Infertility as Disease: Accepting and Navigating the Medical Side of Infertility

It was my first Mother’s Day mass after being married.  The previous month I had an experience where I was sure I was pregnant. I can’t explain this experience, and no test I took that month was positive.  But the next cycle did arrive later than usual and with more pain than normal.  During the consecration, my husband and I began to sob.  We felt a sense of loss that we couldn’t explain, a sense of deep heartbreak. And then during the blessing for mothers, the priest saying mass didn’t include Godmothers or spiritual mothers, so I didn’t stand up for the blessing.  And I cried even more, because I so wanted to be able to stand up for that blessing.  It was after that experience, that my husband and I decided to seek medical help for fertility because of my medical history. Making that decision was very emotional for me, because it meant opening up a very private part of our lives to medical intervention.

Infertility is not merely a cross or a struggle.  It is a symptom of an underlying disease. According to RESOLVE, about 12% of married women (1 in 8 couples) have trouble getting pregnant or carrying a pregnancy to term.  Of those struggling with infertility, approximately one-third is related to female causes, one-third related to male causes, and one-third is attributed to both or is unexplained. Trying to figure out what is causing this struggle has been a trying and long journey. Besides my hormone levels and pain, we have very few clues as to what could actually be behind our infertility.  The CDC lists numerous possible causes for infertility in women, including but not limited to Polycystic Ovary Syndrome (PCOS), improper function of hypothalamus or pituitary glands, obstruction of the fallopian tubes, abnormalities of the uterus, and endometriosis.  Infertility in men can be caused by varicoceles, diabetes, autoimmune disorders, heavy alcohol use, improper function of the pituitary and hypothalamus, and cancer treatments.  However, many of the causes of infertility remain unknown.  It is my hope that our scheduled consultation with a NaPro surgeon might give us some answers.  Sometimes a couple can be perfectly healthy in all respects though, and still struggle with infertility.

Infertility needs to be treated as any disease would be.  I am grateful for the experience I had with Napro-technology as a teenager.  Rather than simply handing me the pill, they showed me how to track my cycles.  I learned more about my body, my cycle, and how I was affected by my cycle.  I learned more about what should happen when my reproductive system is functioning normally. I took bio-identical progesterone timed with my cycle to help adjust my hormone levels. I learned from my experience with Napro-Technology as a teenager that I should expect medical care that respects my dignity and seeks to provide me with a treatment that addresses the underlying cause of my symptoms.

It was natural then, when we decided to seek medical advice for achieving pregnancy, that we turned to Napro-Technology (NaPro) again.  Developed by Dr. Hilgers at Creighton University, it is a system of treating infertility that is rooted in Catholic theology and modern science.  I am immensely grateful for my doctor and the doctors that trained him in this system.  NaPro is an alternative approach to infertility treatment.  Many treatment systems begin with trying to identify physiological causes of infertility, but then move into artificial reproductive technologies such as artificial insemination, IUI, IVF, and others. NaPro sets itself apart from other treatment systems because it uses knowledge about the women’s cycle and hormone levels based upon her fertility charts to treat her.

Unlike common suppressive or destructive approaches, NaProTECHNOLOGY works cooperatively with the procreative and gynecologic systems. When these systems function abnormally, NaProTECHNOLOGY identifies the problems and cooperates with the menstrual and fertility cycles that correct the condition, maintain the human ecology, and sustain the procreative potential. -NaProTechnology site

Since NaPro is rooted in Catholic theology, I know that none of the treatments recommended by my doctor will be contrary to Catholic teaching.  The Church teaches that the procreation of children should remain within the marital act.  Having experienced the heartbreak of infertility, I can understand why couples turn to artificial means for having a child, and they have my deepest sympathies.  We should not treat parents who have turned to artificial means of treatment harshly, nor should their children be treated differently, as their children have equal dignity.  That being said, for my husband and me, we know that these are not an option for us.  I see in treatments like IVF and IUI the same sort of approach that using the pill to treat all cycle issues results in–treating the symptoms and not the disease. This is precisely part of Dr. Hilger’s motivations for creating the system of NaProTechnology, after he observed a paradigm shift in the treatment of infertility.

“Until 1978, most of the effort in medicine in evaluating and treating women with infertility was placed in trying to identify and treat the underlying causes.  In 1978, in vitro fertilization produced a paradigm shift.  It led to a “skipping over” the causes and this continues up to the present time to be the foundational management approach.  In essence, this is a symptomatic or Band-Aid approach to treatment, not one that gets to the root causes.” -NaProTechnology site

Fortunately, NaPro is just as effective (and in some cases more effective) as IVF and it is less expensive.  Treatments used by NaPro involve hormone correction, fertility-focused intercourse, use of modern fertility medications such as Clomid or Metformin, and surgery to correct possible endometriosis, tubal occlusions, and other physiological issues. NaPro results in pregnancy in 38.4-81.8% of cases, depending on underlying causes (NaPro textbook, pg 691).  IVF, however has between a 20-40% success rate.

If you are struggling with infertility, there are options for you.  You don’t have to spend $10,000-$12,000 on fertility treatments.  You can seek treatment that helps you understand the underlying cause of your fertility issues. There is hope, and there are doctors that don’t use NaPro that take a similar approach.  I do know that NaPro isn’t for everyone, and that many Catholics approach NaPro as a miracle fix for infertility.  It can actually be hurtful to couples with this struggle when NaPro is approached as the “end all be all” infertility treatment.  The reality is that 20-60% of NaPro patients don’t get pregnant, depending on the underlying cause.  There is nothing that any person can do to guarantee a pregnancy. Sometimes that is hard to accept. The greatest blessing of using NaPro is remembering that children will happen in God’s time.  We cooperate with Him by seeking medical help and better understanding my fertility, but in the end, the Lord is in control.  It is God who creates and gives life.  And while I sometimes want to shout at the Lord, “Why not now, God?” I know that this suffering is not without purpose.  I know that His timing is perfect, though His timing doesn’t seem to match my plans.

Through it all, I learn to let go.

I let go of control, I let go of my pride.  I let go of my desire for having a child to be easy.  I am humbled each time I have to take medicine so that my body can do what it already should. For a time I would spend the evening crying after every blood draw, as they were a reminder to me that my body was broken. I now begin to look at every pill, every medication, every procedure as part of my labor. For after the fall of man, God said to Eve, “I will intensify your toil in childbearing; in pain you shall bring forth children” (Genesis 3:16).  I have come to understand that toil in childbearing is not limited merely to the actual birth of the child.  For those with infertility, it is all that they undergo in order that their bodies may function as they should.  It is all that they do to try to cooperate with God in procreation.  I still struggle with accepting the medicalization of this process.  It feels like medicine is invading something that should be very private and deeply personal.  I still struggle with the stress that comes with trying and hoping again each month.  But I have learned that when I hand these things over to Christ and say “Not my will, but thine” that I feel a sense of peace.

My husband and I are helpless in a sense–there is nothing in our power that we could do to guarantee that this month will be “the month.” But what we can know is that Christ holds us close to His Heart.  He walks with us as we try to walk with Him on the path to Calvary.  And when we reach Calvary, we cling to hope.

For we know that on the third day, there will be the resurrection.

 

This is the third post in a series for National Infertility Awareness Week. You can read the first two here: Gratitude: The Gift Amidst the Cross and here: Put Out Into the Deep 

Put Out Into the Deep

I remember sitting in the doctor’s office where I was shown a chart of normal hormone levels throughout a woman’s cycle.  The doctor told me, “These are the normal levels. These are yours.”  And as I looked at the second line, I realized that where my progesterone and estrogen were supposed to be gradually rising before dropping off slowly like a bell curve, that mine dropped down in a nearly vertical line.  I knew enough about ovulation and conception to know that successful conception and implantation for a baby would be rare at those levels. I then understood that the severe pelvic pain I felt after running and at other times resulted in part from these low hormone levels.  That was the reason I was there after all: the pain.  I was too young to worry about having a baby, and yet, it was at 16 that I found out, though it wasn’t explicitly stated, that for me, having a baby would more than likely necessarily involve hormone support.

The issues with the pain seemed to get better, and eventually I stopped the progesterone support for the pain. When I thought I was going to be a sister, or nun, the knowledge that my hormone levels were off and that having a baby might be difficult for me didn’t really bother me.  In fact, I used it as a sort of confirmation that I might be called to religious life.  I thought, “Well, since having biological children might be difficult for me, then perhaps God is calling me to a spiritual motherhood.”  Of course, I hoped that my levels had improved with age.  I hoped that it was just a passing thing that happened because my adolescent body hadn’t quite figured itself out yet.  And I hoped for those things all the more when I began courting Nicholas and knew that I would end up marrying him.

I remember the first time I told Nicholas about my experience with NaPro Technology as a teenager.  It came up because we were talking about NFP and children. I told him about how odd I felt learning NFP at 16 so that the doctor could figure out why I was feeling pain. And then I told him that I feared future struggles with infertility.  I told him my hope that the issue had resolved and my deep fear that maybe it hadn’t.  He listened, and though he too was wary, he assured me that God would carry us through whatever struggles we went through.  And so when we were married, we knew that infertility might be a struggle for us.  But we clung to hope that it wouldn’t be.

I remember my first “two week wait”.  Before then, I had thought that pregnancy just happened.  I hadn’t really considered the waiting that was involved.  I hadn’t thought at all about the wondering that would happen between that week of fertility and the week that the next cycle was due.  I hadn’t thought about all the hope that could build up in those weeks, only to be brought disappointment when the next cycle arrived. And I hadn’t thought about the fact that because these were cycles that a couple went through the same roller coaster of emotions each month.

This reality felt like a slap to the face.  I wondered why no one had told me about this stress during my marriage prep.  I wondered why infertility hadn’t been talked about either.  And I was angry that people talked all about the struggles of using NFP to avoid pregnancy, but didn’t talk at all about the emotions and struggles that come with trying to have a baby.

And sometimes, it felt like I was drowning in my emotions.

Nicholas wrote me a letter and handed it to me the morning of our wedding.  The final line read, “Let’s go get married, our children are waiting for us.” I want to sob even as I type that line.  Because now, I feel like I’m waiting on them. I feel like I’m waiting on God.

Charts cover my deep blue dresser next to green, yellow, red, and white stickers. They remind me that it is time to take the progesterone that is in the steel refrigerator downstairs and the estrogen in my small bathroom. Another glance reminds me that I need to go to the hospital today to get my blood drawn to check my hormone levels. I do this every month; it is now routine. I am now used to the needles, I am now familiar with which arm is the easy stick and which is the difficult stick, and I know when the nurse is struggling to draw blood without hurting me. There is a familiar script that the nurse and I go through. Often she comments that my blood doesn’t clot well. I laugh and tell her that my dad has commented on the same thing. Sometimes we talk about how I hate needles and used to faint when I was stuck with one, and then we both laugh as I tell the nurse that my father, an anesthesiologist, is afraid of needles.

I wish I could tell you that I am going to give an outsider’s perspective on National Infertility Awareness Week. I wish I could tell you that this hasn’t been my reality. I wish I could tell you that this has been easy for us. But since we were married in January 2016, we have been open to life. And no babies have come.

We started seeing a NaPro doctor in May, four months after our marriage, because of my previous medical history of low progesterone and low estrogen.  We found out that I was still dealing with that. And we hoped that it would be a simple matter of giving me the hormones that my body wasn’t making.  Maybe it still is and it’s just taking time.  Since then, I’ve started Clomid.  I’ve had an ultrasound to check for ovarian cysts. I’ve had an HSG to check that my fallopian tubes were clear.  And after talking to my doctor, we’ve scheduled a consultation with a NaPro surgeon for possible endometriosis.  It’s the only thing that seems to fit my symptoms at this point.

I get my blood drawn every month. I have a list of medications to take. And it feels sometimes that medicine is invading our bedroom and sometimes I just want to scream, “Enough!”  But that’s what infertility does. It makes you feel like you’re drowning. And yet, the waters we drown in are not without purpose.

One in eight couples struggle with infertility. Infertility is defined as the inability to conceive within a year or multiple miscarriages for women under 35.  NaPro Technology, a system of treating infertility in line with Catholic morality, defines infertility as the inability to conceive after six months of fertility-focused intercourse. Infertility is a disease, as there is something that is preventing the reproductive system from functioning as it ought to function. Couples can struggle with primary infertility (the inability to conceive a first child) or secondary infertility (the inability to conceive a child after a first has been born). Either way, infertility is a true cross that brings inconceivable grief. (I despise puns, and when showing this draft to my husband he remarked, “This is the saddest pun I’ve ever read.”)

And yet, I hear the call amidst the crashing storm, amidst the drowning waves of my emotions: Duc in altum. Put out into the deep.

And I am tempted to look at the Lord as Peter did and say, “Master,  we have worked hard all night and caught nothing, but at your command I will lower the nets” (Luke 5:5). I am tempted to look at Christ and seeing the strong wind surrounding me exclaim, “Lord, save me!” And yet, our Lord turns to us, “[stretches] out his hand and [catches us], and [says] to us, ‘O you of little faith, why did you doubt?'” (Matthew 14:31)

Christ is using this struggle to call me to a radical trust. I have been broken by this struggle, and that is good.  Because in my brokenness, I am able to turn to Christ more deeply. I am able to look at the Cross and say to Jesus, “Can you not see that I am drowning beneath the waters of infertility, tied down by the weight of this Cross?”  And Jesus smiles at me and lovingly says, “Yes, but the water you are drowning in is the sea of my Mercy. The Cross you carry is My Cross.  Your pain is my pain. Come to the water. Come and drink, and have new life within you. Come and drown in my mercy, and be renewed by it.”

It may seem counterintuitive, but I have found deeper life in my struggle with infertility. I have found a deeper desire to rely on my husband and on the Lord, something that is particularly difficult for me.  I want to have control.  I don’t want to rely on others or ask for help, because I often view that as weakness.  And while it is deeply humilating for me to say that my husband and I need medical help to have a baby, it also points to the deeper truth present in the Body of Christ: that we all have need of Christ and that we all have need of the other members of the Church.

Through it all, I hear one call, “Duc in altum—put out into the deep.” Peter went fishing, but caught nothing. Christ asks him to go deeper, to trust, despite the fact that they have caught nothing all night.

I await the day when I am able to put out into the deep, to trust the Lord’s Mercy with infinite hope, to believe in his promises, and then be rewarded as Peter. I want to look at Christ and say, “Lord, at your command, I will lower the nets. I will trust in your promises and your Mercy. I will trust that you have plans for my welfare and not for woe. I will trust that you have plans for a future full of hope.  I will stand at your Cross, I will be with you in this storm, and I will await the resurrection and the calm.” For after Peter put out his nets into the deep, “they caught a great number of fish and their nets were tearing.  They signaled to their partners in the other boat to come to help them. They came and filled both boats so that they were in danger of sinking. When Simon Peter saw this, he fell at the knees of Jesus and said, ‘Depart from me, Lord, for I am a sinful man.’  For astonishment at the catch of fish they had made seized him and all those with him.” Luke 5:6-9

All were astonished at the Lord’s greatness and mercy.  I await the day that I may walk out onto the water trusting in the Lord’s goodness, and be astonished by the abundance of graces, blessings, and gifts that He pours out upon me. And so each day, each week, each month, I step out of the boat again. I cast out into the deep again.  Sometimes I drown, and that’s okay. I try to imitate Peter in his radical trust, knowing that the Lord is good and He will answer me. For though I am carrying this cross with Christ and my husband right now, I know that there will be the resurrection.

 

This week I am going to be releasing a series of posts for National Infertility Awareness Week.  It is my hope that this series may provide comfort to those struggling with infertility, while being a tool for those who have friends or loved ones with this struggle.

You can read the second post here: Gratitude: The Gift Amidst the Cross