a journey toward parenthood

Nathaniel and I have wanted a child for a while, but we also wanted to wait until I was far enough along in my PhD program that I would not be sabotaging myself academically and professionally.  So after I passed my general exams (the Master's benchmark), I went off birth control and started tracking my cycles.  I was pretty confident it would only be a few months—most couples get pregnant within 3 or 4 months of trying.

A year of ovulation and pregnancy tests, temperature charting, and prenatal pills (just in case) later, we went in for the infertility diagnosis so we could move on to treatment.  That first year of trying was emotionally draining, but the following year of treatment was far, far worse.

We learned that my body produced too much FSH (follicle simulating hormone), which usually means that a woman has a low egg count.  Even if one could control the FSH somehow, the underlying issue of too few eggs would remain.  My day three FSH reading was usually around 24 or so.  Less than 9 is considered normal for childbearing age—to put things in perspective, my FSH reading was what should be more typical of a premenopausal woman in her mid forties, and I was only 28.  Over 19 means that many fertility centers won't even try to help you with your own eggs.  It also meant that our Aetna insurance was not guaranteed to cover anything, but we could appeal and make a case for coverage.

At first, I was still optimistic.  Of course I would get pregnant, right?  But then I didn't really respond to the pills they gave me to "ripen" more eggs.  So we moved onto the more powerful injectable medications.  In addition to going in to get my blood drawn every few days (which made me look like I was shooting heroin) and getting intrauterine ultrasounds regularly, I learned to give myself shots in my stomach to both encourage egg development and induce ovulation.  And despite all the needles and early morning poking and prodding, I still only produced one egg at a time.  Well, once I produced a lucky two.  Dealing with insurance was also beastly, though our center handled the brunt of it.

At some point during this process, Nathaniel and I realized that we might never be able to have our own biological children and we each went through our own depressions.  I was angry when television shows, movies, and books used pregnancy as a plot point, especially for a single sexual encounter.  I had a hard time being happy when friends and family announced their own pregnancies.  I had to avoid Facebook because everyone seemed to be talking about their kids.  Church was torture, especially when I listened to lessons or talks from the pulpit on parenting or families.  People unknowingly teased us about not wanting kids or asked us when we were going to have them or if we wanted them.  I had been that person previously, asking inappropriate personal questions, but now I know better.  As the receiver, I would respond with a smile, then go home and cry.

Then our story took a happy twist: after about two years of trying, I was pregnant.  We were actually taking a break from fertility treatment and were not at all expecting it.  N pulled the test out the trash and squinted at it to see the first signs, and I took a dozen more tests through the following days.  A huge burden had been lifted, and the grief had passed, replaced by joy.  I was looking up strollers and other baby equipment, and making plans on when to tell everyone.  I figured out how much weight I needed to gain.  I found a doctor and had my first appointment.  I got rid of my sharps container and used kitty litter to safely get rid of my remaining injectable medications.

I reminded myself that not everyone gets this lucky.  That year of grief taught me a tiny sliver about what it would be like to go through a lifetime of infertility.  It wasn't until I thought I had broken down every single emotional barrier that I got pregnant, or so I told myself.  I needed to gain that humility—I needed to be okay with every option, including adopting (which was easy—I was planning on adopting if I didn't get married), having a special-needs kid, or getting an egg donor (this last one was the hardest).  I needed to want to be a parent so badly that I would realize that being a parent isn't about defining my own identity, but about being willing to fill that role for a child who needs it.  I thought I had come so far.

And then I miscarried at just before 8 weeks.

I was in denial.  I kept reading online about how you can bleed and still be pregnant, even after passing pretty substantial blood clots.  I was in contact with my doctor, and holding out hope for the ultrasound in a few days.  I was tense as the technician looked.  After a while she apathetically told me that she didn't have anything to show me, then left me (without bothering to send in my equally anxious husband) to go talk to the doctor.  There I was, half naked and alone, with the devastating confirmation that I was no longer pregnant.  The icing on the cake was the terrible break-up music being pumped over the speakers.  After a while, she came back and, despite my having told her about the miscarriage concerns, she tried to tell me that maybe I just wasn't as far along as I thought.  I might have visibly rolled my eyes at her—I had been monitoring everything pretty carefully and knew when I had ovulated.  The baby was gone.

We took a while to mourn the loss, but eventually the grief passed.  We tried to look at the silver lining: now we knew I could get pregnant.  And so it was never as hard as it was before the pregnancy.  The darkest times had passed.

We decided that we were going to be parents one way or another, and that if I couldn't get pregnant again, then we would adopt.  We had the capacity to be loving parents, and we wanted to use that capacity.  Some infertile couples end up using that love through volunteering or their jobs, but given the nature of our careers, adoption seemed like the best fit for us.  (Though we understand that it's not the right choice for everyone.) That made things easier some days, but it was still a question of when: when should we make the transition from trying for biological children to trying for adoptive children?  Not yet, we felt, especially with so much uncertainty ahead with graduation looming and possibly new jobs on the horizon.  We didn't want to get all set up with the approval process only to relocate.

I started up acupuncture, since my insurance covered it.  I also consumed plenty of Chinese medicinal teas, many of which were incredibly bitter.  Eventually I stopped going because it was a lot of effort for no obvious benefits—I imagine it could work for some people, but it wasn't my thing.

My church asked me to speak on Mother's day.  I thought long and hard about it, and decided to do it. I basically just cried continuously, but told everyone that Mother's day can be hard for some people.  It can be hard for people who have lost their mothers, or don't get along with their moms, but also for women who have never married, who can't have children, or who have lost a child.  I told them that we were struggling to have kids and that biological children just might not be in the cards for us.  But I also gave thanks for my mother, grandmothers, and other women who have touched my life.  I learned to turn despair into gratitude.  Or at least to try to do so.

Eventually, we went back to western medicine.  We were going to do maximum dosage injectables on an IUI cycle to see how I responded.  If that went well, we could move to IVF.  But I didn't respond well.  At full dosage, I still only produced one egg, which meant that IVF wasn't worth the risk.  I took a home pregnancy test at the end of that cycle and saw a very slight line, but then I bled the following day.  Because the medications can mess up urine tests, it's not clear if it was actually a pregnancy, albeit short lived.

When we next met with the doctor, she told us that we should only try a few more IUIs on low dosage oral medication.  She said we had maybe a 5% chance.  Imagine taking twenty alternate universe versions of this situation: only one will be successful.  It's about the chances of rolling a total of 3 with two dice on a single throw.  It's low.

We wanted things to be more black and white.  We wanted "you can't have children" to make the transition to adoption easier.  But they kept stringing us along.  Adoption comes with its own set of emotional challenges, such as a mother choosing you to adopt her child, then deciding that she wants to keep her child.  Of course she has that right, but it's still difficult for the potential adoptive parents.  So we pushed it down the road...we decided that when we moved away from the area in a year or two we would begin the adoption process.  After about three years of trying, we were ready to be parents, but we could wait a little longer to make the logistics easier.

On another break from treatment, due to scheduling issues, I took another pregnancy test.  It was ever so lightly positive.  I tested again in the following days, and it was clearer: I was pregnant again.  But there was not a lightness or joy this time.  Instead, I felt mostly dread.  When would the miscarriage be?  Every twinge was a sign of loss.  Here comes the sorrow, here comes the despair.  I couldn't let myself enjoy it, at least not until I heard the heartbeat, or so I told myself.  But in the meanwhile, I was looking up really morbid statistics, like the chances of stillbirth or late-term miscarriage.  I even worried about having a child that would die young.

It wasn't until around the time I got a call from my nurse at the infertility center that I started to get excited.  She was calling to check in and make the plans for the next treatment cycle.  I was in a meeting at the time, so I listened to her long message with detailed instructions on how I was going to need to get medications from two different pharmacies (a standard one for the pills and an online order for an injectable to induce ovulation).  So I left her a message in return to say let's put a hold on that for now, and let's where this pregnancy goes.

The following day she asked me to check in with my insurance to see if they would cover early monitoring with them, and for the first time insurance was a breeze.  The insurance guy I talked to was incredibly helpful and cheerful, and it looked like everything was going to be covered.

I think there's something about telling other people that starts to make things real, even if those people are medical professionals and not friends or family.  We still were not really to tell loved ones yet, since in some ways, we would rather have waited to find out ourselves until things were more certain—the roller coaster of excitement and loss is exhausting.

The first ultrasound mid-week 5 went as expected—we saw the amniotic and yolk sacs.  But mid-week 6, I had some severe cramps in the early hours of the morning.  Here it comes.  N went for a walk with me, and we watched a Star Trek episode in the middle of the night to get our minds off things.  But the cramps turned out to be digestional, and N had similar ones soon after.  Still, it put us on edge, to be reminded of how suddenly miscarriage could come.

Two days later, we went in for the next ultrasound, and saw and heard a heartbeat of 116bpm.  That meant the miscarriage risk was around 18%.  It put us a little at ease, and even encouraged us to get a little excited, but the risk was still there.  Risk will always be there.

We told our immediate families and some close friends.  The weeks ticked by.  I defended my PhD and graduated.  Now I'm 28 weeks along, and everyone who sees me in person can tell I'm pregnant.  Frankly, we're lucky.  There are many people who deserve to be parents and don't get that chance.  And while I am very happy with out current situation, I would never give up the three years of heartache—it taught me some much needed empathy.  The pain of this journey may fade, but we won't forget it.  I think it makes me a better person, even if I still have a long way to go, because it's stripped away a lot of my desire to judge others and taught me about how to be more sensitive to others' hidden experiences.

For instance, I developed a much deeper respect for those that become parents either through an egg or sperm donor, or through foster care and adoption.  Being a parent is about the love you give your child, and while giving birth and breastfeeding are ways of showing that love, they are only some ways to do so.   And biological similarly does not necessarily help you be a better parent.  Again, it's all about the love and care you give the child.  This applies even if you aren't a guardian, but are an aunt or uncle, teacher or friend—if you have the love of a parent, you are a parent in your heart.

I also learned that there are so many kinds of infertility that it isn't really helpful or encouraging to share a success story for a type of infertility that doesn't match what the person is going through.  Like don't try to inspire someone with a story about surrogates when the person is having trouble making their own eggs.  There are a bunch of articles about dos/don'ts.  Even if you think you don't know anyone struggling with having kids, whether it's secondary or primary infertility, or recurrent miscarriages, I guarantee that you do.  About 6% of married women of reproductive age struggle with infertility.  That means that if you have 100 female acquaintances that get married at some point, about 6 of them have, are, or will struggle with this.

Miscarriage is a whole 'nother ballpark.  The stats on that are a little trickier, because most miscarriages are mistaken for periods.  Recurrent miscarriages (3 or more) happen in about 1% of women, but it feels like almost every woman has a miscarriage story, either her own, or one from a sister, mother, or close friend.  Miscarriage is incredibly common.  I say this not to diminish the emotional impact of a miscarriage, but to remind folks that 1) if you've gone through a miscarriage, please remember that you aren't alone and there are people out there that want to love and comfort you and 2) someone you know and love has gone through a miscarriage, even if you don't know about it—use that as a reminder to always be kind, sensitive, and loving.

There are also people who don't want kids, but get pregnant accidentally or feel constant social pressure to have kids.  There are infertile women who judge those who get abortions, and people on birth control who judge those who are pregnant.  It's so, so messy.

The more open I am with my own history, no matter the context, I find that many other women have their own stories to tell, be it about infertility, miscarriage, or being pressured to have kids.  And men aren't immune—just because they might not go through the same physical processes doesn't mean they don't feel the emotional pain.

So if you don't know, don't assume.  Just try to understand, but be very careful with your personal questions.  I learned not to ask questions about having kids directly—what you think might just be an ice breaker could actually hurt someone a lot.  I'm sure I am guilty of this in many domains, not just infertility, but my go-to ice breaker is now some variant of the vague, "So, what are your interests?"  (If you've made it this far, I'm probably preaching to the choir.)

And yes, you shouldn't need to tip-toe around worrying about everything that could possibly offend someone.  As long a you cultivate true love and respect for other people, that will shine through.  But that kind of love requires putting in the patient effort to understand our fellow men and women, just as one should to understand a child.

I'm putting my story out there because I believe it's important for these issues to be more public.  When you think you're alone, it hurts all the more.  But you aren't alone.


Jeff Kaufman said...


Tom said...

Congrats and crossed fingers. I hope everything goes well for both you and Nathaniel. Two close friends of mine has been struggling with infertility, multiple mis-carriages, etc. for several years and are now -- finally -- are expecting twins in 5 months.

take care,

Tom said...

Congrats on the birth of your son, Andrew! Glad everything went well for you.