Infertility. Geriatric pregnancy. Spontaneous abortion. Incompetent cervix. These are the words and phrases that those struggling to conceive often hear from their doctors — clinical, isolating, demoralising terms seemingly wrought from another time (and yet another patriarchy), inadequately revealing the many shades of grey that characterise all the many corresponding paths to parenthood. They don’t show the grief of losing a pregnancy, the stigma of being 30-something without kids — or the fact that being diagnosed with infertility doesn’t mean the end of a dream to become a parent. This is because fertility isn’t binary — “fertile” or “infertile” — but rather a diverse spectrum of biological markers, chronic conditions, medical procedures, and the multitude of journeys people take toward parenthood.
Over six million women in the U.S. ages 15 to 41 struggle with the medical diagnosis of “infertility,” (and one in eight women in the UK) which means having trouble conceiving or staying pregnant after having unprotected intercourse over a specified period of time. It’s a loaded term that many perceive as the death knell for their hopes of becoming a parent, but in reality it’s an inflection point where the treatment and advice of a reproductive specialist can bring new knowledge and possibilities.
Because having a baby is an individual and occasionally complex experience, and restrictive labels such as fertile and infertile do way more harm than good.
The factors that determine how easily you’ll be able to reproduce vary. Age, as we all know, plays a big role in pregnancy, but it’s not the only thing. Variables such as unique health conditions, habits, partner fertility, access to care, financial support, or desire to have children in the first place all play a big role, too. And despite biology’s indisputable facts — you’re born with a fixed number of eggs that declines as you age — a person in their late 30s could in fact have an easier time getting pregnant than a person in their late 20s. Because having a baby is an individual and occasionally complex experience, and restrictive labels such as fertile and infertile do way more harm than good.
It’s time to see and talk about our ability and desire to have kids in a new way. And hopefully launch a long overdue dialogue that shines a light on this crucial topic while also helping to remove the stigma and shame that so often accompanies difficulties conceiving. Introducing The Fertility Spectrum — a collection of surveys, interviews, and essays that allows us to see fertility through fresh eyes and puts some of the power back in the hands of potential parents everywhere. “It’s not black and white,” says Dr. Rachel McConnell, a fertility specialist at Columbia University Fertility Center. “Just because you have difficulty getting pregnant doesn’t mean that’s going to last, or that will not change,” she says. In fact, the majority of patients that have infertility struggles eventually will become pregnant, she adds.
That “eventually,” however, can easily read like “never” if you’re in the thick of it, getting one line on pregnancy pee sticks month after month. Add that to the fact that many of us are still reluctant to openly discuss our fertility journeys — whether they’re joyous or debilitating — and you’re left with a lonely, confusing, and potentially costly process to navigate on your own.
What’s more, many of us never even learn how our reproductive systems work in the first place. You might remember the date of your last period, but do you know when you last ovulated, or which days in a month you’re most likely to conceive? Learning how to track this, while also figuring out why you can’t get pregnant, can be embarrassing, depressing, anxiety-inducing, and isolating. Studies have shown that women trying to conceive have the same levels of anxiety and depression as women with cancer, AIDS, and heart disease.
There’s a “cloak of vague sexual shame” surrounding infertility, says Dr. Alice Domar, the executive director of the Domar Center for Mind/Body Health. “It affects every aspect of a woman’s life.” But we can shed this shame if we can ultimately reframe the language around fertility. That’s why it’s important to talk — with candour and realism — about the wins and losses of expanding our families and to educate ourselves about our bodies and options.
We know that the majority of fertility issues arise from a physiological source, such as problems with ovulation or hormonal imbalances. Structural issues are also common culprits, such as blocked Fallopian tubes or uterine fibroids. If someone has a history of endometriosis, polycystic ovarian syndrome, or an autoimmune disease, those conditions can affect their ability to get pregnant, too. Then, there’s male partner’s fertility, which accounts for one-third of all fertility issues but is rarely talked about. And finally, there are a variety of key lifestyle factors that can influence your fertility, including smoking, diet, stress, and alcohol consumption. But many don’t know where they stand with regards to these factors until they’ve already struggled to get pregnant and are seeking help from a specialist.
The good news, however, is that if you’re thinking of having kids, deciding whether or not to, or having trouble conceiving, your options are growing rapidly. Successful treatment varies based on the cause, and can range from medications that stimulate ovulation, surgery to repair uterine problems, or intrauterine insemination. Depending on the scope of concerns, you may also require assisted reproductive technologies, such as IVF, donor eggs and sperm, or a surrogate or gestational carrier. Egg freezing, while new and not entirely foolproof, represents a new wave of freedom for those choosing to delay parenthood for a variety of personal reasons. Then there are those who adopt or foster children — a beautiful way to grow your family and give a child in need a home.
Some of these options aren’t available to everyone primarily due to finances, however, and outcomes vary greatly. A single round of IVF can cost between $10,000-$15,000 in the U.S. (in the UK, if you can't get it on the NHS, a single round can cost up to £5000) and most people undergo several rounds. The success rate for the relatively new procedure (it was first fully completed in the late ‘70s) is roughly around 48% for women under 35 — and that percentage decreases as you age. Egg freezing can cost close to $17,000, including procedure and storage (costs are around £5000 plus storage in the UK) and a frozen egg doesn’t mean a future baby. Most fertility care isn’t covered by insurance and the statistics are a sobering reminder of just how unattainable reproductive advances are to most: the average salary for full-time, year-round working women is $41,512 (it's a little lower in the UK - about £25k), while the median U.S. household makes $57,617 (the median household in the UK has around £28.4k disposable income). According to survey from FertilityIQ, a startup that provides crowd-sourced data about fertility clinics and doctors, women with a household income of $100,000 are two times more likely to achieve success from IVF than those who make under $100,000.
Thus, in an effort to gain greater insurance coverage, many medical professionals are rallying for fertility issues to be recognised along the same lines of other serious health conditions. Because while some consider procedures that help you conceive or carry to term a child as elective, they’re not. “When you think of all the things insurance covers, why would being able to create a family not be one of the most obvious?” Dr. Domar says.
The road to becoming a parent, loving and rearing a child, and having a “family” — however you define that — are myriad, and everyone’s journey is personal and different. If you can’t get pregnant easily at first, you’re not exactly “infertile” as medical textbooks and protocol might lead you to believe. You’re simply somewhere on the Fertility Spectrum, just like the rest of us.