Infertility: Longing for more children

It was one of those moments you never forget. I was sitting across from my gynaecologist, waiting for the results of some recent blood work, when he looked up and said: “I’m afraid it’s early menopause.” Menopause? At 38? What about more children? “That’s not likely to happen,” he said gently.

Read more: 5 things you should know about early menopause>

It’s not that I didn’t know I’d pushed the fertility envelope by delaying the decision to start a family. In my 20s, I worked alongside a woman who was a decade older. One day, she confided she’d recently experienced a miscarriage in her ongoing quest to conceive. Through tears, she urged me to consider kids sooner rather than later. “Time is the enemy, Sharon,” she said. I heard her words, but I wanted to be ready before I had children. And I assumed children would come when I was ready.

Initially, that’s exactly what happened.

I was 33 the first time my husband, Phil, and I played “condom roulette.” The payoff was an immediate pregnancy, which, sadly, terminated in a second-trimester miscarriage. Conceiving a second time required two years of choreographed sexual encounters, an intimate knowledge of vaginal mucus and a dose of the fertility doctor’s little helper, Clomid. Finally, my daughter, Ki, was born. Naive as it may seem, I genuinely believed having one child guaranteed my ability to have another.

I couldn’t have been more wrong. Secondary infertility (defined as the inability to conceive after having been pregnant once) affects around 15 percent of North American women. While it can strike at any age, it’s most common among those—like me—who postpone child-bearing till their mid-30s and beyond to establish careers, settle into relationships and gain financial stability. While I’d been playing fast and loose with my biological clock, my time had simply run out.

Overnight, I changed from a woman who coochy-cooed every infant who crossed my path to someone who fled from church to avoid the sight of cherubic newborns being baptized. I got a lump in my throat watching other children play, or fight, with their siblings, knowing my own child would never have that experience. I suffered persistent nightmares in which my daughter died, or was taken from me, and I was left childless.

Friends, relatives and complete strangers compounded my distress with well-meaning, but hurtful, comments like: “Time to have another.” The inevitable “Is she your only?” pushed me to the verge of tears or left me feeling like I should apologize for being a fertility failure. Even when I explained my situation, I was frequently brushed off with platitudes like, “Oh well, at least you have one.”

Yes I did have one. And I wanted another, desperately. The intensity of that desire warped my perspective of the world. Rather than empathizing with harried mothers who hissed angry words at their children, I jealously sniped that they “didn’t deserve to be parents.” My daughter’s milestones—the first day of preschool—initiated days of secret mourning because they marked the permanent end of a chapter in my parenting life. I vacillated between asking God, “Why me?” and feeling selfish, greedy or guilty for not being satisfied with the child I already had. After all, I had friends who had experienced the agony of stillbirth, endured multiple miscarriages and unsuccessful fertility treatment. What right had I to complain?

Finally, exhausted, depressed and wrestling with relentless hot flashes, I returned to my doctor. On his advice, I started on hormone replacement therapy (HRT). The treatment eliminated the hot flashes. It also generated predictable menstrual periods for the first time in a couple of years.

Even though I’d been told pregnancy was a virtual impossibility, I began counting days between cycles and initiating sex at “peak” ovulation times. When my breasts ached (a common side effect of HRT), I convinced myself it was a sign I had somehow miraculously defied the odds. Countless mad, hopeful dashes to the drugstore to buy pregnancy test kits all ended the same way: weeping over negative results, then burying the evidence underneath piles of garbage.

Through it all, Phil remained supportive. He listened to me rail about the unfairness of it all. He held me when I cried and shared his own sorrow at not being able to enlarge our family. But he’d accepted what was, and moved on. I could not.

I considered in vitro fertilization. But the idea of Petri dishes, donor eggs and harvested sperm made me uneasy. Also, I couldn’t rationalize the prospect of gambling away the equivalent of our daughter’s education fund on a laboratory long shot. Those concerns—coupled with the non-stop demands of raising a busy preschooler—pushed assisted reproduction off the option table.

Read more: In vitro fertilization: And then there were three>

One evening, despite his misgivings, I persuaded Phil to come with me to a foster and adoption information session put on by the Children’s Aid Society. “No pressure,” I promised.

The stories of abused and abandoned children in dire need of loving families spoke to the empty space I felt at the core of my being. “I could do this,” I told myself over and over. Phil wasn’t convinced. We had a loud fight in the lobby after he expressed a concern that fostering meant “taking on other people’s problems.” As shocked fellow participants looked on, I accused Phil of being heartless, selfish. He denounced me as irrational, impulsive. In the bitter silence that accompanied our ride home, I imagined leaving him, taking my daughter and starting a new life in the country, surrounded, like Mia Farrow, by hordes of adopted children. In the end, Phil and I agreed to disagree. But I struggled with lingering resentment at his unwillingness to just “get onside, dammit!”

In the absence of a solution for myself, I became determined to save younger friends a regret-filled future and started, like my co-worker of long ago, to preach the gospel of having children earlier in life. As Lynn Moore, a Fredericton mom and sister secondary infertility sufferer puts it: “The worst case is not that you’ll have a child before you’re ready, it’s that you might not have a child at all.”

I’d like to say I woke up one day free of the weighty emotions I carried following my diagnosis. In truth, the sight of a ripe round belly or a toothless baby grin can still be difficult for me. I suspect it will ever be so. But time, which sweeps away what might have been, also diminishes the intensity of grief. Now that I’m 44, the stab of sadness I used to feel when friends gave birth has been replaced by genuine joy at their happiness. The tenor of my prayers has also changed. Instead of begging for another child, I now ask for the ability to fully appreciate my healthy, happy daughter.

Here’s the tick-tock reality of baby making: A woman’s fertility begins to decline at age 27, falls off after 35 and takes a major nosedive at 40. (Recent studies show fertility is also reduced for men over 35.) It’s possible for a woman to conceive, carry and deliver a healthy baby in her late 30s and early 40s. But the likelihood of that happening without—often pricey—medical intervention diminishes with each passing year.

So why does fertility decline as we age? For some women with secondary infertility, the inability to conceive is linked directly to previous pregnancies. Postpartum infection, for example, can scar the uterus or fallopian tubes, hindering future fertility. Semen abnormalities, ovulatory problems, endometriosis and tubal blockages all act as roadblocks to conception.

Then there’s the limited shelf life of the human egg. The average female enters puberty with about 400,000 oocytes (eggs). During each menstrual cycle, hormones trigger scores of those eggs to mature — with one usually becoming dominant. When it’s released by the ovary, the others degenerate and are reabsorbed. But not all eggs are created equal. “It’s like apples in a barrel,” says Albert Yuzpe of the Genesis Fertility Centre in Vancouver. “As you keep emptying the barrel of good apples — the eggs that stimulate easily — you move closer to the bottom of the barrel.” The remaining eggs are often fragile or damaged from exposure to toxins from smoking and pollutants, increasing the likelihood of miscarriage or genetic abnormalities.

Yuzpe’s advice? Educate yourself about the whys and wherefores of fertility. Then make an informed decision. “No woman should ever say: ‘Nobody told me I’d have trouble getting pregnant if I waited too long.’”

Infertility Speak

Those who do venture into the world of fertility specialists often find themselves lost in a labyrinth of acronyms and medical jargon. Familiarizing yourself with these terms may help you better navigate:

• Follicle Stimulating Hormone (FSH) Measuring this hormone on the third day of your cycle tests the ovary’s ability to produce eggs. High FSH readings signal diminished ovarian reserve and mean you may have difficulty getting pregnant.

• Hysterosalpingogram (HSG) X-ray test in which special dye is injected into the uterus through the cervix. Reveals blocked or dilated fallopian tubes, fibroids or adhesions within the uterine cavity, or an abnormally shaped uterus. Usually performed on day seven to ten of the menstrual cycle.

• Intrauterine Insemination (IUI) The placement of washed sperm (partner’s or donor’s) directly into the uterine cavity via a small catheter. Done to increase the number of sperm that reach the fallopian tubes.

• Intracytoplasmic Sperm Injection (ICSI) The injection of a single sperm directly into the mature egg, which is then implanted in the uterus. Increases the likelihood of fertilization when there are abnormalities in the number, quality or function of the sperm.

• In Vitro Fertilization (IVF) Eggs and sperm (donor, own or a combination) are mixed together in a laboratory dish, where fertilization occurs. Two to five days later, the resulting embryos are transferred back to the woman’s uterus for natural development.

• Laparoscopy An investigative procedure performed under general anaesthesia. Involves inserting a small telescope-like instrument through an incision in the navel to examine a woman’s reproductive organs for endometriosis or scarring.

• Reproductive Endocrinologist (RE) A gynaecologist who has received advanced training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women.

• Superovulation, also known as Controlled Ovarian Hyperstimulation (COH) Stimulation of multiple eggs in one cycle using medication. Most women inject themselves to reduce the number of clinic visits. Frequently performed in advance of IUI, IVF or ICSI.