Mourning has Broken

A few months ago, I was browsing a thread on an online fertility forum and I took note of a woman dealing with severe male factor infertility who described she was mourning the loss of not experiencing a 'natural' or 'normal' pregnancy. Loss is an appropriate description. There is a loss of privacy. In the landmark decision Roe v. Wade, the Supreme Court declared that 'the decision whether to beget or not to beget a child is so fundamentally private' that it deserves constitutional protection. Unfortunately, this right to privacy doesn't extend to discussing your sex life with your RE. There is a loss of intimacy and there is a literal disconnect between you and your partner during aspects of the process, as well as the inclusion of other individuals. There is a loss of dignity, as all your lady bits (both internal and external) are repeatedly exposed and your partner has to wank in a special room, where many other men have...yeah, don't think about that. There is a loss of self-assurance and some times a displaced self-confidence. Everyone feels a sense of betrayal when one learns that his or her body can't perform in the way it is expected. Some experience a loss of femininity or masculinity. Infertility can create doubt and cause couples to question if they actually should become parents, and some may interpret IF as a sign that they don't deserve to have a baby. Bank accounts certainly reflect a financial loss.

Although it is legitimate to grieve these losses, I reminded this woman about a previous thread she started where she asked the forum, "Does anyone ever feel they are lucky to experience infertility?" The responses were astounding. Many women replied that their IF issues became a catalyst to make healthy lifestyle changes. Diets improved, exercises programs were started, a few commented that they had easier pregnancies because of their weight loss. One woman noted that while dealing with IF, she finally acknowledged that she was an alcoholic and became sober. Some forum members noted that the experience strengthened their relationships with their partners, and others commented that it enhanced their appreciation as parents. A few detailed how they were found to be carriers of certain genetic diseases and they were able to use PGD to avoid the devastation of bearing a child with a fatal or disabling condition. One woman described that she felt fortunate to have gone through IVF as the "right" sperm and "right" egg were selected to produce her amazing daughter.

I thought about some examples in my own life. A good friend of mine met the love of her life when she was 35 and married two years later. They wanted to start a family right away, but a few months after their wedding, his older brother was diagnosed with Hodgkin's lymphoma and his father was diagnosed with lung cancer (a non-smoker). The next year and a half of their life was dedicated to caring for their loved ones and procreation was pushed to the back burner. After six months with no conception, they went for their work up. No major issues were identified, but IVF was recommended because of her age. After three rounds of stims, and despite adequate retrieval rates and ICSI, no embryos were ever available for a transfer. I asked her if she thought the failure to fertilise was so their children would not inherit that cancer history. She agreed. They proceeded with embryo adoption and had a pair of boy/girl twins last year. I couldn't think of a better ending for their journey.

Last year, I saw a newly pregnant patient and while reviewing her history I saw she had an infertility work-up and severe male factor infertility was found. She met with an RE, who thought they were candidates for mTESE and IVF/ICSI, however their current pregnancy was achieved with Artificial Insemination(AI) using donor sperm. I asked if they would't mind sharing how they made this decision. Her husband answered, "Go through all that torture just to pass my family history of diabetes and heart disease onto my kid? No, thank you." I loved the way he used the term 'my kid'. Additionally, they did their AI at home. Full of male pride, he bragged, "At the end of the day, I'm still the one who got her pregnant." I have another friend who went through adoption to create her family. Her husband is a second generation American whose family hails from Taiwan. They went to his county of origin to adopt their son and met members of his extended family and travelled over Asia. No, they never had the moment of witnessing a heartbeat on an ultrasound, but their adoption process led them to the journey of a lifetime.

It all reminds me of a pep talk I received before competing in my first triathlon. The event organisers arranged to have a former Olympian provide words of wisdom to newbie triathletes. She asked various members of the crowd how they prepared for the event and she asked "what did you gain from your training?" Some learned to swim or bike for the first time. Many lost weight, but gained muscle tone and confidence. New friendships were forged and bonds of established relationships were strengthened. "Think about all that you have achieved before you even reach the starting line..." she instructed all the nervous participants. Yes, the losses associated with infertility are very tangible and painful. However, the gains associated with infertility are also very real. It's worthwhile to take a step back and appreciate all that has been achieved prior to achieving a pregnancy.