Fertility. It’s the F-word people don’t say in public.
A whopping one in eight couples has trouble having children, yet it often seems like the story women tell most easily is how they got pregnant the first month they tried.
For most women—particularly healthy, active ones—being unable to have children easily can be a shock. “No one ever talks about what happens when it doesn’t work those first few months,” says Karen*, a 35-year-old Seattle native, who had a daughter with the help of in vitro fertilization (IVF).
Before she started trying to have kids (“trying—I hate that word!” Karen says), she knew people judged those who used fertility treatments to have a family. She did, too. When she’d read about celebrities having twins through in vitro fertilization, she felt like they were cheating. Her own mother always talked about how easily she and her siblings were conceived, and she assumed the same would be true for her.
But often, talking about fertility struggles can reveal how common they are. Karen spent six months charting her temperature to figure out when she was ovulating, and her own physician told her to relax. Then, when a longtime friend asked Karen when she was going to have children, Karen almost started to cry. The friend pulled her aside and told her that her own two kids had been conceived with the help of a fertility clinic.
And she wasn’t alone. According to the Centers for Disease Control and Prevention, more than 1 percent of the babies born each year are conceived with IVF and similar treatments.
Karen also thought infertility was a problem that older women had. Age can be a factor in fertility challenges, and more women are delaying pregnancy until their 30s and 40s. A 40-year-old woman might look so youthful she gets carded and be sprinting past younger runners in the Seattle Marathon. But on average, she has just a 5 percent chance of conceiving each month.
Younger women can have trouble conceiving, too. For couples that go through fertility testing the cause of infertility is almost evenly divided among female-factor problems, male-factor problems, and a mixture of both partners or undetermined reasons.
A range of options is available to address infertility. Fertility drugs, targeted to different aspects of conception, can be used alone or coupled with additional treatments. One of these treatments is intrauterine insemination (IUI), in which sperm—whether from a partner or a donor—is inserted directly into a woman’s uterus close to the time she is ovulating.
Depending on a woman’s health history, age, and other factors, these treatments’ effectiveness may vary. IUI can have a pregnancy rate of up to 20 percent for each menstrual cycle.
A woman may start with fertility drugs and IUI or, depending on her age and specific fertility challenges, may decide to move directly to assisted reproductive therapies, in which eggs are removed from a woman’s ovaries and combined with sperm in a laboratory. With in vitro fertilization, the most commonly used assisted reproductive therapy, a woman usually takes fertility drugs to encourage the body to produce more eggs; then eggs are retrieved from follicles in her ovaries in a minor surgical procedure. If an embryo forms after the egg is inseminated with sperm, it is placed back in the woman’s uterus. Embryos can also be frozen for future use.
IVF is more expensive and intensive than other treatments; in many cases, it also has higher success rates. In 2010 the Society for Assisted Reproductive Technology reported that, for women younger than 35 nationwide, about 40 percent of embryo transfers in a given cycle became new babies.
Usually, a woman’s own fresh or frozen eggs are implanted. But sometimes—whether because of genetic conditions or advancing age—a woman uses donor eggs. The CDC reports that in 2008 close to 12 percent of assisted reproductive technology cycles nationwide used eggs or embryos from donors. In 2011, two Seattle clinics performed a combined 494 IVF cycles using donor eggs—210 with frozen embryos and 284 with fresh. Live birth rates for the two clinics were roughly 32 and 49 percent using the thawed embryos, and 62 and 67 percent with fresh embryos.
A 40-year-old woman might look so youthful she gets carded. But on average, she has just a 5 percent chance of conceiving each month.
No matter what route a woman takes to address infertility, treatments aren’t easy. To prepare, women give themselves injections—41-year-old Jennifer Johnson sometimes had to give herself six shots a day. The drugs are pricey; can send a woman on an emotional, hormone-induced roller coaster; and aren’t a guarantee. After Johnson’s first round of fertility drugs, she went to the clinic only to discover her body had made too few follicles from which eggs could be harvested.
“It was devastating—and expensive,” she says. She feels fortunate her husband’s insurance covers some of the cost of treatments, and that they can make up the rest—something she knows not everyone can afford.
The nationwide average cost of an IVF cycle is $12,400, according to the American Society of Reproductive Medicine; Johnson and other Seattle-area women pay more. Fertility clinics often offer financial assistance and payment plans. “Even so,” she says, “if I was making $30,000 a year, it wouldn’t be an option.”
Going into these treatments, a woman can be frustrated by not knowing her individual chance of becoming pregnant. “It’s all or nothing: you’re either pregnant or you’re not,” says Dr. Julie Lamb, a physician at Pacific Northwest Fertility and IVF Specialists in Seattle. Regardless of published success rates, a woman doesn’t know if a fertility treatment has worked for her each and every time, until she gets that positive pregnancy test.
And then there’s the worry that the stress itself is responsible for each cycle of IVF that passes without a pregnancy. Recent research might take this particular concern off of a couple’s plate: A 2011 study in the British Medical Journal found that stress did not play a role in the success of individual IVF cycles.
But dealing with the stress that infertility causes can only be helpful, Lamb says, whether through yoga, acupuncture, or counseling. These techniques can prepare a person to deal with problems in other areas of their lives—and help to weather unexpected fertility challenges.
Finding others who are going through the same experiences can help. Some women take refuge in online support groups, including those through Resolve, the national infertility association. Others read blogs where people chronicle their journey through infertility. And even though Lynn Jensen’s weekly Seattle and Kirkland Yoga for Fertility classes are spent primarily in poses, not in conversation, women approach her after class to tell her how helpful it is to have “a whole roomful of women who understand what I’m going through,” says Jensen, who experienced fertility challenges herself.
Even if a woman becomes pregnant, infertility can color the experience. Misty, who was 32 when she started fertility treatments, went through several rounds of IVF before becoming pregnant with her first child. She lost two pregnancies along the way, including a twin pregnancy that terminated at different
stages and ultimately ended in a D&C. “I’d already envisioned running with my double Bob stroller around Green Lake,” she says. Losing the second twin was particularly traumatic. “I felt like I was cursed. I was lying in the fetal position for days on end.”
What kept her going? The desire to have her own family. “For me, I felt like there was no other way,” she says. She considered adoption, but thought it was more expensive and “just as much of an emotional roller coaster.”
A fourth round of IVF resulted in two embryos. One was implanted in her uterus, the other frozen. Misty says she was a basket case throughout her first pregnancy. And even after she had her daughter, her fertility challenges still haunted her. “When breastfeeding was going bad, I thought it was more evidence that I was a reproductive failure.”
About a year after her daughter was born, she went through another round of treatments using the frozen embryo. Pregnant again, she felt more confident because she’d been through it before—also a toddler kept her too busy to spend as much time worrying.
Other women who wish they had thought about their fertility when they were younger are urging friends in their 30s to freeze ’em while they got ’em.
Here is the trouble with stories about infertility: It feels better to end with a successful treatment, looking at a beautiful baby held in its parents’ arms. But sometimes that’s not what happens. After six months of IUI, Rebecca and her husband decided to put treatments on hold and revisit the idea in 2013; financially and emotionally, the treatments became too much. “We expected at the end of this, we would have a baby, and I think most people expect they will,” says Rebecca, 38, who has a preschooler conceived without fertility treatments. She wishes she’d prepared herself for the possibility that she might not have more children.
Other women wish they had thought about their fertility when they were younger.
Johnson would have had her eggs frozen in her early 30s, and advises younger women to do so. “If you’re pushing your career and not pushing your relationship,” she says, “you might go and get your eggs harvested, just in case.”
Statistics aren’t readily available for how many women freeze eggs for future use; until recently, the American Society for Reproductive Medicine considered it an experimental technique.
One of the things Lamb, at Pacific Northwest Fertility, suggests to her patients is always knowing their next step if the current strategy doesn’t seem to be working, whether it’s moving on to IVF, taking a break from treatments, or considering adoption. “I’m convinced that everyone can build a family, and there are a lot of different ways to do it.”
That’s what Johnson is doing. She plans to go through up to two more rounds of IVF treatments, and then reevaluate her options.
Sometimes the destination of the fertility journey isn’t exactly what a woman had envisioned. When, after two miscarriages, Heather and her husband had tests done at a local fertility clinic, they learned she had a rare chromosomal abnormality called a balanced translocation. A genetic counselor told Heather she had a 5 to 10 percent chance of conceiving a baby with her own eggs. Heather blamed her parents for not knowing about her genetics and felt sad that she’d never have a baby that shared her genes.
And still, they tried. After another miscarriage and a lot of soul-searching, the couple decided that they would use a donor egg, and that Heather would carry the embryo. Three embryos—from the donor’s eggs and Heather’s husband’s sperm—were frozen. One didn’t thaw correctly; another resulted in a miscarriage. Throughout the process, she says, “I learned that I’m stronger than I thought I was, and that I’m more open than I thought was.”
The third embryo implanted and Heather’s little boy was born—albeit prematurely—on January 8, 2013.
*Like many of the Seattle-area women who wanted to share their fertility struggles, Karen wanted to be identified only by her first name.