Myth: The Ability to Get Pregnant is My Hall Pass Out of Infertility*

Busted! Many couples who have gotten pregnant in the past are still diagnosed with infertility. A couple may be unable to conceive or maintain a pregnancy after having successfully done so before. This is called secondary infertility. It is thought to be more common than primary infertility, and its causes are similar to the causes of primary infertility. Another version of infertility occurs when a couple is able to conceive, but their pregnancies do not result in live births. This is called recurrent pregnancy loss. It is far less common than than the simple inability to conceive. Sources differ on the actual statistics of recurrent pregnancy loss (or RPL), saying it affects as many as 5% of women of childbearing age, or as few as 1 in 300. In any case, I am one of those women.

The pain of a miscarriage is different from the pain of infertility, although in both cases, parents-to-be morn for their lost hopes. However, most couples who experience an isolated miscarriage can and do go on to have healthy subsequent pregnancies. In fact, one in four women experience a pregnancy loss at some point during their reproductive years. The fact that isolated pregnancy losses are so common, does not in any way diminish the pain felt by the bereaved parents. A single miscarriage is still very painful. However, an isolated loss is not usually considered an indication that the couple will experience problems in future pregnancies.

About half of all miscarriages are due to chromosomal problems in the fetus, and these types of problems are not usually predictive of the outcomes of future pregnancies. Most isolated miscarriages fall into this category, but sometimes back-to-back miscarriages can also be due to these, supposedly non-recurring, chromosomal errors. The other half of all pregnancy losses are primarily due to problems in the mother's body, although there is some evidence that there are paternal causes of miscarriage, as well. When there is a maternal or paternal cause for pregnancy loss, the result is that nearly every time the couple conceives, the mother will miscarry before term. Losing pregnancy after pregnancy, baby after baby, is very emotionally painful for the couple. Medical advances have made testing and treatment for the causes of RPL more and more available, but most couples suffer through at least two or three devastating losses before any investigation is even begun.

RPL is defined as three (or sometimes two) back to back pregnancy losses. It is considered a form of infertility, because, the more miscarriages a woman has, the more likely it is that they are due to a recurring, maternal or paternal factor, and the less likely it is that the mother will carry to term without medical assistance. Many of these recurring problems can be diagnosed and treated, just like many of the problems that interfere with conception can be diagnosed and treated. Infertility is a disease in which a couple needs medical assistance in order to conceive and carry a pregnancy to term and give birth to a healthy baby.

Couples who struggle with any form of infertility, including RPL, experience a roller-coaster of emotions, ranging from hope to despair. There is also the marry-go-round of testing and treatment to contend with. Sometimes a couple gets lucky and the first cause found is the single cause. In these cases, treatment is usually effective quite quickly. In many other cases, multiple causes are found, and no one ever knows exactly which treatment was the "key treatment". Couples are often put through basic initial testing, treated for the first cause found, and then only tested for more causes if that treatment doesn't work. This approach means that precious months or years may be spent on useless treatments, before all the causes of the couples infertility are found.

One of the most painful experiences for a couple to go through is a miscarriage after infertility. Finally, often after several years of treatment, the couple conceives, only to have a miscarriage. This sometimes happens because of non-recurring issues, but all to often, it happens because of recurring issues that weren't tested for in the infertility work-ups. RPL is often the final form of infertility found, because it is only discovered once the couple finally conceives. It is heartbreaking to loose any pregnancy, and doubly so when the loss comes on the heals of months or years of trying to get pregnant in the first place.

Comprehensive testing for all potential reproductive issues, whenever infertility is suspected, could save time, heartache, and money in the long term. However, many doctors do not offer this kind of comprehensive testing, and many insurance companies will not cover these tests, or the necessary treatments, making such testing prohibitively expensive. Even when a couple knows that comprehensive testing is available, the thought, "The solution could be simple, so why spend all that money on potentially unnecessary tests?" can be very seductive. It can be very hard to be your own advocate and request more testing than your doctor offers. The emotional turmoil that almost always accompanies the experience of any form of infertility is very draining and leaves little energy for self-advocacy.

Emotional turmoil is one of the hardest parts of dealing with infertility. The experience of RPL, in particular, is an extreme roller-coaster ride from hope and joy, to grief and despair. Each pregnancy brings a painful mix of hope and anxiety that can be very, very difficult to cope with. The following poem tells the story of my experiences in dealing with RPL so far.

Spark, Star, Seed

A little spark of life flickers and trembles with promise
Hopes blaze up only to collapse in ash
A phantom baby slips away

A new star blinks and bursts into flame
Blazing a trail of bright hope
Across an imaginary future

A black, baby-shaped hole opens
Life-sucking grief swallows all joy

Denial Not my life NO!

okay . . . alright . . . This is what is

Family history leads to tests
Life becomes a series of acronyms in a land of refills, needles, herbs
Plans to begin again are laid

Windblown seed falls on fertile soil, sprouts, and stets down roots
Suspicion germinates hope,
Envisioning growth, focusing on each moment, each now

Roots lose their grip, sap ceases to flow
Left empty, an Unmother, again

Left to face the labels:
Recurrent Pregnancy Loss
Infertility

Left to embrace the sisterhood of Unmothers

Why, God?
Why?

*Title inspired by starfishkittydreams

Because 1 in 8 is someone you know.  National Infertility Awarenss Week, Infertility 101