Disclaimer: parenthood can come in many different forms. For the purposes of this article, we are focusing on conception between a male and female partnership.
The journey to becoming a parent can sometimes be a long and arduous road – especially if you are coping with infertility. While you may feel discouraged or lonely during your struggle to conceive, remember that you are not alone. In the United States, about 10-15% of couples experience infertility and about 12% of women between the ages of 15 and 44 struggle with infertility or use infertility services. That amounts to over 7 million people who may be going through the same obstacles as you are and taking the bumpy road to parenthood. As you navigate your options and explore infertility services, it’s important to keep in mind that hope is never lost and you might still be able to become a parent, even if it’s not in the most traditional way.
The medical criterion for infertility defines it as not being able to get pregnant for at least a year despite having frequent, unprotected sex. Infertility may arise from an issue with either partner, both male and female, and it can be attributed to a variety of factors. While infertility doesn’t typically manifest in physical symptoms, if you are over the age of forty or having irregular, absent, or very painful periods, it might be helpful to speak to a doctor before trying to conceive. Seeking medical advice is even more advisable if you have known fertility problems, have been diagnosed with endometriosis or pelvic inflammatory disease, have undergone cancer treatment, or have had multiple miscarriages in the past. While these conditions definitely do not guarantee infertility, they have a chance of hindering your ability to conceive. And remember, infertility does not always start and end with the woman. Roughly 1/3 of infertility cases arise because of an issue with the woman and the exact same fraction, 1/3, can be attributed to a problem with the male partner.
So, what can actually cause infertility? For women, the primary reasons are ovulation disorders, uterine or cervical abnormalities, fallopian tube damage or blockage, endometriosis, primary ovarian insufficiency (early menopause), pelvic adhesions, or cancer and its treatment. Examples of ovarian disorders that may impair fertility include polycystic ovary syndrome (PCOS), the syndrome that can cause a hormonal imbalance that interferes with egg growth and release from the ovaries, or hyperprolactinemia, the condition that causes an overabundance of prolactin (the hormone that stimulates breast milk production) and thus, can exert a negative feedback that prevents your brain from releasing hormones that are needed for reproduction. Thyroid disorders, being severely under or overweight, or exercising excessively may also affect your menstrual cycle. Another cause of infertility may be the presence of tumors or irregularities in your uterine shape, or damage to your fallopian tubes that can stop fertilization from occurring. Though several of these issues can be caused by genetic defects, there are also lifestyle changes you can implement to help prevent infertility. For women, it may be helpful to quit smoking, avoid alcohol and street drugs, limit caffeine, exercise at a moderate level, and remain at a healthy weight to increase your chances of becoming pregnant when you are trying to conceive,. Though these actions won’t fix every infertility issue, they’re certainly a start towards a healthier lifestyle for both you and your baby if you do become pregnant.
If your infertility problems don’t have a simple fix, there are still a multitude of options to explore including IVF, surrogacy, or adoption. However, it’s completely understandable to still struggle with negative emotions such as feelings of failure or guilt as you explore nonconventional options. Infertility is a painful process to overcome, but learning how to cope is a fundamental step to moving forward and assessing other options to possibly build a family in the future. The first step in your path to overcoming infertility lies in acknowledging and understanding your feelings. During this time, you may feel grief and loss, as well as loneliness and despair especially if it appears that natural pregnancy is coming easily to your friends and family. This feeling may be compounded if you’ve suffered a miscarriage in the past, or even if you’re just mourning the road to motherhood that you’d always envisioned for yourself but find yourself unable to achieve. It may seem difficult at first, but it’s important to vocalize these feelings to your loved ones and admit that you’re struggling with some negative thoughts. You can also try to find some healthy outlets for your emotions through activities such as physical exercise, journaling, or volunteering for a cause that’s important to you. If you don’t express these feelings, you could find yourself battling emotional distress and even physical side effects such as insomnia or missed periods that further decrease your chance of conceiving naturally. In all this, remember that the most important shoulder for you to lean on during this time is that of your partner: the only person who is fully as committed to this parenthood journey as you and who will be there for you when you need it the most. If the cause of your pregnancy struggles lies with your partner, it’s natural that you might feel some resentment or anger - but it’s vital you try to overcome this through prolonged, healthy communication and honesty. If these conversations become too difficult, don’t hesitate to reach out to a trusted therapist or counselor for some help. If you’re already working with a fertility clinic, they might be able to refer you to a professional who’s dealt with couples going through infertility in the past and can help alleviate some of your stress or disappointment. Another key factor in maintaining a healthy relationship with your partner during an infertility crisis is reestablishing intimacy – and not solely for the purpose of conceiving. While trying to get pregnant can sometimes make your sex life seem robotic or overly scheduled, taking time to be properly intimate or sensual can go a long way towards relieving stress and making you feel like your old self again. Try to “reignite the old spark” by going out on a date or buying a small present. It doesn’t have to be over-the-top or expensive; just the simple act of trying can help you and your partner remain connected and harmonious during your struggle to conceive.
When experiencing infertility, it’s integral to understand all your options going forward. Being optimistic is great, but you should also be realistic. While conventional pregnancy may be the desired route, it might not always be the safest or most practical one. With modern science and new innovations every day, there are a lot of infertility options out there and it’s important that you, your partner, and your fertility counselor or reproductive endocrinologist explore the best possible choice. In most cases, the first infertility treatment that couples undergo is fertility medications. For women, this is most likely a drug aimed at stimulating ovulation or thickening the uterine lining. For men, your doctor may try to increase sperm count or improve motility through medication. If drugs don’t help a couple in conceiving naturally, a fertility specialist may then suggest one of many medical procedures, collectively known as assisted reproductive technology (ART). The best option will always depend on your unique situation, but some options include artificial insemination or in vitro fertilization (IVF). IVF is the most widely known ART procedure and involves harvesting sperm and egg cells from each partner and then performing fertilization in a laboratory setting. Once the embryo develops, it will be implanted in the women’s uterus and the pregnancy will proceed like any other. However, you should keep in mind that there’s no guarantee that fertilization or implantation will be successful, and IVF is a costly procedure, averaging about $11,000-$12,000 with insurance. IVF can be augmented by assisted hatching to make it easier for the embryo to implant but given the steep price, you may consider other options. One of these is intrauterine insemination which is possible if harvesting the egg is not needed and instead, problems lie with the sperm delivery. Both of these methods are viable if you and your partner’s sperm and egg can be used to make a healthy embryo. If not, gamete donation may be necessary. There are a plethora of sperm and egg banks that can be useful in this situation and if only one donation is needed, at least one parent can preserve a genetic connection with your future child. But sometimes identity or personal issues can arise when considering a donor-assisted pregnancy, so it’s vital that you and your partner talk through the idea to make sure you’re comfortable before proceeding. The parents are equally as important as the child in any familial relationship so every step you take should be for everyone’s benefit and happiness.
If your infertility crisis lies with not being able to carry a child, surrogacy is an option. In this case, the embryo is created by the intended parents (either from their own gametes or through a contribution from a donor) and then implanted into the uterus of the surrogate who will carry the baby to term. Your fertility specialist will likely be able to recommend a surrogacy agency if you do want to pursue this option. Even though you're not the one carrying the baby, surrogacy can still be a physically and emotionally taxing process and you should prepare for any challenges or obstacles you have to overcome.
Yet another option for non-traditional parenthood is adoption. The process has evolved rapidly over the past few decades and can be an incredibly positive experience for you and your future child. If you’re considering adoption, you can either adopt from the foster care system, internationally, or do a private domestic infant adoption where a pregnant mother will choose you and your partner to be her child’s adoptive family. Each process has its own unique hurdles and guidelines, but at the end of the day, it’s important that you choose whatever works best for you and your family. And even though you might not have a biological connection to him or her, from the moment your adoptive child enters your home for the first time, they’re yours to love and cherish.
Infertility is a momentous obstacle to overcome but it can often have bright outcomes. If you can’t conceive in the way you thought you would be able to, try not to feel guilty or blame yourself. And even if you do, find outlets for those negative emotions and practice honesty and communication in your daily life and with your partner. Try to consider all your options, even the more nontraditional ones. No matter the infertility struggles you may face, remember that the journey to motherhood is rarely a straight line and it may choose you in a wonderful yet unconventional way that you never expected.