Our Bodies, Ourselves (102 page)

In addition to these emotional responses, your body will be going through changes. It is important to have a follow-up visit with your provider not only for physical reasons but as an opportunity to ask questions. Request the first appointment of the day or one before the day officially starts, so that you don't have to face a room full of pregnant women. Ask a support person to go with you if you think that might be helpful. Bring your questions with you in writing, and take notes—or ask your support person to do the note taking so you can focus on the conversation.

The depth of grief is not simply related to the duration of the pregnancy or the age of the infant; unexplained loss can be especially hard to accept, and healing from the loss can be a long process. You may feel a strong resurgence of grief on the date when your baby would have been born or when you see children the same age as your child would have been.

Our society has few formal ways of dealing with loss. Some of us find solace in creative expression—sewing a memorial quilt, creating artwork, or writing. Creating a ceremony or ritual helps us recognize the significance of the loss and honor the memory of the one who died. Some women mark the anniversary of important days in the lost baby's life—such as the date of conception or of her or his birthday—to acknowledge the baby's existence and place in the family.

This summer we will be planting a tree in front of our house in memory of Kyle. Summers will forever bring mixed emotions for us, July especially. Growing up in Brazil, summers were such a highlight of our lives. I like to think that there is a reason why we lost Kyle in the summer. Perhaps slowly we will be able to hold his memory as one of those forever-treasured childhood memories of joyful and innocent summers. With time, we are better able to embrace the full cycles of life even when it feels unnaturally “wrong” that some life cycles are not as long as we expect
.

Some of us heal by working to improve the way that women who experience loss are treated by hospitals and providers, or by creating resources on pregnancy or infant loss. As a
result of such efforts, many hospitals now have bereavement teams and pregnancy-and-infant-loss support groups. There are also a number of support organizations and books on loss—most formed or written by women with personal experience of it—that offer guidance on grieving as well as on coping during future pregnancies (see “Recommended Resources”). You may be the beneficiary of such work; or, if you experience loss, you may also feel moved to use your sorrow, anger, and determination to help others.

Trying to get pregnant again as soon as possible helps many of us to cope. Others may decide not to try again. There is no right decision; there is only a decision that feels right for you.

Many women who have experienced a pregnancy or infant loss find that future pregnancies are emotionally challenging. Despite achieving a long-desired pregnancy, you may find that grief for your previous losses and anxiety about whether this pregnancy will be healthy dominate your experience. You may embrace the use of technologies such as home pregnancy tests, home Dopplers, and ultrasounds that may help you feel more connected to the pregnancy, or you may choose to forgo technologies that did nothing to protect your last pregnancy. Being pregnant again can raise all sorts of feelings: detachment, worry, guilt, hope. Be gentle with yourself, and give yourself permission to cope in ways that work for you. If the pregnancy results in a baby to bring home, there will be plenty of time for love.

Depending on your experience, you may want to remain with your health care provider or find a new one. Either way, talk with your provider about her or his policy for dealing with pregnancy loss and monitoring a woman who has had a prior loss. If the provider brushes off your questions or does not respond compassionately to your concerns, consider finding a new provider.

You are likely to feel most anxious around the time in the pregnancy when the previous loss occurred. It may help to remind people around you as you approach that point, so that they are prepared to support you or give you the space you need—and to celebrate with you when you pass that point, while recognizing that fears remain. And you may experience a resurgence of grief around the time of childbirth. If possible, talk with women who have had the same experience to learn how they managed their feelings and found the courage and optimism to try again. Pregnancy-after-loss support groups and therapists knowledgeable about pregnancy loss can be especially helpful. For more information, see “Pregnancy After Infertility or Previous Pregnancy Loss,” at the Our Bodies Ourselves website, ourbodies ourselves.org.

It was six months after the second miscarriage before we felt ready to try again. We became pregnant easily. Understandably, we were terrified. We tried to face every test with guarded optimism. Pregnancy test, hormone levels, first sonogram, heartbeat, nuchal translucency, amniocentesis. By the time we made it through the twenty-week sonogram, I believed we were actually going to have a baby. I never complained about any of the discomforts of pregnancy. I didn't want to jinx it. I loved being pregnant, loved giving birth. . . . I felt and still feel such gratitude for our two sons. Because the path to motherhood was more bumpy than I imagined, it feels especially miraculous, especially precious
.

CHAPTER 19
Infertility and Assisted Reproductive Technologies

W
hen we started trying to become pregnant four months before our wedding, we expected that I would be pregnant on our wedding day. I was in my prime childbearing years. After nine months, I saw my family doctor, sure there must be something wrong with me. Sometimes it can take twelve months, she said. . . . [But] the twelve month mark came and went
.

Many of us grow up dreaming about the day when we will have children. The forces that contribute to these desires are complex, powerful, spiritual, and sometimes unexplainable. Our longing for children is a deep primal need, and being unable to conceive or carry a pregnancy to term can be devastating.

Infertility can rock our very foundation—our sense of control over our futures, our faith in our bodies, and our feelings about ourselves as women.

I've been infertile since I was twenty-two and had a hysterectomy. . . . It feels like a pretty cruel fate. I've always been enthralled with what women's bodies can do. I know there are other options for having families and that at some point I will choose one of them, but it doesn't make my situation of being infertile much easier
.

It can be a source of frustration, as we find ourselves on the wrong side of the statistics.

I always believed that I would have children without any problems—as many as I wished and when I decided it was the right time. Unfortunately, after four years of trial and error, tests, and operations, my husband and I are realizing that life does not always happen the way we plan it
.

Societal pressures intensify the pain of infertility. In many religions and cultures, our worth and power as women are measured by our ability to procreate. Some of us are viewed as irresponsible for having “too many” children, while others are pitied or perceived as not being truly fulfilled if we choose not to or are unable to bear a child.

Infertility treatments have allowed millions of people around the world to build the families they so deeply desire. Yet, as with other medical treatments, they have limitations. Glossy media images of fifty-year-old celebrities who just gave birth to twins can lead us to believe that infertility treatments are universally successful and accessible; unfortunately, this isn't true. The success rates of infertility treatments vary greatly, depending on the kind of procedure used, the skill and expertise of the treatment clinic, and the health and age of the woman treated. Infertility treatments also include risks, are physically and emotionally demanding and are expensive.

This chapter offers information on the causes of and treatments for infertility, as well as guidance and support for women navigating the world of infertility.

Infertility is medically defined as the inability to become pregnant after twelve months of regular sexual intercourse without birth control or, for women over age 35, six months. Infertility also refers to women who are unable to carry a pregnancy to term. The Centers for Disease Control and Prevention (CDC) estimates that at least
one in ten U.S. women age fifteen to forty-four has difficulty getting pregnant or staying pregnant.
1

For pregnancy to occur, many complex processes and factors need to line up. A woman must produce a healthy egg; a man must produce healthy sperm. Favorable cervical fluid needs to be present so that sperm travel from the vagina to meet the egg while it's still in the fallopian tube. Timing of intercourse or insemination is critical, since an egg generally lives only twenty-four hours. Once the sperm and egg join, this single cell divides to become an embryo, which must implant properly in the uterine lining before it can grow.

Couples can experience infertility when there is a problem with any one or more of these delicate phases of conception. The CDC estimates that about one-third of infertility cases are associated only with female factors and another one third of problems are associated only with male factors. The remaining cases are caused either by a mixture of male and female problems or by unknown causes.
2

I am 39 years old; finally, my life is settled enough to start having a family . . . the doctor did a blood test and told me even though I had regular menstrual periods, my ovarian function was poor, I was premenopausal, and my chances of getting pregnant and not miscarrying were low
.

Age is the most important factor affecting a women's fertility. Long before menopause, our bodies' reproductive capabilities slow down. This natural decline of fertility happens in all women,
though it happens at different ages for individual women. Though women can experience other causes of infertility at any age, infertility among older women is often the result of normal age-related changes occurring in the reproductive hormones that make a woman's ovaries less able to release eggs, decrease the number of healthy eggs she has left, and increase her risk of miscarriage. (For more information, see
“Aging and Fertility.”
)

Overall, one of the most common causes of female infertility is linked to problems with ovulation, the physiological process by which eggs mature. An important sign that a woman is not ovulating normally is irregular or absent menstrual periods. However, a woman can be having regular periods and still have problems with ovulation. One cause of ovulation problems is polycystic ovarian syndrome (PCOS), a metabolic disorder affecting nearly 10 percent of all women, that can interfere with hormone
production and ovulation
. Premature ovarian insufficiency (POI) is also linked to ovulation problems and occurs when a woman's ovaries stop functioning fully before the age of forty. POI, which affects about 1 percent of all women, is not the same as
early menopause
. Ovulation problems may also be due to thyroid disorders, adrenal gland disorders, benign pituitary tumors, excessive exercise, diabetes, weight loss, obesity, or medications such as for cancer treatments.