I park the car at the neighborhood kiddy store and embark on my mission—buying gifts and goodies for the next several upcoming baby showers and toddler birthdays. I make difficult choices between the gift certificates and the miniature clothes I am invariably drawn to and have to tear myself away from. As the checkout cashier gauges if I have a half a dozen kids (perhaps it’s my purchases, perhaps I have begun to look the part) I concentrate on ticking off all the invitations on my gift list, and tiredly wonder, not for the first time, if and when my friends will ever buy gifts for my baby celebrations. When I will be the one cutting that baby shower cake shouting cheerful anticipatory slogans like “good-bye tummy, hello mummy” or “pink or blue, we welcome you,” or open the colorful gifts and feel the soft cotton of onesies and blankies with my cheek, send thank you and “baby is here” notes. Heck, these days, I even long for the snapping temper and dark circles around my eyes from staying up all night. These baby events are getting to me, getting me down, getting very very difficult … While my husband and I have been planning and trying hard for a family, everyone has raced way ahead in the procreation race.

Of course, I cannot decline the invitations to the showers and christenings and naming ceremonies. These are friends we care about and whom we are very happy for. Like us, they planned their pregnancies and the subsequent celebratory events with immense passion and zealousness; unlike us, their plans have translated into reality.

I have seen many of them through their first shock and delight at finding out, their search for the perfect doctor, their food cravings, their false alarms, their rapture at hearing the first heartbeat, feeling the first kick, their initial embarrassment and later, their nonchalance at heartburn and unavoidable loud burps, their discomfort at nights (where to put that large belly), sifting through baby names (must be Indian, yet easy to pronounce, tested repeatedly on the nurses at the maternity wards). Sometimes I was glad that I was not in their shoes, that I had control over my body and that some unborn being was not dictating how I would feel every morning when I woke up. More often, I envied them. But at all times I was aware that I was not part of this experience.

At social occasions, I would smile benevolently at all the comments made at me, some good-natured, some curious, some quite malicious, some merely conversational. So, when are you planning your family? An elbow nudge, with, now it’s your tum, some gentle souls chasing their kids attempting to feed them the last bite of their apple sauce, saying, lucky you, you can still sleep at night. But no matter what the words, what the intention, they all alluded to the fact that I was not one of them, not privy to the exclusive yet universal club of motherhood. One by one, my friends dropped out of my schedule, my workout buddies, my Starbucks mates, our skiing co-enthusiasts … fell out of the loop, willingly and happily to make way for the new and joyous period in their lives, baby time. As we continued on with our routine, wishing desperately for some success …

Phone calls and visits home were another matter altogether. Without preliminary social niceties, my husband’s family and mine would always ask the same questions, sometimes cloaked in other conversation, some¬times unabashedly overt. After all, they all had a right to know when they could expect to be grandparents again. Besides, they were doing all they could from their end. An aunt had been to Shirdi, ma-in-law had just given up eating desserts, and mummy was making frequent trips to ayurvedists and homeopaths and astrologers. The gods of barter will surely listen, they all said. When you give up something, you get something in return. This was pressure of the most intense kind, someone making changes in their lives, making sacrifices for our benefit, at least until we produced (or rather, reproduced) a solution.

It is hard to realize at this time of confusion and uncertainty that one is not alone. Today, there are 10 million infertile Americans and this generation is the first in U.S. history that will not fully reproduce itself. The American Society for Reproductive Medicine defines infertility as the in-ability to become pregnant after one year of regular unprotected intercourse for women under age 35 and six months or more for women 35 and older. Many fertility specialists recommend an evaluation if the wife is over 30 and the couple has not conceived after six months of frequent intercourse without birth control. Today’s generation has chosen to marry later and delay childbearing until it is financially, economically, and emotionally ready for parenthood. According to statistics, more than half of women aged 20- 24 and 1/4 of those 25-30 had never married, more than twice the percentages of never married among the same age groups in the 19605. Age plays a very important role in conception (as mothers and mothers-in-law of infertile friends never cease to point out). With increasing age, in addition to the natural decline in fecundity (the ability to become pregnant), a woman’s body has to survive all the effects of drugs, chemicals, and X rays it has been exposed to all these years. The stress and anxiety of surviving and succeeding in this highly competitive world and work environment has taken its toll on the reproductive health of both sexes. Ironically, the very reasons couples choose to delay childbearing are often the reasons that prevent them from successfully conceiving. This, in tum, causes great frustration, and a feeling of lack of control over their lives and bodies and subsequently, a very real and profound sense of guilt and failure.

HOW DOES ONE TALK ABOUT IT?

 

Sharing information on infertility with friends and family can yield mixed results. This is not a subject you can take too many people into confidence about. Those with the privileged information tell you to relax (we have all heard this one before), go on vacation, and not think about it too much. They suggest home remedies and small tips that have worked with someone they know. They all have stories of couples who “tried and tried and did not conceive,” but when they were a week away from adoption, (and the time frame changed depending on who was telling you the story, sometimes, it was even after the adoption) they found out that she was pregnant. Unhelpful and insensitive statements may be made through ignorance (my god, I had to just look at my husband to get pregnant, I wish I had your problem) or in an attempt to reassure you of your physical adequacy (there is nothing wrong with you, its all in your head) or to give you hope Oust pray hard enough and it will happen. In spite of unconditional support, interactions may become strained. If their support is important, the best way to garner it is to educate them on what is going on and how they can be there for you, what they can say or do that will be positive and nurturing for you.

HOW DOES ONE START LOOKING FOR HELP?

 

Medical science is taking giant leaps ahead and each day brings new advances and miracles in reproductive technology. About 65% of couples that seek medical help eventually succeed in having children. Previ­ously impotent men have fathered children. Menopausal women have worked through a reversal of hormones and have successfully conceived and carried their pregnancy to term. With the help of knowledgeable repro­ductive specialists it is possible to find out what the factors prohibiting conception and birth are, and how medically assisted tech­niques can help. Your insurance carrier or health care agents will be able to tell you what type of fertility treatments if any, are covered. Although traditionally, most companies resist covering new treatments, there are new laws passed by several states mandating infertility coverage.

For women, it is perhaps best to start your research with talking to your ob/gyn (obstetri­cian/gynecologist) or general practitioner who may either direct you right away to a fertility specialist or conduct a series of small and fairly generic tests first. These basic tests include pelvic exams, a check of basal body temperatures, and the monitoring of some baseline hormone levels (Prolactin and Progesterone levels during the luteal phase). In addition, some may perform a postcoital test, endometrial biopsy or diagnostic laparoscopy. The urologist, the male coun­terpart of the gynecologist, will perform se­men analysis, sperm quality analysis, look for varicoceles (varicose veins in the scrotum) and check hormone levels. Most of the time, fertility specialists begin with the simplest, least invasive procedures before they move on to the complex ones. At all times, be aware of the services your doctor is providing you and how comfortable you feel in their care, their pace, willingness to answer questions, accessibility, wait time, availability via phone etc. For example, if your doctor cannot pro­vide you medical care on a weekend and those days happen to be important days in the ovulatory cycle, then you are probably better off seeking help elsewhere.

WHAT OPTIONS EXIST?

 

Female related problems account for 40 of infertility and male related problems for another 40%. A combination of male and female problems account for 10% while the remaining 10% are due to unexplained causes. Today, medical advances have al­lowed us to negate the effects of several of these causes and have found a way to cir­cumvent the obstacles. Some of these ad­vances include super ovulation, intra uterine insemination, laser surgery through laparoscopy, unblocking fallopian tubes, electro ejaculation, miscarriage immuno­therapy, micromanipulation, assisted fertili­zation, and in vitro fertilization (IVF).

The birth of a test tube baby (they actually use a petridish, not a test tube} is no longer a miracle except to the anxious parents. In North America, there are more than 300 centers that perform lVF and the best of them report pregnancy rates of more than 30%, as against Mother Nature’s rate (natural concep­tion) of 25%. Most assisted techniques reo quire a great deal of financial, physical and emotional commitment and it is important for the couple to make that commitment and support one another through it. Finding the right treatment for yourself is through a combination of your specialist’s diagnosis and your decision on how far you want to go to make it hap­pen. This is an en­tirely personal decision and since many of the treatments are intensely invasive, it is highly recom­mended that one ask as many questions as needed and get a very clear picture of what is expected from one’s body, mind, and wallet be­fore embarking on anyone of them. If after one or more at­tempts, it becomes a possibility that one may never have a child with both part­ners’ genes (if one of you is diagnosed as incapable of causing conception) then donor insemination may be an option, where one or the other partner contributes to the birth by donating sperm, eggs or embryos. The pro­cess of donor insemination is very involved and raises several social, legal, and ethical issues and carries implications that reach far into the future. For the couple for which parenthood is a requirement, but having a genetic child is not an option, adoption may be a worthwhile solution.

AT WHAT PRICE, THIS?

 

Most couples dealing with infertility be­lieve that finding the problem means also finding a solution. There is an underlying belief that if they are committed and dedi­cated to the process, it will eventually result in success. Unfortunately, this is not always true, since there may be factors beyond their or their specialist’s control that determine the outcome of their fertility treatments. The im­pact of infertility extends from before, to dur­ing, to after the treatment. When there is success, the emotional and physical up­heaval seems worth it. When after valiant attempts, there is failure to reach conception and childbirth, the trauma of the process can leave one weak and frail with emotional and physical exhaustion. Along with shock, grief, denial, sexual dissatisfaction, and anger may come a need to blame and find fault with your partner or your life. Feelings of inad­equacy, quite normal in this situation may run out of this framework into the job front and other interpersonal relationships. It is imperative, at all times, to explore one’s feel­ings and understand and work through them, as well as begin to repair battered and worn out relationships that have withstood the enormous Impact of this phase.

One of the most difficult choices to be made at the time may be to determine at which point to stop seeking treatment. Do whatever seems right to you and your part­ner, so that you know that you have made an honest attempt at confronting the Issue. If you have heard of a success story through alter­nate methods such as acupuncture or home­opathy or relki, and you feel strongly about going that route, consult your specialist and work along with them for medical assistance. Most specialists seem to think that alternative healing, because of its non invasive nature, will yield success at best and at worst will never harm. If you feel that you cannot risk your current health by subjecting it to a barrage of invasive hormones and medica­tion, then ask that your partner respect that wish. Be informed and focused on your needs and have all your concerns and queries adequately answered, At all times, however, remember to approach the situation as a team, and not as adversaries.

A friend, grappling with infertility and seeking solace in humor once told me, that if she knew how hard it was to get pregnant, she would have experimented a lot more in col­lege. Surely many of us would have done things differently if we had known that child­bearing would not necessarily be an option. Some of us may not have put our lives and careers on hold, some of us may have consid­ered never taking birth control measures, some of us may have never gotten married. After all, as much as having babies is social conditioning, it is as much or more a genetic need for survival, a biological necessity made legitimate and viable by the institution of matrimony. In many older cultures and some very young and flourishing ones, our children are our Insurance to old age. They will look after us when we are no longer capable of looking after ourselves. They will give back, in multiples, all the love and nurturing we gave their growing years. They will be our pillars when we can no longer stand on our own feet. They will be the steady hands that feed us as ours grow frail, theirs will be the strong hearts that pump life into our dying bodies. They will be our one chance to redeem ourselves, to relive our lives with 20/20 hindsight, to mend past mistakes or recreate previous victories.

But now some of us will have to question whether we will have that chance. Having children will no longer be a question of when, but rather, if the world around us will not stop reminding us about our failure, our incapacity to imitate what most people find so easy to do. Society’s values have long fostered In us the idea that Infertile couples are somehow in­complete. And for those of us who spend years avoiding pregnancies and perhaps aborting some, this may be a crazy joke that the powers may be are playing on us. After all, there was never a question of not being able to repro­duce, was there?

Our challenge is to sort out the messages we are given, and make some sense of them for our own lives and the world we seek to create. For most of us, although parenthood is not the be all and end all of our existence, it is certainly a welcome dimension, a new way of looking at life that is enriching and fulfilling, In spite of all its demands. But if it is not to be, we need to find other things in our life that can bring us as much passion and fulfillment. We cannot be swept away by the “parenthood mandate” that threatens to suck away at our self-esteem, destroy our belief in ourselves and our spouses, and our determination to live life on our terms. We must remember that our adequacy and identity does not revolve simply around our ability to have children. Like any other crisis, we must give this one it’s due, gradually try to put our learning and experi­ences into a ‘better perspective, reach accep­tance and resolution, and then move on.

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