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Barren among the Fruitful
Navigating Infertility with Hope, Wisdom, and Patience
By Amanda Hope Haley Thomas Nelson
Copyright © 2014 Amanda Hope Haley
All rights reserved.
ISBN: 978-1-4016-7976-7
CHAPTER 1
"Just Give It Time"
Discovering There's a Problem
It happens just as soon as you say, "I do." People go from asking, "When are you getting married?" to asking, "When are you having children?" I was a twenty-two-year-old bride standing in the receiving line at my own wedding when I was first smacked with this question. Ignoring the complete impertinence of the person who so boldly invaded my business, I blushed and said something like, "Not until we finish grad school."
Such temporal benchmarks can stall your nosy acquaintances for a while, but eventually they—and you—start to wonder why no baby has come. It was around year four that "When will you?" turned into "Why haven't you?" and my answers became markedly less polite.
It is tempting to say that the tendency for all of us to get into each other's business is a result of social-media culture. We put almost everything about ourselves online, so the world logically assumes it has a right to know the rest. But I contend the digital exhibition of our personal lives only exacerbates humanity's millennia-old concern with procreation (and yes, narcissism, but that's a topic for another book).
Consider God's first words to the first man and woman: "Be fruitful and multiply. Populate the earth" (Gen. 1:28). At the beginning of time, children were necessary to continue the human race, so everyone had a vested interest in every woman's fertility. Once the population started growing, sons were needed to perpetuate family fortunes (Num. 27:8–11) or national monarchies (1 Kings 1:17). When survival—physical, fiscal, or political—is at stake, there is no such thing as privacy. Ladies, your mother-in-law wants to know that the family she gave birth to will last forever (Ruth 4:13–17). That longing is in her DNA, and it's probably coded into yours as well.
In year four I may have understood why others were so nosy, but that didn't make their questions any easier because I didn't know the answers myself. We'd been "not preventing" children for two years, and nothing had happened. At my next annual gynecology appointment, I told my doctor we'd been trying for two years, not knowing I was pushing the panic button. Within a week I was seeing specialists. I was officially scared.
Kristine's Story
Life was good. I had married my college sweetheart, Jason; he had finished law school; and we were back in Chicago, the city we loved. We both had great jobs, wonderful friends, a nourishing church, and supportive families. We had just bought a house with lots of room to grow ... so it was time to make some babies! Life up to that point had been easy and fun.
It took a few months, and another month, and it was starting to be not so easy and fun. Why wasn't I pregnant yet?
I had polycystic ovary syndrome (PCOS). I was partially relieved to learn I actually had something, but I was mostly discouraged. What did this mean? My normal OB/GYN wasn't really qualified to help, although she suggested I try one round of Clomid. If we couldn't get pregnant on Clomid, then she'd refer me to a specialist.
A light period made me think the Clomid hadn't worked, so Jason and I faced the truth that we were off to the fertility clinic. We treated ourselves to Walker Bros., a Chicago breakfast spot. There we decided that this process is not easy and fun; but we were going to face all this together, strengthened by our faith in God, who had a plan for us.
We met with the infertility specialist, who did some tests and said that once I got my period, we could start the Clomid therapy over again. When my "period" did come, something was different. We found out I was six weeks pregnant.
For one day Jason and I were beyond excited. We kept it to ourselves until the doctors got the results from my blood work, and the next day my hormone levels didn't indicate a healthy pregnancy. I was miscarrying, and no amount of synthetic progesterone could sustain the baby. I got the call at work, and it all felt so unceremonious, impersonal, and just awful. The following weeks were pretty rough.
After a few months we returned to the infertility specialist. He wanted to continue the Clomid regimen and add intrauterine insemination (IUI). We tried Clomid for three months but were only able to have an IUI two months because a January snow day kept us from driving safely to the doctor.
The continued use of Clomid was really harsh on me. I was a mess. Clomid has a long half-life, so remnants of the previous month's dosage were still in my system when I started the next month's prescription. Jason and I were having a really rough time just getting along because of my emotions. I was mean, tearful all the time, angry, and annoyed.
The second month we did the IUI (which was the third month in a row I had taken Clomid), we got a negative pregnancy test. On that same day Jason was laid off from his job. We had to stop the infertility treatments because of money, and I was slightly relieved.
Jason and I regrouped that summer. He didn't have a job, I was finally getting the Clomid out of my body, and we needed that break from all the purpose-driven "trying." We were exhausted.
And I was fully bitter. I couldn't open Facebook without being crushed by another pregnancy announcement from a dear friend or hometown acquaintance. These kind people were just living their lives; they weren't expanding their families just to hurt me! But it felt like it. And it felt as though everyone's life was moving along while ours was staying still.
In the back of my mind, I knew God would take care of us, our miscarried baby was in heaven, and that I shouldn't complain about the life I was blessed to have. But I continued to struggle. I was being shaped by God in so many ways, but that wasn't always clear to me, and my faith wasn't always strong.
We were at a dead end, so I started reading. Thanks to the Chicago Public Library, I picked up a couple of books about PCOS and the best diet for treating symptoms. I changed my food habits and exercised more. And I felt amazing. I lost about fifteen pounds and had tons of energy. I also started getting my periods regularly, which had not happened since I'd stopped birth control.
After about ten months with my renewed health, a close friend who also had PCOS told me about her new doctor at a university hospital. He had taught her about artificial hormones and other environmental factors that may influence infertility. We could afford a co-pay or two, right?
I scheduled an appointment at the University Medical Center, not a dedicated fertility clinic. The doctor was a skilled clinician in a normal office. As any good doctor would, he listened intently to my situation, and he was thrilled that I was healthier and had more regular cycles because of my eating and exercise regimen. He explained some options but suggested I try another drug therapy before investing in a bunch of tests. The breast cancer medicine Femara, when used off-label in fertility patients, blocks estrogen production and doesn't have many of Clomid's emotional and physical side effects.
I started to feel pregnancy symptoms, but this was nothing new to me or Jason. The past three years had been full of phantom symptoms. I wanted a child so badly that I would read any bump or hiccup as a sign I was expecting. Imagine our surprise when, a month later, the pregnancy test was positive. It was surreal.
Jason and I were cautious throughout the first trimester. We didn't tell people and tried not to get our hopes up again. But on February 24, 2012, over three and a half years after we started trying, Madeline Kristine arrived and all the waiting was over. It was the end of a long road I hope never to travel again, and one I surely will never forget.
"Let's do a few tests ..."
It all starts easily enough: a blood test here, an ultrasound there. But what the tests can reveal run the spectrum of minor and fixable to dangerous and permanent. What follows is a survey of the most common causes of infertility in women. This list is by no means exhaustive, but it demonstrates how all things in our bodies and world work together to create a sustainable pregnancy.
Age
The first question I was asked at every visit to the fertility clinic was, "How old are you?" As long as I said I was in my twenties, I received a smile and a pat on the knee from the nurse. The implication was that there was nothing to worry about; the fertility clinic could help. Once I hit thirty, no nurse ever smiled again. Without words (and sometimes with them), they accused me of waiting too long to get pregnant and wouldn't make any promises about the clinic's ability to help such an "old" woman. They didn't need me dragging down their live-birth statistics.
While I would love to dismiss the sometimes-callous concern for a woman's age as discrimination, this ageism has been justified by the medical community:
• As a woman's age increases, the time it takes her to get pregnant also increases.
• Women under the age of thirty have a 71 percent chance of conceiving; women over the age of thirty-six have a 41 percent chance.
• For every five years of age, a woman's body is 10 percent more likely to spontaneously abort a pregnancy due to chromosomal abnormalities.
The truth is clear: the younger a woman is, the easier it is to have children. However, women are typically not in control of when they begin a family. What if a woman is thirty before she finishes her education, thirty-five before she reaches career benchmarks, or forty before she gets married? We will look more closely at the social and professional reasons more women are waiting to start a family in chapter 6.
Enometriosis
Affecting 8 to 10 percent of all menstruating women, endometriosis is the most common physical abnormality associated with infertility. In this pathology, uterine tissue is present outside the uterus. Commonly found around the ovaries and fallopian tubes, it has also been known to occur outside the abdomen, even at the base of the brain. It is a stubborn condition that is difficult to diagnose (requiring endoscopic surgery at a hospital) and nearly impossible to treat. One woman can have just a few cells of endometrial tissue and be unable to conceive; another's ovaries could be covered in the tissue but she may never know she has the disease and deliver as many children as she desires.
Of the women diagnosed with endometriosis, approximately 30 percent will be unable to conceive. This may happen for two reasons:
1. Endometrial tissue physically blocks the progress of fetal development, either preventing the egg from moving as it should or so thickening the uterine wall that a fertilized egg cannot implant.
2. Endometrial tissue produces hormones that imbalance the body and prohibit a sustainable pregnancy.
This condition is maddening not just for the woman, but for the doctor as well. Common treatments are hormone therapy and tissue removal, which may or may not allow for conception. Neither targets the source of endometriosis (which is unknown), so most women must wait until menopause to get complete relief from the often-intense abdominal pain and cramping associated with it.
Hormone Imbalance
Hormone When David and I jumped on the fertility train for the second time, our practitioner spent twelve months charting us. He took blood regularly and asked that we make significant lifestyle changes to try to balance our hormones naturally. At the top of the to-do list was eliminating artificial hormones from our lives. This meant changing all of our cosmetics and toiletries, eating biodynamically grown foods, repainting our house, installing a whole-house water filter, and replacing all of our floors with wood or natural stone. This was an expensive endeavor that still isn't completely finished six years later, but every change we made was valuable.
Artificial hormones are everywhere, and they are just as dangerous for men as they are for women. You commonly find them in plastics, house- hold dust, air fresheners, preservatives, cosmetics, and medications. It is impossible to avoid all artificial hormones all the time, but chapter 5 will explore how we can limit our contact with them without abandoning all modern conveniences.
Malformation
As my yoga instructor likes to say, "We are all made exactly alike, but with infinite differences." It's an encouraging reminder that not every woman can elegantly twist herself into every shape of pretzel Miss Evelyn prompts, and that I shouldn't push my muscles and spine to the point of injury for fear of not "looking like my neighbor." I may be able to touch the top of my head to the floor in a forward bend, but my neighbor can practically unhinge her hip joints.
Similar physical differences are certainly present inside our bodies as well. One woman may have textbook anatomy, but her neighbor has a disconnected fallopian tube. Thankfully, malformations of the body due to injury or congenital development do not automatically mean infertility—in one rare case, a woman had eleven children before her doctors discovered she had a malformed uterus and only one ovary. That's right: eleven children. In the cases where malformations are interfering with conception, endoscopy is a likely solution. Typically an outpatient procedure, "We are all made exactly alike, but with infinite differences." endoscopy is a nearly noninvasive surgery that produces little scarring on the stomach or at the site of the surgical repair.
Polycystic Ovary Syndrome
Kristine's story accurately reflects the frustration 5–10 percent of all menstruating women feel when diagnosed with PCOS. It is a condition that is equal parts mystery and complexity. Doctors refer to polycystic ovary syndrome as multispecialty, meaning patients need not only a gynecologist but also an endocrinologist, dermatologist, and nutritionist to properly manage it. It affects a woman both on the outside and inside. Symptoms include:
• acne flare-ups coinciding with the menstrual cycle, resistant to topical treatments, and requiring hormone replacement for full control
• excessive facial hair in unusual areas, such as around the chin
• male-patterned hair loss
• thickening skin in creases, such as the neck, elbow, and behind the knee
• insulin-related symptoms, such as high blood sugar, fatigue, fatty liver, and anxiety
• irregular menstrual cycles.
PCOS is a cyclical disease: insulin resistance can be a result of imbalanced hormones, but imbalanced hormones can cause insulin resistance. The most common and most effective therapy for fertility patients is breaking that cycle through weight loss, increased physical activity, and a whole-foods diet. Such lifestyle changes are important to any woman wanting to conceive, whether she has PCOS or not, and will be further explored in chapter 5.
"Try not to worry. It only makes things worse ..."
It has been clinically proven that stress reduces an already-infertile couple's ability to conceive. In a nutshell, stress naturally induces the body's fight-or-flight response, which raises hormone and protein levels in the blood. As our brains focus almost exclusively on physical survival, less-necessary processes (such as reproduction) are slowed down or stopped entirely.
When there are so many possible causes of infertility, fear and worry are natural reactions. A patient wants answers as soon as possible, so it is tempting to turn to the Internet. Thanks to medical websites, we have all become armchair physicians. Unfortunately the information at our fingertips tends to highlight the rare and worst-case scenarios. No matter how much time we spend "researching" a condition online, no amount of anecdotal or even quality medical information will alleviate tension.
Instead of indulging our curiosities after an infertility diagnosis, we patients should practice patience and wait for the informed opinions of the medical professionals. I am not suggesting you be apathetic in advocating for your health. Make sure you are comfortable with your physicians and clinicians, ask them every question you can think of every time you see them, and trust them. Do your best to partner with a doctor who shares your value system. You may encounter life-threatening issues together as you and your husband attempt to conceive, and you are more likely to trust a practitioner with your worldview. If you ever find yourself doubting the care you're receiving, change doctors—don't become your own. A trusting relationship between a well-educated, well-liked doctor and an infertility patient is an effective way to manage fear during this uniquely stressful time.
(Continues...)
Excerpted from Barren among the Fruitful by Amanda Hope Haley. Copyright © 2014 Amanda Hope Haley. Excerpted by permission of Thomas Nelson.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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