Fertility…the ultimate lesson in futility and humility?
Alanis Morissette really nailed it—life is a game of ironic opposites and undoubtedly one of the biggest is the fertility/infertility challenge.
Crazy how you can spend so many years of your life being terrified of getting pregnant and suddenly you’re faced with the unfathomable reality that you’re unable to conceive. You go through, “Is this the right time…yes…no…no…yes…” Then finally, “Cool…let’s get this party started!” and then, “Hummm…that didn’t work…must have been this, that, or the other thing.” Fast forward through months of crazy stunts to hit the right time and then finally facing the realization that intervention is inevitable…and downright scary, confusing, and daunting.
For most of us, all of this goes down in the middle of what’s become some pretty good career years, and life years for that matter. For me (and for most), it's the early to mid-30s. To be honest, I had a weird road mentally to even get to that point. I’d gotten married ridiculously early at 23 to my college buddy and at that time figured kids would happen by my late 20s (I was the oldest of five in a Catholic family). Yet once I reached my late 20s, I’d found myself in graduate school and really loved all of it. Meanwhile, my lawyer-husband worked an inhuman schedule and traveled relentlessly. There was no way I was going to be a “single mom” at that point.
Fast-forward to my early 30-something years and I figured it was time to get started or I’d find my choices narrowing. To be honest, I really never embraced the idea of being a mom because my career was progressing and I didn’t want to let it kill my momentum, but knew my husband really wanted to be a father and I worried that I’d regret not being a mom at a point that I wouldn’t be able to do anything about it. Combine ambivalence with one of the most bizarre processes any human could ever go through—by choice—and you have a strange dynamic. The tests, the shots, the pills, the scopes, the miscarriages, the surgeries, the unknowns, the hope springs eternal, the surprising painful and scary stuff no one warned you about—it’s every day for years and years with huge costs and massive time and emotional torture.
I went into the whole process determined to not let it own me or defeat me. I went into it promising myself that I would stay bigger than all of the junk that was happening, that I’d treat it like a job and stay unemotional and objective. I survived it by breaking down the overwhelming and daunting and seemingly impossible into bite-sized chunks, compartmentalizing it, rewarding myself in one way or another when things didn’t go right.
One of the toughest parts that made keeping perspective particularly rough was going through all of it in the midst of friends and family just having sex when they wanted and boom, having babies. :) Bellies everywhere, showers everywhere, people quitting and moving to the burbs everywhere. Suddenly, people are looking at you with pity and all sorts of advice—"You’re probably too stressed at work and should quit if you really want to get pregnant.” So, you’re supposed to sit around at home waiting for something magical to happen while giving up your life not only in that moment but compromising what it could be for years thereafter?
On top of all that, fertility requires two to tango and dudes are the source of the problem at least 50% of the time. Crazy thing is that regardless of whether it’s you or the guy who has an issue, it’s the woman who undergoes all the “stuff”—the crazy drugs and tests and scopes and procedures. As my dad has often reminded me, “life is not fair,” and this is definitely proof of that.
Anyway, I went into the whole thing determined that I’d come out of it the same person—whether it worked or not, whether we ended up with kids or remained lifetime DINKs (Dual Income No Kids). I also didn’t want the whole time spent on this long, strange trip to be a “put my life on hold” period that I’d regret.
An important thing to note is that fertility is brutal not only physically, emotionally, and cognitively, it can be a huge butt kicker financially as well. While I got lucky living in a state (Massachusetts) where the law requires insurance to cover it, most states don’t (check online and with your doctor to confirm what’s covered as part of everything vs. things you’ll have to fund out of pocket). While this isn’t something I had to deal with first hand and I’ve been out of this game now for over 15 years, the average investment ends up being about the same as adoption (more or less)—i.e., tens of thousands of dollars with no certain outcome.
Moreover, on top of evaluating whether you’re able to endure the whole “human” side of the process, you might be gated by not being able to make it happen financially or face massive trade-offs in your personal life as part of it. If it all works out in the end like it did in my case, you tend to forget the costs and sacrifices endured. However, for those who commit years of their life and massive savings that could have been used for other purposes, the toll it can take on you as an individual and as part of your relationship with a partner or spouse can be too much to bear. I’ve seen many couples make it through and many who don’t. The reality is that marriage, or committed relationships more broadly, is just plain challenging even under the best of circumstances—it’s asking a lot to expect two people to be perfectly compatible interpersonally, physically, and fiscally, especially over decades. Throw in big adversity—challenging illnesses, financial crisis, or something like the fertility gauntlet—and it’s a recipe for disaster. Like all adversity in life, it can be a “that which does not kill us…” outcome or something that completely destroys one or both of you in a way that there’s no path back to normal (whatever that means).
Looking back now nearly 20 years from when the whole thing started and knowing that the process produced two amazing boys, it’s easy to discount or even forget the tough stuff that led up to it. But I think it’s good to remember the intestinal fortitude required and the strategy I took to survive it. I attempted to take a “glass is half full” approach through the whole life event, trying to view the whole process as a unique experience I was oddly lucky to know because of how it gave me additional strength, humility, and perspective.
Do I have any regrets that I didn’t proactively address my fertility earlier when I was in my 20s? After all, I was married at 23, so I had many years where I could have started having kids much sooner than I did. I’m not quite sure on this one because if I’d gotten pregnant in my 20s like many of my peers did, chances are I never would have had a career, or at least the amazing one that I ended up realizing. Interestingly, when Paul and I were first together, I had 26 as the magic age where babies would happen yet when I reached 26, it made absolutely no sense to me based on what was going on in my life. By then, I felt compelled to do more and pursued graduate school, finding myself in a fantastic MBA program at the University of Chicago that absolutely changed the trajectory of my life in countless ways. At the same time, Paul was in the early years of his career as a corporate attorney and NEVER around—he typically got about three hours of sleep, frequently pulled all-nighters, worked non-stop on weekends, and was always on the road. I wasn’t willing or able to be the lead parent at that point in my life. Plus, having grown up as the oldest of five kids, I’d essentially raised the three youngest siblings (or at least played a major role in all of that), so I didn’t romanticize what it would be like to be a parent. I found myself looking at all of it—our personal situation while also watching siblings and peers having babies—and thought there was absolutely no way that I was ready to take that on myself. Frankly, I was having a blast in my late 20s and felt like a “kid” who wasn’t equipped to have a kid. :)
So, I guess you could say I have absolutely no regrets about having waited, but I caveat that with a few things. One is that it can’t hurt to track the state of your fertility readiness—both yours and your partner’s if you have one—through your late 20s. If it looks like something might present challenges, you can factor that into your decisions and determine how much the clock is working against you. Also, this might seem a bit too Margaret Atwood-ish, but your insurance policy could be harvesting and freezing eggs and/or embryos in your 20s if it’s something you’re worried about and just aren’t ready to be pregnant and a parent at that point. I’m not sure that’s something I could have done or would do now if I were younger, but it’s great to know that it’s possible and might make great sense for some people.
One thing to note is that fertility does seem to fall off a cliff for many through their 30s even though there are many of us out there who are robust breeders well into our 40s. :) Given all of that and how important this might be to you, it’s worth weighing all of the costs and benefits along with the myriad of options you have. In the end, the goal is to ensure you end up with all of the ingredients you need to maximize your success and happiness in the short term through your 20s and 30s and over the longer haul of your life. For better or for worse, there’s really no right or wrong answer to all of that as it’s highly personal and situational on so many dimensions.
So, what’s actually involved in fertility? How does it all work? There’s a whole continuum of things you can pursue and the right course of action depends on what your challenge is, how much you can/want to invest, and what you’re willing to endure. In my particular case, we started with something called IUI (a.k.a. Intrauterine Insemination or the “turkey baster”), which involves taking a powerful drug called Clomid that causes your ovaries to produce an excessive number of eggs when you’re ovulating. You then track your cycle daily or even hourly and at exactly the right point go into the doctor’s office or clinic with your partner where they do their “thing” and that is then manually injected into your uterus. Throughout the entire process, you’re continuously required to head into the hospital/clinic/doctor’s office for a combination of blood tests and scopes as they track what’s going on with your hormones, how many eggs are being produced, etc.
The goal of this whole IUI approach is to achieve a higher probability of achieving conception by having more eggs in the mix and providing more direct interaction with the “swimmers” so everyone doesn’t have to work as hard to find each other. :) If memory serves me, I went through three-ish rounds of IUI, one of which worked but then I miscarried at around eight weeks. Anyone out there who’s endured a miscarriage can tell you what a horrible experience that is…ugh, no fun at all, but something so many women endure and you can too.
Somewhere along this process, I ended up having laparoscopic surgery to address something called an endometrioma on one of my ovaries. One of the many challenges of this whole fertility workup process is that when you go poking around your body, chances are you’re going to find something that’s not exactly right. While this thing wasn’t necessarily impacting my fertility, it was worrisome because it was unclear whether the growth was benign or malignant. Luckily, it was the former, but the whole process prolonged the “getting pregnant” process by at least six months because of everything it entailed and just added to the overall gauntlet factor—the physical challenge of surgery, the emotional challenge of maybe having cancer, and also wondering how the whole thing would impact the broader fertility process, and the broader life challenge of taking time out of work and life.
About two to three years into this whole journey, we changed doctors and hospitals and started to dig in on what ended up being the next level of fertility—ICSI, or Intracytoplasmic Sperm Injection (say that 3x fast!). This was the route doctors recommended since we were facing some mobility challenges (a.k.a. lazy/slow swimmers). Like the IUI process, the goal is to create more direct contact between eggs and sperm, but this is more extreme as the procedure involves drugs via a longer series of injections that prompt your ovaries to ideally mass produce eggs (I only produced five-ish at a time but the woman next to me achieved ~30…whoa) that are harvested from your body as part of what is sort of a day surgery process because it involves a spinal block of anesthesia. Once the eggs are harvested, they put them into a lab environment and inject them directly with sperm to create embryos. They then watch how the embryos evolve over several days to see how much the cells divide—while they believe that the volume of cell division is a proxy for robustness/healthiness, they’re not entirely certain on this. For example, my first son (who’s absolutely beautiful and brilliant in every way) was the result of what they described as three “poor quality” embryos, but it was all that we had.
The ICSI process for me went on for several months because while the first round worked, I miscarried quickly at six weeks and then had to start the whole process over again several months later. Throughout both processes, which each required several months of injections, I was traveling periodically for work on top of trying to manage the ongoing blood tests and scopes that monitored by hormone levels and tracked the development of eggs and embryos and more. My amazing husband (St. Paul :)) often traveled with me so that we could achieve everything required with the injections. While some of them were “small needle” and relatively easy for me to administer myself, the “big needle” progesterone shots were something I couldn’t do. Guessing there are some women who figure out how to make it happen, but I was too much of a wuss, especially once you end up with a challenge finding places that aren’t already bruised.
While all of this was very challenging, I was relatively lucky because I was able to carry my babies and didn’t have to pursue a surrogate. From talking with women who’ve had to ensure this process, I know it adds a whole other dimension of stress and can be absolutely daunting on so many levels. Once I was able to get pregnant, I had really fantastic pregnancies—felt great throughout, had no major hiccups, delivered on time, etc. I became a fat shit for the first time in my life and ended up weighing more than my husband (which was my absolute ceiling from the outset yet I completely violated it…ugh…funny thing is thinking back to all the people who told me I didn’t look pregnant from behind…I want to go back and tell them they were all so full of shit but I love them for lying to me at the time :)).
Over the course of the five-ish years this all went down, did I freak out? Hell yes, I did! I really stopped socializing with most of my friends—e.g., quit book clubs where everyone was pregnant and no one was drinking, tried to avoid any sort of “shower” that I could evade, focused on hanging out with Paul and mostly single friends. The whole thing was just so exhausting and relentless in the moment, which made it tough to keep everything in perspective. All that said, I really made a concerted effort to achieve “detached engagement” in all of it, taking concrete steps in my life to ensure I would be okay either way—whether I ended up being a mom or not. I took each day one at a time, each procedure and stage of the process one step at a time, tried to eat the fn elephant that is fertility one bite at a time. There’s no doubt that it can and will utterly defeat you without a concerted effort to focus on the great things in your life without kids—the fun dinners out, the new cool cars you can drive, the amazing trips you can take on a whim, the peaceful and clean house you get to enjoy every day, the ability to spend however long you want at the gym or spa. I could go on. :)
So why do I tell this story? Most importantly, because other women are going through it or will have to face it at some point. The “do I pursue the fertility treatment route or not? How does all of this work? Can I keep working while trying to deal with all of it? What if it doesn’t turn out the way I want after all of the time and money and stress and discomfort and….”
Here are my thoughts and guidance on all of it:
Don’t feel pressured to pursue the fertility route but know that it can work and create an amazing outcome.
You can figure out how to have a high-pressure job and get through the fertility treatments—it won’t be easy, but it definitely can be done. Treat the whole thing like a job and figure out how to evolve your job to accommodate it. DON’T QUIT (unless you really can’t avoid it) because sitting around waiting for something to happen while eliminating your normal life will absolutely lead you to lose perspective in the short run and give up something important for your longer-term success and happiness in life.
Protect yourself all along the way—stay away from people, places, and things that are likely to make the whole thing harder or more stressful for you. Focus on treating yourself with your favorite restaurant, a cool trip, etc.
Make time to be with your partner. Relish the things you’re able to do because you don’t have kids—great weekend trips, fun loud concerts, new house stuff and cars, movies in the afternoon, golf and gym together.
Realize this is going to be a lonely time and try to keep all of that in perspective. Carefully pick the people in your life at that time who can help you get to the other side. Avoid telling loads of people because it will come back to bite you in the ass.
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Christina Van Houten is the founder of Women at Work. Based in Boston with her husband and two teenage sons, she has spent the last 20 years of her career as a senior executive in the enterprise technology sector. Prior to evolving into tech, Christina founded a women's athletic apparel brand and served in several public interest roles focused on community and economic development. She started working at age thirteen and hasn't stopped since. She’s eager to help women find their way to the best possible life they can achieve.