Journeying to Parenthood: By Malkie Bobker
Get married and a start a family. It is an idea that most of us are conditioned to internalize early on in life, especially in the Jewish community. Little girls dress up as brides, and young children push their dolls and teddy bears in their toy strollers, pretending to be Mommy or Daddy. When a couple gets married, family and friends excitedly await a pregnancy and birth in the first year or two of marriage. Unless someone has a condition that they are aware of before they get married, no one has any reason to believe that it won’t happen easily. Until it doesn’t.
Although my husband and I were married nearly five years before I became pregnant, it took two and a half years to conceive our daughter. It was a long and arduous journey, filled with pain and disappointment. I questioned myself, and wondered if not being able to conceive a child was the universe’s way of telling me that I would be a bad mother. I reflected on every indiscretion and imperfection and started to believe that infertility was my punishment.
It was after 11 months of trying to conceive naturally by the time my husband and I were sitting in our reproductive endocrinologist’s (RE) office for our first visit, answering all sorts of questions about my menstrual cycle and our intimate life, and I was – to borrow a term one of the lab technicians used to describe me at another visit – “nervous and nuts”. It had been almost a year of disappointment, months of tracking ovulation, months of questioning the twinges in my abdomen and the slightest bouts of nausea and running to the all-knowing Dr. Google to tell me if my symptoms matched PMS or early pregnancy, and then after prematurely taking a pregnancy test and getting a negative result, running back to Dr. Google to tell me the likelihood that I could still be pregnant. It had already been an emotional roller coaster, and I had no idea what was yet to come.
At that point in my life, my hatred for needles, blood, and physical examinations had earned me the title of Worst Patient Ever. To this day, I am almost convinced that if doctors were allowed to blacklist patients, I would have been at the top of that list. Yet there I was, in a physically vulnerable position, being poked and prodded. Everything with me had checked out so far, but a postcoital test revealed that there was no sperm. No sperm? What does that mean? All this time trying to conceive was for nothing? And of course, my shame voice joined this panic-pity party, telling me that I was stupid and naïve to think I could have been pregnant all those times I took a test or ran to Dr. Google.
My doctor said that my husband and I were to return to the office for an IUI. I did not know what to expect. My husband was not able to come with me, so he had to provide his sample at home and I had one hour to drive from Far Rockaway to the doctor’s office in Brooklyn, with the test tube between my legs to keep it warm. The number of sperm was a tiny fraction of the minimum they look to insert for an IUI. Was there even a point to going through with this? “All you need is one,” the nurse told me. Needless to say, it was an unsuccessful cycle.
My husband was told to repeat his sperm analysis and shortly after, we were back in our RE’s office. The results from both sperm analyses revealed a strong male factor infertility, as neither the sperm count, motility, and morphology were producing good numbers. The doctor then shared two possible courses of action. The first option was for my husband to consult with a urologist, and explore having the varicocele surgery. It would take three months after the surgery before we would know if it had been effective, and at that point, we may want to try to conceive naturally, or return to try IUI once again. The second option was to try IVF. Due to the fact that our insurance did not cover IVF, and I was not ready for what IVF entailed, we decided to consult with a urologist.
To say that I was angry is just about the understatement of the century. Though I really felt sad and fearful, anger somehow made me feel just a tiny bit more powerful in a situation where I felt completely and utterly helpless. I was angry at the doctor, angry at my husband, angry at G-d, and angry at myself. Our doctor told us to be in touch if and when we were ready to resume treatment. A month later, after seeing the urologist, we decided to pursue the varicocele surgery. Surgery was not scheduled for a few months, and then it would be another three months before we would even know if it worked and could consider trying another IUI. We were now in, to borrow a phrase from Dr. Seuss, “The Waiting Place”.
“The Waiting Place” defines so much of the infertility experience. First, we are waiting for ovulation. Then comes the dreaded “Two Week Wait”, often bringing intense angst, over-analyzing of symptoms, and a lot of consulting with Dr. Google. Outside of the two-week-wait, couples are often waiting to start treatment – due to insurance, finances, availability, emotional readiness, etc. – which can only intensify the feeling of being in limbo and starken the contrast between feeling like your life is on pause while everyone else’s seems to be racing along, and subsequently worrying that you will never “catch up”. There are also no guarantees that we will get the results we were hoping for. All of this time was passing, and we were helpless.
About a month after we entered “The Waiting Place”, I had a chemical pregnancy. While there was this tiny part of me that felt hopeful that I had gotten pregnant, the rest of me became anxious that this was indicating that there was something wrong with me that we had not even discovered yet. As we had decided in regard to our infertility, we did not share this with people – not even our parents. We could not stand to talk about it. I did not want to be pitied and looked at with the “Poor you” tilt of the head and lowered eyes. I did not want to be asked questions I did not want to answer, and I wanted to try to avoid unsolicited advice as much as possible. I could not admit it then, but truthfully, I was carrying a boatload of shame. Why are we not able to do something that seems simple for so many?
A few months after my husband’s, the urologist gave us our first piece of good news – there were significant improvements in both the sperm count and motility, placing both within normal range. However, there was minimal improvement in the morphology, though the doctor informed us that that can take longer to correct. The urologist recommended that we try to conceive naturally and return in a few months. We did, still not pregnant, and the urologist discharged my husband and recommended that we return to our RE.
As much as I yearned for a child, and as painful as it was to go from month to month without a pregnancy, I could not bring myself to set up an appointment with the RE. In the choice of fight or flight, I had clearly chosen flight. It was one thing to repeatedly have failed attempts to conceive naturally, but the idea of possible failure after putting myself through treatment was not something that I was able to confront yet. The process of fertility treatment is harrowing and an emotional roller coaster. Without hope, we would not put ourselves through waking up at the crack of dawn to go for monitoring, self-injections, procedures, the emotional ups-and-downs, and the financial stress this whole process brings. After being let down so many times already, I just refused to hope. I could not allow myself to be vulnerable to hurt and disappointment anymore.
It was not until my birthday a few months later when, still not pregnant, I was able to acknowledge that the pain of being childless and feeling helpless was greater than the potential disappointment I would feel if I resumed treatment, so I made an appointment. Our doctor and I spent a long time speaking that day. I acknowledged that I wanted to avoid IVF as long as possible because I did not feel emotionally prepared for it, nor did we have the financial resources to pay for it without insurance coverage. We agreed to move forward with another IUI, with the understanding that IVF was still a likely possibility.
A week later, my husband and I were back for the IUI. This time, the number of sperm about a million above the minimum preferred. I was optimistic, but two weeks later, I took a deep dive down the emotional roller coaster when I found out that I was not pregnant. Blaming myself, I took inventory of all of the things I must have done wrong that could have prevented a pregnancy.
After my next cycle, when a faulty ovulation test displaying a false positive led me to have to have an IUI when I was not actually ovulating, creating a lot of confusion about why I neither pregnant nor getting my period, our doctor recommended IUI with Ovulation Induction. We all agreed to attempt 3 cycles, before moving on to IVF. Given my anxiety about IVF, I was very invested in the success of this treatment.
The next three cycles were a blur. I was waking up at around 5:30 in the morning to go for monitoring, and some days needing to stay in graduate school past 9:00 at night. At this point I had become a pro at blood tests. I went from jumping at the sight of a needle to simply holding out my arms for the phlebotomist and asking her which one she wanted to use that day. Cycles one and two were both unsuccessful, and I was having terrible reactions to the Clomid. Among other things, it made my fingers swell up so badly and painfully, that I was sitting in my classes with ice packs on my hands.
The longer we went without getting pregnant, the less we fit in with our friends, and the more isolated we became. As we were already married for a few years, we did not really identify with our newly married friends without kids. Nearly all of our friends who got married around the time we did, already had children, and we struggled to relate to their conversations about sleepless nights and the never-ending mess of toys. Things as simple as trips to the grocery store or Shabbos afternoon walks, would trigger me as I would often see so many pregnant women, or couples pushing strollers. Would that ever be us? Would I ever experience the feeling of life inside of me? Attending family events became painstaking, and going to shul became impossible. As time went on, I could not bear to see people, even my friends. We just crawled deeper and deeper into our shell and felt completely alone.
When we started Cycle 3, I was not even sure it was worth it. Why would things work out now when everything so far has just felt like a miserable failure? It was when I was finally told I can induce ovulation that the death knell came from the insurance, denying coverage for this final IUI. Their reasoning was that it was “highly unlikely” that I would become pregnant. The out-of-pocket cost was not money we could easily spend. With the doctor’s help we appealed, but they still denied it. It felt so cruel. Plus, the insurance’s reasoning for denying coverage, made me feel stupid for being hopeful enough to even consider going through with it. After all, weren’t they right? I really was not likely to get pregnant. After a lot of back and forth, we decided to go through with the IUI. On the morning of the IUI, I was feeling sick and we were super stressed, and I was convinced this was already doomed to fail. The two hours between arriving at the doctor’s office and the IUI was plenty of time for all of the voices of self-doubt to tell me that this was pointless and I was stupid to be spending this money. When I did go into the procedure room though, I learned that the number of sperm was the highest it had ever been. I dug deep and found my last bit of optimism.
A week passed and I started having cramps, my tell-tale PMS symptom, and I just broke down. How could I have allowed myself to hope? Without even bothering to wait for confirmation, we scheduled our appointment with our doctor to start discussing IVF, even though I was only half-listening at that point. We felt depleted and defeated. It was Purim that week and I just could not get into this holiday that is so centered around children, and wanted to hide until it was over. I was also expecting my period, and I was filled with this foreboding sense of doom and gloom. Several days passed though, and I was clean. After some denial, I started to acknowledge the likelihood of being pregnant. I just could not bring myself to test and find out, in case I was not. I was not ready to confront the finality of not being pregnant and all that it would signify. Finally, when I was a week late, my husband told me that it was time to go for a blood test, as I refused to take a home pregnancy test. A couple of hours later, we got the news that I was finally pregnant, and three weeks later I was discharged to OBGYN.
While I was relieved to be moving forward, I found myself feeling sad. This doctor, along with the nurses and staff, had, in some strange way become a second family. They had accompanied me on what was the most difficult journey of my life, and metaphorically held my hand through the various ups and downs. I never had to put on a brave face for them – all I had to do was show up exactly as I was, and they met me there. The day after I gave birth to our healthy, beautiful baby girl – a true blessing in every sense of the word – I called our RE from the hospital and thanked him for everything he had done for us. Two years later, we were blessed with our son, and three years later, after a pregnancy loss at 9 weeks, we were blessed with our third child, a daughter.
I will be the first person to tell you that there was nothing graceful or inspiring about the way that I handled this particular challenge, other than my ability to get out of bed every morning and put one foot in front of the other. I continuously invalidated my experience, and even do so to this day, doubting my right to “claim infertility” when we were able to escape IVF, or doubting my right to “claim pregnancy loss” years later, when it was so early on in my pregnancy. I am still working to internalize that infertility is not a “one size fits all” experience. I hope that by reading this, you can draw strength, or even just feel validated that your experience is real, no matter your cause of infertility and journey to parenthood.