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.