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The Pain of Infertility

Emotions run high when you wait for a child. By Jill Smolowe



The high-powered job and the marriage were choices made along the way. But Susan, 29, of Houston, cannot remember ever choosing to be a mother. That was simply a given. “Even when I was 7,” she says, “my goal in life was to be a mother.”

Five years ago, she and her husband started trying to conceive. The first year, Susan charted her temperature daily and made sure the couple had sex whenever the mercury dipped. The second year she took a fertility drug—and withstood its resulting mood swings and hot flashes. Two exploratory surgeries followed, then expensive injections of more drugs, which induced potentially fatal ovarian hyperstimulation. Still, the couple pressed on. Susan finally got pregnant after taking a final drug—only to miscarry 11 weeks later.

After mourning that loss, the couple is ready to try again. “Sometimes I feel I am out of control of my life,” Susan says. “There have been times I’ve been ready to give up. But when you have a dream you will do anything for it.”

Infertility Injustice

Infertility is a prolonged shriek of pain that makes no sound. It is the woman who averts her eyes each time she passes a baby in a stroller, wells up at the sight of a diaper ad, goes numb when a friend announces that she’s pregnant. It is the man who resents providing semen samples in plastic cups, dreads injecting his wife with fertility drugs, longs for spontaneous sex.

Infertility is also the only medical condition that involves two people, but produces three patients: him, her, and them. He resents her obsessive talk about babies; she accuses him of insensitivity. Together, they nurse a lifetime of shared grievances: the disruptive visits to the doctor’s offices, the exorbitant costs, and the thoughtless comments of relatives and friends. Month after month, often year after year, they endure the physical emotional, and financial toll, all in hope of fulfilling one of nature’s elementary designs.

Once, conception meant a man, a woman, and sex. If that failed to produce a baby, couples adopted or resigned themselves to childlessness. In the decades since the birth of the first test-tube baby, however, the list of fertility treatments has expanded. While some infertile couples view each new scientific development with hope, many more fret that the growing list of advanced technologies makes it ever-harder to say enough is enough, and to reconcile themselves to a “child-free” life or to pursue adoption.

Infertility Stress

Once a couple steps onto the infertility treadmill, it’s hard to get off. Warns one angry woman: “You keep feeling you have to do everything you can before you give up.”

It begins with months of scheduling business meetings, trips, and social events around visits to doctors’ offices for diagnostic tests. Once a problem is identified—or worse, if no problem is found—it can become a full time preoccupation.

For Nebraskan lawyer Elizabeth, 32, that meant getting up in the dark, driving 100 miles to a lab in Omaha, then speeding back to rural Columbus. Such stress convinces some women that they must quit their jobs. In Elizabeth’s case, the stress damaged her self-esteem and strained her marriage before she finally conceived.

When so much time, energy and money is invested, the disappointments are magnified, and the losses cut deeper. If a couple doesn’t accept their infertility and move on, they can cycle repeatedly through the other stages associated with a major life loss: denial, anger, and grief. “The uncertainty is what’s devastating,” says Wendy, 28. “Every time you get your period, it’s as if the child you dreamed about died and you go into mourning.” Although she eventually became pregnant, Wendy admits, “When someone says an insensitive remark, it’s the infertile Wendy who reacts, not the pregnant Wendy. This experience has changed me for life.”

Insensitive Comments

Ultimately, about half of all people who seek medical assistance will enjoy a happy outcome—but no couple can predict which half they will fall into. After a while it provides no cheer when well-meaning friends say, “I know a woman who tried for six years and finally…” Such remarks can make a couple feel that they are not trying hard enough. Yet, the harder they try, the more stress they experience, and can inhibit their chances of getting pregnant.

“If I hear one more person say, ‘Relax,’ I’ll shoot them!” Elizabeth says. Eventually, many couples withdraw. “I didn’t want to be around friends or family,” Wendy recalls. “Too many people had said the wrong thing too many times. I just didn’t want to be hurt anymore.”

But even the home nest can begin to feel unsafe if spouses are not attuned to each other. A husband may not understand why his wife would refuse to take any more mood-alternating fertility drugs. A wife may feel her husband isn’t serious about having a baby if he refuses to undergo the testicular surgery that may—or may not—make the difference. Perhaps he feels no procedure is too extreme; perhaps she’d rather adopt.

Or perhaps they are simply at different points in the grief cycle. “Depression associated with infertility is more intense for women than men,” says Patricia Mahlstedt, a Houston, Texas, psychologist who treats infertile couples. “The good news is that most couples who go through infertility treatment and can speak honestly about their emotions end up with stronger marriages.”

No Guarantees

That still leaves even the most harmonious couple not knowing when to move on from treatments. Doctors often fuel hopes by providing misleading statistics about a couple’s chances for success. While many IVF clinics claim to have a one-in-four success rate—the same odds enjoyed by fertile couples—the American Fertility Society reports a national success rate more like one in seven.

While infertile couples tend to talk most about their bleak encounters with doctors who are evasive, insensitive, and cavalier, there are, of course, a good many practitioners who feel deeply for their patients. “We all have guidelines, and we do tell some patients we can no longer help them,” says Dr. William Gibbons, chairman of the department of OB/GYN at the Jones Institute for Reproductive Medicine at Eastern Virginia Medical School. “But ultimately, it’s the patient’s decision when to stop."

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