Imagine yourself as an eight-year-old child again, and you have this deep, unquenchable desire to have a puppy. You can picture the perfect puppy, how soft he'd be, how cuddly. You know just what you'd feed him (only the best, of course); you know just where he'd sleep (at the foot of your bed). You know you'd make a good puppy owner. You'd love your little puppy so much, and you'd take him on walks and on trips with you. And he'd grow old with you and be there for you.
Now imagine your parents telling you that you can't have this puppy; not because they don't want you to have one, but because you are allergic to puppies. You have a medical problem that prevents you from owning the very thing you want most in the world. And your parents want to get you a fish, instead. You feel disappointed, angry and confused. Why did you, of all people, have to be allergic to puppies? Just what makes your parents think a fish is just as good? You don't understand, and it hurts.
The emotions an eight-year-old feels at not getting a puppy just scratch the surface of the depth of feelings an infertile couple experience throughout their journey to parenthood, or acceptance of childlessness. The life a couple with fertility problems lives mimics the highs and lows of a roller coaster ride. The highs are like floating on a cloud in heaven, and the lows, well, the lows are like swimming in the deepest pit of flames in hell. They deal not only with physically extensive tests and procedures, but also with feelings of guilt, inadequacy and blame among others (Panuthos and Romeo 35). They question "why me?" while listening to family tell them to "relax and it'll happen" or "just adopt, lots of children need homes." All of this can take its toll on a person's emotional and physical self, as well as on a couple's marriage.
To understand these emotions, you must first understand what infertility is. Infertility is the inability to conceive and carry a pregnancy to a live birth (RESOLVE). Couples are considered infertile if they have not conceived after twelve months of having sex without the use of any form of birth control (Infertility). This disease does not discriminate. It can affect men or women, of any race and age. Infertility is not something that a person consciously causes. It is something that happens to a person, or couple. Sometimes "the causes of infertility are discernible" (Panuthos and Romeo 34). It can be as simple as a hormone deficiency or as involved as scarring from a childhood illness or surgery. Other times, doctors never find a cause. A woman can have previous children and be unable to conceive again. A multitude of feelings can arise from this inability to conceive. I know these feelings firsthand; my daughter was conceived with the help of fertility drugs.
At first, I felt desperation and a sense of urgency. We didn't have much money to invest in treatments, and our insurance only covered diagnostic tests. We needed to conceive before the money ran out. My need to have a child born of my own body was indescribable. It filled my every waking moment. I couldn't be around a child, much less a baby, without almost breaking into tears. I began to resent "normal" couples. During this time, my teenage cousin became pregnant with her second child because, in her words, "birth control pills made me get fat." The anger I felt at her was outrageous; I could hardly remain civil when around her. Every time I heard of someone abusing a child, I wanted to personally rip his or her head off. Then I would wonder how God could give a person like that a child, yet I, who dearly wanted one, was forsaken. I began to feel punished for some transgression in my past. My despair was so great that I would break down in tears and tell my husband to find himself a wife that wasn't "broken."
I had always had a feeling that something was wrong with my body, so, in a way, it was almost a relief to have a medical professional say, "yes, you have an inability to get pregnant." For months, family had told me "relax, you're stressing too hard" and "you're worrying about nothing." These comments didn't help. My doctor, however, was very understanding of my feelings. She remained both tactful and supportive when giving my husband and me a run down of our options.
From the moment a couple finds out they have fertility problems, they basically have three options: seek medical treatments, look into adoption, or resign themselves to living a childless life. Some end up choosing all three, in that order. Others will get lucky and need only to choose option #1 to have a baby. Still others will skip the first two options and go directly to dealing with the natural grief process that follows a loss; and not being able to have a child when you dearly want one is a loss (Panuthos and Romeo 35). A mixture of things determines a couple's choices. Physical and mental health, how severe the infertility, and money all play a part. Medical treatments can quickly add up into the thousands, and, as I quickly learned, adoption costs upwards of $20,000 or more with waiting times of up to two years. If the infertility is severe, no treatment options may exist. The same if the person has poor physical health. A person must have a reasonably healthy mental outlook in order to sustain all the tests, the waiting and the possible disappointments.
If a couple chooses to try medical treatments, a doctor will do a fertility work up first. Health history is taken for both partners. A semen analysis and possibly blood work will be done for the man. For the woman it becomes more involved. Blood tests will be done to determine if ovulation has taken place (Progesterone test). Other tests may include a Hysterosalpingography (HSG), an X-ray of the inside of the uterus and fallopian tubes after injecting dye through them; a Postcoital test which examines the ability of sperm to enter and move past the cervix; and an Endometrial Biopsy, a test performed to show whether problems with the lining of the uterus exist (Infertility). Some of the tests are relatively easy and painless. The results of each test determine the need for further testing. The doctor keeps testing until the infertility is explained, or until exhausting all possibilities.
Some factors that affect fertility are as simple as excess alcohol intake; men are more vulnerable to this than women, although no one has discovered why (Lauersen and Bouchez 104). Drinking as much as four cups of coffee per day, or the equivalent in caffeine content decreases fertility in both men and women. Some of the more potent barriers to fertility include tobacco and recreational drugs.
For women, endometriosis is one of the most common problems impeding conception. This is a condition in which tissue that normally lines the uterus is found outside the uterus (Infertility). Abortions performed incorrectly can cause a damaged cervix, a torn uterus or a perforated bowel. This makes future pregnancies difficult or impossible (Lauersen and Bouchez 29). Other causes can include scar tissue anywhere in the reproductive system, Pelvic Inflammatory Disease (PID), or excess weight (Infertility).
For my husband and me it was, luckily, a rather simple problem. My body did not produce enough of the necessary hormones to stimulate ovulation. Without ovulation, I would never get pregnant. The most common infertility treatment, Clomiphene Citrate (known as Clomid) was our prescribed plan of action. Clomid encourages ovulation by tricking the brain into producing more estrogen. There is an eighty percent chance of ovulation and a fifty percent chance of becoming pregnant within six months of use (Lauersen and Bouchez 270). The risk of multiples with this treatment is minimal (six percent or less). I felt encouraged at the success rate for this treatment. I just knew I'd end up pregnant the first month I took it, and planned for a December baby.
Thirty-five days after the start of my first Clomid treatment, my menstrual cycle began. I could not move, think, or function without crying. I called in sick to work that day and went into a severe depression that lasted for four days. I finally came out of the depression and started functioning fairly normally again. My hopes grew, even though I tried to control them, and, again, I just knew the next month I would conceive. And again I was wrong.
"Those who cannot conceive a child they want are surely bereaved" (Panuthos and Romeo 35). How can I describe such a deep sense of loss? Is infertility really a loss? Yes, surely. Not only did we mourn our natural ability to conceive, but also the loss of the potential child. Each month that I didn't become pregnant, I would grieve as though I'd lost a loved one. The medication's side effects only added to these feelings, constantly reminding me that my body didn't work correctly.
The most common side effects of Clomid are hot flushes, bloating or discomfort, breast discomfort, and nausea and vomiting (Tucker). I experienced all of these. At exactly fourteen days into a cycle I would have a bout of illness comparable to morning sickness. It became predictable for me to call in late to work that day. The hot flashes had me feeling as though I was going through menopause, and I do not look forward to that event any longer. Jennifer Mason sums up the mood swings perfectly. "They put the female on hormones which make her go from the devil herself to the sweetest person you've ever met to screaming at the top of her lungs to crying because she was so mean. [Her husband] used to joke about my head spinning, but it was true. You never knew who you were going to be talking to while I was on hormones." My own husband would, at times, have problems knowing how to treat me during this time. I would go from being full of hope to depressed and pessimistic in a matter of hours. Later, I felt sorry for my husband, having to deal not only with my moodiness and trying to keep me happy, but also with his own feelings during this difficult time. I never really thought about how he felt until afterwards. Now I realize that it was just as stressful for him as it was for me.
This disease often takes its toll on a couple's relationship with each other. They lose their sexual spontaneity, placing themselves on a rigid schedule trying to optimize their chances of conceiving (Panuthos and Romeo 35). "For years we had been told when to have sex and it was controlled by a doctor or a test and after I delivered . . . the act of 'spontaneous' sex was a foreign concept" (Mason). I could glance at a calendar and tell you exactly what days we'd be "doing the baby dance." Our marriage began to feel more like a business partnership than a loving relationship. My mood swings frequently caused arguments. At times we would unintentionally take our disappointment and frustration out on each other. This does not strengthen a marital bond; it only weakens desire, which is counterproductive when trying to conceive.
I continued this cycle of hope and disappointment for six months although I did take a two-month break in the middle from the Clomid. My husband had to go to France for Air National Guard duty, and even though he was gone for only fifteen days, the timing of the trip took up two cycles. Clomid is one of the few fertility drugs that can be taken sporadically and still work. The month that I got pregnant was also the last month my doctor would allow me to take Clomid, as the chance of ovarian cancer increases with prolonged use and no pregnancy. By this time, I was more pessimistic than hopeful. It hadn't worked yet, so why should I believe it ever would? My doctor decided that she would contact a specialist in artificial insemination and refer us there. It saddened me to think that we would not conceive even close to the "old-fashioned" way. At least with Clomid alone, there is still physical interaction in the conception. With Artificial Insemination, it was completely scientific.
Artificial Insemination is simply "insemination by means other than intercourse" (Infertility). Sperm are treated (or "washed") to enhance the possibility of fertilization, and then injected either around the cervix or into the uterus. This takes place while a woman lies on an exam table with doctors and nurses present and all sorts of medical equipment around. This definitely takes the "fun" out of conceiving.
During this last month, my husband and I took a small vacation to Arizona, and ironically, I kept insisting to my younger sister that I wasn't pregnant. The postcoital test showed that I was hostile to my husband's sperm; I had only a slight chance of conceiving. Three days after returning home, I began to feel nauseated on the way to work. I dismissed it as a dislike of my occupation. While taking the Clomid I had a cycle that began every thirty-five days, like clockwork. This month I hit day thirty-seven still waiting. I refused to get my hopes up or take a pregnancy test. My doctor called me on day thirty-nine, a Friday, to inform me that she had set up everything with the specialist. I told her that maybe, just possibly I was pregnant. She was elated and immediately insisted I schedule a blood test. She scheduled my test for the Wednesday after Labor Day, which seemed like such a long time to wait. I continued to refuse to take a home pregnancy test, so great was my fear of seeing another negative result. I didn't think I could handle another disappointment. I finally caved in to some need greater than I, and on Labor Day itself, I took a home pregnancy test. I could not watch the test as it progressed. I sat on the edge of my bed praying that I would see two lines, a positive result. When I saw the results, I immediately broke into tears. Joy filled my heart! I would live my dream. I was fortunate; not everyone who attempts this route of treatment is so lucky.
Jennifer Mason, an online friend of mine, struggled for four years to get pregnant. After exhausting all other treatment courses, she and her husband decided to give it a one-shot try at in vitro fertilization (IVF). IVF is a highly involved procedure in which multiple mature eggs are removed from the woman, fertilized with sperm in a petri dish and then a certain number of the resulting embryos are placed in the woman's uterus (Infertility). This type of treatment has its own unique emotional costs. Daily injections are required to ensure the availability of enough mature eggs for retrieval. Remember what the hormones do to a woman, let alone having to inject them into her body herself. Daily sonograms and blood work are essential to know when to retrieve the eggs (Mason). Imagine the disruption this causes in normal day-to-day activities. "Going through true infertility treatments takes a toll on every aspect of your life" (Mason). Throughout all the injections and doctor visits, the knowledge that IVF is not a guarantee remains ever present. It might not work. Where does that leave a couple? If they have good insurance, which few actually do, they might try again. A person can only go through so much pain, both physical and emotional, before giving up though. Luckily, Jennifer found out she was pregnant two weeks after the transfer of embryos, and gave birth to twins in May 1999.
As of 1995, fertility problems affected 6.1 million people in the United States (RESOLVE). Even though science constantly expands upon the many ways to aid conception, these methods do not always produce the desired result--a child. The joy an infertile couple feels at finding out they are pregnant is no less, and in some cases may be more, than the joy a couple with a healthy reproductive system feels. However, the disappointment felt after spending perhaps hundreds of dollars trying to get pregnant without success devastates them. Friends and loved ones customarily offer well-meant advice that, however lovingly spoken, often sounds like criticism. Others will offer a glib response to "just adopt," or "think of all the money you'll save." Comments like these can heighten the stress and frustration of an infertile couple. You wouldn't tell a person who lost a leg that there are plenty of prosthetics out there, get one and move on. So why tell couples who can't have children to "just adopt." We must "recognize infertility for the grief-causing loss that it is" (Panuthos and Romeo 37). We must lend our support in helping them heal, so that they truly can move on.
"We will never know what the purpose of . . . having to wait four years to become pregnant was, but I believe I was meant to educate others about what they are getting into with . . . infertility procedures" (Mason). I, also, do not know why I had to go through this to have my daughter. I only know that children truly are a gift and a blessing, no matter what way they come into existence. May all who endure this long, hard road to parenthood feel equally blessed.
Krystina L. Clunk, 16 November 2000