WHY IS FERTILITY INFO SO ELUSIVE?

here are three stages in a person’s life: not knowing where babies come from; knowing where babies come from; and knowing where babies come from. Most of us reside in stage one until grade school health curriculums reveal the illusion of the stork. Then we progress to stage two, and many people blessedly remain there the rest of their lives, conceiving with the candlelit ease of a Nancy Meyers movie. Yet for those of us that have had issues with fertility, stage three looms, where one learns way more than they ever wanted to know about where babies come from. In 2018, my wife and I entered stage three.

We began the process of trying to conceive with hope and an open mind. But as the months passed and hope turned to concern, we craved answers. We consulted with friends who’d had fertility issues, but their experiences were so singular it was hard to know what was relevant for us. Should we try the conceive-under-a-full-moon-at-midnight method, or go straight to IVF? Both were apparently viable options.

Then there were the blogs, replete with intensely personal stories that were both hopeful and harrowing but rarely anything in between, and full of esoteric shorthand and abbreviations, like BD for “baby dance” (i.e., sex), DH = “dear husband”. Everything was anecdotal, only each anecdote was suffused with a level of emotion that didn’t exactly soothe our anxious souls or provide a sense of direction.

Lastly, there were the doctors. When we bit the bullet and scheduled an appointment with a fertility specialist, it was like stepping onto a conveyor belt that had only one destination: medical intervention. I’ll never forget sitting with the first doctor we consulted in an antiseptic room in Mount Auburn Hospital. She laid out our options as if the choice was between a leather or suede interior; as if we were deciding on what kind of procedure rather than if.

“Would you recommend we keep trying for a couple of months?” my wife, Courtney, asked at the end of the clinical presentation.

“Well, you’re here, aren’t you?” she answered. “It seems like you’re ready.”

But we weren’t ready. We wanted to understand what was going on, yet it was hard to tease out the salient from the sensational, and the most obvious lesson from that period was that it is hard to learn about conception. We had entered what I began to call the “fertility fog.”

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Why is it so hard to learn about fertility? For one, there is the sexist research history that has left gaps in the medical literature regarding women’s health. In addition, women are typically assumed to be the problem, despite male infertility making up over half of global infertility cases. This assumption skews research away from male infertility issues, providing an incomplete picture of how and why conception occurs. After all, it takes two to tango, and the manifold factors that determine fertility are difficult to isolate. When couples have trouble conceiving, pinpointing the precise reason can feel more like art than science.

“It’s a strange field of medicine because it’s more about statistical probability than getting to the cure,” noted Dr. Alison Zimon, a fertility specialist at CCRM Boston. “In some cases we find an absolute barrier, and we know that without intervention no pregnancy can occur. But we often don’t find that absolute barrier, and so we’re playing with probabilities. I think that’s what makes it confusing for people. They just want to know why.”

Finding an absolute barrier can be crushing. Chiemi Rajamahendran, the founder of Miss.Conception Coach, works with couples dealing with infertility trauma and loss. Her online community began as a resource in 2014 after she experienced her own pregnancy loss, and she has since counseled many people through one of the most trying periods in their lives, amassing over 37,000 Instagram followers in the process.

“The experience is confusing because the learning curve is huge and not only is all of this info intense but life-altering,” explained Rajamahendran over email. “The pivots that people have often come out of left field and lead to decisions based on ratios and statistics and worse, with a timeline that feels looming.”

Making impactful life decisions based on ratios and statistics was not something Courtney and I anticipated when we began the process of trying to conceive. After consulting with Dr. Zimon, we were grateful to learn that we had a chance to conceive naturally (and to have found a compassionate doctor with whom we connected). But we also learned we had longer odds. We were in the gray area, conception improbable but not impossible, playing the probabilities.

According to the American Pregnancy Association, 30% of couples achieve pregnancy within the first month, 60% within three months, and 80% within six months. We were well past six months when we met with Dr. Zimon and were on the verge of intervention. Did our longer odds mean that eventually, we would conceive, or that we were wasting precious time in a limited fertility window? After debating this privately for months, and on the cusp of giving up and turning to IVF, we let down our guard on vacation. That’s when we conceived.

It was a stressful time, but all things considered, we had it easy. Many couples try for much longer to no avail, and many deal with much deeper traumas and struggles. Yet the experience revealed how much of a stigma there can be around infertility, and the fact that it can be hard to know where to turn. Part of the reason we spent so much time Googling things and scouring message boards was that scheduling an appointment would feel like admitting defeat.

“There are so many stories, views, and perspectives online, and infinite scrolling often feels overwhelming,” related Rajamahendran. “Often at this middle place, we realize that the people closest to us are not always the ones who we share with and turn towards to feel validated in our fears and pain.”

So what can couples do to navigate the fertility fog aside from doom-scrolling and bottling up their emotions in a pressure-cooker? Rajamehendran recommended leaning into the emotions that come up.

“Remind yourself you are doing this all for the first time and you aren’t supposed to have all the answers,” said Rajamehendran. “There are no ‘negative’ feelings, only different fears and levels of loss. You don’t have to judge these feelings or internalize them. You can give yourself grace in the wait and confusion.”

Given the ease of telehealth appointments these days, and the fact that knowledge of one’s reproductive health will set the parameters of what is possible, Dr. Zimon highly advocates for scheduling a fertility assessment. Whether one is single, in a relationship, or simply reproduction-curious, she believes it to be an empowering step. “Don’t hesitate to acknowledge that this is something you want to learn more about and then go ahead and use the tools and supports around you,” she said. It would lead so many more people to stage three—knowing where babies come from—before arriving there through the fog, confusion, and pain of infertility. And wouldn’t everyone appreciate the magic of conception so much more if they knew what a miracle it could be, long odds or not?

Courtney and I have a two-and-a-half year old daughter and are hoping for another child. This time around we know the odds, and we know where to turn should we require support or intervention. We’re staying off the message boards and having more conversations with friends about the process. Though we occasionally get the blues, we feel far removed from the confusion that shrouded us the first time around, and far more aware of the fact that we’re not all living in a Nancy Meyers movie. Our reality is all the richer for it.