“You have a recruitment problem,” Dr. Matthew Retzloff told me. I shifted on the paper-covered exam table, the vinyl cold against the backs of my knees, and laughed.
As an ROTC graduate, a former U.S. Army Reserve Lieutenant and a physician and U.S. Air Force Major with nine years of service, recruitment had never been my issue. What the infertility specialist was really telling me was that I wasn’t developing enough mature egg follicles with each menstrual cycle to fertilize. Having a biological child would be an uphill battle ― and maybe more of a war.
This fertility story doesn’t have a magical ending. Rather, I’m the poster child of failed fertility. I was reminded of this after reading yet another article about infertility that ended in a successful pregnancy and birth. I know these stories have a purpose: They destigmatise infertility and give women hope for pregnancy. But that outcome is not always the case.
I was 37 years old when I sought fertility treatment. My husband and I had been trying to conceive for two years. Besides age, I had no risk factors: I was a “normal” weight, exercised regularly but not excessively, didn’t use tobacco or drugs, didn’t drink excessively, and didn’t have any preexisting disorders or infectious diseases. I did have heavy, long, irregular, painful periods (metromenorrhagia) beginning at age 12, but other women in my family also had heavy bleeding and had conceived. I had been on birth control for about 18 years, but had stopped using it when we started planning a family.
The Centers for Disease Control and Prevention defines infertility as the inability to get pregnant after one year or more of unprotected sex. In the U.S., 10% to 15% of women in their reproductive years have trouble getting pregnant or carrying a pregnancy to term. And about one-third of women over 35 have fertility issues. That’s about 6 million women in any given year.
I was initially undaunted about my age. To me, it seemed as though friends and colleagues all around me were delaying starting families and still getting pregnant without difficulty. If they can do that, surely I can, too, I reasoned, and marched onto the battlefield of conception.
Our next point of combat: We discovered that my husband, Jim, had an infertility issue of his own. I breathed a private sigh of relief that it wasn’t just me. In 35% of couples facing infertility, there is a coexisting male reproductive issue, according to the CDC. Jim had developed a varicocele, an enlargement of the testicular veins, which “overheated” the sperm and reduced its count. He was quickly booked for an outpatient surgery. Afterward, he spent several days with an ice pack on his groin, but he had a normal sperm count. Our shared problem was now mine alone.
“Month after month, I went home hopeful, only to find out four weeks later that the latest treatment hadn’t changed anything.”
We tried a variety of procedures and therapies to fix my fertility issues. First, the doctors removed a small polyp in my uterus. Next, my husband injected me daily with hormones to stimulate follicle production. I squeezed my eyes tightly to steel against the pain as Dr. Retzloff inseminated my uterus directly with a concentrate of Jim’s sperm using a long pipette. Month after month, nothing worked. My egg “recruitment” numbers stagnated. Month after month, I went home hopeful, only to find out four weeks later that the latest treatment hadn’t changed anything.
I most likely had premature ovarian insufficiency, meaning my eggs had gone AWOL without any reasonable explanation beyond my age. My fertility specialist was honest. “Your chances of getting pregnant are between 3% and 5%,” he told me. He also said I would hear many stories of people who gave up trying, and then, almost magically, got pregnant. But this was not the reality for most patients.
My specialist suggested we try in vitro fertilisation. IVF success rates vary with age, but the statistics are less than comforting, and often complicated: The rates for the first attempted fertilisations are 43% for women under 35 years old, 31% for those 35 to 37, 20% for those 38 to 40, 10% for women 41 to 42, and less than 3% thereafter. To further muddy the picture, 23% to 60% of couples exit after the initial treatment, often because of the expense and frustration. “This makes it hard to define failed treatment and prevalence,” Dr. Retzloff told me.
IVF with my own eggs had a poor chance of success, so my doctor suggested we fertilize a donor egg with my husband’s sperm or inseminate a surrogate.
I looked at my husband. I did not want to have a child that was biologically his and not mine, but a lot of men are passionate about having their own genetic offspring. “If the baby cannot be both of ours, I am not interested,” Jim said. I could have wept with relief.
Meanwhile, all around me, everyone seemed to be getting pregnant. Almost daily, I ran into happy pregnant women — in line at the grocery store, at church, in my office, in my neighbourhood. I was angry. I was jealous and sad. Some women hadn’t even tried; their pregnancies were “accidents.” Others were on their third and fourth pregnancies (enough already!). Still others had miscarriages or early infertility but were able to conceive after all. I even met women who had initiated the adoption process, only to then find themselves pregnant.
I congratulated the mothers-to-be. I bought baby shower gifts and smiled dutifully while they cut cake and opened presents decorated with bright bows and wrapping paper dotted with rubber duckies. Each time, I secretly died inside a little.
Well-meaning women tried to console me. “You’re so lucky you don’t have to go through morning sickness, stretch marks and childbirth,” they said. Lucky? I would have given anything to experience the pain and inconvenience, if it meant having a child of my own. But I didn’t have the choice. This is entirely different from having the ability to get pregnant and opting not to — like my sister, Robin, who is four years my junior and had decided she didn’t want to have children.
I was getting older and was running out of options. I was 40 and wanted to be a mother. During a visit, Robin offered to donate her eggs to our cause. I briefly considered it — it could be our ticket to having a child who contained both my and my husband’s DNA. But she was going through a difficult divorce, and I didn’t want to add the discomfort of egg harvesting to her list of stressors. What if, given her age, her eggs weren’t viable? And what if she someday came to regret, or even resent, her decision?
Meanwhile, my periods were like black-hatted drill sergeants from basic training. Each month would bring a new round of bleeding, which, while uncomfortable, seemed like a positive sign. But every month I didn’t get pregnant made my internal “top hat” yell, “You worthless maggot! You call yourself a WOMAN?” I felt incomplete. Defective. Discharged from duty.
The luck we lacked in getting pregnant seemed to transfer itself to the adoption process. We found an agency we felt comfortable with and began our application. There were a large number of children available for adoption that year, and we were quickly matched with a child. The whole process took nine months. Coincidence?
“I became a forever parent to a beautiful 5-week-old baby girl. With the exception of witnessing the birth and the umbilical cord falling off, we got to experience all of the joys and fatigue of new parenthood.”
I became a forever parent to a beautiful 5-week-old baby girl. With the exception of witnessing the birth and the umbilical cord falling off, we got to experience all of the joys and fatigue of new parenthood. Like intelligence officers, my husband and I learned to decipher our baby’s unspoken language: She preferred to be cradled in our laps while falling asleep. She giggled when her father blew “raspberries” on her belly. She absorbed everything around her with wide-eyed wonder. She howled if her bottle of formula was not in her mouth within a minute of waking. And she wanted her baths very warm — not the tepid, checked-on-the-inside-of-the-wrists temperatures that parenting guides suggest.
I was promoted to the rank of proud mama.
Four years after our adoption, I started to bleed again. I bled and bled for over a month without stopping. Because I was 44, my new gynaecologist wanted to perform a dilation and curettage, or D&C — a scraping of the uterine lining to stop the bleeding and rule out any cancerous changes. As part of the preoperative work-up, she took a pregnancy test.
“Your HCG is positive,” the gynaecologist told me over the phone. ”Do you want to keep the pregnancy?” Of course I did! My draft number was finally called. The doctor asked me to return for an ultrasound the following week. I was still in a giddy, dreamy state when I told my husband the news.
A week later, at 0900 hours, I reported for the ultrasound. It showed a small embryo but no yolk sac. The heart rate was also slower than expected — more like that of an average adult. The gynaecologist was quiet. “While it’s possible we have detected the pregnancy so early that the yolk sac hasn’t begun to form yet, it’s more likely the pregnancy is abnormal,” she said, and quickly looked away. She recommended we check again in two weeks.
I returned home, agonising over the situation. Maybe we were just too early, I told myself. But I had none of the typical symptoms of pregnancy: no nausea, no breast tenderness, no cravings. Nothing.
I had somehow determined this embryo was a girl. My mind turned over with a snippet of song from the Presidents of the United States of America: “She’s lump, she’s lump / She’s in my head.” It was a strange, maybe even perverse thing to be thinking at a time like that. But I think it helped me make the impending loss less painful. Maybe I wouldn’t get so attached to this little ball of cells.
The next ultrasound revealed that the embryo was being taken over by numerous cystic-like growths. There was still no yolk sac. The heartbeat was undetectable. The gynaecologist asked if I was OK, and I cried, maybe more out of relief from the agony of uncertainty than from the loss itself. I had entered the clinic pregnant, and would go home not.
As devastating as it is to miscarry, the experience actually made me feel a bit more whole. The pregnancy hadn’t been viable, but I’d at least been capable of getting pregnant. I had been given back, at least in part, one of the mothering opportunities I’d missed out on.
And at home, waiting for me, were my husband and daughter — this child I had loved in an instant. Now 14, she is beautiful, bright, funny, talented, wilful and frustrating. She even resembles me in mannerisms and type-A tendencies. I would die for her, even when she’s at her teenage snarkiest. I may not have birthed her, but she is as much my daughter as any biological child could be. And, no, she is not lucky to have us as parents; we are lucky to have adopted her. We are family.
Over the years, the nagging shouts of “unfit” and “unwhole” from my subconscious drill sergeant got softer and softer each time my daughter squeezed me and gushed “I love you!” The sadness, bitterness and longing faded. I have celebrated many triumphant pregnancies of friends, and I have shared their grief and devastation when they’ve miscarried. When I see a woman on the street whose belly is swollen and bursting with life, I am genuinely happy for her.
Much like the decorations and ribbons on my USAF uniform that tell the story of my training and experience, my many roles, including mother, tell the story of me. There are dozens of meaningful ways to end an infertility story, with or without children. I may be infertile, but I am still a woman — as well as a professional, a sister, a friend, a wife and, finally, a mother. Mission accomplished.
Special thanks to my sister, Robin Catalano, an exceptional writer and editor, who encouraged me to tell my story for my own healing and to help others like me.
Jill Feig is a retired physician and a graphic designer. She is also a former U.S. Air Force Major. She lives in Helotes, Texas, with her husband, daughter, two dogs and two cats.