How Does Anyone Have a Baby?

If you are having difficulty getting or staying pregnant, you are not alone. At some point, infertility affects 15% of all couples. Recurrent pregnancy loss affects another 3% of couples.

If you are one of these couples, you may feel isolated and depressed. You will get all sorts of helpful and unhelpful advice from people (including yourself) who really do care. Perhaps one of the worst things someone can tell you is to “relax” or “quit trying so hard.” This advice generally has two effects:

To make you even more tense.

To make you think it’s all your fault.

At Tennessee Reproductive Medicine, we understand the stress that infertility and pregnancy loss causes. While it is true that in extreme cases stress can cause a woman to stop ovulating, very rarely is stress a cause of infertility. If stress isn’t causing the infertility, as so many people commonly think, let’s consider what is normal and abnormal in the world of conception so you can take charge of your fertility. 

Normal Conception Rates
After one year of adequate unprotected intercourse, 85% of couples ages 20-40 will be pregnant. Of the 15% who aren’t pregnant, half of those will be pregnant within the second year. The monthly chance of conceiving among couples in which the woman is less than 32 years old is approximately 20-25%. This illustrates that human reproduction is very INEFFICIENT! It may take some couples many months to conceive and this is within the range of normal. After age 32, monthly conception rates start to decrease slightly, then more significantly after age 35 to about 10-15% chance per month.

When Should I Seek Help Conceiving?
Infertility is considered the lack of conception after 12 months of unprotected regular intercourse (timed adequately during the suspected time of ovulation). All couples who have not conceived after 12 months warrant a full evaluation. While some couples will spontaneously conceive after 12 months of attempts, most will need some form of fertility therapy and further attempts at natural conception may be wasting precious time.

Furthermore, many couples warrant a sooner evaluation if there is a history suggestive of:

-ovulation disorders
-tubal disorders
-male reproduction disorders
-female greater than 35 years old
-endometriosis
-female with prior radiation or chemotherapy treatments

Do I need a fertility specialist?
Sometimes this is an easy question to answer, sometimes it's difficult. Consider your situation and conditions by taking this TRM Quiz at http://www.trmbaby.com/welcome/do_I_need_fertility.shtml. If the total number of points equals or exceeds 15 points, and you wish to conceive, strong consideration should be given to seeing a fertility specialist, specifically a reproductive endocrinologist.

The Unspeakable Truth

It was something we didn’t talk about.

Because we were both secretly ashamed of it, my wife and I didn’t admit it to each other. We barely wanted to admit it to ourselves. We certainly didn’t discuss it with even our best friends – some of whom may be reading this now.

And before I go on, let me say that I believe what I am about to tell you says much more about me and my wife than it does about our friends. At the same time, what I am about to describe is a nearly universal experience for couples with long-standing infertility.

So here goes.

When we were struggling to get pregnant and if you got pregnant… we hated you.

It’s true. (Though my wife denies this, officially.)

We hated you because you were so happy. We hated you because you didn’t want to tell us you were pregnant, because you didn’t want to hurt our feelings. We hated you because we felt abandoned. It was one more reminder that we were relatively alone in this predicament.

It was even hard to feel happy for other infertile couples who finally conceived. When they got pregnant we felt even greater abandonment.

Now there were times when I tried to soften this word, tried to work around it and redefine it. I’d call it anger at our situation. I’d call it envy, jealousy, resentment, spite…

But in the end, all those words and all those emotions still felt the same… they felt like hate or some other withering emotion.

And like hate, this emotion took much more of a toll on me and my wife than it did our friends.

In fact, I’m not sure anyone ever knew how we felt. My wife hosted baby showers for friends, visited new mothers in the hospital, held new babies and marveled at them.

So no, we weren’t totally consumed by these negative emotions, but they were always there… like a slacker college roommate who never left the couch. While our friends were largely unaware, we had to live with the negative emotion. We had to secretly wonder what it said about us. In some ways it was further confirmation that we were just bad people.


In talking to patients, I’ve come to realize how common these feelings are. With rare exception, patients have confessed that they feel this way, too. Nearly always, the patients are racked by guilt over these feelings. They think they are being petty and spiteful. They think they are terrible people because of it.

I tried to talk my way around these feelings, to shun them, to shut them out. But I have to confess, it was only after I could openly admit my feelings that I could begin to work through them.

These feelings were nothing, if not humbling. They were a reminder of my imperfection. But knowing how common these feelings are, knowing how imperfect so many of us are has also given me comfort.

Perhaps that’s why I’m so willing to share my experience with my patients. I can see the visible relief on their faces when I confess this story.

I give them permission to be angry. I am hoping they have the same experience I did: by embracing the pain, it starts to ease.



Afterthought:
Jim Benton, author of the very funny “Happy Bunny” series writes: “Hate is a special kind of love we give to people who suck.”