You always took parenthood for granted. Graduating from college with honors and getting into graduate school were endeavors to be fought for—hard-earned accomplishments you never imagined achieving. But having children always seemed guaranteed, as natural and expected as growing old. So you become increasingly concerned, confused, and anxious when after almost a year of trying, you are still not pregnant. It doesn’t help that from Teen Mom to I Didn’t Know I was Pregnant, the media has no trouble portraying the drama surrounding unwanted pregnancies.
But despite feeling like the only one of your friends who can’t get pregnant, you are not alone; infertility is not uncommon. According to the Centers for Disease Control and Prevention, about 10 percent of women in the United States between the ages of 15 and 44 have difficulty getting pregnant or staying pregnant (“Infertility Fact Sheet”). That’s over six million women who share your struggle. You pour over their online blogs and heartening successes. You have hope. But it is fleeting. Your biological clock is ticking. And so you and your husband frantically launch your selves into the fight of your lives–for something you never thought you would have to fight for.
You’ve been trying “naturally” for over a year and still no baby. Congratulations: you are officially infertile according to U.S. Department of Health and Human Services, which defines infertility as “not being able to get pregnant after one year of trying (or six months if a woman is 35 or older)” (“Infertility Fact Sheet”). As the woman, you naturally feel responsible for you and your husband’s lack of offspring. After all, infertility is a woman’s problem, right? Wrong. Of the total number of couples with infertility, 40 percent of the time, men carry the biological factor. 40 percent of the time, women carry the biological factor. 10 percent of the time, the problem is interactive, and 10 percent of the time, the cause is unknown (“Couples and Infertility”).
The most common causes of infertility in men are problems that affect the production and movement of ample, normally-shaped, sperm while the most common causes of infertility in women have to do with ovulation (“Infertility Fact Sheet”). Of course you’ve read up on all the various factors that could increase your and your husband’s risk of infertility from excess alcohol consumption and smoking to over-exercising and weight (“Infertility Fact Sheet”). Both of you are non-smokers who enjoy a glass of Chardonnay every now and then with your heart-healthy meal of salmon and brown rice. You are the picture of fertility—blessed with an hourglass figure and child-bearing hips. So why no baby?
You are desperate for answers, so you decide to see a gynecologist, who typically administers a semen analysis, blood tests, and an ultrasound of the ovaries (Infertility Fact sheet). Don’t be surprised if these tests all come back fine. More often than not, finding the cause of infertility is a long and arduous process. Jacqueline Bodnar, a freelance writer who struggled with infertility for five years before finally becoming a mother never found a clear cause for her inability to have children: “They found nothing wrong so I went home and kept on trying each month. After another year went by, I went to another doctor and went through some tests only to once again be told that everything seemed normal and healthy” (41). Michael Snider, a reporter for Maclean’s magazine and author of “My Fatherhood Dreams,” similarly attests to the taxing nature of the inability to find a direct cause of infertility: “In some ways, it would be easier if they found something that medically disqualified us from having kids. Then, we could just get on with adoption rather than go through more frustration” (19).
And frustrating it is. According to Menning, an infertility researcher and author, “…the realization of a fertility problem may come as quite a surprise, particularly for those who are achievement orientated and who believe themselves capable of surmounting any obstacle” (qtd in Matthews, 481). You are achievement orientated, and while you are anxious and confused, you are equally hopeful and determined. You will become parents. It may just be a tad harder than you expected.
Not surprisingly, the type of treatment for infertility depends upon the cause of infertility and can include medicine, intrauterine insemination (IUI), and assisted reproductive technology (ART) (Infertility Fact Sheet). Michael Snider and his wife Tammy, whose infertility is unexplained, began with drugs that affect ovulation: “We started with a prescription for a drug called Clomiphene. It tricks the brain into thinking the ovaries are slacking off. After a year, we moved to Gonal F, which I would inject into the tissue of Tammy’s stomach” (19). Similarly, Rachel Giese, a lesbian who struggled desperately with infertility before deciding to adopt, describes her unpleasant experience with clomiphene: “Thanks to clomiphene citrate–better known by the brand names Serophene and Clomid– I was in the throes of menopause at the age of thirty-three… For sixteen months, I had been trying unsuccessfully to conceive. My doctor hoped the drug would at least jumpstart my sluggish ovaries” (23). But for Tammy and Rachel alike, Clomid failed. Yet this is far from the end of the journey.
The next step for couples with unexplained infertility is typically intrauterine insemination (IUI), a procedure where the woman is injected with specially prepared sperm (Infertility Fact Sheet). English Professor Michael Ryan and his wife Doreen had been trying on their own to conceive for four years before proceeding with nine IUI’s, each of which failed. Ryan explains, “with IUIs, the chances of conceiving get worse with each attempt: from one in five-to-fifteen after the first try to about one in a hundred after the sixth” (46).
With these dead-end statistics, your doctor finally suggests in vitro fertilization, or IVF, “the most frequently used procedure to treat infertility, with an average success rate per cycle of 23.8,” according to the European Society of Human Reproduction and Embryology ( Panagopoulou 678). But this does not come without a cost. Unlike IUI, which Ryan describes as “easy and cheap,” IVF is “invasive and expensive” (47). Just how expensive? According to the American Society For Reproductive Medicine, the average cost of an IVF cycle in the United States is $12,400 (“The Costs”). Depending on the number of cycles and whether or not your health insurance covers it, you may or may not spend more conceiving your child than sending her to college.
IVF also comes with an emotional cost. In fact one study even suggests the stress of in vitro, ironically enough, can lessen a woman’s chance of getting pregnant. Based on the data from the experiment, “women who refused to participate in the study were more likely to get pregnant” (Panagopoulou 678). What, exactly, does IVF entail? The American Pregnancy Association summarizes the process in five basic steps: monitoring and stimulating the development of healthy eggs in the ovaries, collecting said eggs, securing sperm, combining the eggs and sperm together in the laboratory under optimal conditions for fertilization, and transferring the embryos into the uterus (“In Vitro”). Sounds simple enough, and with a 30-35 % success rate for women your age (under 35 years old), you’re on board.
It’s a good thing you don’t have a phobia of needles, because stimulating egg production requires a copious amount of “scary injections” according to Sarah Bernard and Hugo Lindgren, a couple who conceived their twins via IVF (65). Similarly, Michael Ryan, who must inject his needle-fearing wife with Gonal F and Lupron every night, writes, “Before this cycle of treatment is over, she will have been punctured with needles more than two hundred times…” (48). In addition to the injections, you must also get used to daily, early morning visits to monitor egg development via ultrasound of the ovaries and urine or blood test samples to check hormone levels (“In Vitro”). Next, your eggs are removed from your ovaries using a hollow needle in a minor surgical procedure known as follicular aspiration (“In Vitro”). Don’t worry, you will be sedated, though you may feel sore for the next several weeks after (“In Vitro”). During this time, your husband will be required to produce sperm for the inseminations. Hopefully, he does not feel like Michael Ryan did when he was expected to “produce a specimen.” Ryan muses, “My wife is about to have an operation that entails unconsciousness and intubation. This does not inflame me with desire” (50). Assuming your husband is able to get it on in the hospital bathroom, his sperm and your eggs are placed in an incubator and fertilization is monitored. Once it is confirmed that cell division is taking place, the fertilized eggs are considered embryos (“In Vitro”). One to six days later, you return to have a predetermined number (usually 2-6) of embryos transferred into your uterus via a catheter. You pray to God, or Buddha, or whoever it is you worship that one of these embryos will implant in your uterus and grow into a baby.
Despair and Acceptance
Rachel Giese describes how she felt following a failed attempt at in vitro: “Somedays, I couldn’t stand being in my own skin, didn’t know how I could bear to take another breath, felt like the pain and disappointment would never end” (Giese, 30). In addition to disappointment and sadness, anger, isolation, and guilt are also common responses to involuntary childlessness. According to a study on the psychological implications of infertility, “anger as a response to infertility is usually related to the loss of control involved in the treatment process” (Martin Matthews, and Matthews 485), and can be divided into two types: rational and irrational. You have reason to be angry about the emotional, physical, and financial costs of infertility; that is totally understandable. Your raging hatred of Octomom, abortion clinics, and diaper advertisements on the other hand– not so acceptable. You’ve also taken to avoiding social gatherings that involve children or pregnant women. The study from Family Relations states: “Infertile couples wish to avoid having to confront other people’s pregnancies and other people’s children” (Martin Matthews, and Matthews 482), presumably as a measure of self-protection. Additionally, some couples may blame themselves and feel a sense of guilt associated with their infertility, which is mostly attributed to “the traditional Judeo-Christian belief that infertility is a punishment by God” (Martin Matthews, and Matthews 482). Giese was no stranger to any of these negative emotions, capturing how she felt in a darkly humorous description:
I felt as though Jenn and I had been exiled from the ordinary world–where people just had kids when they wanted them and everything turned out okay—to the Land of the F–ed, a vast, ugly desert with vultures flying overhead and the two of us with blisters and sunburns and never enough water. And to make matters worse, everyone else seemed to be living it up and sipping fruity drinks in a shady cabana (30).
Similarly, Snider reflects on the truly unbearable nature of involuntary childlessness: “I’ve discovered that being unable to conceive a child is the most depressing thing a couple can face” (19). Not surprisingly, according to a counseling and therapy video on infertility, “when asked to rate their most stressful life experiences, research participants in one study indicated that the stress of infertility was almost as profound as the death of a child or the death of a spouse” (“Couples and Infertility”). Researcher Anne Martin puts it eloquently by stating, “just as the living mourn the dead, so do the infertile mourn the fact that they cannot produce the living” (Martin Matthews 483).
But the mourning process can be elusive, especially for couples with unexplained fertility, who “may be torn between mourning what they cannot have and hoping for what they may yet achieve” (Martin Matthews, and Matthews 483). According to this observation, you may only be able to find peace once you either decide to stop trying or hit menopause. Until then you find a way to cope because frankly, you have no other choice. And although you are in sorrow and pain, it does get better. While Rachel Giese was never able to get pregnant, she describes a “happy ending” of a “different kind”: “… slowly, it began to hurt less. There was no epiphany, just a quiet realization that it wasn’t as hard as it used to be” (32). She compares acceptance to getting over a drawn-out sickness: “like the recovery from a long illness, there was such relief and lightness in just feeling something close to normal again” (32). Perhaps you fall into the estimated 11 – 24 % of couples who pursue adoption after exhausting infertility treatments (“Beyond Infertility”), or maybe you are one of the lucky 5 % who spontaneously become pregnant after struggling with infertility (“Myths and Facts”). But for now you just rest. You are tried. You are broke. You do not want to fight any longer.
Bernard, Sarah, and Hugo Lindgren. “The Price of Multiples” Infertility. Ed. Piehl, Norah. Detroit: Greenhaven, 2008. 63-74. Print.
“Beyond Infertility Treatments.” American Adoptions. N.p., n.d. Web. 08 Mar. 2013.
Bodnar, Jacqueline. “Infertility Strengthened My Family.” Infertility. Ed. Piehl, Norah. Detroit: Greenhaven, 2008. 40-43. Print.
Couples and Infertility: Moving Beyond Loss. Dir. Steve Lerner. Prod. Ackerman Institute For Family Therapy. Psychotherapy.net, 2006. Alexander Street Counseling. Web. 11 Feb. 2013.
Giese, Rachel. “I Feel Like a Failure.” Infertility. Ed. Piehl, Norah. Detroit: Greenhaven, 2008. 22-32. Print.
“Infertility Fact Sheet.” Womenshealth.gov. U.S. Department of Health and Human Services, 16 July 2012. Web. 17 Feb. 2013.
“In Vitro Fertilization: IVF.” American Pregnancy Association. May 2011. Web. 06 Mar. 2013.
Martin Matthews, Anne, and Ralph Matthews. “Beyond the Mechanics of Infertility: Perspectives on the Social Psychology of Infertility and Involuntary Childlessness.” Family Relations, 35.4 (1986): 479-487. Web. 11 Feb. 2013.
“Myths and Facts About Infertility.” RESOLVE: The National Infertility Association. N.p., n.d. Web. 08 Mar. 2013.
Panagopoulou, Efharis, Anthony Montgomery, and Basil Tarlatzis. “Experimental Emotional Disclosure in Women Undergoing Infertility Treatment: Are Drop Outs Better Off?” Social Science & Medicine 69.5 (2009): 678-81. Print.
Ryan, Michael. “Waiting for a Miracle.” Infertility. Ed. Piehl, Norah. Detroit: Greenhaven, 2008. 45-57. Print.
Snider, Michael. “I Just Want to Be a Dad.” Infertility. Ed. Piehl, Norah. Detroit: Greenhaven, 2008. 18-21. Print.
“The Costs of Infertility Treatment.” RESOLVE: The National Infertility Association. N.p., n.d. Web. 08 Mar. 2013.