A friend who is in her 20’s recently told me she’s going to wait until she’s 40 to start having babies. Sure, there’s Nicole Kidman who delivered her first baby at age 41 and Halle Berry at age 42 and Madonna delivered her second child at age 42 and so. Many. More. Over 40 women who have graced countless magazine covers giving women the false perception that they can hold off on having that first or second baby for as lonnggg as they want.
The truth of the matter is, once a woman hits her 30’s, her chances of conceiving drop to 15-20% according to Medicine Net and, “It does drop significantly after age 35.” According to an article posted on infertility on About.com, “At age 40, your chance of getting pregnant in any given month is just 5%.”
For those that didn’t find The One until later in life or simply found out the hard way — whether age was a factor or not — it wasn’t easy (or even possible) to get pregnant the first or second time around after years of being warned to the contrary, it can be an uphill battle. Shira Kfir, a Licensed Clinical Social Worker with a specialty in Reproductive Medicine and Women’s issues, discusses secondary infertility, the latest options for couples hoping to conceive, what’s involved, and the costs as well as options if it doesn’t happen. First, one mom shares her own emotional journey with secondary infertility and the impact it had on her personal religious beliefs as well.
We started trying for our second baby when our son turned one. It had taken about nine months to get pregnant with him, so we thought we should get started. We kept our disappointment in check the first several months since we didn’t really expect it would happen that quickly for us, but as month nine, then ten, then a year passed, my disappointment turned into confusion, sadness and panic. I was certain there was something wrong, it shouldn’t take this long! I had heard of secondary infertility and now here I was experiencing it.
First, I went to see my OB-GYN where they ran some blood tests to check hormone levels throughout my monthly cycle. The result was that nothing was out of the ordinary. Due to my “Advanced Maternal Age” of 36, they recommended I see a fertility specialist as soon as possible, since I wasn’t getting any younger!
I have a strong Christian faith and I believe in this big God who can do anything. I knew that if God created me, he could create a little life in me but, He wasn’t doing it. I felt this frustration in my faith, I told God, “why should I have to go to a doctor to help create this life, you can do this!” But, still the months passed with no pregnancy.
Before taking the giant step into the medical world of infertility, I decided to take the natural route and began seeing an acupuncturist a friend recommended who had helped in her struggle with infertility. I would lay on the table with needles poking all over me and cry. I was hopeful, yet skeptical, but mostly sad. After six weeks, I decided to stop going sensing that my body wasn’t at a place to accept this healing.
A few months later (and after 15 months of trying to conceive) we finally interviewed two infertility specialists (which I think is odd, shouldn’t they be fertility specialists?) and chose the one who was closest to our home and came highly recommended. Proximity is key as there are many early morning and daily appointments throughout the process.
Both specialists gave us a very high probability for success, we were still fairly young (many couples who go through this process are in their late 30s, early 40s), healthy and had already experienced a healthy full term pregnancy. So, this should be easy, right? The first doctor suggested we go straight to In Vitro Fertilization (IVF), siting that in his experience Inter-uterine Inseminations (IUI) were not as successful. The second, whom we chose, gave us an overall plan: three IUIs maximum then move to IVF if not successful. We were hopeful that perhaps we just needed a little help in getting the swimmers to the right place at the right time, after all, they have done it before, right? We completed one unsuccessful round of IUI and found that my progesterone level drops early in my cycle, so for round two, we boosted those levels with regular progesterone shots starting mid-cycle.
I was sure we had found the “issue” and was really excited that this could be it! We settled into the nightly shot routine, which really wasn’t that bad and my husband enjoyed the close up of my tush even though he was sticking a two-inch needle into it!
Two weeks of shots later, I hit my lowest point ever in the process. We learned that round two was also unsuccessful and our next step was to either repeat the process again or move forward to IVF. I was extremely crushed and so emotional. I knew that no matter what we decided to do, nothing was going to work, at least not then. Just as it had been with the acupuncturist, I knew I was too emotionally stressed, I knew my body was not going to truly receive anything, so we decided to take a little break and re-group.
This was an extremely painful time for me and I felt very raw. It was difficult to talk with friends or family as most people had their “take” on things–“time a vacation for when you are ovulating;” “take up a hobby and forget about it for awhile;” “oh, it will happen, just be patient”–and it was just too painful to hear. No matter what any one’s opinion on the situation was, this was my experience and I felt no one really could quite understand. I found that even my friends who had gone through infertility but were on the other side of it (successful IVF stories, or natural pregnancies) were not as comforting as I would have hoped.
For the first time in my life, I felt a deep hopelessness. Again, I struggled in my faith wondering why God wasn’t answering my petition for a child. I wondered if God wasn’t providing naturally then why would I think he would provide through medical help? Was there another plan he had for me?
It was around that time when a good friend of mine adopted her son. I listened to her story and I began investigating other stories of adoption and as my husband and I learned more, that dark hole of hopelessness began to fill again with the light of hope. I had so much dread that we would go through the rigorous process of IVF only to have it fail. Now through the hope of adoption, I knew it was no longer if we would have a child, but when.
We dove into the process and six months later (I know not all adoptions are this quick) we brought home our precious, long awaited, baby girl! We were thrilled and as time went on things continued to confirm that she was made for our family and us for her. Yes, her arrival filled the void we felt in our family and we were so grateful for the gift of adoption, however, a successful adoption does not erase the pain of infertility. When a woman is pregnant it is like a great confirmation of her–a stamp of approval that she is worthy to create life. I still had that lingering feeling of being passed over, of somehow not being worthy of that gift (that may sound severe, but I am sure I am not alone in this feeling).
I found that I was still carrying that torch–a hope that one day perhaps I would get pregnant again, or that perhaps going down the infertility route would seem right to us. But for the time being, I was content with my role as mommy of two.
A month after celebrating our daughter’s first birthday, we found to our great shock and amazement that we were pregnant with our second son! I was still reeling from our daughter’s amazing adoption story, and now this! We felt extremely blessed!
As we shared with people our news, we often heard “oh, isn’t that always the case? Once you stop thinking about it, it happens.” I couldn’t disagree more. I now know that my struggle had a purpose, that although I felt God was withholding from me, He was actually giving me an amazing gift, one that we could have never “produced” on our own. The timing and placement of our daughter was so perfect that there is no doubt that our inability to conceive was the catalyst to open our hearts toward adoption at just the right time for our sweet girl. Conceiving again gave meaning to the confusion of my secondary infertility. And that meaning is our daughter.
Once a couple gets married, the first question asked by family and friends before walking back down the aisle is…..”When will you have a baby?” After the first baby is born, the next question on the list is “What about Baby #2?”
How common is it for a couple to have a first child and then not be able to conceive a second time?
Over three million Americans are affected by the painful experience of secondary infertility. Many are couples who did not experience any troubles getting pregnant in their first pregnancy, may go on to then experience difficulty or an inability to become pregnant again. According to RESOLVE, a national organization dedicated to helping families navigate through infertility, “Secondary infertility is defined as, the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. Even though the couple already has a child, the couple experiences secondary infertility as the loss of a child, the loss of pregnancy, and the loss of childbirth.”
While secondary infertility is very common, most couples are less informed about how and where to seek assistance. Furthermore, couples oftentimes wait longer before seeking treatment than they might have if the infertility occurred with the first pregnancy. Couples commonly think that fertility in the past insures future fertility. Unfortunately, this is not the case for many couples.
The emotional aspects that arise for a couple are numerous while dealing with fertility issues. Couples often feel anger, grief, depression, isolation, guilt and self-blame. These feelings stem from the inability to produce a sibling for their existing child, as well as the guilt in some couples who may feel they waited too long to start having children. Often, partners may have different coping styles that can lead to a distancing between the couple. While one partner may feel comfortable discussing and finding out more information about treatments and options, the other partner might be more willing to “wait things out” and see how things unfold naturally. This can cause anger and frustration to develop between the couple. Sex and intimacy may also become an issue of concern between couples. While most fertility treatments include “sex on demand,” sex may become “a chore” and lose its spontaneity instead of its previous association of intimacy and togetherness. Sex also becomes associated with the pressure to succeed and can be difficult when a cycle is unsuccessful, the association of sex as a failed attempt. Thus, it is important for couples to openly discuss their feelings and reconnect emotionally in ways other than just sex.
Another important issue when discussing secondary infertility is the consideration of the child that already exists. Discussing with the child, in appropriate terms, what is happening with the family can be an effective way to provide an outlet for the child to express himself/herself. Children, as we know, are aware of their parent’s emotions and grief.
“It is naïve to think that a child will remain unaware of her parents’ grief just because the parents do not talk about it or address it directly. In fact, if there is an absence of information, children resort to egocentricism and magical thinking to interpret events. For example, the child may be worried seeing the mother go to the doctor, getting shots etc. or the child may think her parents are dissatisfied with her if they are upset and anxious.” (RESOLVE website)
Sadly, couples experiencing secondary infertility tend to receive less social support from friends and family. While family and friends may seem to understand the disappointment a couple is feeling, they may think a couple should be grateful that they have one child and may discount the feelings of loss a couple feels in not being able to conceive again. In addition to trying to explain to family and friends what the couple may be experiencing, support groups are a great way for couples to receive additional support and understanding with other couples who are experiencing a similar situation.
A couple must work together to talk about these and other issues that might arise while coming to grips with the idea that the family they had once envisioned might end up looking different. Couples are encouraged to discuss their sense of loss and the vision they had for their “ideal family.” It may also be useful and helpful to become a part of a support group or seek assistance from a mental health professional who deals specifically with reproductive medicine so they can further assist a couple in discussing and dealing with the issues and options that may arise.
- Fertility Medications
There are a variety of medications used to treat infertility. It is important to understand the medications and what their purpose is and to speak with your physician about the medications that will be used in your specific treatment plan. Costs will vary according to medicines used and insurance coverage.
IUI Intrauterine insemination is most commonly referred to as artificial insemination. This is a procedure where the woman is injected with carefully prepared sperm from the husband or a donor. IUI is often performed in conjunction with ovulation stimulating medications. IUI is used to treat unexplained infertility, minimal male factor infertility of for women with cervical mucus problems.
Average cost of an IUI cycle: $865; Median Cost: $350
Assisted Reproductive Technology is defined by the CDC as a procedure in which a woman’s ovaries are stimulated, her eggs surgically removed, combined with sperm and returned to a woman’s body. IVF is the most widely used of the ART procedures.
Average Cost of an IVF cycle using fresh embryos (not including medications): $8,158; Median Cost: $7,500. Medications for IVF are $3,000 $5,000 per fresh cycle on average. (RESOLVE website)
What are a couple’s option if they still haven’t conceived?
Couples have a few options if they have been unsuccessful in becoming pregnant and have chosen to stop further fertility treatment. Couples can choose adoption, surrogacy, and foster parenting as alternatives to continuing further invasive treatments. There are many issues a couple needs to discuss and come to an agreement upon with each of these alternative options.
Anything else you’d like to share?
Infertility, primary and secondary, is an emotional process that consumes the family unit. Being prepared as a couple for the emotional ups and downs as well as choosing a physician that you trust and can work with is important to making the process smoother and more successful. There are so many different theories and beliefs regarding fertility and treatments, make a choice that works best for your family.
Shira Kfir is a Licensed Clinical Social Worker with a specialty in Reproductive Medicine and Women’s issues. Shira works with women and couples who are working through fertility and family issues. For further questions, contact ShiraKfirLCSW@yahoo.com.