Where to begin?

I’m not really sure how we ended up here. I’m not sure anyone ever expects to be here. Where is here? Infertility. They say 1 in 8 couples is faced with infertility, although I suspect when you get to be my age it is actually higher. Just looking at my close friends from college–of the five that I keep in close contact with, 2 have been through treatments to have their babies. That means half of us have had to deal with infertility. I’m the only one who still doesn’t have my baby though. It’s a lonely place to be.

We started down this road innocently enough. “Let’s have a baby.” “Ok.” No more birth control and just have a lot of sex, right? That’s what you are taught growing up. You can get pregnant if a boy looks at you wrong. But after 4 or 5 months of trying without success, I begin to worry. Of course I’m overreacting. I do tend to over think everything. So I read, I study, I take my temperature, I pee on little plastic sticks that promise to tell me when I am ovulating. We don’t just have sex, we have sex *at the right time.* Six months later, still nothing and now I’m really worried.

At that point we move on to the next step–testing. But everything comes back normal, and so we continue to try on our own. I eventually hit a point though, where I can’t do it anymore. It was fun and exciting at first, but after a year I knew it wasn’t going to work. The average couple concieves within the first 4 months of trying. The majority of those that don’t will conceive in 6 months. And by one year, 90% of couples are pregnant. The rest of us? Infertile.

We finally make an appointment with a fertility specialist. After a few more tests, and looking at everything, she gives us our diagnosis: unexplained infertility. That means nothing is wrong. There is no explanation for our inability to conceive. I have no problems. He has no problems. We have no problems. Except we don’t have a baby. As a physician, I find this diagnosis particulary upsetting. If you have no problem, how can there be a treatment? I am constantly having this conversation with my patients: I can’t treat you for something if I can’t find anything wrong. With unexplained infertility however, the thought is that there is something wrong. It is just subtle, and is not revealed on the typical tests. Maybe it’s a combination of old eggs and slow sperm. Maybe my hormone levels are just a little bit off. No one knows.

The treatment in this case is to increase the number of eggs produced each month to give the sperm more targets, and take the best swimmers of the bunch and put them right in the uterus, therby avoiding that trecherous journey through the cervix. So we tried that–four times. The first three, I took Clomid. Clomid is a common medication prescribed when people have trouble getting pregnant. It blocks the effects of estrogen, so your body thinks you need more, thus stimulating the ovaries to make more eggs. It also makes you feel like you are going through menopause. Despite an excellent response (one month I had 5 eggs!), it didn’t work.

For attempt #4, we tried a different medication. One of the problems with Clomid is that it also blocks the effect of estrogen on the endometrium (the uterine lining) which can make it hard for a pregnancy to “stick” even if the sperm does manage to find the egg. There are other medications (injectable ones) that are synthetic forms of the hormones that stimulate egg growth. The good: they don’t have anti-estrogen effects. The bad: they are expensive and carry a high risk of overstimulating the ovaries. Again, the meds worked great. Again, we aren’t pregnant.

So what next? IVF–in vitro fertilization. Of course, this is me trying to be my own doctor again. my theory is that something is wrong. Something that is not detected with the testing we have done so far and something that cannot be fixed with intrauterine insemination. Maybe I make crappy eggs. Maybe the sperm can’t find the eggs. Maybe the eggs aren’t getting fertilized. Maybe the fertilized eggs aren’t sticking. We won’t know unless we try IVF. So tomorrow we have an appointment with the fertility specialist to discuss IVF and see if it will be our next step.

That is where we are today. And that is how we got here. You are welcome to follow along for the rest of the journey.

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