What not to say to someone struggling with infertility

"Just relax!" People who have struggled with infertility reveal all the unhelpful things well-intentioned people have told them.

What it’s like to watch a surrogate give birth to your baby

"In my infertility groups, people often described surrogates as angels, but with her slick skin and the tubes twisting off her like seaweed, she looked more like a mermaid."

Photo: Chloe Cushman

Jeremy and I met the woman who would give birth to our son in January: bleak weather, waning hope. For almost five years, we had been on what insiders call a “surrogacy journey,” which was torturously long and complicated. In Canada, unlike the U.S. and India, surrogacy is largely unregulated, with prohibitions around payment. Even discussing paying a surrogate can net the parents up to ten years in prison and/or a $500,000 fine. But without the ability to legally compensate surrogates for pregnancy, few women in Canada offer to do it. The result is that many intended parents wait years to match, even with the services of paid ‘consultants’ who work to match waiting would-be parents with women willing to carry pregnancies for the cost of monthly expenses.

After having “journeyed” with a paid consultancy for almost a year—during which time we received no matches—we had been connecting with prospective surrogates ourselves, using websites and our own personal connections. Our first, and then our second, surrogates each miscarried our three remaining embryos in turn, before deciding not to continue. Around the same time, I had an ectopic pregnancy that required surgery. My infertility felt less like the absence of something than a malignancy, spreading from one part of my body to the next, from me to these other women who tried to help.

We went back to the Canadian consultancies, who gave us a timeline of a year-long wait to match with a surrogate. With the additional time of legal and medical screening, it could be two years before we brought home a child. I wasn’t sure I had the stamina for that. The remaining options were also grim: an American surrogacy would take less time but cost up to $200,000; the surrogacies overseas, in places like India or Kenya, were legally murky, and while the conditions of the surrogates likely varied, we were uncomfortable with not being able to confirm first-hand that the women were consenting, healthy, and had adequate control over their pregnancies. The risk of a failed adoption—where the birth mother takes the child back during the early stages of a placement, an occurrence far from uncommon in our province—still rendered adoption a non-starter. Out of embryos and nearly out of cash, with my womb in literal tatters and no other womb in sight, Jeremy and I spent our Christmas holiday trying to imagine which was more difficult: a year-long wait to even try for a baby, or a future as a family of two.

In my initial panic, I had emailed a number of family members and friends, asking if they knew anyone who could help. It was a desperate email, and one I’d sent many times to no avail, so I didn’t think about it much after I pressed “send.” But then, as I was fear-googling American surrogacy expenses, an email popped up from an address I didn’t recognize. It was from a woman named Mindy who worked in college admin with my cousin and had posted about our search for a surrogate on Facebook. She was 29, and since she and her husband had had their first child the previous year, she’d been thinking about surrogacy.

“Having Charlotte was one of the most important things I’ve done,” she wrote. “I really want to help someone who can’t do that experience that for themselves.” She was OK with the fact that we didn’t have embryos, and she knew miscarriage was still a possibility. Her husband and mother supported her, and when Jeremy and I met them all, we felt not only a rush of relief at how kind and trustworthy they seemed; but also a shock of familiarity at their dynamics: the dark-humoured banter between Mindy and her husband, Eric—so much like mine and Jeremy’s—their love of animals, the fact that they’d named their daughter Charlotte Elizabeth—the name we’d had for years on our list of names for girls. As the four of us sat in their living room and agreed to go forward, Charlotte popped up and down over the edge of her playpen, peering at me, like a tiny firecracker with pigtails shooting straight up from her head.

We also found Anna, our egg donor, online. I loved her immediately, not only because she had thick reddish hair like an Alphonse Mucha illustration and shared my taste in books and art, but because she was willing to have an open, known relationship with any children we had using her eggs—something that was important to us. She had initially donated eggs for the money—around $10,000—but seeing the twins created from her prior donation had since made her excited about the possibility of helping create families. Going from my own eggs to hers was initially an easy decision. Many women I knew had taken years to warm up to the idea of using donor eggs, but unlike them, I had the advantage of having been stubbornly disinterested in my own DNA. I had always been uncurious about the branching family trees my aunt put together; I had never fantasized about seeing my mother’s eyes or my grandfather’s grin on my own child. Still, as we moved toward the reality of it, I felt new grief. Not so much for the loss of my genetics, but for the total loss of a conventional motherhood story. False as it may be, for many people, mothers are people with both a genetic and gestational connection to their children—certainly at least one of the two. Using Anna’s eggs in addition to Mindy’s uterus made my parenthood so different from that of most women, I worried I’d always feel different and alone. But after Anna completed her egg retrieval and we started texting, I felt a relief and pride at my new connection that mostly outweighed my anxiety. In one sense, as with Mindy’s, Anna’s presence didn’t diminish my motherhood, but added to it: I had another partner in the process.

calm pregnant woman graphic What you need to know about gestational surrogacyBy the fall, Jeremy and I had nine frozen embryos, but, eager as we were, the gravity of the situation hadn’t fully impressed itself on me. Jeremy, Mindy, Eric, and I slogged through the routine of clearing medical, legal, and psychological screening, and then the wrenching process of shipping embryos to Toronto, thawing the best one, and, after she’d undergone a trying regime of injections and monitoring, transferring it to Mindy’s uterus. It worked on the first try. But as the pregnancy went on, each blood test promising, each series of heartbeats measured and deemed perfect in frequency and strength, I had to accept something multiple losses had made seem impossible: we were having a baby. In gaps in my days, I found myself saying this to myself silently, over and over, like a mantra: We’re having a baby. But the excitement wasn’t there, just relief that he was still alive, that this one wasn’t dead yet. And as long as he was alive, I would not have to keep trying for him. Waiting for my baby felt less like anticipation than a break from prolonged effort and pain.

Mindy, her belly rounding, her cheeks flushed with hormones, was the site of this break, the space in which I located my relief. I saw the baby inside her—I saw him on ultrasounds, his nose sharply upturned, his spine a delicate puzzle in the translucent skin. Every week, his fist was raised up by his face, and we’d joke that already he was a very political, very left-wing baby. What I couldn’t feel of him, Mindy narrated: he kicked a lot, mostly at night, and he moved around when he heard music, or she’d play Jeremy’s and my voices for him using headphones she’d stick on her belly. Every visit, he was more and more present, pushing Mindy’s belly out the front of her parka, making it difficult for her to sit or run. But despite these signs of life, he was still mostly a theory, an idea. The baby that hadn’t died yet.

Since he’s still alive, maybe I can start buying things, I rationalized, when he was still a few months away. I bought onesies with prints of ponies and hamburgers and a big soft toy bunny, because years ago I’d seen a little curly-haired boy holding one, in a dream. I put the things in the Room, the room that every infertile couple has, the one that is supposed to be for a baby, then fills with sad junk, until (if) luck changes. I moved around some of the junk and spread out the new cute things. But it still didn’t look like stuff for a real baby, in a room for a person that would actually exist. It felt provisional—stuff for a baby that hadn’t died yet.

A familiar pattern of anxiety for an infertile parent-to-be, but luckily the baby himself would have none of it. He came five weeks early and quick as a flash flood, before Mindy’s epidural had a chance to work, and while Jeremy was in line at a Walmart, hurriedly buying a car seat. But I haven’t even processed this yet, went a line in my head. He was still just an idea! It didn’t matter, I realized, because the baby didn’t care, and the baby was here. I had spent years lamenting how invisible I felt in my infertility, how little understood, but in truth, no one would ever be more indifferent to my neuroses than my newly born son. No one cares less about your trauma than a baby. But how quickly he eclipsed it, too, and us, and everything else. He changed so much in those first few minutes: at first just a head between Mindy’s thighs, then a wiggling eel, yellowish, laid down on her belly. Then, wiped down, a squalling red silhouette with a rubbery cord I cut myself and the doctor clamped with a plastic clip. Then a series of measurements—six pounds! 20 inches!—that the doctor shouted into the room from the tiny basin in which the newborn was prodded and measured. The room collectively sighed: despite being born premature, he was healthy and robust, and wouldn’t need NICU. Then, finally, a tiny little baby in a diaper that a nurse laid between my bare chest and my hospital gown: silent suddenly. Sleeping.

Apparently I was crying so hard I could barely stand—I don’t remember that. What I remember is the screaming red child, the way the exact pitch of his voice had an immediate and indescribable meaning to me, the way he plugged into my chest in a very exact and deliberate way and instantly fell asleep.

At some point, Jeremy returned from Walmart. I looked at him. We had a baby. His name was Charlie, and he was sleeping on my chest. Jeremy put his arms around both of us. Across the room, doctors adjusted beeping machines around Mindy while Eric cradled her head and her mother held her hand. Off to her side was the placenta, bloody and beached, doctors picking through it. In my infertility groups, people often described surrogates as angels, but with her slick skin and the tubes twisting off her like seaweed, she looked more like a mermaid, and the air smelled damp and old.

Eventually, Mindy turned her head and we caught each other’s eye. Oh, I thought. This is what she wanted me to have. This is what she was talking about. The fact of this: that there was so great a feeling I had not known—and that another woman had been willing to give it to me—overwhelmed me as much as Charlie’s existence. Mindy and I looked at each other for a few moments, breathing.

Later, the nurses guided me, Jeremy, and Charlie into our own room. The hospital had not been prepared for our labour team of four, but had found a space for us with twin beds, between which they wedged a bassinet for Charlie. But these provisions were mostly moot; no one slept for a good 48 hours, so constant was the care of this tiny body. His demands were a punishing combination of frequent and random—there was no way to predict the next task, despite it being always either feeding, changing, burping, or holding him. The physical and primal labour was impossible to streamline or hack. The only thing to really do was to surrender to it, to let our big adult world contract to a tiny star and orbit Planet Charlie.

Top: Baby Charlie, Jeremy and the author, Alexandra Kimball. Bottom: Alexandra with her surrogate, Mindy, and Mindy’s daughter, Charlotte. Cover: Chloe Cushman. Photos: Alice Xue; Jennifer Bel.

Mindy had been given a room down the hall to recover in the company of Eric and her mother. When Charlie would let me, I thought about her, about the nice symmetry of the moment, each family in an identical room, her labour ending as mine had begun. A common second-wave feminist objection to surrogacy (as well as for C-sections and drugged labour) was that it separates motherhood from the bodily work of pregnancy and childbirth. I already knew this was bullshit. The medical experience of my infertility—all the miscarriages, surgeries, tests, and IVF, as well as the physical burden of the attendant grief—was as much a part of the process of conceiving Charlie as Anna’s egg retrieval or Mindy’s pregnancy. (This is my labour, I said to myself after every surgery.) But I was less prepared for how bodily early motherhood was, how the combination of fatigue and a newborn baby would produce an effect that was hormonal—almost postpartum. My stomach cramped; I was sweating buckets. Most surprisingly, my breasts were sore. Curious, I let Charlie latch and suckle, and immediately felt milk pull down to my nipple. The nurse told me that, having been pregnant multiple times, I already had the plumbing to produce breast milk, and now my body was responding hormonally to the proximity of a baby. Jeremy, too, got folded into this biome, a three-person constant exchange of touch and skin and hormone-steeped sweat; soon we all smelled the same, like slightly sour breast milk. I did not need to go through labour to learn—as all new mothers do—that the term labour is an insulting misnomer that implies it ends after birth.

There was also a loneliness in this closeness, but it wasn’t until the day after we were discharged, when we had to return to the hospital for a hellish early-morning checkup, that I was able to touch it. I missed them. For over a year, Eric and Mindy had become entwined in Jeremy’s and my lives in a way no other two people had. We not only made Charlie together, but we had become friends. New parents themselves, they had become our sherpas to the journey of not only having, but also raising, a baby. Few days had gone by when Mindy and I weren’t constantly texting about parent stuff: what to buy and what wasn’t worth it; what various dramatic personae in the Canadian surrogacy world had said or done online that day; the ridiculous pressures mothers faced in a “mommy culture” of brand-sponsored Instagram posts of $20,000 nurseries and strollers with four iPhone chargers (or whatever). As delighted as I was to have Charlie back in Toronto with us, shrinking our parenting team of four down to two was disorienting. When we saw Mindy and Eric at Charlie’s checkup, bearing a cooler of pumped colostrum, I felt my unease melt. Online, I’d been advised frequently by other parents to not continue a relationship with a surrogate because I might feel intimidated by another mother figure in my baby’s life. We had an open relationship with Anna, but the connection between Mindy and Charlie was more immediate and intimate, and thus more potentially threatening. But it never felt right to me to sever it, and now I knew for sure we weren’t doing that. Charlie had knit us together.

And yet, even this flourish of optimism germinated from that familiar black seed: all the miscarriages, the years and years of grief. Some people say the condition of modern womanhood is one of navigating contradictions and clashes: between the personal and the political, the said and the done, the body and the heart. For me, every time I saw Mindy, or Charlie, or even Jeremy, and every time I texted with Anna, I was aware of two stories, the one in which I had to have other women help make my baby (how sad!) and the one in which I got to have a baby with other women (pretty cool!).

Was this a feminist experience? I wasn’t sure. One of the reasons women in my infertility groups often considered surrogacy, like adoption, a ‘last resort’ was that their infertility would become very public and visible, and, because they still faced so much stigma, make them extra-vulnerable. But in the weeks and months that followed Charlie’s birth, I found myself trumpeting his unusual conception, hopeful that by being so public, I might start to chisel at others’ discomfort with, and misconceptions about, female infertility. It was an easier time than ever to be loud: infertility was having a moment in the press. Some of the most revered pop feminist celebrities, including Chrissy Teigen (my favourite), Beyoncé, and Kim Kardashian, were opening up about their struggles with miscarriage and infertility, as well as their experiences with IVF, while gay men such as Elton John, Tom Ford, and at least one of the new Queer Eye guys were talking about building families through egg donation and surrogacy. Articles about infertility ran in almost every publication, including parenting magazines and websites. TV shows were addressing the topic in ways that were surprisingly nuanced: for example, Tyra Banks’s character on the show Black- ish, a new mom after infertility, who confesses that ‘when you’ve tried this hard to have a baby, you think you have no right to complain.’ (Banks is herself infertile and had recently had her first child via surrogacy—I imagined she had something to do with this bit of dialogue.) Screens were full of it: the CBC web series by Wendy Litner, How to Buy a Baby, based on the writer’s own experiences with IVF (Litner subsequently became a mother via adoption); the beautifully told documentary Vegas Baby, about a queer single woman trying to conceive via donor eggs and sperm; and Private Life, a drama about a couple struggling with the aftermath of failed fertility treatments and an unsuccessful adoption. Social media was beginning to provide a welcome alternative to infertility support groups, with Twitter feeds (my favourite: a man with azoospermia who tweets as Balls Don’t Work [@gotnosperm]), Instagrammers, and Tumblr bloggers using imagery and humour to express not only their personal grief, but the often-messy politics of infertility. Many stories, such as Michelle Obama’s disclosure that her daughters were born after a miscarriage and IVF, spurred a long-overdue conversation about infertility and race.

Activists were also making news: in 2016, the Human Rights Tribunal of Ontario decided in favour of a Markham woman who was fired from her job after suffering depression related to a pregnancy loss, issuing a decision that could ultimately redefine miscarriage as a disability. The same year, the World Health Organization announced they were considering adding single people of all genders, as well as couples in same-sex relationships, to their definition of infertility. An author of the proposed change argued that such people deserved equal access to reproductive health services, including reproductive technologies such as IVF, under their home countries’ health-care programs. While the proposal is still up in the air, it suggested something provocative: that infertile people, as well as people in non-reproductive circumstances (like being single or in a same-sex partnership), may have a “right to reproduce”—a declaration that ultimately expands the idea of “reproductive rights” beyond the negative rights to abortion and birth control.

Alana Cattapan, a feminist historian who documents the history of assisted reproductive technology (ART) legislation in Canada, has argued that the creation of the private ART industry in the West mirrored and entrenched the idea of “reproductive citizenship” in neo-liberal society: a person whose rights to reproduce, or not reproduce, are enabled by their access to free-market biomedical resources, such as birth control, abortion, and technologies like IVF. Legislation, such as the Assisted Human Reproduction Act (the same one with which Jeremy, Mindy, and I had to contend to have Charlie), worked not only to legitimize ART as a private consumer option (instead of a health-care issue to be folded into public health-care plans), but to define who did, and who did not, count as a “reproductive citizen.” Ultimately—and unsurprisingly, given the paucity of feminist voices on the committees that shaped the act—reproductive citizenship was afforded to infertile, straight, middle-class Canadians, while the interests of LGBTQ Canadians, third parties such as surrogates and egg/sperm donors, and the children born of these technologies were marginalized. (For example, only one surrogate was consulted in drafting the policy around surrogacy, and the legislation around sperm donation allows donors to remain anonymous, to the ongoing protest of many children born of donor sperm.)

By privileging the interests of infertile straight couples with money, Cattapan argues, reproductive technology was used to uphold the patriarchal idea of the two-parent, genetically linked, heterosexual family. This reflects a distinction I had long noted in the surrogacy community specifically, where infertile women seeking surrogacy were consumed by the possibility of recreating the typical conception as much as possible—making the surrogacy feel as close to “actually being pregnant” themselves as the situation could allow—while LGBTQ parents-to-be tended to embrace the situation as a whole new way to have babies, a step into the unknown.

Back home, still knit to Mindy but feeling increasingly snug in our pod of three, I spend time in between feedings reading about these families (Charlie strapped on my chest as I hold my phone above his head— the consummate pose of new motherhood in the digital age). The most radical families were born from a technology designed to uphold patriarchal convention. Andrew Solomon has a rambling, widely-flung-but-still-close family composed of kids conceived with his sperm but raised by lesbian parents, a child with his partner conceived through egg donation and surrogacy, and a stepchild via his partner’s former spouse. Michelle Tea, an infertile queer woman who carried and birthed her son, who was conceived with an egg from her partner, who is transmasculine, and donor sperm. Or, closer to home, a single, gay man in my IVF group who is conceiving with a donated embryo and his sister as a surrogate, or my friend Victoria, a surrogate who has carried two children for a gay couple she remains close to in an ‘auntie’ role, and is currently considering a traditional surrogacy (her egg, their sperm) for two men, one of whom is living with HIV (she will be called the child’s ‘surrogate mother’). I used to think the transhumanist theory of Donna Haraway—in which the marginalized appropriate technology to create new ways of being, and new patterns of kinship, identities, and language (one of Solomon’s kids calls him ‘doughnut dad,’ a riff on ‘donor dad’)—was overly utopian, but it was basically already happening. In a Haraway cyborg world, children like Charlie, with his multiple mothers and his biotechnical conception, were not objects of pity but harbingers of a more equitable world, in which the pleasures and risks of family were available to all.

A few weeks after Charlie was born, I found myself going back to my old IVF and surrogacy message boards, wondering what these communities of women could have been like had there been even a vague feminist ethos. If earlier feminists had seen us as sisters, rather than patriarchal dupes or oppressors of other women. If infertility lobby groups had embraced an idea of infertility as an issue of medical, emotional, and spiritual health, rather than a type of consumer identity. I imagined a feminist movement parallel to the one for abortion access, in which women would call for more research into the causes of infertility, the potential efficacies of various treatments, as well as their risks. We could call for expanded access to proven reproductive health care for all Canadians—not just the rich ones, not just those in cities who are partnered and straight—by demanding it be brought under the auspices of a properly regulated health-care system. We could align ourselves with, rather than against, surrogates and egg donors, lobbying for a system in which policies around third-party reproduction are shaped by them, for their own safety and interests, opening up the possibility of them organizing as workers. We could support infertile women who do not conceive in either finding other forms of family or healing into satisfying lives lived without children. Truly patient-centric clinics could bloom under our watch. Perhaps most importantly, infertile feminists could embrace our status as different kinds of women—as the kinds of women who eat people in folk tales and get thrown down elevators in movies—to challenge the idea that motherhood is unthinking, automatic, and instinctual, and be living examples of how maternity is instead a thing that is both worked at and worked for, sometimes by multiple people, and sometimes not by women at all.

I scrolled through the boards, the endless posts about follicle counts and sperm fragmentation and beta results, the proffers of “Hang in there” and wishes of baby dust, and thought I should add something like this, but then the baby started whimpering, and my mother was coming over soon, and within a few minutes I’d forgotten, sucked back into the routine of feeding-then-changing-then-holding Charlie, who still couldn’t care less about whatever pointless debate I was planning on social media. What a creature he was. The incredible muchness of my many-mothered child. His multipronged roots of will and optimism, and shit-tons of money, and advanced science, and—quite deep down now—that black seed of longing and loss.

Much is born from less.

Excerpted from The Seed: How the feminist movement fails infertile women,” by Alexandra Kimball © 2019. All rights reserved. Published by Coach House Books. 

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Why is there hardly any support for moms after a miscarriage?

Nearly three-quarters of moms say they weren't given information about what to expect or how to find support after a miscarriage. That's not OK.

Photo: iStockPhoto

Lisa Plouffe wanted to take a copy of the ultrasound image with her, knowing the baby inside her wouldn’t be coming home. She was three months pregnant and had just found out she was having a miscarriage. That little grainy photo would be the only picture she’d ever have of Maci, the daughter she would never know.

But the ultrasound techs told her that print-outs were only for women with appointments, and Plouffe was there as an emergency. Their answer? No.

Jeannie van den Enden was already in her second trimester when she found out her unborn daughter had died. She sat with her obstetrician and made the difficult decision to deliver her stillborn baby at home. When they were done talking, the doctor stood to leave, squeezed her shoulder and said jovially, “Have a good one!”

For both women, the trauma of their miscarriages was exacerbated by a distinct lack of compassion and support on the part of the doctors, midwives and nurses who cared for them. What’s worse is that their shared experience tends to be the norm, rather than the exception.

We know this, with a degree of certainty, anyway, thanks to a research survey recently completed by the Pregnancy and Infant Loss (PAIL) Network, part of the women and babies program at Sunnybrook Health Sciences Centre, with Jo Watson as the principal investigator. More than 600 Ontario families shared their experiences with pregnancy loss in one of the first comprehensive Canadian studies to analyze, from the perspective of families, the quality of care offered during and after miscarriage.

The results were eye-opening, according to Michelle La Fontaine, program manager at PAIL.

This therapy helps grieving parents process child loss and miscarriageMore than half (53%) of respondents said they didn’t feel they were treated with kindness and respect by their health care providers, and 72 percent—a “staggering number” according to La Fontaine—weren’t given information about what to expect, or how to find support.

“It was surprising the degree to which families felt stigmatized, and the degree to which families identified their care was not meeting their needs, particularly families who experienced a first trimester loss,” she says.

Plouffe knows this stigma all too well. She lost her first baby when she was a teenager, and that loss—as well as the cold, detached way she was treated by her nurse—haunted her for years. When she experienced her second miscarriage, she was married with a young son, and dreamed of adding to her family. This time her treatment was even worse. For example, the examining doctor sat down beside her and began touching her body without introducing himself or explaining what he was doing, an experience that left her feeling violated. He also answered two personal phone calls while in the midst of explaining to her that her baby had died. The nurse who brought her a glass of water ahead of her ultrasound was just as curt.

“I was devastated to have lost this baby,” she says. “I was bent over crying, and this woman just comes over (with a cup), no gesture of empathy and connection. She was devoid of compassion and understanding.” What’s more, Plouffe was sent home with no information or resources.

Van den Enden said her experiences echo those of Plouffe, and so many of the respondents of the survey. Earlier this year, she lost her seventh baby, whom she chose to deliver in hospital after a previous and traumatic miscarriage at home.

“It’s always been very important to us to see our babies and hold them, even if they’re born not alive,” van den Enden says. “[Doctors in the operating room] kept referring to our baby as ‘product of conception’. I remember lying on the table and just crying and saying, ‘You are talking about my baby’.”

At that point, she recalls, a nurse came over and hugged her and said, ‘Don’t worry, I’m going to make sure your baby is taken care of’.”

“It’s those little tiny things that mean so much when you’re in the middle of a difficult time,” says van den Enden. “And it doesn’t take much—it’s just a matter of wording that could add a whole other layer of compassion.”

Given how common miscarriages are—it happens to one in four women—it’s surprising the system has been failing women for so long. “What happens in those moments in hospital will stay with those families for the rest of their lives,” La Fontaine says. “All that families want is for someone to tell them ‘I’m so sorry for your loss’, and to treat that loss like it’s a baby, not a ‘product of conception’.”

 

It’s that level of compassion—like referring to a baby as a baby—that PAIL is working hard to improve. The passing of Bill 141, which was introduced by MPP Mike Colle and mandates that the Ministry of Health invest in research and support for families going through miscarriage, has helped tremendously.

PAIL, which has received funding from the Ministry to conduct research and expand programs, offers compassionate care workshops for hospitals and clinics, something health care providers seem to desperately want, La Fontaine says. “They were all asking for more education, more training, more tools to do a better job… and minimize potential trauma,” she says. “(Compassionate care) can mean the difference between developing clinical depression, or knowing ‘I’m not the only one, and I can talk to someone any time I want’.”

“There’s a direct link between the level of care you’re given at the hospital and the way in which you recover, and your grief,” adds Plouffe, who has taken her grief and her frustration, and turned it into action. She facilitates the PAIL peer-led support group in Peterborough, Ont., for families who have lost a pregnancy or baby.

Recently, Plouffe helped organized a butterfly release for grieving parents, which was attended by an elderly couple. “A 90-year-old man openly wept during the ceremony, and said it was the first chance they had had to honour the baby they had lost,” she says. Such is the level of silent grief that many families carry with them.

All three women agree that doctors should offer care kits for families to take home from hospital, with pamphlets about what to expect during and after their miscarriage, as well as information on how to find peer-support groups. Right now, no such mandate exists, although PAIL does provide pamphlets and support groups for anyone who asks.

They’d also like to see more hospitals hosting compassionate care workshops for staff. “A lot of the time nurses are in tears (at these workshops), saying they just didn’t know what to say, what to do,” says Plouffe.

Some hospitals are currently looking to create dedicated early pregnancy assessment departments, says La Fontaine, which would divert women from emergency rooms, allowing them to be assessed by dedicated and compassionate staff on a priority basis.

For most families who have lost a pregnancy, what they really want is for people to recognize that their babies were important to them. They existed, they were loved, and they mattered, even though their lives didn’t come to pass.

And the little things that health care providers do and say matter, long after that family has returned home and tried to pick up the pieces of their loves. One compassionate word can alter their memory of that trauma forever.

“Miscarriage is such an isolating experience,” Plouffe says. “It’s just not talked about. And no one should feel ashamed for grieving the loss of a baby, even if that baby was never born.”

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I lost my child when I was 20 weeks pregnant, but I’m still her mother

In honour of October being Pregnancy and Infant Loss Awareness Month, Allison McDonald Ace shares her heartbreak over the baby girl she loved and lost.

Photo: Courtesy of Lawrence Ng

The other day, I sat across the table from my friend, in deep conversation over her fears that she might never become a mother. I found myself saying these words to comfort her: “The thing is, once you open your heart up to becoming a mother, even before you hold the baby in your arms or carry it in your body, in that very instant, you become a mother.”

As I said these words, I realized I wasn’t just saying them to her; I was saying them to myself, because I needed to give myself permission to admit that I was a mother, too—not only to the child I had carried successfully into this world but also to the one that I hadn’t.

I am the mother of a beautiful, healthy four-year-old boy named James. But I am also the mother of a baby girl who died at 20 weeks. This statement—that I am a mother of two—hasn’t been an easy one to come to. When my body finally decided to let her go, I woke up in the middle of the night bleeding, feeling in my gut, before the ultrasound confirmed it, that I had lost her. The experience came with trauma and memories that I am still processing to this day: how it felt to lie awake all night in the hospital after I was told my baby had died, waiting until the next day to undergo a C-section to deliver her because of complications with the placenta. It was so strange, those hours, knowing that she was no longer alive but I was still carrying her inside of my body, allowing me the illusion of her life just a little while longer. I remember the way the skin on my face felt, so puffy and inflamed from crying that my eyes had been reduced to slits I could barely see out of. Walking down the hallway after my surgery, I recall each pull on my fresh incision reminding me that she was gone and I was still here—that everything was going to be different now.

The baby girl I almost hadAlong with her death came the death of how I saw myself, as a woman and a mother. Before, I had been almost arrogant about how fertile I was since I had conceived on the first try for both pregnancies. It was the death of the perfect family I almost had, even though I knew there was no such thing as perfect. But that’s how it felt to me: one boy, one girl, the ideal three-year age gap. The struggle that came to define the past two years of my life began at that moment, when I had to figure out what it meant to be a mother all over again in a situation that was completely imperfect, to one who had lived and one who had not.

For those of us who dream of a child who never comes to be—who imagine what that child will look like, what they will smell like and how they will sound when they say “Mama” for the first time—we exist in a realm of parenting all our own that is often kept in secret, in shadow. It’s where we are mothers to all that could have been but isn’t. There is nothing quite like knowing, viscerally and in the depths of your being, that you are meant to be a mother—again, or for the first time—to believe that there is a baby somewhere in the ether for you and then be forced to face the harsh conundrum that, because of life’s circumstances or your body’s inability to carry a child all the way through, you aren’t able to be a mother to that child. Or are you?

I lost my daughter almost two years ago, and I’m starting to get asked the questions every parent who has lost a pregnancy dreads: “Is this your only child?” followed by “Are you going to have any more?” Up until recently, my answers were designed to keep everyone comfortable—“Yes, he is our only child, but we’re hoping for more and having fun trying”—to disguise the fact that, each month that goes by and my period comes, I worry that the possibility of becoming a mother to another child is slipping away. For the longest time, I couldn’t summon the courage to say “I am a mother to two children: one living and one dead,” partly because I was scared of the reaction but partly because I didn’t believe it myself. Did I really get to say that I was the mother of two children when I hadn’t even held one of them in my arms?

But when I said those words to my friend—that we become mothers the second our hearts open up to a child—the truth of what I was saying rang like a gong in my own ears and resurrected my sense of being, as a woman and a mother, bringing my journey over these past two years to a precipice. I was finally able to step out of the shadows and allow for the truth that I am a mother to more than one child. I am the mother to a baby girl I loved so desperately and lost, and I will always be her mother. Nothing can change that, not even the fact that I have never held her in my arms. I am also the mother to a child I long for, the one I hope will give me another chance to live through pregnancy cravings, sleep deprivation, brutally sore nipples and the pure joy of first steps and first words.

The other day, while picking up my son from school and chatting with one of the other moms in the yard, she asked me the inevitable: “Is he your only child?” This time, I replied calmly and proudly, breathing deeply before I spoke: “No, I have two children, but only one living.” She was unnerved at first and didn’t know what to say, but when I explained to her that I had lost my daughter late in pregnancy, she was compassionate and relief flooded over me. By acknowledging my daughter’s brief existence, I was also acknowledging my own version of motherhood.

The thing I know now about being a mother that I didn’t know then is that it’s more than just a physical relationship; motherhood happens in all different ways, in all different forms, to all different types. And when it does happen, it’s a deep state of being and a sense of knowing that, quite simply, can’t be undone and can’t be denied.

Allison McDonald Ace is a writer, mother and co-founder of The 16 Percent, an online community dedicated to creating a safe space for sharing stories of infertility and pregnancy loss. She is also a co-editor of Through, Not Around: Stories of Infertility and Pregnancy Loss.

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Male infertility is on the rise—so why aren’t we talking about it?

Sperm counts have been in a free fall in Western countries over the last 10 years, yet infertility is still largely seen as a women’s issue.

Photo: iStockphoto

When Bryan Dubé and his wife, Carolynn, had trouble conceiving in their mid-30s, it was a “shock to the system,” especially when they found out that a low sperm count was the problem. “We had just gotten married and a thousand things were going through my mind: Will we stay married? Will she leave me? What’s going to happen to our relationship?” he recalls.

Happy couple on the couch7 ways to boost male fertility From that point on, their experience mirrors what many of the one in six Canadian couples who face infertility go through when they struggle to conceive. They paid more than $10,000 for a round of in vitro fertilization (IVF) in 2012 that was unsuccessful, plus hundreds more to freeze more eggs. The following year brought better luck and they welcomed a son in 2013, but the journey took a toll on their relationship, their finances and their sense of self. “It’s hard for a man to express what he’s going through and say ‘I’m the problem,’” says Dubé.

While there’s definitely more awareness about the hardships that accompany infertility, what’s less commonly discussed is that male infertility, specifically, is on the rise. A robust meta-analysis of studies published in Human Reproduction Update last year shows that sperm counts have been in a free fall in Western countries, dropping 52.4 percent from 1973 to 2011. The authors found this decline consistent with other research in male reproductive health, and when they limited the studies to those published since 1995, they saw an even steeper decline.

The stigma associated with low fertility is very real and carries into the doctor’s office. “When I see patients in my office, women often say ‘I hope it’s me and not him,’” says Dr. Arthur Leader, an ob-gyn based in Ottawa. Women tend to see sexuality and reproduction as separate, he explains, whereas men tend to conflate sexual prowess and reproduction. “The reality is that it’s 50/50,” he says. “More people who come to us have a male factor for infertility than ever before.”

There are many reasons for this rise, says Leader, who has helped couples conceive since 1981, first as co-founder of the IVF clinic at Foothills Medical Centre in Calgary and then as a professor of obstetrics, gynecology and medicine at the University of Ottawa and co-founder of the Ottawa Fertility Centre.

First of all, men are waiting longer to have kids. And while headlines consistently focus on women’s biological clocks and the risks involved with getting pregnant over the age of 35, there is a persistent myth that virility stays high in men until they are much older. In truth, as men age, their sperm quality (including the shape and movement of the sperm) declines. Their “best-before date,” as Leader puts it, is 40. Even if their partners are younger, it can be more difficult for couples to conceive and studies have also shown a link between advanced paternal age and a greater risk of children developing autism.

Hagai Levine, an Israeli epidemiologist who is a professor at the Hadassah University Medical Center’s School of Public Health in Jerusalem and lead author of the sperm count study, blames environmental factors (including exposure to chemicals like pesticides, heavy metals and radiation) and lifestyle factors (like poor diet, inactivity and smoking). He characterizes the rapid decline in sperm counts as the canary in the coal mine. “Something is very wrong with the way we live,” says Levine. “It’s amazing that so many people can’t conceive naturally — it’s really something we should pay attention to.”

He compares the scale of the problem to that of climate change — an issue right in front of us that people would rather fix with technology, rather than explore the root cause.

So why is no one talking about it? While men are overstudied in nearly every medical specialty, infertility is an area where experts say the opposite is true. This, in part, has led to the perception that men are less likely to be the “problem partner.” Experts say there’s also the assumption that impotence is the main symptom of infertility, which simply isn’t true. Sperm count, shape and movement, along with blockages in various places like the testicles and vas deferens, can interfere with fertility but not necessarily the ability to have an erection.

Liberty Barnes, a medical sociologist at the University of Oregon, studies how culture shapes ideas about male infertility. “The general consensus is that ‘real men’ gush sperm,” she says. “Male infertility destabilizes the presumed fundamental basis of masculinity, disrupts traditional gender roles and hits personal masculine identities right where it counts,” she writes in her 2014 book, Conceiving Masculinity: Male Infertility, Medicine and Identity. She suspects more pervasive ideas tied to masculinity are behind the lack of research, education and awareness of infertility among men. She spent seven years shadowing infertility doctors across the United States, their patients and their partners for her book, and one of her stark observations was that most women have an ob-gyn who focuses on their reproductive health, but most men don’t.

Barnes also found that male infertility specialists themselves were shielding men from the reality of their situations. “These doctors put a lot of effort into making men feel manly in their clinics,” she says. Doctors weren’t even using the words “infertile” or “infertility” at these appointments. “Instead, they would say ‘Your sperm count is at three million and I was hoping for 15 million.’ When a man hears that, they could think that’s really good, but in fact it’s terrible.”

All of this adds up to a kind of obvious reality: Men simply don’t expect that they’ll be the problem when trying to conceive, says Barnes. That also means they may not get the emotional support they need when they find themselves in that situation.

Devin Leslie and his wife started trying for a baby as soon as they got married three years ago. After six months, they were overjoyed at the sight of a positive pregnancy test but miscarried a short time later. After experiencing difficulty conceiving again, the couple saw two fertility specialists. Leslie discovered that the shape of his sperm was part of the challenge. “I’ve wanted to be a father for a while, but I didn’t realize how much until we got that test result and how bad it felt when the bad stuff happened,” says Leslie.

He doesn’t consider himself a macho guy—he recognized that he was going through a difficult emotional time and leaned on his mother for support—but he says there’s definitely the idea that men should just “tough it out” rather than confide in others about their experiences.

Ignoring the fact that men can be as invested as women in having children has left them out of the discussions of reproductive health altogether, says Marcia C. Inhorn, a medical anthropologist at Yale University who has studied infertility for 30 years. “We need to help them too,” she says, adding that the conversation around fertility needs to shift from being associated with masculinity to being seen as a purely medical condition. She sees including male fertility in early sex education as part of the solution. “No one talks to young men about the fact that they could be infertile or why they might be infertile,” she says. “These are medical situations that they should be aware of.”

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What does it mean to be “infertile”?

If you’re struggling to get pregnant, you might wonder what exactly it means to be infertile. Turns out, the answer is trickier than you might think.

Photo: Stocksy

What does “fertile” mean?

Specialists use the term “fertility” to describe the ability to conceive a pregnancy, which is slightly different from the capacity to have a live birth, which is known as “fecundity.”

       
   Could I be infertile? What to do next
So how do you know if you’re fertile? Unfortunately, the short answer is, unless you just got pregnant, there’s no sure way to tell. However, if you’re a woman, the two most important clues that you may be fertile are your age (the odds are highest before age 35) and a history of regular periods. Your chances are also better if you have never smoked and have no history of a pelvic infection that could cause blocked fallopian tubes. But still, that’s no guarantee.

Why? For one thing, there are causes of infertility in women, such as poor thyroid function and low levels of progesterone, that often go undetected prior to a fertility workup because they don’t always cause obvious symptoms like irregular periods. And some women have perfectly normal test results but still aren’t getting pregnant. This is known as “unexplained infertility,” and it accounts for 20 percent of all cases of infertility, notes Basim Abu Rafea, a reproductive endocrinologist and infertility specialist and medical director of The Fertility Clinic at London Health Sciences Centre in London, Ontario. Without testing, you also won’t know if your partner is fertile because a man can have a low sperm count or poor sperm motility without having any other signs of trouble.

What does infertile” mean?

If you meet with a doctor and are diagnosed as infertile, that doesn’t necessarily mean that you will never get pregnant and go on to have a baby. In fact, that’s why some specialists are beginning to use the term “subfertile” because “infertility has a permanence to it,” notes Neal Mahutte, a reproductive endocrinologist and infertility specialist and director of The Montreal Fertility Center. While there are different definitions, Canadian fertility specialists describe a couple as “infertile or subfertile” if a woman is “under 35 and has been having unprotected regular sexual intercourse for a year and has not achieved pregnancy,” explains Abu Rafea. “If you’re 35 and above, it’s six months.”

These timelines were decided because your chances of getting pregnant actually decline the longer you try without success. Mahutte notes that in one study of healthy couples ages 23 to 37, 30 percent conceived in the first month of trying, 10 percent conceived by the seventh month and only about four percent conceived after a year.

If you haven’t seen results in a year (or six months if you’re over 35), that’s when you should head to your doctor to look into causes, advises Abu Rafea. That said, if either of you has something in your medical history that suggests you might have fertility issues, such as a family history of menopause before 40, prior abdominal or uterine surgery, irregular or very painful periods or a past sexually transmitted infection, talk to your doctor immediately.

If you’ve conceived but miscarried in the first trimester or very early in the second, your doctor will investigate after three consecutive losses, explains Abu Rafea. (Technically, this is a problem with fecundity rather than fertility that is known as recurrent pregnancy loss.) The above definitions apply both to couples who have never had a baby (primary infertility) and those who have (secondary infertility).

Being diagnosed as infertile isn’t an endpoint in your pursuit to expand your family, and it doesn’t mean that you have a zero percent chance of conceiving. Identifying any problems and getting the help of reproductive technologies to overcome barriers like blocked fallopian tubes and poor sperm motility can greatly improve your chances. Up to 90 percent of the time, simple treatments, such as medication, are sufficient.

“Very rarely do we tell a young, healthy couple that they can’t have children,” says Abu Rafea. “It’s just how you go about doing it.”

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Why I told everyone when I was trying to get pregnant

Fertility challenges can make a couple feel so alone, but one woman found there’s no fear in telling everyone in your life you’re trying to have a baby.

Courtesy: Jessica Player

My husband, Mark, has a genetic condition called Klinefelter syndrome, which causes problems with sperm production and makes it difficult to have kids. Luckily, we found out about it in advance—when my husband got hit in the groin during a floor hockey game, his doctor tested his sperm and discovered that he has the condition. When we decided we wanted to have a baby, we put our name on a waiting list for a fertility clinic.

Trying to get pregnant isn’t usually something you share with the world, but from the moment we got a referral to a fertility specialist, I started talking to my friends about what we were doing. For us, having a baby would involve intracytoplasmic sperm injection, which is a type of in vitro fertilization (IVF) where they put the sperm right into the egg before inserting it into me. That meant I was going to have to take medication so I could produce a lot of eggs—I joked that it would turn me into a frog. A doctor would harvest the eggs, like 10 at once, and fertilize as many as possible. Eggs on a pink background5 things you should know before starting IVF

I never thought of trying to conceive as something that should be private. My husband is also very open—even more than me. I would usually say something like “We have fertility issues and, luckily, we found out early.” But Mark would tell people, “I got hit in the balls and found out I have Klinefelter’s, which makes me produce very low levels of testosterone and have a very low sperm count and poor sperm mobility. Now I’m on testosterone, which makes me sterile, so I also have some frozen sperm.” Sometimes, after seeing our friends, I would tell him, “You probably don’t need to go into that much detail.”

We discussed it with everyone, whether we had people over for dinner or went for coffee with friends. We would explain what was happening, and I’d get a chance to talk about everything I was going through to try to have a baby.

I had heard of the three-month rule—where you’re supposed to wait three months to tell people that you’re pregnant because miscarriages are common in the first trimester—but the idea of having to reveal a miscarriage, if that happened, didn’t bother me too much. It probably helped that we didn’t have to go through what many people with infertility do: all those years of trying and not being successful and all the emotions that come along with that.

It was so helpful to be able to talk about it and get my friends’ support because I found the IVF process so difficult. I had to go in every other day for a vaginal ultrasound and take hormone shots every four hours. I felt like I wasn’t in control of my body, I wasn’t in control of my hormones and, on top of that, I was making a huge life decision: to start a family.

When I found out that I had to go for all those ultrasounds and give myself shots so frequently, I decided to tell everyone at work, too. I’m an engineer in the oil and gas industry, and my team is almost entirely male. But they were all very supportive. They didn’t ask any awkward questions—they were just happy for us that we were trying for a kid.

Telling my colleagues made it much easier: I didn’t have to pretend I wasn’t all hopped up on hormones or hide my injections. I didn’t want to do the shots in the bathroom, where someone could walk in, so I did them in my office in front of my co-worker. If I’d had to sneak around, it would have felt so onerous.

I ended up developing ovarian hyperstimulation syndrome (OHSS) from all the hormones I was taking through IVF. The condition made me retain so much water that it was hard for me to walk, and I had to take two weeks off work. Fortunately, I got pregnant with my daughter, Addison, on our first try, and the OHSS resolved itself almost right away once I was pregnant.

A few years later, we decided to try for our second child. We had frozen some extra embryos the first time around, which made the process simpler. That time, I got pregnant with our second daughter, Isabelle. It wasn’t entirely without problems—we had two embryos that didn’t implant along the way—but it was easier in a lot of ways because I didn’t have to miss work or do the injections. We told all our friends again, but this time I didn’t feel the need to tell my co-workers.

Through all of this, we were much more open than the average couple about what was going on—and I have no regrets. Being able to talk about it normalized the situation, gave me an outlet and stopped it from being this huge thing that I had to deal with myself. Even though we were alone in what was happening, we never felt alone.

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Learning to trust your body when you’re struggling to get pregnant

It’s normal to develop body issues when it won’t give you the one thing you want. Here are six ways to reconnect with your body and learn to trust it again.

Photo: Stocksy

Thirty-two-year-old Eva Li has always wanted to be a mom, so when she and her husband got married two years ago, they started trying for a baby right away. “At first, the anticipation each month was so exciting,” she recalls. But her excitement quickly turned to worry when the months of trying became a year without a positive pregnancy test. Li and her husband went to a fertility clinic, where they were diagnosed with “unexplained infertility”—in other words, standard testing couldn’t find a cause for why they weren’t getting pregnant. With this frustratingly vague label, Li couldn’t help but blame herself. “It’s like my body is broken, but there’s no way to fix it,” she says.

   intrauterine insemination iui graphic    
   What is intrauterine insemination (IUI)?
Li went through two rounds of intrauterine insemination (IUI) and after each failed, she lost more and more trust in her own body. It didn’t help that it seemed like all her friends were becoming pregnant effortlessly. “It’s devastating every time you open Facebook to another pregnancy announcement when your own body isn’t doing what you so desperately want it to do,” she says.

Jen Reddish, a counsellor at The Essence of You in Calgary who specializes in body image and the perinatal period, says that mistrusting your body after several failed pregnancy attempts is incredibly common. For women who are struggling to get pregnant or dealing with a miscarriage, she suggests spending time and energy reconnecting with their bodies to rebuild that trust. Here are some ways to do so.

Listen to your body’s cues for grieving
The battle of infertility involves grieving multiple losses: an unwelcome period, a failed IVF attempt or a devastating miscarriage. When grieving, listening to your body’s signals can help you reconnect with it. Feeling exhausted? This could mean taking some time off work to rest or waiting a few months before trying again. Fighting back tears? Just let yourself cry or express your emotions through writing or talking to your partner. Once you feel energized and strong, this will likely mean that you’re ready to move forward with another fertility treatment. Although grief looks different for everyone, tuning into and following your body’s cues will send the message that you trust your body’s wisdom about what it needs to grieve.

Take care of yourself
Infertility and miscarriage can be physical nightmares, filled with shifting hormones, bruising injections and nauseating drugs. Women often don’t share what they’re going through with others, and keeping up the facade of normalcy can be exhausting. When possible, it’s important to care for your body in gentle and supportive ways. Stay hydrated. Go for walks in nature. Take time for treats like a warm bath, a pedicure or a massage. “On the day after I get my period, I’ll go to the pool and sit in the steam room,” says Li, “and I usually treat myself to ice cream afterwards.” Finding small, well-deserved moments where the body feels cared for and nurtured can help you heal.

Relate to your body as a whole
A 2006 study published in Human Reproduction found that women may feel dehumanized while undergoing fertility treatments, like they are “reduced to the body parts associated with reproduction.” Practices like yoga and meditation, which incorporate mindful awareness of the body, can help women relate to their bodies as a whole. Thirty-four-year-old Katy Allen, who is currently undergoing fertility treatment in Toronto, does yoga regularly and follows an infertility meditation program. She says these practices have helped her listen to her body and “address the emotional side of things.” Similarly, Li does guided meditations from YouTube, which help her connect with her body like she used to, when she felt like “a whole person—not this stressed-out woman with a stubborn set of eggs.” For her, the meditations are like “little vacations” from all the worries swimming around in her brain. “It’s like 10 minutes where I get to just be,” she says.  

Practice self-compassion
Allen says she used to grasp at anything she could control about her fertility. “Changing your diet, getting on your head after sex, eating the core of a pineapple—there are a lot of old wives’ tales out there, and I’ve tried a lot of crazy stuff!” she says. However, Allen says she’s starting to realize that there’s nothing more she can do to make her fertility treatments more successful—she has done what she can, and the rest is out of her hands. In fact, she knows she’s already doing everything she can, so she doesn’t beat herself up over it. In not doing so, Allen is practising self-compassion, which a 2015 study in Psychology of Women Quarterly found was related to well-being among women struggling with infertility. Authors Trisha Raque-Bogdan and Mary Ann Hoffman suggest that self-compassion—which involves being kind to yourself and recognizing that you’re not alone in your suffering—can reduce self-blame. This seems to be the case for Allen. “I don’t blame myself, and I have trust in my body,” she says. “I just hope one day one of those embryos wants to hang out in it.”

Although treating yourself with kindness isn’t always easy, practice makes, well, if not perfect, at least a bit easier. One way to cultivate self-compassion is to treat yourself the way you’d treat a friend going through a similar situation. Even if it feels a bit silly, speak kindly to yourself (instead of “My body is a failure,” try “It’s doing the best it can”), address yourself with an endearing nickname (like “Sweetie”) or even give yourself a gentle hug.

Seek professional support
According to Reddish, the mistrust that women feel toward their bodies can sometimes escalate into hatred. “It can become overwhelming and cause symptoms of anxiety and depression,” she says. In these cases, it can be beneficial to work with a mental health professional, like a counsellor or psychologist. These practitioners might help you explore questions like “How do I feel about my body?” “What am I saying about my body inside my head?” and “Where are these feelings and messages coming from?” Voicing your answers in a non-judgemental environment can help you work through any challenging emotions that arise while feeling validated and supported. Practitioners can then help you connect with your body by using techniques like visualization (imagining your body as healthy and fertile), challenging unhelpful thoughts (“Just because this belief about my body feels real doesn’t mean it’s true”) and making behavioural changes (like managing triggers and implementing self-care strategies). When ready, you can be supported to forgive your body for all the disappointments, helping to create a clean-slate relationship with your body for moving forward.

Normalize and connect
“There’s this expectation that getting and staying pregnant should be easy, but for one in six couples, it’s not easy,” says Caitlin Dunne, an infertility specialist at the Pacific Centre for Reproductive Medicine in Vancouver. Despite this statistic, women often feel alone in their experiences. Dunne says she tries to normalize and destigmatize what her patients are going through. Both Dunne and Reddish also recommend that women connect with others who are going through similar struggles. Some find it helpful to read infertility blogs and commiserate with friends, while Li says that joining a support group has linked her with a community of non-judgemental women. “I definitely don’t think of them as failures, even though they’re also struggling with infertility,” she says.

Li and Allen are both still trying for a baby. Although the road ahead feels daunting, Li says that she isn’t giving up. “I’m doing everything I can to take care of my body and trying to trust that it will do what it’s meant to do,” says Li, as she and her husband prepare for another round of IUI. “I know I’ll be a mom someday—whatever that might look like.”

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How to talk to your partner about your fertility worries

It’s important to share concerns regarding conception, but kick-starting the conversation can be daunting. Here’s how to make it as painless as possible.

Photo: Stocksy

If you’ve been trying to get pregnant with no success, it’s natural to worry about your fertility. “There can be a sense of urgency if it’s not happening as quickly as you expected,” says Mary Gillis, a registered clinical counsellor in Vancouver who focuses on reproductive issues.

       
   Could I be infertile? What to do next
Although doctors don’t consider your fertility to be problematic until you’ve gone a year without trying (or six months if you’re over 35), if you feel worried at any time, it’s important to talk to your partner about it. “Together, you can decide if you’re ready to see a doctor about fertility testing and what your next steps will be,” says Gillis.

Here are some strategies to help you have a successful conversation with your partner about your fertility concerns.

Time it right
You might not want to ambush your partner with a talk like this when they’re on their way out the door in the morning or after a long day at the office. “Choose a time when you’re both relaxed and free of distractions,” says Gillis. You know your partner best, so consider whether they might want a heads-up on a serious discussion like this.

“Keep in mind that your partner might not know how concerned or upset you are, so this could blindside them,” she says. Before you initiate the conversation, make a plan for yourself about what you’d like to discuss. Is this just a chance to share and vent your worries, or are you hoping to make an action plan with next steps?

Avoid the blame game
Saying something like “Why don’t you seem as worried as I feel?” can make your partner feel like the conversation is a personal attack. To avoid this, Gillis recommends sticking to I-messages like “I’m starting to feel nervous because it’s not working out the way I expected and I’m wondering if we can talk about this more.” Personal statements put less pressure on your partner because you’re conveying what you’re feeling as opposed to launching into research you may have done online or grilling them about what they’re thinking or feeling.

It can be a difficult discussion, but try to keep it upbeat if possible. “It’s important to start on a positive note,” she says. “Acknowledge and appreciate your partner, and remember that the goal is to have a baby together because of your love for each other—you don’t want this to pit you against each other.”

Think of yourselves as a team
One of your first goals should be to understand the issue better together, so you may want to start your conversation by saying “I’m concerned and I think I we should discuss this with my doctor.” Consulting your family doctor to rule out low sperm count, problems producing eggs, hormone imbalances and other common stumbling blocks to conception is a good place to start, says Gillis. If you think you may need to see a fertility specialist, this will require a referral. The clinic is likely to have a waiting list, so it’s important to get the ball rolling, especially if you’re over 35.

If your chat doesn’t give you the comfort you expected or help you figure out your next steps or if your partner doesn’t share in your concerns, you might consider some professional help to move the conversation forward. “Talking to a counsellor together can help normalize the situation and discuss all of your medical options, as well as how far you’re willing to take this,” says Gillis. You don’t want to get ahead of yourselves, but she says it’s important to figure out early on where you both stand on issues like the cost of IVF if needed. This might not be a topic you need to broach yet, but it should be on your radar if you decide to see a fertility specialist. “That’s when friction happens in a relationship: when your perspectives are at odds,” she says.

Get real about grief
Be honest about how you really feel and know that it’s OK to be sad. “For women who are hoping to conceive, a period can be the death of a hope and dream and experienced as a mini grief cycle,” says Gillis. Sharing these feelings with your partner can help you get through it. If your partner is having trouble supporting you through this, the advice of a fertility counsellor might be helpful.

If either of you has a history of depression or anxiety, talk to each other about any changes in mood or behaviour that you notice in yourself or the other person. It can be helpful to learn breathing and mindfulness techniques to help manage the stress and be on the alert for negative self-talk. “Women can get into cycles of shaming self-talk about their bodies, and it’s great when a partner can help reframe it into kinder thoughts and be really supportive in that way,” she says. “It’s important to know that infertility concerns don’t have to pull you apart—partners can grow closer because of them.”

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Fertility treatment guide

5 fertility myths that are hurting your chances of getting pregnant

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I'm not sure how to tell my kids about my miscarriages

When my son asked if I had experienced the loss of a baby, all I could say was, “Yes. And we’ll talk about it sometime.”

Photo: iStockphoto

“Mama, my friend Emily had a baby brother, but something bad happened and he died.”

My six-year-old son delivered this information at bedtime one night. Grasping at how to reply, the best I could think of was, “Oh. That’s very sad.”

“Yes, it is,” he replied. “They don’t know if it was a boy or a girl, because the baby died before it could get big, but Emily wants a baby brother.”

Close up of a woman's hands wearing an orange sweater holding a tissueCoping with miscarriage: grief, recovery, and how to tell people It took a few more statements like that for me to realize my son was saying his friend’s mom had suffered a miscarriage. I didn’t use the word, but I explained to him that sometimes babies don’t grow and the pregnancy ends. I told him it happens to a lot of moms and it’s very sad but they usually can have another baby.

“Did that happen to you?” he asked. And my ability to be objective in my explanation kind of fell away. All I could say was, “Yes, it did. And we’ll talk about it sometime.”

I have never been so grateful for bedtime in my life.

I had three miscarriages before my sons were born and I have talked about it a lot with my doctors, my husband and my friends. I have even written about it, in the hopes that my experiences might resonate with and offer comfort to other women who have also suffered a loss.

Over the years, talking and writing about my miscarriages has given me perspective and helped me heal from the emotional loss, as has being able to give birth to two healthy children. But now that my kids are old enough to wonder about where babies come from, I find that it’s a lot harder to explain the pregnancies—and the babies—I lost to the babies I was able to have.

For example, my older son is eight now, and he’s not as curious about babies and birth as his younger brother is. He’s particularly sensitive about the topic of death and asks not to talk about it whenever it comes up.

Likewise, he can’t stand the idea of anyone being in pain, so even the story of his own birth causes him to shake his head and say, “Let’s not talk about it.” He does know, and takes pride in, the fact that he is the one that made me a mother. This distinction is something we talk about on his birthday and Mother’s Day, and any other time he wants to be reminded of how precious he is to me.

I haven’t explained to my older son that he is my rainbow baby, the one who came after three losses. But one day I will and I do think it will make him happy to know what it means.

It’s a bittersweet truth for me, because I spent so much of my pregnancy with him fearful of suffering yet another loss. When I made it to the second trimester without losing him, I still couldn’t quite believe I might actually become a mother.

I don’t tell him any of that right now, though. I know he’s not ready to know and, to be honest I’m not ready to explain it to him. I thought I was over the grief of my miscarriages—as much as any woman can ever be over it, at least—but my youngest son’s simple question, and the rush of emotion that followed, let me know that I still have some unresolved feelings to process.

But unlike my older son, my youngest is curious about everything that relates to babies and becoming a family. I knew the time would come when I would have to explain not only pregnancy and childbirth, but also miscarriage. To have him bring up the topic was a surprise I wasn’t prepared for, and now that he understands the basics of what a miscarriage is, I know we’ll be talking about it again soon.

I have started building a reading list of books that cover pregnancy loss and grief so I can hopefully use someone else’s words when my own words fail me. I know the day will come when my sons will ask me about the older siblings who were never born and I will have to find a way to explain what I understand in theory, but not in my heart—where the emotions are still, and may always be, a little raw.

It doesn’t seem possible, but I sometimes forget that I have been pregnant five times.

Five positive pregnancy tests, three of them never meant to be. Time has blurred the memories of shock and grief, but it’s like a punch to the stomach when a simple question makes it all come rushing back.

I find myself wondering what those babies would have looked like and how they would have changed my life and added to our family. I am grateful for my little family of four, especially since I was told my chances of conceiving and carrying a baby to term were less than five percent.

After three losses, I was gifted with a double rainbow: two healthy babies born less than two years apart. No one, least of all me, could have imagined I would be so lucky. But I can’t help wondering what might have been and it’s a path I’ll have to wander down again one day with my two boys.

As they get older, I hope they will understand everything I went through to become their mother. But most of all I want to make sure they know they are loved all the more because of it.

Read more:
Miscarriage and pregnancy loss: causes, treatment and research
Pregnancy loss and miscarriage support groups and events

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