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The Big IF

Four writers look back at the roads they've traveled since wrestling with infertility.

by Julie Corby, Tanya Gabbay*, Jaymee Giddings, and Danielle Pennel

You never get to infertility by choice. But then, once you're there, you must make a seemingly endless array of decisions. When do you walk away from fertility treatments? Give up the dream of being pregnant? Consider adoption? What route, which country? Donor egg? Donor embryo? Gestational surrogacy? In what combination? Which donor, which surrogate? Living childfree....? There are countless ways to work though these intensely personal decisions. Here's how some who have traveled this road made their choices.


REGRETS ON THE ROAD TO MOTHERHOOD
Dear Infertility Patient

From a woman who finally became a mother after a decade of trying, here are a few things I wish someone had told me years ago.

by Julie Corby

Dear Infertility Patient,

I sat in that seat you're sitting in. Comfy, isn't it? Nice, rich, dark leather? Ask the receptionist for some water. They put lemons in it, very refreshing. Oh, see that door behind the front desk? That is the door the celebrities use. That big movie star with the new twins, she snuck in through there. Before you get started, I want to tell you a couple of things, things that I wish someone had told me years ago.

Your doctor, the one whom you are about to meet, is really, really nice. Those pictures of bouncy, beautiful, babies on his bulletin board are his success stories. He is pretty successful. He has three homes, one with an ocean view, drives a Porsche, and takes fantastic vacations. He likes football. He is going to make you feel more hopeful than you have felt in months. You may even have a slight spring in your step as you leave today, your grief temporarily lifted by a solid plan of action and a brand new prescription.

That woman there, she is your nurse. She is also really nice. She won't get upset if you faint after your first injection. If you slump to the floor, as I did, she will get you some juice and a cool cloth for your face. When you go for your blood draw in the next room, make sure to ask for the male phlebotomist from the Philippines. He is the gentlest and can find a vein on the first try. You will be giving a lot of blood and getting a lot of injections.

About those hormone injections, you know how you feel when you have PMS--crabby, emotional, and sort of angry? You are pretty much going to feel like that all the time. Those arguments that you have been having with your spouse about what to do next, and how you are going to pay for it, might become a bit more volatile and upsetting. You will gain weight. You will have bruises on your arms, legs, hips, and belly. People might mistake you for a junkie.

Did you cut out caffeine, as they recommended? That part sucked for me. I really love coffee. Have you been taking folic acid and prenatals? Are you eating yams and warm foods? How do you like acupuncture? Some women swear that adding acupuncture to their infertility treatments is what finally did the trick for them.

Oh, is that your husband who just arrived? He looks sad, lots of lines around his eyes. This is not a very fun way to spend a lunch break, I know.

Look, this is the thing. This might not work. It does for some, but not for everyone. Before you spend thousands of days, and tens or hundreds of thousands of dollars, on something that is not a sure thing, please hear me out.

I think I know how you are feeling. Maybe you feel like you aren't a real woman? Maybe you feel the reason you can't get pregnant is because, somehow, the universe or God or whatever thinks you would totally suck as a mother? Maybe you think you will never recover from that last miscarriage you had? Maybe you feel like no one understands, and that everyone else and their sister are happily pregnant with their third child. Maybe you have withdrawn from all your friends. Maybe you have changed your diet, and done anything and everything anyone has ever recommended, to help your fertility. Maybe you wish you could just crawl into bed and stay there forever.

And you, I want you to know that your wife still loves you very much. Part of the reason she wants this baby is that she can't imagine anything more profound and meaningful than having a baby with you, her soul mate. Perhaps, lately, you feel like she is treating you like some sort of superhero in boxers (briefs might inhibit reproduction), the Sperminator is here! Maybe you think she desires you only when she's ovulating? Maybe sex is all about baby-making now? Maybe it is timed and planned, and the opposite of romantic.

I have some good news for you. The test result you get today does not determine your worth as a man or your potential as a father. You have done everything you can to support your wife and her feelings. That secret beer you had last month, although your doctor said cutting out alcohol might help, has nothing to do with why this isn't working. Impregnating your wife doesn't make you a good father.

You may find out how good a father you are in the middle of the night when your baby's fever won't go down, and you need to take him to the emergency room. You may find out you are a good father when you explain the solar system to your curious six-year-old. You may find out you are a good father when you know exactly the right moment to remove those training wheels from your son's bike.

You may both find that being in a delivery room is not a prerequisite for starting a family. You may find that birthing a baby is not a requirement to be a mother. Amazing thought, isn't it? I couldn't believe it either. Perhaps you'll realize you are a mother when you let your four-year-old daughter sleep on top of you for three months, because it makes her feel safe after all the loss she has endured. Maybe you'll know when your infant son reaches his hand up to stroke your cheek.

You might get lucky, like me, and meet a child who makes you feel happier than you've ever felt before, a child so full of life that her eyes sparkle in a supernatural way. You might be fortunate enough to raise a son who is the epitome of boy, and who wakes up every morning shouting, "MAMMA!", as if he doesn't see you immediately, he will not possibly be able to begin his day. Maybe there will be pancakes, and play dates, and purple and pink. Maybe, if you are lucky, like me, the pain you are feeling now will almost completely disappear. Maybe you will find your way back to each other, and the two of you will share something that is indeed the most profound expression of love between two soul mates, raising a family. Maybe you thought that sitting where you are now is your only way to get there. It is not. All you have to do is stand up and walk out of that office. There is a great coffee shop across the street. I am happy to meet you anytime. They make an excellent cappuccino.

Julie Corby lives in Los Angeles with her husband and their two children, adopted from Ethiopia. She blogs at theeyesofmyeyesareopened.blogspot.com. "Dear Infertility Patient" was originally published at inCultureParent incultureparent.com.

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SELECTING AN EGG DONOR
When Egg Substitute Is on the Shopping List

How do you choose the person you want to make babies with? Everyone has her priorities; these are mine.

by Tanya Gabbay*

After a few inseminations and IVF treatments, I was ready to abandon hope for a genetically-related child and to pursue my fertility doctor's next suggestion: poring through the clinic's donor list and selecting an egg substitute.

It was strange that egg donation had never occurred to me before, since sperm donation has been in the medical mainstream for decades. As you might expect, the process of choosing either one is the same: you identify the qualities most important to you, then you pick someone to build a family with.

You know: online dating for eggs.

And like online dating, you have several categories of qualities to choose from. But before you even start looking, you pretty much have to accept the fact that you'll never find perfection. If you're a Type-A personality who's delayed having a family until everything in your life is absolutely perfect, which you don't realize is never going to happen until you're completely infertile, that's a hard thing to face.

It's an extremely personal decision, and priorities vary for everyone, but after days of perusing profiles, I determined my order of importance:

  • Appearance
  • Health
  • Fertility
  • Intelligence
  • Personality

Appearance tops my list. Some people refuse to look at donor pictures, but photos are my first filter before putting anyone on my short list. Yes, there's height and hair color, but I'm specifically looking for someone who's from my family's part of the world. I'm a first-generation American, with a where-do-you-come-from look, and that's a big part of my identity. While I'm ready to let go of a genetic connection to my kids, I'm not ready to let go of my heritage. But there's another aspect of appearance that's important to me, too: I want a donor who's pretty. People will call me vain, but I happen to believe that attractiveness is an advantage in this superficial world. Everyone has her priorities; these are mine.

Health ties for first, or at least runs a very close second. Medical histories include everything from allergies to birth defects, and you get information on the donor, as well as her whole and half-siblings, parents, and grandparents. I'm ruling out genetic ailments, cancers, and mental health issues, but I have no problem with lifestyle diseases (like adult onset diabetes), small limitations (like glasses), and anything that I also have (like glasses). I have to admit that this part is tricky, since the information is volunteered and could easily be falsified, but what choice do I have? Might as well trust.

Fertility comes a very, very close third. There are only three ways to predict a donor's fertility from her profile: by her age, previous pregnancies, and prior successful cycles. Age-wise, I won't consider anyone older than 27. I'm prioritizing women who have had children and abortions, and weeding out miscarriages and ectopic pregnancies. Proven donors cost more than first-time donors, but I believe it's money well spent. And, honestly, I'm already spending a fortune, so what's another grand to better my odds?

Intelligence is fourth by default. I could list it as another tied-for-first quality if I wanted to take months searching for the perfect donor, but I don't. I debated it, though. Intelligence is clearly genetic. In fact, donors with medical degrees and Pulitzer Prize-winning uncles can cost $25,000, so it's obviously valuable to some people. I, on the other hand, am just looking for a 3.0 GPA and the ability to communicate sensible thoughts. It's a low bar, I suppose, but I'm hoping that my husband's brilliant sperm will do all it can, and we'll get a math tutor for the rest.

Personality-related information runs dead last. It includes things like the donor's favorite color, favorite book, and favorite movie, which is invariably The Notebook. I find the questions banal and ridiculous because these qualities are not genetic, but the truth is that I'm in the minority here. Most intended parents want an emotional connection with their donor, which I guess I understand, but I can't help it: I just don't care what kind of vacation she prefers. On the flip side, I have eliminated donors whose answers reveal that they're idiots, so that's been useful.

So that's my definitive list of priorities.

Sort of.

There's actually a super-duper, top priority that trumps everything else: I need a donor who's willing to be known to me and my kids. I believe strongly in the lessons learned from the history of adoption, which include the cultural shift from "no one has to know" to "tell early and often." This means that donor anonymity is a deal-breaker.

After all, if my kids want to meet their ethnic-looking, pretty, healthy, fertile donor, they should be able to. And if they gripe about inheriting her less-than-brilliance or questionable personality, I'll tell them the truth: "Don't blame her. You're my kids, so, let's face it: donor or no donor, you were pretty much doomed from the start."

Tanya Gabbay* is a member of the PVED.org community and one of 15,000 women who will have a donor egg embryo transfer in 2012. She blogs at chickandeggs.com.

*Author's name has been changed to preserve privacy.

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CHOOSING SURROGACY
Becoming an Intended Parent

Deciding on gestational surrogacy and navigating the complex process involves listening to your heart and your brain at the right times.

by Jaymee Giddings

There is one thing I have wanted since I was very young--a family. For seven years I have been married to the most wonderful man in the world. He has the ability to drive me crazy like no other human being, and to make me happier than any other person on the planet. All that's missing is a child. And for many of those seven years, we have been debating how to start our family.

As I write this, we are starting to work with a surrogacy agency, which is only slightly less terrifying than a Brazilian wax (not that I have ever had one--I am too much of a chicken). How did we get here?

I have a medical condition that causes me to have marathon periods (six months of straight bleeding being my record). I also have polycystic ovary syndrome (PCOS), so getting pregnant would have to involve fertility treatments. At first, my husband and I discussed my carrying, but two years ago that became impossible. My medical problems had gotten so bad that, in order to preserve my sanity and quality of life, I had a uterine ablation, giving up the chance to carry my own child.

We then toyed with adoption. We've always known that it was an option, since I myself was adopted, but I knew I couldn't stand the heartbreak if it did not work out. I also wanted my husband to be able to pass on his--in my opinion--super genetics. Another reason that surrogacy was right for us is that I want to be my child's mother from his or her first breath. I can't explain why this is so important to me. Much of this decision-making process is emotional, rather than intellectual.

This is difficult because, once you choose surrogacy, you have to prioritize and make many legal decisions that emotions should be kept out of. As you go through choosing an egg donor, choosing a surrogate, and trusting people to do their jobs, you'll have days when seeing a diaper commercial can lead to hours of tears, yet you have to listen steadily to your brain, not your heart. Luckily, I have parents and a husband who seem to be able to think straight when I cannot.

At the same time, you can't cut off communication between your heart and your brain, because your heart is what keeps you going by telling your skeptical brain that this will all work out.

Jaymee Giddings is the proud mother of a two-year-old son, born to a gestational surrogate. She blogs at babygiddings.blogspot.com.

REASONS NOT TO CHOOSE

Wondering if you're ready to adopt or pursue a specific method of third-party reproduction and be a parent? Examine your motives. If you recognize yourself in any of the following statements, you probably need more time to contemplate this life-changing step.

  • Infertility has made you feel inadequate as a man or a woman.

  • You are the one who is infertile, and you feel guilty about it. You feel you owe it to your partner to pass on his or her genetic traits.

  • Your partner is the one who is infertile, and you are intent on having a child who is genetically related to you, despite his or her hesitation.

  • You want to "save" a child in foster care or an institution.

  • You want a playmate for the child you're already raising.

  • A close friend or relative offers to donate her eggs or be a surrogate. You consider accepting her offer because you don't want to hurt her feelings, or you feel that's your only chance.

  • You believe that adoption is a way to spread your religion.

  • You think that having a child will improve your shaky marriage.

  • All of your friends and siblings have children.

  • You've heard about people who have gotten pregnant after adopting or after having a child through third-party reproduction, and you hope it will happen to you.

  • You feel that going forward with an adoption plan or with third-party reproduction will entirely resolve the pain of infertility.

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CLOSING THE DOOR ON TTC
No Longer Hoping for a Miracle Pregnancy

An imminent hysterectomy is helping me realize that I no longer want to become pregnant--I only want to be the best mother I can be to my children, who came to me through adoption.

by Danielle Pennel

Mothers who come to adoption by way of infertility may think, in the back of their minds, that they could have a surprise pregnancy. It's not that we aren't happy with our choice of adoption, but it's natural for a woman to feel the desire to be pregnant and give birth. My infertility stems from my body's inability to release an egg. If you don't ovulate, the odds of conceiving naturally are zero.

Ten years ago, when I did IVF, my odds of success were an unheard-of 80 percent, and I did become pregnant. After I miscarried, however, we began our adoption journey and never went back to fertility treatments. I now have three amazing children through domestic adoption, and I love being their mother.

Over the years, I've taken medicine a few times a year to induce a period, in order to shed my uterine lining. Otherwise, I'd be at a very high risk of cancer. There were a few times when I thought I had ovulated naturally, and I seized on the possibility that I could get pregnant. But that's not how my body works. The only time my eggs have met my husband's sperm was in the lab of the IVF center.

For the past year, the medicine I was taking to induce periods began to cause migraines. I worked with my doctor, trying different medicines, to no avail. One of my final options was to get an IUD inserted, which would thin my uterine lining. I was shocked at how upset I got at the thought of permanent birth control. I haven't ovulated on my own since I was a teenager, but I hesitated to get an IUD because it would rule out the slight-to-zero percent chance I may ovulate.

Guilt overwhelmed me as I looked at my three beautiful children. I have never regretted choosing adoption over continuing with fertility treatments. So why was my heart breaking over the idea of ending any chance of pregnancy?

I had to remind myself that the reason for the IUD was to keep me healthy. Without it, I'd be at a high risk for developing cancer. What kind of mother would I be if I didn't preserve my health? I want to be around to see my children grow up and their children grow up.

I got the IUD inserted. Unfortunately, my body did not like it very much. I had gotten the IUD because I want to be around for my kids, but I was having such horrible side effects that I couldn't be involved in their lives. I cried a lot and beat myself up emotionally. I relived a lot of the anger I'd felt during my fertility treatments, anger at my body for not working like a normal woman's. I loved my kids and missed being with them because of all the problems my reproductive system caused. I got angrier and angrier at my body, my life, and this situation.

I had the IUD removed five weeks later, and it was a freeing feeling. I got back to my role as mother. Unfortunately, the only option left was a hysterectomy. I had known this before I got the IUD. I tried not to think about it, because it meant the end of any chance I had of becoming pregnant.

After the complications caused by the IUD, however, I surprised myself by being OK with the hysterectomy. I knew that I no longer had the desire for a miracle pregnancy. I only had the desire to be an involved mother to my children. I had a similar clarity of mind after my miscarriage, when I realized that I no longer wanted to become pregnant--I only wanted to become a parent. That fueled my fire to begin my adoption journey.

My surgery is tomorrow, and I am an emotional mess. Is it because I think I'll be less of a woman without my uterus? No. Is it because I'll never experience a successful pregnancy? No. I am a mess because I know that, during my lengthy recovery, I won't be able to do stuff with my children. I know they'll be well cared for by my husband and visiting family members. Still, I won't be the one sending them off to school, playing soccer with them, or carrying them to bed for quite awhile. I have to remind myself that it's only for a short time, and that the alternative, cervical or uterine cancer, is not worth the risk.

I've talked to my children about my surgery and why I'm having it done. They didn't say much at the time, so I didn't know whether they understood everything. Then, the other day, out of the blue, my nine-year-old son said, "Mom, I hope this isn't rude to say, but I'm really glad your stomach doesn't work like other women's. Because if it did, then you would never have adopted us, and I really love our family."

I couldn't have said it better myself.

Danielle Pennel is the mother of three through domestic adoption. She writes the "My Paperwork Pregnancies" blog on adoptivefamiliescircle.com.

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