Sunday, November 23, 2008

Degrees of infertility

Of late I have been thinking quite a bit about infertility. I’m sure you’re surprised – why should I be thinking of infertility? I have such a full life, right? Yeah right! ☺

No but seriously – I’ve been thinking and I wonder if some infertiles have it worse than the others. The more I think, the more I feel like the answer is not that simple. IF is very subjective. And before I start – please, I am not making ANY judgments here.

What is infertility? This is what Wiki.pedia says about the topic. Most of us know most of what’s mentioned there, and most of us unfortunately are among the “1 in 7 couples” (I thought for some reason that it was 1 in 6 couples).

So a couple starts trying to conceive and 84 out of 100 couples will be pregnant within the first year. Now the catch is to know WHEN you can get pregnant. A surprisingly large number of women do not know their cycles, and their fertile times. Therefore, they are not getting pregnant purely because of lack of timing. After a few months of frantic research, or even panic attacks, most women figure their cycles out, and a large number will get pregnant. I actually know people that have panicked – and by panic I mean really panicked – gone and seen doctors and even spoken to doctors that they felt they needed to get started with ~ get this~ IVF. In one real life case, the sensible doctor took the couple through a detailed presentation of a typical IVF cycle – the shots, the ultrasounds, the retrieval, the fertilization, transfer etc. That freaked this couple out even more and caused a bigger panic attack. But that panic attack brought some sense into the couple. They were pregnant within the following 2 months – naturally. (Of course)

Then there is the group that needs medical intervention to the extent of clomid / femara, and that, along with timed BD, does the trick. Infertile? Perhaps not. Sub-fertile? Maybe.

The next group is given clomid/ femara and goes through IUI cycles.

The next group does injectables with IUIs. How many IUIs are enough? My RE had wanted to move us on from IUI to IVF after we had done 5 IUI cycles. I believe 6 IUI attempts is typically when either the doctor decides to ask the couple to decide for IVF or the couple decides and either proceeds with IVF, or other routes.

Financial strain plays a huge part in this decision-making. Only a limited number of insurance coverage actually covers infertility treatment, and not a lot of us have thousands of dollars lying around to bet on perhaps a 30% chance at conception.

Some are lucky to have good insurance coverage, and after 5 or 6 IUI attempts, their frustration and desperation pushes them to do something more aggressive. I know I moved onto my first IVF with 2 feelings. One was complete despair and frustration and therefore the feeling of “Bring on the big ones!”. The second was complete belief that IVF would work. I mean – that’s the mother of all treatments in infertility isn’t it?

Then there’s the group that ends up repeating IVF attempts again and again.

Then there’s the group, which conceives, but does not get to the happy ending of bringing baby home. Pregnancy losses takes you right back to the start line. You start all over again. I am unfortunately part of this group.

Some will achieve success and get to realize their dreams of having a baby, and life moves on. Some may not be so lucky.

My question is simple – Can these situations be compartmentalized into “degrees of infertility”?

To me, the answer is not as simple. While it would be easy to say yes – the first few groups are in the “easier stages of infertility” and the latter groups have a “rawer” deal in the whole thing, at the same time, these conclusions are drawn in retrospect. What happens WHILE the first few groups are still trying? Going into a treatment cycle, nobody knows if their first round of clomid will work, or if they will need to spend the next 5 years of their lives spread-eagled with their feet up in stirrups in a doctor’s office.

Infertility is one part diagnosis and treatment, and one part analysis and stress. The part of analysis and stress gets worse with time. But I think the acceptance and ease with which we are able to stick injections into our tummies becomes easier with time.

With each cycle there is hope. But with hope there is deep dark despair too. The stress that a person in each of the groups mentioned above is going through COULD be similar. Then there is the personal threshold too. I could be the types who panics at not getting pregnant after 3 months of “trying”, or I could be the types who is more calm and does not let the stress get to me so easily.

Repeated failures manifest themselves in so many ways. Stress in relationships, stress in social interactions, loss of confidence, the feeling of being let down by your body, the feeling of failing, feeling isolated and “on the outside”.

When is the point when you move from the hope / despair cycle to bitterness? Is that when you really have it bad?

Again, please, I am NOT trying to make any judgments here, I’m not saying one group has it easier than the other. It may appear so – but I feel the answer is very subjective. The pain, the loss and the despair are pretty unifying.

That is why a community of IFers “gets it”, and sometimes someone who has moved on from being an IFer to having a baby suddenly stops “getting it”. The community of IFers that gets it could be from any of the groups above - the stress they are all under could be so similar. 


April said...

maybe it's not a spectrum of infertility, with easy to hard, but rather different types. there are so many factors that are involved: eggs, sperm, uterine lining, genetic abnormalities, anticoagulation problems, etc, etc. each of these problems can be on some sort of a spectrum of mild to severe, but when you put all of the factors together you end up with "type" of infertility. for example mine might be something like: anovulatory-PCOS-male factor-post cancer-poor lining type.

did i think that i had it easier when i was doing only IUIs with oral meds? i'm not sure. i was still stressed. i still worried about my lining. i was still scared but optimistic. as you progress along the IF timeline you have to deal with more difficulties, but you are stronger, too.

i do know this for certian: IF sucks...regardless of how long you have had it.

Anonymous said...

Well said. It's also what you're willing to accept in yourself. Having gone through 2 IVF's, my husband's brain surgery, and 1 miscarriage, I still was unwilling to accept myself as part of the IF community until last week. And while I now accept that this is what I'm dealing with, I still have moments where I think, "No, this can't be right. I'm healthy! I take care of myself. I'm doing everything right." And yet here I am. Here we are. IF is, in a lot of ways, levels the playing field. All we can hope for is that the game ends in a home run.

Lorraine said...

I myself have been in almost all of those groups, in succession. I can say that in the very beginning i didn't really consider myself infertile -there were a million excuses. Bad timing, an unlucky month,husband under too much stress.

I didn't really want to move on to being a fully-fledged infertile, but in hindsight I wish I had just gone on to IVF earlier in the process. Yet I still wonder if I count as a "real" infertile since I do actually have a child (from the dark ages of my twenties)! Too complicated...

Heavy heart said...

You are spot on on many of your observations.. when I first started lurking the IF blogs I went in search of blogs that had issues similar to mine..and even better had succeeded with issues similar to mine.. sometimes the fear of being confronted with new possible issues stops you from reading blogs that have seen too much pain..but then you realise that is just stupid and those with more pain have more courage and hence have much more to learn from!

Amanda said...

Well, I think I get what you're saying, but it's a pretty non-productive to think about this. Bottom line, all IF hurts... different kinds of hurts, but they all hurt. Who can say it's worse to have a loss than to never see a pos in many years of trying. The person that had the loss will never know what it's like to have never seen the positive and the person that never saw the pos will never be in the position to have a loss. IF sucks for both.

I was diagnosed with PCOS when I was 15 and told I probably wouldn't be able to have kids. So, I was anxious about my IF for 10 years before I even started TTC. I had my hope taken away from me when I was really still a child. And I had to go through dating knowing I had a secret that could make a big difference in how my boyfriend felt about me. It hurts, but does it hurt more or less than someone that has been trying for years or has failed an IVF or something? I don't know.

So, I get what you're thinking, but it won't help you any to think like that. Just be supportive and help to educate those are probably just missing the knowledge to get pregnant and preserve yourself from the jerks of the world.

Miss Tori said...

I try not to compare myself to others, because we all have our own unique situations. Have I had as many procedures as someone else? No. Am I infertile? Yes. Why? My eggs just aren't there. Ovarian reserve failure.

Luckily for DH and I, we decided to skip the IUIs and go straight to IVF, where after three failed attempts to even get to retrieval, we were told that my egg reserve is like that of an old old woman, which ended up saving us not only money, but needless ups and downs on this IF roller coaster.

Our option is egg donor.

One thing that I do want to throw out there, and again not judging, but I really don't consider the woman "infertile" if it is the man who has the issues. If those issues are what is making them do IUI or IVF, then it's the man who should carry that "title" and not the woman. I think some woman will call themselves infertile in this situation, when in my opinion, they aren't. But again, it's only my opinion and not worth much.

Lisa said...

It's interesting to think of things like this. For me, in my depths of despair, I sought out blogs of women who had been to hell and back and lived to tell about it - ideally with a happy ending which meant a baby (via some route) or peace with moving on. Those blogs were a lifeline for me. I definitely do find myself comparing situations. We had a family friend when I was growing up who had at least 2 still births, possibly 3. She went onto have 2 living children and during the dark times after my m/cs, I thought of her often. It was along the lines of "if she could survive that, I can survive this".

Lisa said...

Nikki, what a great post. There are so many degrees and types of intertility. Some people have it so much harder, others go through it so much longer. Really, when I think about other people who have had it worse than me, it breaks my heart. But all of us have struggled so much. It's so unfair and sad, this beast called infertility. And I hope we all kick its ass!!