Our Infertility Journey (1.1): Who’s to “Blame”

A man and a woman on a pierCrumpled up in a ball on the sofa, I stared at the television with heavy eyes. I was exhausted, but I had that strange high that sleep deprivation brings. Although I had been up for 36 hours, my adrenaline high had yet to fully fade. I had delivered several babies, coded a patient in the intensive care unit, and admitted over 20 patients overnight. I could never go right to bed when I made it home. My body longed for sleep, but my mind wanted just a few minutes to unwind. My usual routine on post-call days was to hit the sofa for an hour of mindless TV before trudging up to bed.

Lately I had been following the reality television show, Giuliana & Bill. On this particular post-call day, the show revealed that G&B’s only option for having their own child was to pursue In Vitro Fertilization. My heart sank for them, and then I thought of myself. What if that was our only option? What if we really couldn’t get pregnant on our own after all? I tried to shake the fear. I dismissed it as emotional irrationality from exhaustion. But, the next morning after a good night’s sleep, that same sickening feeling lingered in my stomach. What if?

My husband is an eternal optimist. I love him to death, but sometimes he doesn’t just see the glass half full, he believes that it’s overflowing! When he started to question if something was wrong with our ability to conceive, I knew that the sick feeling in my stomach was more than just paranoia. It was time to get some answers.Three Hands Pointing

Dave had been diagnosed with a varicocele in college. Many men have these harmless dilatations in the blood vessels in their groin, and they are usually nothing to worry about. In general, they don’t lead to infertility if they are small, but larger varicoceles can potentially heat up the testicle, leading to damaged sperm. Countless hours of standing in the operating room with gravity as his enemy had caused Dave’s varicocele to become rather large and uncomfortable. Because this was the most obvious issue contributing to our baby making struggles, he decided it was time to get it reevaluated. Part of this evaluation included a semen evaluation.

This was Dave’s first journey into the uncomfortable world of infertility. Our medical center had one small room for sperm collection (aka male masturbation station). The idea just seemed dirty, but it guaranteed the most accurate specimen. After uncomfortably waiting his turn for the room and accomplishing his mission, Dave transported his own sample to the lab where his swimmers were scrutinized for quantity, quality, and movement. Now we waited.

I remember Dave’s voice of concern laced with optimism when he called me with the results. His genetic components were great, his sperm movement was great, but…his count was incredibly low. I tried to sound positive, masking my dismay. I didn’t want him to feel worse than I knew he already did, but the sickening feeling in my stomach was so strong that it made me want to throw up. Something was wrong! Although my mind was racing in a million different directions, I managed to ask, “So, what now?”unhappy heterosexual couple

The plan was to repeat the count just to make sure that it wasn’t a lab error. When the repeat number was worse than the first, I was devastated but optimistic at the same time. Varicoceles could be surgically corrected! And, the urologist told us that we could still get pregnant on our own; It would just be more difficult. We decided that surgery was worth a try, and we didn’t want to waste any time. But, before we could schedule the operation, I received a call from the emergency room that changed everything!

From The Mom in Me, MD

destigmatizing infertility in a baby booming culture

Beautiful young woman with pregnancy test. In bathroom.

In my previous blog I alluded to the fact that the inability to get pregnant is laced with stigma and shame. People put autism puzzle stickers and breast cancer survivor stickers on their cars, but I have yet to see an “Infertile Couple” awareness sticker. Is the diagnosis of infertility any less of a diagnosis? Insurance companies lead us to believe this by their lack of coverage for medically necessary infertility services (a blog for another day).  Although infertility may not be life threatening like breast cancer, it is a painful and limiting condition that profoundly impacts many lives.

I assume that the stigma of infertility in part stems from the fact that SEX is broken. Who wants to admit that their sex doesn’t “work”? And, although Sarah Jessica Parker may have normalized talking about explicit sex over the dinner table, many of us don’t want to share the intimacies of our relationship with friends, let alone strangers. In my mind, one of the beauties of intimacy is that it is something shared just between my husband and me. And, although I don’t shy away from joking about sex with friends now and then, I don’t make it a habit to share what I do in private. Talking with girl friends about periods, child-birth, and boobs is no big deal. But, infertility doesn’t naturally or comfortably fall into that “normal” girl talk.

Our culture is inundated with sexuality, but the idealized kind filled with Victoria’s Secret Angels, Tatum Channing physiques, and Ryan Gosling charm (okay, and physique!) Infertility is poor performing sexuality. Who wants to talk about that? Not men, and not most women. No, men hate bringing up (sorry for my choice of words here) their struggles with erectile dysfunction. Most aren’t even able to verbalize their complaint. Instead, they just point at their crotch and stutter, “I can’t, umm,” followed by a fill in the blank. And, in the past 15 years I have only had one woman come to me concerned over her lack of orgasmic ability.

Thus, infertility falls into the hush, hush sensitive topic category. It is sensitive, but the shame and stigma associated with it prevent women and men struggling with infertility from getting the resources and support that they need. Breast cancer used to have a similar stigma associated with it. Women should not openly talk about their breasts! How improper! Yes, it was cancer, but the “unmentionable” kind. Thankfully, the shame that used to accompany the diagnosis of breast cancer has been diminished due to proactive campaigns encouraging and empowering us to embrace our womanhood, “feel our boobies,” and kick cancer in the butt. This change in culture has led to life saving advancements in breast cancer research and treatments.

Can a similar cultural revolution transform how infertility is viewed? Yes, but only if people are willing to step outside of their comfort zones. If thirty year olds still refer to their genitalia as their “junk,” how are we going to have a real conversation about infertility. Using real words and talking about real life problems is a good starting place. Acknowledging that the human body often fails us, and that infertility is one of these physical and biologic failures that is out of our control, lessens the stigma, even if slightly. Normalizing the idea that infertility is incredibly common may also empower men and women to open up more readily about their struggle toward parenthood. The more that people talk about this culturally uncomfortable issue, the less uncomfortable it will become.

Reducing the stigma of infertility will positively and powerfully impact the infertility world. Infertile couples will have a larger support system if more people are willing to share their stories. This in turn will lead to increased social networks and social capital. With increased unity focused on the cause of infertility, more money will be raised for research, leading to improved infertility treatment options. Additionally, awareness campaigns may lead to political activism, forcing insurance companies to take infertility seriously and cover necessary treatments. Imagine a world where people have increased fertility because of improved infertility treatments and insurance coverage! If population control is your thing, then this may not excite you. But, for those of us hoping to add to the human race, this thought is utopia!

From The Mom in Me, MD

Sex at its Worst

Distressed Couple Finding Out Results Of A Pregnancy Test

The worst sex is baby-making sex. It starts off romantic, even inspired, but it quickly loses its charm. Some lucky couples may be exempt from my assessment. For example, the “oops couple” may have been having the time of their life only to find out that they are unexpectedly pregnant. Or, the “let’s stop the pill for one day and see what happens couple” may really enjoy the added benefit of being off of a medication that has a tendency to stifle orgasms and intense sex drive. For most of us, baby-making sex is timed, routine, get it done sex. It is layered with the stress of, “Will I ever get pregnant?” It may start off fun because the thought of making a baby together is beyond incredible, but when months start to pass and periods keep coming, the giddy gitters are replaced with a nervous question, “Will it ever happen?”

It would be nice to tie a bow around fertility and say that most of us have it. Realistically, one in eight couples struggles with infertility according to The National Survey of Family Growth from the Centers for Disease Control. That indicates that if more than eight of you are reading this, at least one of you is struggling with or will struggle with infertility. Not to rain on the stork’s parade, but this is something that women should be aware of so that they aren’t blindsided in their journey toward motherhood.

Knowing that you may struggle with infertility may be hard to acknowledge, but it may push you to seek help a little more quickly. Many women have embraced the career path, pushing back their nesting days into their thirties. In our culture this is more the norm than the exception, myself included. Although the typical rule of thumb is to try for at least a year before worrying about infertility, this doesn’t apply to those of us with ticking fertility clocks. Those of us desiring to enter the motherhood arena past the fertility prime of our twenties should be aware that the timetable is quite different. Women in their mid-thirties should actually consult an infertility specialist after only six months of unsuccessfully trying to make a baby the old-fashioned way based on current recommendations.

Although this may seem like a very short time to let nature take its course, the infertility workup path can be quite protracted. Many infertility clinics are booking out several months down the road. Completing a full infertility workup takes at least a month for all of the blood work, testing, follow up appointments, and decision making on how to proceed. So, if you haven’t gotten pregnant in six months, you most likely won’t even start infertility treatments for several months more. And, who is to say how many infertility treatments you will need before you actually get pregnant? Going into baby making in your thirties or forties with this knowledge may improve your chances of getting pregnant by encouraging you to be more proactive in investigating your fertility status sooner.

On a side note, some of you may be offended that I mention your twenties as your prime fertility years. Don’t start chewing me out. Biology and genetics are the ones running the show. I’m only stating the facts. Besides, it’s not like I’m in my twenties either. It is a confirmed fact that our ovaries have fewer and fewer healthy eggs with each passing year. Acknowledge it. Accept it. Embrace the fact that you are no longer in your twenties!

In addition to seeking an infertility evaluation sooner, knowing that one in eight couples struggles with infertility may also make you feel just a little bit less broken. People who are getting pregnant share the news. This is why it may seem like you are the only one not getting pregnant. People who are infertile often keep it to themselves. Infertility is a heavy word. It is weighted with shame, embarrassment, and feelings of inadequacy, despair, and desperation. Even the most optimistic couple can’t help but feel a little defeated when faced with this diagnosis. The possibility that parenthood may never be in their future can be world shattering. Knowing that you aren’t an anomaly can soften the blow…just a little bit. And, in the midst of an infertility diagnosis, any softening helps immensely.

In addition to knowing you aren’t alone with your infertile status, being aware that infertility is common (6.7 million women in the United States alone struggle with infertility according to the Centers for Disease Control) may nudge you to find a support system sooner than you would have. When my husband and I realized that making a baby the natural way was most likely unattainable for us, I struggled with the reality that I was an infertility patient. I went to most of my appointments alone, and even though I was in a waiting room filled with other women struggling with similar experiences, an uneasy silence filled the space between us. This silence was laced with pain, fear, and cautious hope. Why we didn’t reach out to each other always confused me. I assume that we wanted to respect each other’s privacy. We didn’t want to overstep the invisible barriers that each of us had build around us. Looking back, I would do things differently. I would risk a little more. I would trade in my pride for the support that these women could have offered. Maybe they didn’t need me (doubtful), but I needed the support that they could have offered. I now realize that enormous support exists for those of us carrying a diagnosis of infertility including online support groups such as Resolve, community support groups, and wow, probably one of our eight friends who is in a similar predicament. If we would be willing to share our story with others, they may just be willing to share their story with us.

If you find that baby making sex isn’t your forte either, embrace the fact that you can throw your birth control pills down the toilet for good! Sex can be entirely recreational and for passion and love’s sake alone. And, although the infertility journey may be the most difficult one that you take, starting the process sooner may increase your chances of success. You are not alone in this journey. Reach out early, and the stamina and strength you garner from other women’s stories may surprise you. Nothing is more powerful than women empowering other women in their journey toward motherhood.

From The Mom in Me, MD