The Maybe Baby: Infertility and Reproductive Assistance (and Pregnancy Loss)

Soft curly hair. Dimples. A vivacious giggle. You vow to teach them piano like your parents did growing up. You will be biased and think your child is the funniest, most beautiful creature you ever envisioned. Many trips to the playground every week. Swim lessons. A pet dog and hamster (because your parents didn't let you). 

Pregnancy is part of the human condition, a miraculous phenomenon when the human body creates another human. It also has historically been known to put the lives of the expecting child and parent at risk.

Maybe you feel unsure about this parenting thing, but you've decided to go solo or finally found a partner you feel safe with, and it's time. You envision what life will be like when you have them—the first night of being scared and waking up for multiple feedings—watching them roll over for the first time. Seeing them crawl, then take their first steps. And that is just the beginning. They will become their own person, and you will witness it. One of the most haunting and remarkable aspects of being human is being responsible for the care and growth of someone else. 

Every school play will be a Broadway show. Movie nights and trips to the aquarium will hold a special meaning now. Your child will be a bright star in your sky. You hope to be the best parent possible. From conception to birth, toddler stages, and adolescence, you will watch a seed become a tree. 

But first, you have to get pregnant.

Trying to Conceive

Infertility is generally diagnosed at 6 months to a year of trying, depending on the age of the parent/couple. This can be emotionally and physically exhausting. Seeing other people with announcements they are expecting can be disappointing, as you hoped to have been the one making the announcement yourself. 

"Why not just adopt?"

"Why is it taking so long? What is wrong?"

"Maybe if you lose weight/take these vitamins/try this position…."

"Sometimes things just aren't meant to be."

"How long will you keep trying for?"

"It's not natural to do IVF. Why not try longer to see if it happens?"

The thought that this dream will not culminate may not have crossed your mind. What if it does not happen, or not right away?

So many of us, in particular those born female, try to have planned pregnancies. Unless you were told of a health condition when you were younger, the idea of getting pregnant, staying pregnant, and bringing home a healthy baby might be seen as a given. 

If you knew that you might have fertility struggles from a younger age, how do you articulate this to a future partner, or others, like healthcare providers, family and friends? 

Types of Fertility Issues

Women and those female at birth can have health conditions that make fertility uncertain. Polycystic Ovary Syndrome (PCOS) can mean irregular cycles and difficulty conceiving as you may not ovulate regularly. Perhaps you never had a menstrual cycle, were born without a uterus/other organs necessary for pregnancy, or were born intersex. 

There are also situations in which a potential mother must consider her health first and fertility risk. Cervical cancer requires chemotherapy/radiation, which makes IVF and surrogacy necessary. Finding someone else to carry your child and the emotional and financial costs can be challenging. There is also the possibility that you cannot carry a pregnancy and how this affects your journey to parenthood. You may not have a fertility issue, but your partner, if male at birth, could have no or low sperm count due to genetics or cancer treatment. How does your partner feel about putting their partner through invasive treatment, such as IUI or IVF? What does it mean if getting pregnant entails donor sperm? 

Maybe you waited later in life to have children or started young and found out there were issues. There can be low egg quantity, concerns about egg quality due to age or genetic factors, and hormonal or structural issues.

Other health conditions are lesser-known but still significant. Due to body dysmorphia, carrying a pregnancy can seem daunting: knowing that your body will change and look unfamiliar. Breasts swell, the skin stretches, and nausea. Dysmorphia can be due to being transgender, past childhood trauma like sexual abuse,  having had an eating disorder, or difficulty with penetrative sex in general (like vaginismus). Gender affirming surgery, though of course beneficial, could force you to make difficult decisions regarding future fertility, and now you need assistance. What if you take life-saving mental health medication, and coming off of it will take you out of remission for debilitating bipolar disorder, depression, or schizophrenia? You want to be a parent, but at what cost? 

Reproductive Assistance

Reproductive assistance is not accessible to all. People must consider health care coverage, possible debt, and invasive procedures (often on the female) to conceive without assurances it will work. IUI tries to give sperm a closer chance at fertilizing an egg. IVF entails frequent ultrasound monitoring for egg growth, injecting medication daily, and anesthesia for egg retrieval, which can be painful. Then create embryos in a lab and see if they are viable to be implanted. Why do people stay silent when going through fertility treatments?

How Therapy Can Help

Being unable to conceive without reproductive assistance is surrounded by rooms of philosophy and debate. People are afraid to talk about these issues openly. 

At Footprint, we believe in "slowly, slowly." We want to take time to hear your story and be there with you, no matter how long it takes. No matter what stage of the process you're in, we're here to help.