was going on.  Glow was telling me I am pregnant still, so  I am not sure why it was telling me my period as due.  Anyway, it came up with a big advert saying download our ‘Nurture’ app, a follow on app to glow for pregnant women.  So I thought, well why not give it a go.  I had already used it once before when I was pregnant after IVF cycle 1 and so downloaded it off my cloud.  Once it installed I opened it up and this is what I was faced with…

huck

 

Are you kidding me???? Oh it was a stab in the gut. Yesterday I was 44 days overdue and Huckleberry was the size of a slightly bigger pumpkin at 46 weeks old!

I haven’t forgotten you Huckleberry. I promise you I never have.  But this was just too much.  I deleted the app straight away as I couldn’t deal with trying to figure out how to reset it.

A little thought

Before I get into this post I just wanted to say….

I received so much love from you all on my last post I can’t thank you enough for your kind words.  Donald Trump might stupidly say that “He knows words.  He knows all the words.” (Please, please America don’t let him be your next president) But actually you guys have all the words and know how to say them just right -for the whole time I have been blogging here on the GPCH your words have meant that I have managed to get through this journey without going insane.  Thank you so, so much XX

OK here is my little thought….

Someday we will probably show our child their first ever photo.  Chris and I have joked that it would be the best photo for a wedding speech.

blastocyst 3BB blastocyst 3CB

But here Rocky is…with his sister or brother that never made it.  This is just heart wrenching and would probably be a bit uncomfortable for some people who twig that we only had one child.  So perhaps we won’t ever show this photo at their wedding, but I will definitely want to show it to them at some point in their life.

I’m not going to lie, I have struggled a little bit with the fact that one of our embabies didn’t make it. It’s been even harder as there are several ladies in my local support group who recently also went through IVF just after me, all of them have found out they are having twins.  And a few ladies on Instagram who went through their IVF cycles the same time as me also found out they are having twins (two are even having identical twins!).

I know that having twins is not easy, but I can’t help but mourn the loss of Rocky’s brother or sister and ask myself – why?  Sometimes I even get jealous of these lovely ladies and I know that is a terrible feeling to have because I am SOOOOOOOO lucky to have one wonderful baby inside me right now.

Infertility is complicated. I read an article that Resolve published an advertised recently on their facebook.  Reading it helped me put into perspective these kinds of feelings I have. I hope you find it interesting too…

infertilty wounds

Read here: “Healing the Wound of Infertility”

The Enhanced 2 Week Wait

It’s kind of like I’ve received my invite to join the pudding club, I’ve completed my application, I’ve done my best to fill everything out correctly, I’ve been thanked for my application and told I will be welcomed, subject to approval!  But there is a pause….no one is communicating with me, my doubts are creeping in.  May be they found something in my application that they don’t like.  May be I won’t be joining the pudding club after all.  This period of waiting is what I am calling the “Enhanced Two Week Wait”.

During this period of time, it doesn’t take much to make me stop and think about what might be.  And when I think about what might be I briefly hold in the tears.  Sometimes it’s tears of sadness and other times it’s tears of relief and happiness. 

With the sadness I think what might happen if we look at the screen and there is no fetal pole or no heartbeat.  I won’t be able to hold those tears back.  The immense sadness will wash right through me.  I  won’t be able to not think about the injections, the pain from the OHSS, the tiredness, the surprising love for someone I have never met….all for nothing.  It will be for nothing with a cruel ending that results in a horrible painful bloody mess.  It will all have been for nothing. 

And then sometimes I’m on the brink of tears of relief and happiness.  With the happiness I think what might happen if we look at the screen and there it is…wobbling around in there – only just the size of a grape, unknowing as to how much it is loved and wanted to be held in our arms.  I will feel relief that it was all worth it; that I am proud of ourselves sticking to the path on this rocky journey. 

I will keep these little thoughts in the back of my mind that will continue to creep every single time I feel a pain in my uterus for the next week, reminding me something is going on down there.  Just 5 more days and one of these opposite realities will come to fruition.

I am just over half way into this ‘enhanced 2 week wait’, and there is absolutely nothing I can do but patiently wait.  It’s been a tough first week being away from Chris in a country where there is a 6 hour time zone difference…picking up the phone to talk has been challenging with the nature of our work, it doesn’t help.  I’m becoming a pro at giving myself these progesterone injections, I even gave myself an injection without icing the area first.  It turns out that it just stings a little bit afterwards so it wasn’t too bad pain wise.

I have had sporadic pregnancy symptoms, which doesn’t fill me with confidence, but I know that this is the case for many women who go onto have successful pregnancies.  I just can’t help but err to the side of negativity. 

Symptoms:

Peeing a lot.  I have been on this plane for just 4 hours and have been to the toilet 7 times already. Boobs.  They don’t like being touched or leaned on (i.e. lying on my front is painful!!) Sorry Chris, no boob touching just yet!! 😉

Nausea.  I have had only a couple of instances of being on the verge of puking, but these were easily resolved as soon as I got some food in me! 

Tiredness.  It has been a hard week with work and travelling to Europe I’ve had little opportunity to catch up on my sleep so I am constantly yawning.  I have even set my alarm a couple of times this week for 10-15 minute PKs (Power Kips). 

Period type pains.  These pains don’t last very long maybe a minute or two and come randomly in waves.

Actually listing out all these symptoms makes me realise that perhaps I am a bit more pregnant than I really thought I was!  In addition to this I am still suffering from OHSS albeit a lot less.  Twisting my torso around or bending down/reaching up still is painful.  😦

I hate to wish my time away in this life, but I really wish it was Thursday already!

PIO on the go

I had a plan!!!! My plan was to give myself the Progesterone in Oil (PIO) injection at Philadelphia airport lounge in between my two flights.  I would get some ice from the bar, put it in the ziplock bag I had packed and ice my backside to numb it.  I would then use the nice clean, usually quiet, restrooms to prepare and administer my injection – there are even sharps containers to dispose of my used needles.  It seemed perfect.

But nothing ever goes to plan in the land of infertility!!! Oh no!!!

My flight to Philadelphia got delayed once we boarded – we sat out on the pan for an hour, then they decided that the aircraft jet engine was actually broken (just as well we didn’t take off then??!) so we headed back to the terminal and de-planed.  Practically all the passengers on the flight were transfer passengers and because I was soooo desperate to pee I ended up at the back and so waited forever in the huge queue to figure out if it was possible for me to get my connecting flight to Amsterdam.  By the time I got to the agent, my flight in Philly to Amsterdam was boarding…so no, I wasn’t going to Amsterdam.  I explained to the agent that I didn’t mind flying the next day – but that flight was oversold already. Grrrrrr.  He was going to send me to Amsterdam via London – and I would need to stay in Heathrow airport for about 15 hours before getting to Amsterdam a day later.

Ummmm no.

So I asked about the possibility of getting to Brussels – my true destination.

After the attacks in Brussels I booked my flights via Amsterdam because there were still no direct flights with my preferred airline – American – from the US to Brussels.  But the agent said…hmmmmm I wouldn’t have thought about sending you to Brussels instead of Amsterdam, but if that is what you want then I can get you there via London tonight.  So I accepted the challenge of the additional transfer in London and decided what the heck, I’ll go to Brussels airport (I guessed it wouldn’t be that bad).  From that point onwards I was just unlucky with every flight and barely made the connections. My plan to do the PIO injection in a nice clean restroom went out the window, I was going to have to do it on the transatlantic flight.

I ended up doing the injection in the teeny weeny aircraft toilet.  Fortunately I got some ice so I was able to numb my backside whilst I prepared the injection.  It was pretty challenging to do all of this in the teeny toilet with no flat countertop space…., plus I just get the general heeby geebies about aircraft toilets (people are just so gross in them and never clean up after themselves -sorry grumpy frequent traveler whining!!!). Then there was the turbulence! Everything went slipping everywhere…the progesterone bottle…the needles…the alcohol swabs! Aghhhh!!!! Finally once I got the injection drawn up and ready to go, I got all flustered thinking about people waiting outside and wondering why the hell I was taking so long!  So it took me a couple of minutes to mentally – wooooohhhhsaaaaaaahhhhhh – breathe – relax.

I waited for the turbulence to calm down and I managed to finally give myself the injection and pierce the skin without any issues.  But of course it takes a few minutes for the oil to be injected because it is so thick…and whilst that was going on the turbulence came back!  I was hopping around the toilet trying to balance on one leg and not tense up my butt and leg muscles whilst the needle was still in it.  Very challenging indeed.

I then remembered it was the day to put on new vivelle dot patches (estrogen) on my tummy, as I was doing this I dropped everything on the floor.  Gross.

But despite all this, I barely had any blood after this injection (impressive considering all the joltyness), and I was super proud of myself for not completely freaking the f*** out.

Having said that….I don’t want to have to do that ever again!! I do not recommend to anyone doing this injection on the go.  I did the Lupron one in the plane toilet before and that was easy compared to the Progesterone.  If I’d been more organized I would have asked my doctor for some progesterone suppositories for the days I am travelling.

Anything to keep this little one growing inside me 🙂

PS.

If you are interested to know – my unexpected trip to Brussels airport wasn’t too bad, but it did trigger some thoughts.  I thought about that day as I went to pick up my luggage.  I thought about how that day there were many customs border staff stopping practically everyone to check their bags as they left the airport.  I recall that how at that time I laughed because I was one of the lucky ones who did not get my bag rummaged through.  But today as I went through customs there was only one man.  I thought about how if I had been stopped by customs that day, I probably wouldn’t have been upstairs in departures when the bombs went off.  It was then weird to walk out of the baggage area to see the boarded up area from where the damage had been caused from the explosions upstairs.  I recalled the images of this area in the media and matched it to what I saw today.  A shiver went down my spine as I tried to find my way out of the airport to the train station.  No starbucks for me today.  The route to the train station today brought us out through the parking garage I had found myself in immediately after the explosions, not knowing where the hell I was or where to go.  Today I found myself thinking back about my whole experience.  It was very solemn…but I was OK.

fierce

Unable to adult today

I woke up really early this morning-like 4AM early!! I wanted it to be Wednesday already! I wanted it to be our second beta day so we would have at least an inkling whether this pregnancy is viable or not. I was anxious and felt numb…this feeling continued throughout the day. It was a feeling of indifference towards life. 

Somehow I drove myself to the clinic. I got out of the car and realised I had no recollection of driving there or what route I took!!  

The nurse could tell I was anxious. And she was right, I was!! I wasn’t up for even the small talk today. 

I simply could not adult today.

I decided to work from home in the afternoon just in case it was bad news. We learned this from our first IVF cycle when I was at work when I received the call saying it was not a viable pregnancy- we were naive and didn’t expect it!! But this time the nurse called with good news. She gave me my hCG level – 2871. Chris and I had checked before hand what would be a good figure to be doubling nicely and that was 2300, so I breathed a sigh of relief, trying to hold back the tears. She told me my estimated due date – 1st Jan 2017 and to come back for an ultrasound from 16th May with my doctor. 


As soon as I got off the phone I burst into tears. It wasn’t tears of happiness or tears of sadness, but a bit of tears of relief and tears of fear of loss – the fall seems greater now. I hugged Chris, he couldn’t quite understand what all my tears meant, but he just hugged me. I know it should be a happy time, but it really didn’t feel like it. This is what infertility does to a woman. Insecurity hides in all sorts of places.

I am grateful to make it past stage 2! I am hopeful enough that I have now reinstalled the pregnancy tracker app I briefly used before. I am even going to go out tomorrow to buy a couple of new bras because I no longer fit into my current ones. So don’t get me wrong, I am quietly happy. We both are! It’s just not easy-I know many of my fellow bloggers will get that, but I’m not so sure my friends and family will understand so easily.

My symptoms have mostly been tiredness and constant yawning! At the weekend I had to have sleep in the car whilst Chris waited patiently with me before we headed into a museum, and then Sunday I had almost a 2 hour sleep in the afternoon! I’ve found it rather challenging to stay awake at work this week! But a friend told me about a privacy room at work that maybe I could use to go have a quick 20 minute snooze during the day. My OHSS is getting slightly better but I’m still very tender under my ribs/upper abdomen area, twisting or moving too quickly isn’t fun, and the bloat hasn’t reduced yet. When I look down I can barely see my lady bits (so I get a sneak preview of what it will be like woth pregnant belly!!!)

I am preparing to travel back to Belgium on Friday – flying via Amsterdam this time because American are still not running direct flights to Brussels airport from the US. I’m a little relieved about this because I’m not too keen on seeing that place again just yet. This will be a longer trip then my previous ones to DC so it will be 9 days in a row of thise evil progesterone injections to give myself 😭 I’m not looking forward to that!!! But hopefully this trip will make time fly by quicker so it will hurry up and be time for my ultrasound!


(These pictures are titled “progesterone by candlelight”!!! The power went out, so we made do! It was actually quite challenging)

Reblog – Start asking friends and family for support —

Day 4 of the Bloggers Unite Conference at missconception.com!  I don’t know who this lunatic blogger is, she is harping on about something for infertility awareness week…..oh wait….it’s me! I’m excited to be part of the bloggers unite conference this year, and very grateful to Miss Conception for hosting it!

I discuss how we opened up to our friends and family about our infertility journey and yet had never actually asked for support from them.  I assumed I didn’t need it.  But I was wrong. People find it hard to know how to help their infertile loved ones, so if you ask, they will leap, I have no doubt about that as we have experienced.  I suggest ways you can ask for support from your friends and family.  You don’t need to be as open about your infertility journey as we have, but knowing when and how to ask for support will help get you through those tough days. Click the link below to read more!!!  XXX

Hi! My name is Dani. My husband, Chris and I, have been trying to conceive (TTC) since December 2013. We were diagnosed with ‘unexplained infertility‘ in January 2015. I decided to blog about our journey of TTC as I quickly realised that talking to friends and family about our situation can be difficult. It can be hard for them to […]

…..read more of my blog post here via #niaw – Day 4, Bloggers Unite Conference – Start asking friends and family for support —

NIAWBLOGGERSCONFERENCE

You can’t always get what you want

A cold. A simple cold is all I have right now.  But this cold is just enough to tip me over and make me want to scream…”WHY ME??”  Why can’t I just grab a break in this crappy infertility journey??

Warning – I’m throwing myself a pity party.

I’m not asking for much am I? Something that can come so easily for some, and yet here we are – lives on hold, physically and emotionally tired of it all.  The drugs, the pain, the hurt, the time and money spent.  It’s a lot to be taking on.

This time last year we were preparing for our third IUI; if you asked me then what I would be doing in a years time, I’d tell you we’d be out on an adventure with our newborn baby.  I had so much hope and confidence then.  I have hope now, just not the confidence.  The confidence I once had in this medical treatment has gone.

We have put our all into this trying to conceive business.  And so where in my life I have put in good effort, I generally get out what I want from it.  But I haven’t got what I wanted within 2.5 years of effort.  No one can tell us we haven’t tried our hardest…we have literally given our blood, sweat and tears to this.

But the Rolling Stones Song “You can’t always get what you want” plays around in my head when I tell myself these things.

“You can’t always get what you want….

But if you try, sometimes you just might find…

You get what you need”

And I have got what I need…my husband’s deep love, a true test of my friendships, meeting and knowing some inspiring and uplifting women in the TTC community.  I’m grateful for that.  But I still want what I want!!!!! A child to love, cherish and nurture together with Chris.

Our journey to get what we want is not over yet, I know this, but maybe I am going to find something I didn’t think I needed along the way?  I just wish I knew – I wish I had a “look into the future” card to play.  I’d play that card right now, just to have a sneak peak.

All because this cold is tipping me over the edge right now.  A stupid cold. It’s not even a serious cold.  How stupid is that??

 

What’s infertility got to do with a terrorist attack?

I have been surprised at how many people have commented on my apparent levelheadedness during the terrorist attack in Brussels airport.  Although the absolute fear and terror was running through my mind, my actions seemed logical.  I’m surprised, because I just did what I did – and even I am somewhat surprised at my own response.  However, I think that it is all mostly about an element of luck.  Some people have told me, they believe in some kind of divine intervention (I personally do not believe that, whether god exists or not).  The luck was the third suitcase bomb didn’t explode.  The luck was that I wasn’t closer.  The luck was that the terrorists were ill prepared to carry out a more sophisticated attack.  (Apparently, they had been planning more, but for some reason failed to implement it).  The luck was that I was in the right place and it simply wasn’t my time to die.

A friend of mine made a really interesting comment about the difference between a man and woman’s propensity to take risk.  A woman’s appetite to take risk varies with her menstrual period, where as a man’s appetite for risk remains relatively stable.  When a woman is in her ovulatory stage, she is less likely to take risks.  Therefore, hormones surely have a role to play in risk taking.  So what does that mean for a woman who is going through infertility treatment and jacked up with lots of hormones?  Does this mean that a woman’s propensity for risk is heightened or lowered depending on the stage of their treatment, how different would it be compared to if they were in their normal menstrual cycle?

During the attack, I was on Day 12 of the down regulation part of my IVF cycle, preparing for my upcoming stimulation phase.  I had already been experiencing some of the side effects from these drugs (I wrote about them in my previous diary entry here).  The question I have is – had I not been on these drugs would I have reacted differently to the situation?  We will never know the answer, because we will never know what could have been.  But it is an interesting question never-the-less!

I can tell you that the feelings and emotions I have been experiencing after getting caught up in the attack are not dissimilar to how I felt after being told our pregnancy was not viable.  I’ve experienced random crying over what could have been.  Sadness, frustration, anger and numbness – all feelings that have washed over me in the immediate days past these traumatic events.  I never thought I could ever liken an impending pregnancy loss to surviving a terrorist attack.  But I am, and that is simply how I have been feeling over the past couple of days.  I’ve also experienced the overwhelming feeling of love and kindness from friends and family after these events.  And I mean overwhelming to the point where I have been dumbstruck.

I anticipate that I might attend some kind of therapy after experiencing what I did this week.  The question I have is, why haven’t I been so accepting of undertaking therapy for infertility after our loss and constant failure? If these feelings I am experiencing are so similar, perhaps I should have gone to therapy over our infertility sooner? I don’t know, but perhaps I just didn’t realise the intense emotions and trauma infertility slowly piles up upon us.  Or maybe, the reason is because I feel like I have absolutely no control over a terrorist attack, and maybe I *believe* I have some control over my infertility.  I think my perspective might have changed over the past week; I know some of you wonderful ladies have tried therapy for infertility and swear by it.  Going to therapy doesn’t mean I am weak, it means that I am strong, strong enough to recognise that help is there for the taking.


 

For those inclined…a couple of journal articles on risk taking and a woman’s hormonal cycle:

Variations in risk taking behaviour over the menstrual cycle:  http://people.uncw.edu/bruce/hon%20210/pdfs/risk%20taking.pdf

The influence of menstrual cycle and impulsivity and risk taking behaviour:  http://www.ledonline.it/NeuropsychologicalTrends/allegati/NeuropsychologicalTrends_17_Iannello.pdf