Our Bodies, Ourselves (108 page)

The business side of infertility treatments also restricts access to care for many families who don't have the necessary financial resources, since infertility treatment is not typically covered by insurance. Many people seek out other options, such as traveling to other countries for cheaper treatment. Several countries have severely restricted infertility treatments or require long waiting times, causing many families to travel elsewhere for treatments. Some are able to get good state-of-the-art care by well-trained physicians at an affordable price. Others find themselves in situations that may be unethical or unsafe, particularly with regard to egg donation or surrogacy, where very poor and uneducated women may be exploited for their reproductive potential. Unfortunately, guidelines, standards, and sources of unbiased information protecting donors, surrogates, and families struggling to have a baby are inadequate.

As technologies continue to proliferate, ethical and social challenges multiply, with complex questions of justice, rights, and conflicting principles continually raised. As a society, we are long overdue to discuss these issues and to guard against leaving them solely in the province of researchers and biotechnology entrepreneurs. We also need to devote resources and energies to identify and remove the environmental and physical causes of infertility. Prevention, education, and increased access to appropriate and cost-effective fertility care, including insurance coverage, are also imperative so that more families throughout the world are able to safely have children when they are ready. For more on the social and ethical issues raised by assisted reproductive technologies, see “Emerging Issues: Biopolitics, Women's
Health, and Social Justice.”

Getting pregnant will undoubtedly bring great joy and relief. Unfortunately, infertility doesn't end with getting pregnant. The experience of infertility often brings its own baggage to a pregnancy: grief for previous losses, anxiety, and fear that your body, unable to conceive on its own, may not be able to carry a pregnancy.

Other than brief spurts, I couldn't get excited until the very end, and even that was guarded. I've had friends who've seemed to go through
pregnancies with an air of expectation that everything will work out, and I'm envious of the joy they seem to have had. I felt like all the commercials and cards out there about the joys of pregnancy were written for someone other than me. It made me feel defective a bit, that I couldn't get into fully loving being pregnant, even though my pregnancy was easy
.

For many of us, pregnancy and parenting after infertility are a balancing act—caution and breath holding on one hand while trying to appreciate every moment on the other. For more information on the common experiences of women who conceive after infertility, see “Pregnancy After Infertility or Previous Pregnancy Loss” on the Our Bodies Ourselves website, our bodiesourselves.org.

I've been working through my feelings over my failed procedure, over the probability that I will never be pregnant. . . . I am feeling really sad, very discouraged . . . angry, [and] frustrated at the fact that we did the best we could but hit another brick wall. I am really uncertain how to proceed. Does it make sense to put more money into a procedure with no guaranteed outcome? How will we feel if we do this one more time and [fail again]? Maybe I should cut my losses and proceed with adoption. On the other hand, I have been pursuing the dream of raising a birth child for a decade. I still deeply want to raise a child I give birth to. I may always wonder if I could have been successful on my second try
.

If fertility treatments don't succeed as you had hoped, you may feel extremely disappointed, angry, vulnerable, and desperate to try any intervention that offers a glimmer of hope. Some of us find ourselves, after every failed intervention, undergoing treatments that become increasingly physically invasive and emotionally debilitating.

If there's always something more that you can do, it becomes a situation where you don't even have control over when is enough
.

On top of our own pain, many of us feel pressure from partners, family, friends, and colleagues to pursue more technically and socially complex treatments. This seemingly never-ending journey may lead some of us into a spiritual and ethical labyrinth that forces us to make quick rather than well-thought-out decisions concerning hormone therapy, IVF, donor egg, sperm and embryos, surrogacy, adoption, and living child-free.

If treatments are unsuccessful, we face difficult decisions: Should we continue trying, pursue adoption or foster parenting, or make the decision to not raise children?

For many of us, adoption provides another path to having children.

For more information, see “Adoption” on page 356.

Some of us decide—generally with a lot of grief and conflicted feelings—not to pursue parenthood.

The challenges of living child-free aren't always easy, and there are definitely still ups and downs. But the downs are helped tremendously by realizing there is much more to life. I also feel blessed to have the support of my wonderful and loving husband and close and caring friends. Overall, I feel that I have grown as a person and can now face the future, whatever it holds
.

For more information, see “Understanding What It Means to Live Childfree After Infertility”
at blogher.com/understanding-what-it-means-live-childfree-after-infertility.

As you decide on the next step, give yourself permission to be uncertain and cautious, change your mind, and grieve. Figuring out how to move forward is hard. But many of us find a way to live with the pain and disappointment of infertility and move on.

Our daughter is now 4 months old. We continue to heal from our six years of infertility and the loss of our son. I have come to believe that there will always be some pain associated with the battles we fought—and so often lost. At the same time, we love our daughter with all our hearts and we are happier than we have been in a very long time
.

Postreproductive Years

CHAPTER 20
Perimenopause and Menopause

J
ust as our bodies changed during puberty and we began to menstruate, so again—usually at midlife—we transition from our reproductive years to the natural end of monthly menstrual cycles. The transition usually begins in our forties and ends by the early fifties, although any age from the late thirties to sixty can be normal.

In keeping with the focus of this edition of
Our Bodies, Ourselves
, this chapter focuses on the reproductive health aspects of perimenopause and the social and cultural context of this significant transition.

I'd finally gotten my PMS and horrible cramps under control after trying everything—vitamins, yoga, massage, eliminating most caffeine, antidepressants, acupuncture—when my gynecologist told me I was perimenopausal. I started getting two periods a month, and they weren't light, either. I was fatigued, cranky, irritable, and I cried easily. Sometimes my short-term memory faltered
.

For some reason I expected a very emotional perimenopause with mood swings and general despondency. Lo and behold, in my midforties I had a few hot flashes, some skipped periods, and that was it as far as I could tell. My two last periods came on April Fools' Day and the Fourth of July
.

Perimenopause
*
is the one-to-ten-year stretch during which the ovaries function erratically and hormonal fluctuations may bring a range of changes, such as hot flashes, night sweats, sleep disturbances, and heavy menstrual bleeding. Perimenopause is a natural transition that affects each woman differently; for about 20 percent of us, the discomforts are so disruptive that we need major support and/or medical interventions.

Menopause is marked by the final menstrual period, known to be final after twelve months with no periods. After no flow for one year, the ovaries settle down and the reproductive hormones—estrogen and progesterone, which the body no longer needs for possible reproduction—have declined to low, steady levels. Most of us will live a third of our lives in what many call postmenopause. (
Chapter 21
, “Our Later Years,” explores the possibilities and issues of that time, including sexuality and relationships.)

Some of us reach the end of menstrual periods early owing to chemotherapy or radiation therapy, surgical removal of the ovaries, or special health conditions. More discussion of early or
premature menopause starts
.

Midlife involves emotional, social, and physical changes, with the biological transition of perimenopause being just one of its aspects. It brings the end of the childbearing years, perhaps a time of relief, or of sadness at the loss of children we never had or never raised. Many of us reach menopause caught among the responsibilities of raising teenagers, launching grown children, caring for aging parents or other relatives, and working at demanding jobs—a stressful balancing act. Changes in living circumstances may couple with the hormonal fluctuations that often emerge during perimenopause to pose new challenges and problems. Everything from a new sort of loneliness to a profound sense of new freedom may emerge.

Women who are now making the menopause transition are pioneers in that more of us are living longer with better health, so the postmenopausal life stage may be nearly as long as our reproductive years. The menopause transition may offer opportunities to take stock of our lives, to be more self-directed, and to make the most of our time and relationships: What do I want to do? What am I not able to do? What can I control? Now that I know myself pretty well, how do I want to live? What do I want to learn? How can I improve my self-care for the next portion of my life?