Infertility

How infertility changed me—for the better

Had I not experienced pregnancy loss, I’d surely be richer, younger, and a little less insane. But what kind of mother would I have been?

Sometimes I wonder, What if I’d gotten pregnant, stayed pregnant, gone to one doctor and poof, had a baby some nine months later, just like in the movies? What if I’d never lost those babies, never had to go to multiple doctors, clinics, countries, and been made entirely and completely a lunatic from all the desperate wanting, hoping, and failing? I’d surely be richer, younger, and a little less insane. But what kind of mother would I have been?

You see, infertility changed me. I used to be a happy-go-lucky optimist, certain that things would always work out. Book a trip at the last minute? Definitely. Lost my luggage? No worries, we’ll just figure it out—and get a whole new wardrobe. Give up my life in L.A. in order to meet a guy in New York? Sure! I was game for anything and everything.

And yet, losing pregnancy after pregnancy, going through unsuccessful IVF cycles made me pessimistic. The medical journey—charting ovulation, planning sex, revolving my entire being around IVF, made me less carefree. Not only did fertility treatment turn me into an anxious worrier, it also made me into a planner, a think-ahead type-A personality instead of a “let’s wait and see” type B.

“Is there more pressure to do everything right because you spent so much time and energy on this?” a “regular” mother asked me. God, there is so much pressure to do motherhood right (I could say “parenthood,” but that’s a blatant lie—[my husband] Solomon thinks he’s a great dad when he gets her outfit on right-side up) that it’s hard to imagine something creating even more pressure. “I Did IVF and All I Got Was This Lousy Kid,” the souvenir T-shirts should say. Except she’s not lousy, she’s wonderful. “You the best mama,” she says to me.

So maybe infertility wasn’t all bad for motherhood. By now you must know that I’m not one of those people who searches for silver linings in everything, so there’s no way I’m going to be grateful for my struggles to have a baby. But I will say that it made some of early motherhood less daunting. “Oh my God, I lost my life, I have no self!” some new mamas complain. Ha! I long ago lost myself in Hormone City, and spent years at a full-time job called “Waiting in Line at the IVF Clinic.” “I can’t believe I have to take all this stuff for the baby just to go on a trip to the grocery store,” others complain. For years my head had been so filled with medicine schedules and prognosticating for every possible outcome that packing for an eight-pound baby’s outing to Midtown was nothing.

And yes, while I did engage in The Great Stroller Debate of 2016, the stakes were so much lower than IVF that it felt like I was doing it just to belong to the Regular Moms Club.

Once, at my friend Emily’s baby shower (a single mom doing IVF ) as everyone went around in a circle to give her a toast or advice, I said, “After years of IVF, nothing will be as hard.” Although the moms of teenagers rolled their eyes, no doubt thinking, You ain’t seen nothing yet, the point I was trying to convey is that infertility is difficult because you don’t know if you’ll ever succeed.

Parenting is challenging, but you have the reward of a kid. And what a reward that is.

No complaining, IVF Mama!

I will never, ever complain about parenting, I promised myself during those long years of Trying. “Oh, you don’t know what tired is until you have kids,” an exhausted mom would say, rolling her eyes. “Your body will never be the same,” another said, pinching her pouch. “Can’t wait to go back to work. These vacation days are killing me,” another posted on Facebook.

Of course I never responded to those parents—those ungrateful, insensitive, unappreciative people who didn’t know how lucky they were to have kids to complain about. I would have given up all my vacation days just to spend it with my kid.

Or so I told myself.

And then I had a baby. So what if my breasts weren’t producing enough milk and my c-section scar wasn’t healing and my mother-in-law didn’t want me to let the baby cry it out and I would never ever sleep again? I was NOT going to complain.

HA!

I mean, seriously. How long can a vow like that last? I’ll tell you: six months. At half a year I was losing my mind from a baby who wouldn’t take a bottle (yup, that meant I couldn’t go anywhere for more than three hours) and the sheer exhaustion of it all.

I was ecstatic to have a daughter and be off the IVF train, but I needed to vent, to let off steam, to rant and rave at Solomon or whoever else might have been in a hundred-mile vicinity. Also, isn’t that a part of motherhood? Infertility shouldn’t steal another rite of passage: complaining. In the age of social media, it seems like an essential part of motherhood.

When I was interminably single, I promised I’d never complain about my spouse, either. But then I got one. Hello! I’m human.

I do complain at times about marriage, motherhood, life itself, but I try to do it only to the right people. Just like I don’t bitch to my single girlfriends about my husband, I try not to complain to the childless, either.

Going through infertility has made me more sensitive to others because I remember what it was like. I don’t remember every hCG beta, every embryo count, every medical protocol. But I do remember the pain, the frustration, the desolation of not having a child.

Having a child—this child, this wonderful, beautiful, adorable person (“I’m not cute, I’m smart!” I’ve trained her to tell strangers)—is beyond amazing.

“She’s incredible,” Solomon constantly tells me. Doesn’t every parent feel that way? Or just those of us who went through hell and back to get here?

The other day, we took our daughter to the pool and saw her swim, without floaties, for the first time—and she’s not even four! A giant balloon of tears welled up in me: I don’t care if she becomes a ballerina, goes to Harvard, or cures cancer. That she had so much of me and my love of water in her, that she had achieved so much in such a short time, made me so proud, so incredulous that I get to shepherd her into the world.

There were so many dark days and long nights when I never thought I would get here. I didn’t know whether I would recover from a pregnancy loss. I didn’t know that I could start fertility treatment, take so many drugs, uproot my life and move across the world, witness the world getting pregnant and moving on without me—me, who was denied the one thing I wanted. I did not know what would become of me, of Solomon, of us together.

Yet here we are, with our curly girl in a mermaid bathing suit flopping around like a fish. Most days the gratitude is too gargantuan to acknowledge, and I have to just pretend to be a regular mom in a regular family. I guess we are a regular family. Regular parents. Regular (extraordinary) kid.

I hope you are all lucky enough to be a parent. You deserve it.

From the book The Trying Game: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind by Amy Klein. Copyright © 2020 by Amy Klein. Publishing by Ballantine Books, an imprint of Random House, a division of Penguin Random House LLC. All rights reserved.

book cover and author headshot

Headshot by Charlotte Crawford

Infertility

6 things people did (not just said) that made me feel seen after my miscarriage

When I experienced a miscarriage, there was nothing anyone could say to make me feel better. Luckily, there are many people in my life who didn't rely on words alone.

It’s true what they say—sometimes, there are no words. When I experienced a miscarriage, there was nothing anyone could say to make me feel better. “I’m so sorry” made me feel like I had to respond with “It’s okay,” when it wasn’t. “At least it happened early on” or “you’ll get pregnant again” made me resentful, like they were missing the point entirely—I didn’t want another pregnancy, I wanted the one that had been taken away. I felt lost at sea, adrift in the middle of an awful experience, and words couldn’t double as a lifeline or miscarriage support.

Luckily, there are many people in my life who didn’t rely on words alone. It was their actions, big and small, that actually did help me feel better. If someone in your life has experienced a miscarriage, here are a few things you can do to make them feel seen and understood—as taught to me by my family and friends.

Be there in person.

When my mom found out about our miscarriage, she immediately hopped on a flight from Calgary to Toronto. She stayed for the week, helping with our daughter, cooking meals, cleaning, and giving my husband and I time to rest and recover. We would have never asked, but my mom sensed that we needed her, and she was there for us in a way that truly made a difference.

If you aren’t able to make it, send a proxy.

Mother and daughter lying in bed together reading a piece of paper The sweet moment from my miscarriage that I choose to rememberMy sister, who couldn’t come to town, sent a stuffed animal in her place. In an accompanying card, she explained that during her own miscarriage, she was sent a stuffed deer named Ferguson who had given her comfort during recovery. I’m Ferguson’s third owner, and he’ll move on to the next woman when the time comes. This simple gift made me feel connected to other women who had experienced the same loss. Ferguson was a reminder that, someday soon, I was going to be alright.

Offer to lend a hand— and mean it.

“Let us know if there’s anything we can do” is something we heard over and over again. But that offer puts the onus on those who experienced the loss to reach out and ask for help. Instead, one friend suggested they babysit and encouraged us to choose a date; another came over and cooked us dinner; our neighbour offered to walk our dog. These simple acts of service shortened our to-do list and made us feel loved and supported.

Encourage self-care.

A few friends pooled their funds and gave me a spa gift card. It was completely unexpected and allowed me to take some time for myself— something I may not have otherwise done. I also appreciated invitations to check out a yoga class, go for a walk, or grab a coffee. Anything that got me out of the house made me feel closer to normal.

Keep checking in.

We initially got a lot of support, but I really appreciated the family and friends who kept checking in week after week. It wasn’t their words so much as the intention behind them that made me feel continually seen. It confirmed that my loved ones weren’t expecting me to just forget what had happened, and they weren’t going to either.

Share your experience.

I personally know six women who have experienced miscarriages. One of my friend’s experience was similar to my own, so when I had to choose between taking misoprostol pills or booking a surgical procedure called a D&C, I knew who to call. She was open and honest, offering a ton of important information and emotional support.

Because so many women in my life have spoken openly about their past miscarriages, I knew I wasn’t alone when it happened to me. Continuing to break down the stigma benefits everyone, including those who have lost a pregnancy in the past, and those who will experience a loss in the future.


Read more:

3 celebrities who opened up about their miscarriages
What is a missed miscarriage?

Infertility

Can a sea moss supplement help you get pregnant?

With so many trends in fertility, it can be difficult to separate fact from wishful thinking. Here’s what you need to know about the latest murmurings.

When you’re trying to get pregnant, it’s really tempting to try to tip the scales in your favour any way you can. So, it’s not surprising that when claims about various health foods and supplements pop up, many women wonder if it could hurt to give it a try.

The latest trend making the rounds online is sea moss (also known as Irish moss), a form of red seaweed found mainly in the North Atlantic. Its scientific name is Chondrus crispus. Some say that mixing the dried form into your smoothie or swallowing a supplement can help boost your fertility because it’s such a rich source of fibre and nutrients like B vitamins, magnesium and potassium. (Kim Kardashian is apparently a fan, although there’s no word on if it’s for baby-making.)

Plus, in the Caribbean, some value sea moss as an aphrodisiac for men

What does the science say?

While it’s true that “sea vegetables” like sea moss and other seaweeds are rich in a variety of nutrients and fibre, the studies on their benefits are pretty limited and mostly use animal and cellular subjects, not humans. In other words, the research is interesting but ongoing, and it’s tough to draw a straight line between sea moss and human health, much less fertility. 

Keri Gray, a Calgary registered dietitian who specializes in nutrition and fertility matters, says that seaweed in general is a really good source of folate, and has some calcium as well. But she warns that those qualities may not be enough to warrant taking a supplement. “We have to take this with a grain of salt however, because a typical serving of Irish moss would be five grams of dried [material], which is about a teaspoon. When you’re consuming a five-gram portion, the amounts of these nutrients would be pretty negligible.” 

Iodine is another crucial factor to consider. Gray notes that Irish moss tends to be high in iodine, and iodine is important in thyroid hormones.

“Issues with fertility can happen with both hyperthyroid and hypothyroid [problems,] so I can understand why people are looking at things like seaweed because of the iodine content,” she says. “However, when you look at the iodine levels in a five-gram portion of Irish moss, they can change a lot. It depends on the time of year it was harvested, and the location. Sometimes the iodine level is within the normal levels and that’s ok, but sometimes it can exceed the upper limit of what’s recommended by a lot.” That’s a concern, because too much iodine can contribute to thyroid problems.  

Gray also says the source of the sea moss is another biggie. “Depending on where it’s harvested, seaweed can be contaminated with heavy metals like mercury and arsenic, so honestly I would be very cautious.” 

egg representing ovulation signs 5 signs you're ovulatingSonya Kashyap, a reproductive endocrinologist and medical director of a Vancouver fertility clinic says that while her patients haven’t been asking about sea moss in particular, when the topic of supplements comes up, she’s more likely to discuss an antioxidant called coenzyme Q10 or CoQ10. “CoQ10 is the energy source for the mitochondria that are the energy source for a woman’s eggs, and [in studies on animals] it’s been shown to improve egg quality and perhaps egg number,” she says.

In addition to taking folic acid, she may suggest a supplement with 600 mg of CoQ10 daily for her female patients. For men trying to conceive, she says 600 mg of CoQ10 isn’t associated with a fertility boost but is good for overall health, and that supplements that contain zinc and antioxidants like vitamin C and E may be helpful for sperm quality. (Always check with your health care provider to see what supplements and quantities are right for you.) 

As for Gray, instead of a sea moss smoothie, she recommends both men and women eat a variety of healthy whole foods to help support fertility. “Most of the research backs up a more Mediterranean-style eating pattern: more fish and seafood, less red meat, lots of veggies, fruits and whole grains, and monounsaturated oils like olive and avocado,” she says.

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Infertility

The sweet moment from my miscarriage that I choose to remember

If it’s possible to have a favourite memory from your miscarriage, this is mine.

On the morning after my miscarriage four summers ago, my then four-year-old daughter gave me the sweetest Get Well card, or as she wrote it, Get Mell. I was bedridden on a Tuesday morning, feeling horrible and having barely slept the night before, though she didn’t know why. I told her that Mommy wasn’t feeling well, and Daddy was going to have to make her breakfast.

Stomach pain subsiding, I managed another hour of sleep before I heard a gentle knock on my door. It was my daughter, clutching something in her hand. She extended what looked like a piece of paper to me.

“What’s this, Sweetie?” I asked groggily.

“I made you a card.”

“That’s so nice, honey!” I was truly touched, but feeling so physically awful that I had to force myself to sound chipper.

I opened the card. Written in her shaky four-year-old handwriting were the words “Get Mell.” I was nearly moved to tears.

“Sweet Potato,” I said, “this is the nicest card I’ve ever gotten. I think Mommy is ready to get up now.”

I searched for my slippers. Mercifully, my husband had already arranged to stay home from work. I was in no condition to be the main caregiver that day. I’d spent most of the night in the bathroom, and when I wasn’t in there, attempting fitful bursts of sleep. The bulk of the stomach pain lasted from midnight to 5 a.m., so by the time my daughter was up, I was feeling a bit better—just so, so tired.

Before heading downstairs, I looked at my daughter’s card one more time. It was such a sweet gesture that made me smile, and it felt especially poignant since my daughter had no idea that it wasn’t just a stomach bug that kept me up all night.

Countless women know the pain, both physical and emotional, of miscarriage. While I have several friends who’ve had one, you can’t possibly know what it’s like until you’ve experienced it. I consider myself very lucky that mine happened early, around 10 weeks, before I could get overly excited about due dates and finding out the baby’s sex, much less telling friends and family the news. I was also mentally prepared for it to happen since my first OB appointment had been, shall we say, less than stellar.

Little girl is playing Princess with her mom How my princess-loving daughter helped me cope after two miscarriagesI saw my OB when I was, according to my calculations, about 8 weeks pregnant. After seeing the familiar plus sign on the home pregnancy test, I alternated between excitement and a laid-back “let’s just see what happens” attitude, given my advanced maternal age of 42. My OB was excited and teased me for not telling her at my last check-up that my husband and I were trying to conceive. Ironically, she herself was pregnant and only about six weeks from her due date, so abundance seemed to be in the cards that day—until she brought out the ultrasound machine.

She moved the wand over my belly, but it wasn’t detecting anything, so she pulled out the vaginal one, saying, “You’ll feel a lot of pressure.” She inserted the wand and moved it around. She kept searching and then said, “Your periods are very regular, right? Every 28 days?” I said yes, except for my last period, which had come after only 21 days.

“And do you know when you ovulate?” she asked.

I started wondering why she was asking all these questions; it couldn’t be a good sign. I told her no, I’ve never been one of those lucky ladies who can “feel” when she’s ovulating.

“OK,”she replied. “The ultrasound is measuring the fetus at only four weeks and five days. So, I’m wondering if you’ve miscalculated your ovulation.”

I assured her that I hadn’t; I mean, come on, there’s an app for that.

She had me scoot back up on the table, and said that I’d either miscalculated my last period and therefore wasn’t as far along in the pregnancy as I’d thought, or that the fetus was no longer growing and I would inevitably have a miscarriage. Though this clearly wasn’t the news I’d been hoping for, I wasn’t completely devastated, knowing how common miscarriage is, especially at my age. She had me schedule a sonogram for the following week with an ultrasound technician—it would be more accurate, and we could check for growth again then.

I awaited the appointment with very little patience and more than a little dread. I didn’t have a good feeling about it, especially knowing there was no way I’d miscalculated the dates. Still, there was a glimmer of hope—there had to be, right?

After a stressful week of waiting, my husband and I went to my ultrasound appointment. The technician was chatty, but when we got down to doing the sonogram, she was all business. She moved the wand around for a few seconds before telling us, “You are most likely having a miscarriage.” Well, that settled that. She went on to say the fetus was measuring nearly six weeks, which was so confusing, because didn’t that indicate a week’s growth? But she was unequivocal. “This is probably a miscarriage. You should be measuring nine weeks now based on your last period.”

“OK,” I said. “What do I do now?” She told me to come back the next week to measure the fetus again, which seemed pointless, but we agreed. My husband asked why I hadn’t had a miscarriage yet if the pregnancy wasn’t looking viable, and she told us the actual having of the miscarriage could take up to two months. Seriously? I thought. But she also said it could happen sooner, so I should schedule the next ultrasound and wait to see what happens. I agreed that was a good plan, even though the last thing I felt like doing was waiting another week just to give her another glimpse of my non-viable fetus. It didn’t seem fair that my body was clinging onto this false hope of a pregnancy. I felt helpless, and like I had no definitive information—only the knowledge that no one could really tell me what was going to happen.

Luckily (if you can call it luck), four days later, the tell-tale spots of blood appeared in the crotch of my bathing suit, which I was changing out of after spending the afternoon at the town pool with my daughter. I had been attempting to keep going about my life like everything was normal, but here was a clear sign that it wasn’t. Was this the miscarriage? I wasn’t sure if I should be concerned or relieved. I grabbed a maxi pad and continued with our evening: making my daughter dinner, getting her ready for bed, the usual. I was feeling OK—maybe a little crampy—but well enough that I wasn’t overly concerned. I wasn’t bleeding much either, and started to wonder if this wasn’t going to be so bad. I can handle this, I thought. My husband and I ate leftovers, and I settled in to watch “Orange is the New Black.” If I’m going to have a miscarriage, at least I can do it watching an awesome show, I told myself

And since nothing had really changed by the time I got into bed around 11, I actually told my husband, “Maybe having a miscarriage isn’t that bad.”

If only! By 2 a.m., I had been in and out of the bathroom more times than I could count, cramping, bleeding profusely, and generally feeling like I was going to die. There was an incredible amount of blood. I kept the lights off in the bathroom, partially so as not to interrupt my husband’s attempts at sleep, but also so I wouldn’t have to witness what was coming out of me.

After one of these episodes, I crawled back in bed and attempted to get comfortable, which was proving impossible. Lying on my side was awful, and lying on my back was even worse. The cramps felt like a milder version of being in labour. My vagina hurt—a lot. It’s not often that that happens, but I remember it all too well from giving birth to my daughter.

(Later, when I told a friend who’d had two miscarriages about this, she commented, “No one tells you this, but a miscarriage feels like labour.” Indeed.)

The card my daughter gave me the morning after my miscarriage

Photo: Courtesy of Caroline Hand

By five o’clock in the morning, things had improved slightly, though I struggled to get back to sleep. Then, once my daughter was up—the card. She had drawn a sun, a heart and a few stick figures, one of whom appeared to be standing in a doorway.

Having a miscarriage was awful, but my daughter’s card is the memory I choose to carry from that day. I still have it. “Get Mell,” it read. And I knew that even though it might take a little while, I would.

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Infertility

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.

Infertility

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."

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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Infertility

What I wish I’d known before my first IUI

From the success rate to what the procedure feels like, here’s a first-hand primer on IUI.

Woman's hands planting a seedling in the dirt symbolizing IUI

Photo: iStockphoto

When our doctor first suggested that we try intrauterine insemination (IUI), I was actually excited. My husband and I had been trying to conceive for a while without any luck. Our tests turned up relatively normal and we were told that we should be able to conceive, yet month after month, I failed to conceive. The diagnosis was frustratingly vague—unexplained infertility (with potential male factor)—so IUI offered a bit of hope. Here was something that could potentially help us have a child.

IUI  is one of the first assisted reproductive technologies typically recommended by a doctor. It’s commonly used when the male partner is experiencing low sperm count or decreased sperm motility, but it can also help those suffering from unexplained infertility, endometriosis or cervical mucus issues and assist same-sex couples. I liked that the procedure is relatively non-invasive: It simply places healthy sperm as close to the Fallopian tubes as possible, giving them a bit of a head start in the race toward the egg.

Like all things to do with infertility, navigating the IUI process was overwhelming. I quickly became emotionally, physically and financially invested in something I didn’t know a whole lot about. I had a ton of questions: What happens? How does it feel? Will it work?

Here’s what I wish I’d known before doing my first IUI.

What happens?

Step 1: The checkup

On Day 3 of my cycle, I did blood tests that checked my hormone levels, and my husband had his sperm analyzed to gauge the concentration, motility and morphology of his little guys. We had two options: a medicated IUI or a natural one. The former involves taking fertility drugs so that more than one follicle (typically two or three) matures and improves the odds of pregnancy; the latter doesn’t involve medication (so only one egg is released). Because it was my first fertility treatment and we didn’t want to do anything too invasive, we chose a natural IUI.

Step 2: Cycle monitoring

I began daily cycle monitoring at my clinic on Day 10. I had to arrive early—between 7 and 8:30 a.m.—for blood work and an internal ultrasound every day for a week. Though I knew the process would give my doctors insight into how my hormone levels and follicles were developing, I couldn’t help but feel like a pincushion. By Day 17, my nurse let me know that a mature follicle was ready to ovulate. (It was about time—I found this gruelling.)

Step 3: Trigger shot

My trigger shot was the first hormone injection I had ever received. I was given the pregnancy hormone hCG, which helps follicles mature and ensures that ovulation occurs within 36 hours. Doctors administer this hormone to help time insemination—they want sperm to be waiting for the mature egg (an egg survives for only 12 to 24 hours post-ovulation, while sperm can live in the Fallopian tubes for days). I don’t mind needles, but I was used to getting them in my arm, not my abdomen. While the trigger shot didn’t hurt, I know I flinched because it felt so weird (my hubby maintains that I took the injection like a boss).

Step 4: Pre-procedure

On Day 18 around 7 a.m., we arrived at the clinic for IUI day. To say that we were nervous is a bit of an understatement—neither of us was sure what to expect. Would the procedure hurt? Would my husband be allowed in the room with me? There was also this great sense of anticipation—we desperately wanted the IUI to work.

I did my usual blood tests and internal ultrasound and my husband produced a semen sample. We were told to return to the clinic around noon—this gave the andrologist time to “wash” his swimmers. (Sperm washing is the procedure that separates the sperm from the semen and weeds out the low-quality “tadpoles.”)  To ensure that there is enough sperm available to wash, men are typically asked to abstain from sex or masturbation for two to four days before an IUI. One hour before the procedure, I had to consume one litre of water, as a full bladder helps the doctor guide and angle the catheter into the uterus.

The wait between our early-morning appointment and the procedure was odd. At around 8 a.m., we found ourselves wandering around Toronto with nothing to do for four hours. For a while, we had no idea how to spend our time—it was clear that we both wanted the IUI to be over. We filled up our car with gas, bought groceries and treated ourselves to brunch (an awkward meal spent talking about everything but what we were thinking about). We laugh about the weirdness of it all now.

Step 5: In the ultrasound room

Once back in the ultrasound room, I sat on the exam table and placed my feet in the stirrups. We were shown a vial of my husband’s sperm and asked to acknowledge that the information on the label matched ours. I remember thinking “I sure as hell hope so!” but all I did was laugh out loud. It was such a funny—but important—request. I think I read the information 100 times before saying “Yes.” I was then asked to lie down and the doctor inserted a speculum into my vagina.

Step 6: The insemination 

As the technician performed an external ultrasound, the doctor inserted the catheter into my vagina and my cervix. Using the ultrasound screen as her guide (which I watched closely throughout the procedure), she pushed the catheter through the cervical canal and pointed it toward the top of my uterus and right Fallopian tube (the side with the mature follicle). She injected my husband’s sperm through the catheter and into my uterus and advised me to stay seated for a few minutes. The process lasted only about 60 to 90 seconds.

What IUI feels like

While the IUI itself was uncomfortable and awkward, it didn’t hurt. The insertion of the catheter felt a lot like a tight, one-second pinch. “Most women compare it to a Pap test,” says Ari Baratz, a fertility specialist at the Create Fertility Centre in Toronto.

After the procedure, the toughest part was dealing with the dreaded “two-week wait.” That’s the terrible time before your period where all you can do is sit and dream about being pregnant. It’s agony—there’s no way to know if you’re actually pregnant that early on, but that’s all you can think about.

To minimize stress, Baratz recommends that women maintain realistic expectations about the chances for IUI success and try to focus on other things. “Don’t put everything on hold for that pregnancy test,” he says. “Do everything you can to live a normal life.”

What are the side effects of IUI?

I thought I was lucky to experience few to no side effects from the procedure, but according to Baratz, my experience is quite common. While some women have minor cramping, spotting or a feeling of fullness post-procedure, the vast majority don’t.

Was it worth it?

It was for us. We got pregnant but miscarried at around seven weeks. While we experienced loss, we were thrilled to learn that we could get pregnant.

IUI success rate

On average, a woman under 35 will have a 10 to 20 percent chance of pregnancy with each IUI, while a woman over 40 will have a two to five percent chance. “The peak IUI effect is around three to four cycles,” says Baratz. “If you’re going to get pregnant [with IUI], you’ll get pregnant within those attempts.”

He says that there’s sort of a cumulative success rate with fertility treatments. The more a couple tries something, the more likely it is that they’ll get pregnant. But just like trying naturally, there comes a point when certain treatments no longer work. If pregnancy doesn’t happen with IUI after a few cycles, a couple should consult their physician about another approach, like IVF.

A woman shouldn’t take a failed IUI as a sign that she won’t be able to conceive, though. “It’s always desirable to conceive in the least invasive way possible, and IUI offers that option,” says Baratz. “[But] there’s no one set path that anyone takes to build a family. The goal is to produce a healthy, live child.”

It’s something my hubby and I continue to focus on. Though we would have done another IUI after our first, we were lucky enough to “win” one of the funded cycles of IVF that the Ontario government now offers about a month after miscarriage. That’s our next “let’s bring home a baby!” step.

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Infertility

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.

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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Infertility

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

Allison McDonald Ace shares her heartbreak over the baby girl she loved and lost.

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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Infertility

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.

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.”

Read more:
How to talk to your partner about your fertility worries
When to talk to your doctor about your fertility issues