Defining Infertility

This article, in which a writer discussed what she termed her “circumstantial infertility,” has prompted heartfelt debates, online and in message groups, about the term infertility and who gets to use it.

Labels are interesting.  I generally don’t like labels, but as I’ve joined the infertility blogging community, I have found myself using the label infertility.  It applies to me.  I have been unable to carry a child to term.  And I am unable to conceive.  I am infertile. I think it took a while for me to be able to accept that label, even when I was already living it.

Related to this have been discussions about a couples’ infertility.  I remember reading a woman’s  blithe comment “oh, I’m fine, it’s my partner who is infertile.”  I cringed.  I remember a friend saying “so you’re the one with the problem” – it cut me to the core.  I cringed because I had been one of those women who had wondered if it would be better for her husband to leave her, and find someone who could have his babies and make him happy.  Do I consider us as a couple infertile?  Yes.  Do I consider my husband infertile?  No.  But in sickness and in health, right? 

I don’t really care how anyone labels themselves.  More people being more public about infertility and childlessness is probably a good thing.  Society is so child-centric these days that an awareness of people who – for whatever reason – can't have children (or choose not to) can only be positive for us, surely?  And so I applaud the author for writing about what life is like for her, living a life without children, a life she hadn’t planned.

But for me, the bottom line is that infertility is a medical condition, and in a woman it is defined as the inability to conceive or carry a child to term.  I personally don’t think you can use this term if you have never tried to have children, when in fact biologically, you may be perfectly able to conceive or bear children.  It’s a bit like saying you are allergic to lobster, when the reality is that you don’t eat it because you can’t afford to.  You could have lobster if the circumstances were right.  I guess that’s what is meant by circumstantial or situational infertility, but it still feels a little wrong for me.  I simply don’t understand why you’d want to describe yourself as infertile.  But perhaps that’s because I struggled for many years to actually be able to say the word out loud.

When I was coming to terms with my infertility, I read a book in which the authors declared that because they were no longer trying to conceive, they were no longer infertile.  I struggled with that interpretation, because I felt broken, a failure, and I felt judged because of that (although let’s face it, I was the one doing the judging).  Now, many years later, I can relate to it a little more.  At 48 I don’t want to get pregnant, and I am not actively trying to get pregnant.  So I don’t feel (as) infertile because I don’t feel as if I’m looking for another outcome.  That’s in the past.  Right now, my body works, it is doing everything I need it to do (within reason), and I feel relatively normal.

Please don’t get me wrong.  I am not saying that being in the situation of not being able to even try to have children is any less painful than for those of us who have tried and been unsuccessful.  In fact, I have to say I cherish the memories of my all-too-brief pregnancies.  I feel lucky to have had that, to have experienced that.  By not labelling them as infertile, I am by no means dismissing the pain felt by those women who were not able to try.

I think really that the issue should be focussed on where we are now.  Emotionally, whether we are medically infertile or not, those women who never had the chance to try to have children, who always imagined they would be a mother someday, share so many of the same emotions as those of us who tried but came up with empty arms.  We are child-less (or child-free depending on the day and our mood and what we want to do at the time).  We feel isolated and judged by society.  We feel as if we are treated differently.  And we share the feeling (at times) that something is missing.  We wonder sometimes what might have been.  Whilst the paths we took might be different, we meet now and walk the same line.  We have much more in common now than whether our ovaries or uterus or fallopian tubes work or not. 

I’ll leave the last word to the author of the article, who said it all in this paragraph:

... my life is not barren.  And to the women who are on the other side of hope, know that you are more powerful than your womb.  You are maternal whether or not maternity ever comes.  You are a woman and your love and how you choose to offer and receive it, is a gift.

Empty roads, busy malls, and Harry Potter

The winter school holidays began on Monday.  I don’t have to spend the next two weeks juggling work and child-care, I don’t have to worry about amusing my kids or my kids’ friends.  I don’t have to worry about not having enough money to entertain my kids or my friends’ kids or my kids’ friends.

But I always know when the school holidays have begun.  On Monday, even if I didn’t know they were starting, I would have realised when I was about a mile down the street.  Traffic was non-existent.  My husband and I left home much later than usual, but got into town about the same time!  Two blissful weeks of clear traffic.

The coffee shop – often frequented by girls from the high school down the street – was empty.  People take time off at this time of year – to look after children, escape to the ski-fields, or escape further afield to a warm Pacific island or Queensland.  Adult areas are often emptier.  I like that.

I will however be avoiding the shopping malls, and will be timing visits into the city to beat the mid-day rush of mothers or grand-parents and kids on a shopping spree.  Finding a parking spot then will be problematic, but I’m self-employed, and can plan to avoid this.

I deliberately plan not to travel at this time of year.  I have bookmarked the website that lists the school term dates for Australia and New Zealand school holidays, and consult it before we begin planning any trips anywhere.  I want to visit my mother in the South Island, but to get a decent-priced flight I need to wait till August.  That’s okay, there’s no rush.  My husband and I aren’t skiers, but equally we always plan our winter escapes to the Pacific or Queensland outside of NZ or Australian school holidays.  We are lucky to be flexible enough (and not to work in the education system) that we can avoid the higher priced school holiday tickets.

So by and large school holidays are not a negative experience for us.  But this year we want to go see Harry Potter.  Wary, though, of cinemas full of screaming, wriggling, noisy children, we’re putting it on hold till for a few weeks.

It gets better

Recently I was worried about an acquaintance who also had a history of ectopic pregnancy.  She was newly pregnant again, and experiencing some worrying symptoms.  I provided her with advice and support, whilst she waited for her first scan to confirm the pregnancy was in her uterus.  It was.  I was relieved.  I was delighted.  There was no twinge of envy or pain.  There was no nagging question “why her, not me?”  There was simple joy in her good fortune.  

 I’m not in that baby-making space anymore.  And it felt good.  It felt good to be rid of those negative emotions.  It felt good to feel good for someone else.  It felt good to feel free.

Infertility decision making - Part II

Starting IVF was exciting.  I was lucky – I was on a protocol that didn’t involve down-regulation (taking drugs that effectively shut down your cycle and put you in a false state of menopause).  I was full of hope.  Normally gloomy Dr Vintage had actually said he thought we had a very good chance of success.  I’d conceived twice before, and when my tubes were taken out of the equation, he didn’t anticipate any problems.  That was a surprisingly optimistic statement from someone who didn’t normally raise hopes.  I wasn’t scared of the injections; each day when I stabbed my stomach with that needle and injected Chinese hamster hormones, I felt hopeful, buoyant even.  I felt like telling people “I’m injecting myself!”  But I kept it quiet, and only told internet friends, and one solitary IRL friend.

The hope was good.  It kept me going, it made me feel happy.

But it came to nothing.  The disappointment was strong.  But it would have been strong even if I hadn’t had hope.  I’m a great believer in clinging on to hope – realistically of course – during a cycle or early pregnancy.  If it doesn’t work, it’s going to hurt whatever.  I believe there’s an emotional terminal velocity.  After a while, however, far you fall, the impact is still going to kill you.

The second cycle didn’t work either.   There was no point in trying again.  Besides, Dr Vintage wouldn't let me, even if I wanted to.  I wasn't responding to the drugs.  He described my ovaries as being the engine of a car, the drugs the accelerator.  But in my car, the accelerator was already flat on the floor.  The drugs couldn't boost anymore.  Anyway, in New Zealand, there is a maximum dose.  I'm horrified at the doses some women in the US are given.  All in the name of selling drugs and making money - because there is no evidence that - after a certain limit - more drugs equals success. 

We considered donor egg, but the one person I would have asked – my sister – was already too old herself.  And when I thought about it, I wasn’t entirely comfortable with the idea.  I may blog on that another time. 

I asked my fertility specialist if there was any point trying by myself for a few more months.  I knew time was running out.  He said yes, but wanted me to have another HSG first.  So I did.  On my 41^st birthday, I went and had the HSG ... alone.  I’d had one before, and had conceived only days afterward.  So I was hopeful.  I lay there and watched it on the screen in real time.  But I could see, this time, the result was different.  The dye didn’t spill through my tubes.  Not this time.  Completely blocked, a result of all the problems and procedures with my interstitial ectopic earlier that year.  With no other options, I knew I would never be pregnant, never breastfeed, never have my own child.

Infertility decisions?  Not so much decisions, as slamming into a brick wall (emotionally or physically or both).  Occasionally there is an alternative route to take, but sometimes the brick wall is a brick wall.  And so we stepped through the door in the brick wall, out of the infertility maze (apologies for all the mixed metaphors), and into our life without kids.

Infertility decision making

When my husband and I first talked to a fertility specialist – he of the “vintage” terminology – he talked about my luteal phase defect, admired my colour-coded computerised cycle charts and observed that I was definitely ovulating despite my GP’s doom and gloom and the progesterone results. (Note:  charting your cycle is more useful than 21 day progesterone tests.)  He opted for clomiphene citrate (clomid is a common brand name)  first off.  

 He then talked about our management plan.  This sort of talk was useful.  Both professionals, we were accustomed to having plans and timetables and KPIs.  Of course, in this case the relevant KPI would be 

a) a pregnancy, and 

b) a baby.   (When you’ve suffered pregnancy loss, you know this isn’t one and the same thing.)  

But the management plan helped.  Knowing there were timetables for clomid, then IUI, was useful to us.  Then he mentioned IVF.  Depending on results of a tubal patency test (HSG), we could be doing our first cycle of IVF in just a few months.  My husband and I looked at each other shocked.  I’m not sure why we were shocked- we were consulting a fertility specialist after all.  We got home.  “We’re not that desperate (yes, he used the word) to try IVF are we?” he asked.  I shrugged.  I hadn’t considered needing IVF.

Fast forward about four or five months.  I was sitting in hospital, having one or other of the procedures/surgeries for my ectopic pregnancy, knowing that the only real option for me now was IVF.  And accepting it.  It seemed the normal thing to do.   My husband seemed to accept it too.  We were on that treadmill, and we weren’t getting off.  Not yet anyway.

Infertility decisions?  An oxymoron.  Infertility makes the decisions for you.