This is a thought provoking article, written straight from the heart, by a brave infertile patient who would like to share her experiences. I learnt a lot by reading it, and I hope you will too....

My experiences with pregnancy and fertility treatments have been rich and varied, carrying with them a great deal of pain, joy, learning and finally, peaceful resolution. In spite of the fact that the fertility treatments that my husband and I underwent for many years did not result in a birth, I look back on all that we did with a satisfying sense of having tried everything that was available to us. The memories of all our efforts definitely make it easier as we finally move into plans to adopt.

I would like to outline what our circumstances were and to offer suggestions to medical personnel, family and friends as to how they might offer further support to people they know who are dealing with infertility. It is my hope that I might share insights about what it is like psychologically to go through this. I really believe that there are many things people on the outside can say, and should avoid saying, that can make a big difference for infertile couples.

My husband and I were married late in life. I was 37. At that time, I was self-employed, working out of my house. Although I did have work, it was not enough and I was doing everything I could to bring in more. The plan was that we would try to become pregnant right away, and by then my at-home business would allow me to stay at home with a baby and still generate much needed income. Naturally I didn't want to give up on my new business just because it was off to a slow start, and this seemed like a good financial plan because after having a baby we wouldn't have to pay for child care as I continued to work.

The problem became more than a slow start. The business I was in suffered due to the economy and the companies that were supplying me with work to do for them at my home began to close. I was terrified. We were renting an apartment with no money at all for a down payment on anything. To make matters worse, my husband's company underwent big changes and he no longer had any overtime available to him. Our income fell short of our basic monthly obligations. My husband and I began diligently trying to make other plans. Every day we worked hard to try to get to a better place. He was job hunting constantly and I went back to school to get a teaching degree.

The only way we could pay our basic bills was to use credit cards for part of them. Debt began. I wouldn't be able to teach until I was out of school, and a job was not a sure thing. When we were in the throes of this financial crisis, we did not try to get pregnant. This was the hardest thing I have ever gone through. Our landlord also told us he might sell the house our apartment was in and that our rent could go up. Rentals were very scarce and very expensive. If we had become pregnant right then, there were no relatives around to help with child care. We decided that we were too unstable to try to get pregnant just yet. At thirty-seven years old, it was horrible for me to put this on hold. In the meantime, we had to field many careless questions from family and mere acquaintances to the effect of, So, when are you two going to have a baby? People treated this question as if it were just as acceptable as How are you? Let me say this: Unless you are very sure that questions about when a couple plans to have a baby are welcome, do not ask this question. It is first and foremost very personal and secondly could be very painful.

People I hardly knew felt totally comfortable asking me when I planned to make my mother a grandmother and to remind me (and I resented being warned) that the older I got, the more difficult pregnancy would be. These intrusions caused much more pain than we already felt. Part of the reason for that was not that these people were pointing out painful truths, but that we began to rethink these associations and to avoid people we used to enjoy. This was hard, because it would have been helpful to have someone to talk to who would listen and just offer support, rather than feeling as if they knew enough about this so as to offer opinions, guidance, or, worst of all, warnings out of a place of complete ignorance. People should be very careful bringing up this topic. It is much safer to wait to hear the topic brought up (if at all) by the person whose business it is. Or, if you do ask a question which is met with a brief or vague answer, drop the subject.

I was able to get a part-time job in a field related to teaching and my husband found a new company to work for. We decided that we couldn't let any more chances go by to try to get pregnant, so now that I was forty years old, we began to try on our own. I was pregnant four months later, and we were overjoyed, of course. The pregnancy lasted six weeks and ended in miscarriage. It was very sad, but we were extremely excited about the fact that we had achieved pregnancy at all. By that time, although we were still struggling, because we had a lot of debt now in addition to regular bills, we were just ecstatic to discover that my husband's new insurance policy covered all kinds of infertility treatments, including in vitro and all the related medications.

We began infertility treatments with simple medications in pill form, which would prepare us for insemination. Although we went through several cycles, it did not prove successful. We were advised to move into in vitro ASAP, given my age. On our third cycle of in vitro, we had success. This pregnancy lasted twelve weeks. Unfortunately, there began to be signs of trouble. An ultrasound revealed that there were many serious problems. This pregnancy ended also. We were devastated by this news and losing hope.

Naturally, these disappointments were hard to handle, but I need to say again that they would have been much easier to handle if we had not had the additional burden of certain kinds of comments and questions. It would mean a great deal to me if I could help well-meaning people understand that they really have to weigh what they say ahead of time, and to be sure that the message they are sending is going to help and heal the hurting couple. We found, in many cases, that what people said to us was burdensome in that their words either indicated that they were making horrendous assumptions about us, or were focused on making sure that THEY (the listener) were fully satisfied as to exactly what happened, why did it fail, how could it have been prevented, and does this mean it will never work.

One of the worst things I had to respond to was a comment made by a nurse in a fertility practice who, although she didn't know me or my husband at all, suddenly said to me out of nowhere that she understood that it was likely that my husband and I were undergoing fertility treatments late in life because we were probably, like many other couples she knew, taking extra time to establish our careers. She went on to tell me that she understood how so many women especially were proudly taking their place in the workforce, taking advantage of all the new opportunities available to them. She then said that of course everyone would like to have two incomes so that there can be a bigger house, a better car and a nicer vacation, but that really these things don't matter as much as the joy of having a child. The implication was that we should not waste any more time waiting until we had established the robust, above-average financial base that was not really necessary anyway.

I can assure you that that was a mistake she would never make again. This was a medical person in a fertility doctor's office having the unspeakable nerve to make any assumptions about anyone, and worse still, to give voice to those assumptions right to the person they were about. And let me add in no uncertain terms that I had not asked for her input.

It may be true that more women are in careers than there used to be, and maybe they do postpone having a child until they are at a certain level in their job that they are trying to achieve. However, please do not assume that when you encounter a fortysomething woman trying to conceive, that this must be the reason she is starting so late. I ran across this assumption not only in people around me, but also in a great many fertility books I read. Just once, I would really appreciate it if a doctor who is writing a fertility book would acknowledge that in some cases, people wait to try to conceive because the world is much more expensive now than it used to be. And where once it was possible for Dad to go out and work while Mom stayed home with the kids, living on just one income as people did (even modestly) in the '50's and '60's is much more difficult now, especially if the couple has no family, friends or neighbors around to help with child care. People would say to me, Oh, don't worry about it. Things have a way of working out, when I was up to my neck in debt, had no job, no help, and they were coming from a position of a great deal of financial assistance from able family, and also surrounded by many available baby-sitters. Of course, this is life, and I have no bitterness or feelings that things are unfair. I would just ask people not to make assumptions and to watch their words.

I can understand how bewildering and frustrating it must be for people on the outside who want to help their infertile friends and family. It might not be hard to make a mistake without intending hurt, so please let me offer some guidelines. Infertility is one of the most painful, disturbing experiences someone can go through. Remember that, and check with the person carefully before you comment or ask questions. Take the pulse, as it were, and do it every time! Don't assume that because the person felt all right about telling you on Tuesday the exact name of the birth defect that caused the miscarriage, that they will feel like repeating that information to you on Friday when you seem to have forgotten the term and are curious. This is not territory for curiosity. It should be approached as if a death has occurred, because that is how it can feel.

Please consider these points also, so you can help those you care about:
  • Do not assume that if a couple is not attempting pregnancy right away that it is because they are waiting until they have sufficient income to support an above-average lifestyle. It may well be that they are struggling to get both their jobs to the point where they can live only modestly, without incurring debt, so as to be stable and responsible parents.
  • Never ask So, when are you going to have a baby? unless you are completely sure that such a question is welcome.
  • Take your lead AT ALL TIMES from the couple undergoing infertility treatments as far as what is going to be OK to talk about. It is very common for people to be comfortable one minute to describe what's involved in treatment, and suddenly not to feel like providing education. ASK if they are up for it every time, and be ready to back off without argument. This can make the person feel that they have a real friend, and that helps immeasurably.
  • If treatments don't work, or if a pregnancy fails, offer love, food, an ear if the person wants it. Ask them what would help. Do not ask lots of questions about why this occurred in order for YOU to be satisfied. This is about THEM. Your lack of understanding is not important.
  • Never ask a pregnant woman, Are you going to have amniocentesis? This is a test for birth defects. I know that this test can also reveal the sex of the baby, but I don't know any couple who has this procedure for this reason alone. Do not bring up the topic of birth defects with a pregnant woman.
  • When time has passed, be very careful about dredging up any information you do remember about what that person went through. They may have wanted to share it with you while the painful things were going on, but are now choosing to forget it after that. Let it lie.
I would like to conclude by pointing something out that I think is even more important than what I have covered so far. I am now forty-nine and my husband and I are preparing to adopt. It took a long time to reach this point, as we continued in vitro until I was forty-five. Of course it was devastating for us to have been unable to have a baby, but the fact that we made use of all the fertility treatments we could has offered incredible comfort to both of us. With only a couple of exceptions, we found the doctors and all medical personnel to be compassionate and helpful far beyond our expectations. We also found the process to be fascinating, rewarding and satisfying in and of itself. I suppose if I had it to do over, I would have abandoned my dream of self-employment earlier than I did so as to have been on good financial ground sooner, but naturally, hindsight is twenty-twenty.

No matter the outcome, I can look back on everything we tried, and how we made our plans based on undeniable practicality, and can confidently say that we did everything possible to have a baby. This is a wonderful feeling. I am infinitely grateful that infertility treatments are available and would highly recommend this experience to anyone. The memories now provide me with unexpected mental and emotional peace.

Thank you and good luck.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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