The Myth of the Biological Clock?

Last year an article came out supposedly debunking the idea that it is more difficult to conceive after 35.  Women around the world cheered, and jubilant articles were written, applauding how science could finally free women from the pressure to start their families before they were ready and the guilt they might feel if they didn’t. Let’s celebrate ladies: the notion that our bodies are too old to reproduce is just another way the patriarchy has been trying to keep us down and out of the workplace.

Now, the articles and critiques are reappearing upon the publication of Tanya Selvaratnam’s book The Big Lie: Motherhood, Feminism and the Reality of the Biological Clock, which addresses the conflicting information women receive about the reality of their bodies and reproductive capabilities and the media focus on the many celebrities over 35 or even 40 having children seemingly effortlessly.  This morning I read an article in Salon by Mary Elizabeth Williams that criticized Selvaratnam for blaming feminism for never tackling the issue of fertility. My first issue with Williams’ piece was that I didn’t think her examples of previously-written articles did much to debunk Selvaratnam’s thesis. Secondly, this quote:

Can we stop setting up the straw man, as Selvaratnam does, that “Biology does not bend to feminist ideals”? Because I’ve got to tell you, I know a lot of people who’ve been to hell and back trying to become parents but I don’t know a single one who put off motherhood because she was a self-centered pawn of feminism.

Here’s the problem. I don’t think any of the journalists who write pieces like this have ever been to a fertility clinic. I have the dubious honor of having been to three different clinics on our 4-year journey to parenthood and I can assure you that at ages 28-31 (hardly a spring chicken), I was often one of the youngest patients in the waiting room. I joined fertility message boards and read blogs from other going through infertility and again, there is a decent number of women who were over 35 trying to conceive.

It’s kind of funny because when I was in the trenches and would read articles escoriating “those women” in fertility clinics for putting their jobs first and bringing their conception problems on themselves, I wanted to scream that not all women having trouble conceiving were older (age was one of the few things Jimmy and I had going for us). But that was the perception: trouble conceiving = advanced age = selfish bitch who put her career ahead of family.

So my question for Williams and others is just who are those women over 35 in fertility clinics? Why are they there? Was it because they just didn’t meet the right person until later in life? Maybe. But the bottom line is that for many women, they are in the clinic over age 35 because they put off having a baby for whatever reason. Maybe it was their career. Maybe it was because there were other issues. Maybe it was because they wanted to travel, see the world, whatever. It doesn’t really matter WHY; what matters is the fact that they delayed childbearing and then found themselves in a fertility clinic because they were having problems conceiving.

Now it appears the tables have turned and women supposedly have more time to conceive and woe anyone who dares to question that “fact.” Because science.  This change is troubling because, well, SCIENCE.  The fact is that while humans have made incredible gains in longevity, basic biology hasn’t changed. Maybe in a few thousand or hundreds of thousands of years, our reproductive organs will catch up to the fact that we can live longer lives, but the reality is that fertility declines with age, especially for women. And if you do conceive, you have a higher chance of miscarriage or having a child with a disability. I’m not going to cite the facts; you can read many of them here. Yes, yes. I know. We all know women who have conceived on their first month trying at age 40 and gone on to have a healthy baby. And of course, celebrities and their apparently amazing fertility after 40. Those are the outliers. Those are the examples that tempt us to believe we have more time than we do.

Selvaratnam is correct in that frank discussions about fertility are a feminist issue. We cannot change biology and the basic fact that the human body is best suited to reproduce in its 20s when we are busy building careers. Yes, I know that SUCKS, but feminism cannot change that and needs to acknowledge that. You know what feminism could change? Policies that make it career vs family. Policies that make it easier to delay childbearing because it hurts your career and earning potential to have a child. We’ve read the articles that tell us women who have children are often mommy-tracked and lose earning potential. That’s what we need to change. That it’s not career OR family but career AND family. The ability to downshift for a few years when children are young. Affordable, quality daycare. Supportive workplaces and flexible schedules.

At the very least, feminism could lead discussions about basic fertility. Why aren’t we taught more about our bodies beyond ovaries, eggs, fertilization and menstruation in school? Every one should be required to read Taking Charge of Your Fertility. I was amazed by what I learned about what my body could do and tell me (mine wasn’t working so well at the time, so it was mostly theory but still) and shocked that at almost 30, I knew none of that information. Put off having children if you want, but at least make that decision knowing the facts about female biology.

But…wait! What about those treatments in the fertility clinic? They allow women to have babies. It’s cool. I can just saunter into a clinic and have IVF whenever. Maybe even get twins! Fertility treatments let us overcome age and are actually a source of empowerment! Oh dear. Bless your heart. Reproductive technology is awesome, and I salute science for helping me to overcome my fertility issues to have my son. But folks, it is not a panacea. Clomid != baby. IUI !=baby. IVF !=baby. What assisted reproduction does is give you a chance, increase your odds.  The stats surrounding success rates for these treatments are fairly dismal. You may have a 0% or 10% chance on your own; IVF may increase it to 30%.  Yes, those are improved odds but not necessarily ones I’d take to Vegas. If I saw we had a 30% chance of it raining, I’d assume that rain was unlikely.

Age rears its ugly head in fertility treatments too. Over a certain age, you may not produce many eggs and the ones you do may not fertilize or develop.  The doctor may tell you your best bet is to use the eggs from – wait for it – a donor who is 10-15 years younger than you are. The only reproductive organ age doesn’t impact as much or can be overcome more easily is the uterus, which is why you read about 60 year old women carrying their own grandchildren. Part of the problem is that beyond concluding that eggs are old and of diminished quality, doctors really don’t know much more about egg quality and why some IVFs work and some don’t. What they do know is that their success rates decrease dramatically for women using their own eggs over 35. Frankly, successful conception is a crap-shoot for everyone, regardless of age.

Speaking of empowerment, there is little empowering about fertility treatments. I did 6 clomid cycles, one injectable IUI cycle, 2 fresh IVS, and 1 FET. I’ve also had a HSG, 2 laps, and a lot of pain. I have one child. I can think of little that is empowering about the following:

• Feeling rage, hot flashes and irrational while taking Clomid.
• Having a doctor tell you that maybe the excruciating pain you feel that makes you seriously contemplate a DIY oophorectomy is normal for you
• Bleeding daily for months
• Finally being in a position to afford children only to have to pay exorbitant sums to attempt to have a child (outcome not guaranteed)
• Feeling depressed and unable to focus at work because you are focused on how you feel less of a woman; you are supposed to be able to do everything – why can’t you have a baby? And why isn’t your career enough for you?
• Hating your body because it failed you so spectacularly (hardly body acceptance)
• Accepting that your only path to a biological child is for another woman to carry your child (are you Mom Enough? Apparently not)
• Looking like a heroin addict thanks to daily blood draws at the clinic
• Two weeks of painful shots of progesterone-in-oil (PIO) in the butt
• Becoming comfortable dropping trou and extremely familiar with the “dildo cam”
• Lack of focus at work because you are in and out for doctor’s appointments and waiting on the daily call on your hormone levels; sobbing uncontrollably when the levels don’t cooperate
• Having little control over your reproductive outcomes; that control resides in the RE, usually a man, which isn’t necessarily bad, but it does reinforce a power differential
• Having your clinic break up with you because you are a hopeless case and they don’t want you to ruin their stats.

Those are just a few I can think of based on my own experiences. Others have more examples I’m sure.

The point of this post is not to blame or shame. Do what you want, wait as long as you want, but do so armed with information. Understand that every decision has consequences. Understand that it sucks for women because our biology pits us against other goals we have that don’t involve children.  And it isn’t talked about. Not as much as it should be.  Ann-Marie Slaughter alluded briefly to the fact that she waited until her mid-to-late 30s to have her children and did experience trouble conceiving, but that tidbit was lost in the brouhaha about how she dared to tell women they couldn’t have it all and that they needed to think carefully about their choices.

So maybe feminism didn’t lie overtly to you about putting off having babies, but at the very least, it was a lie of omission. We can do better than that for each other.

 

NIAW: What Not to Ignore

It’s National Infertility Awareness Week (NIAW), the one week of the year in which it is socially acceptable to allow the infertiles to have their say and to celebrate the infertile in your life although as was pointed out earlier in the week, for infertiles, every week is infertility awareness week.

This year’s theme is “Don’t Ignore Infertility,” and I have a few suggestions:

If you are infertile

• Don’t ignore your intuition.  I suspected we were going to have difficulty after only a few months.  If I hadn’t listened to my intuition, I would have wasted more money and more importantly, time.  I pushed for Clomid after only 6 months of TTC.  I made our first RE appointment before the prescribed 12 month guideline.  If your RE tells you that “maybe pain is normal for you” when you tell him that you hurt so much that you are writhing in the fetal position, crying and fantasizing about ripping out your ovaries with your bare hands because hey, it couldn’t hurt much more, find a new doctor. Six months after starting with our first RE, we moved on to our second who diagnosed me within 5 minutes of our first meeting and told us our only options were IVF-related or adoption whereas the first RE would had had us pursue more useless (though we wouldn’t have known it) IUIs. I’m still a little bitter about that first RE; can you tell?
• Don’t ignore your feelings.  There is a lot of pressure on us to be happy and think positively even when life sucks huge donkey balls.  I call BS.  First of all, philosophically, if you never allow yourself to experience darker, less positive thoughts and emotions, how will you be able to know and fully experience the highs?  And guess what, infertility is mostly about the lows: the physical pain your diagnosis might cause you.  The toll on your self-worth, your body and your relationships.  The hit on your bank account or credit card because many infertiles don’t have insurance that covers treatment; treatment isn’t cheap.  We didn’t, and we had to pay a lot.  Wondering whether your infertility means that you have been deemed unworthy to procreate and that your DNA, the very essence of what you are, is not worth passing on.  Having friends muse that maybe your infertility balances out all the “luck” you’ve had in other aspects of your life such as marriage, school and career.  Dreading the infertility storyline in movies, tv shows and books because they always get it wrong and reinforce stereotypes.   A lot of lows.   So I’m giving you permission to revel in your grief and sorrow.  I’m a firm believer that if you don’t acknowledge feelings, they fester.  Revel in them.  Roll around in them and wrap them around you like a blanket.  Here’s the ugly truth: no one else is going to acknowledge your feelings, your reality.  And once you’ve indulged yourself, it is a lot easier to deal with the feelings, put them back in their box and even experience some happiness.
• Don’t ignore all the family-building options out there.  When we started TTC in 2005, I never in a million, trillion years thought that we would end up having our son through gestational surrogacy. Of course at that point, IVF seemed exotic.  However, by 2007 we had a much clearer picture of our situation and we began thinking more about what we were trying to accomplish (having a family) vs how it happened.  Let yourself explore adoption, surrogacy, donor egg/sperm/embryo, IVF.  What made me willing to consider surrogacy was wanting to make sure we had pursued as many options as possible so that at the end of our lives, we never regretted not taking a certain path.

If you are friends or family with an infertile

• Don’t ignore them.  I know it can be awkward figuring out how to handle the infertile.  I know that talking with us can be a little like approaching a sleeping lion: you never know what innocent, well-meaning comment will set us off, hissing and snarling or sobbing uncontrollably.  The problem is that sometimes, well-intentioned family and friends can decide not to talk about infertility with us and leave that conversational ball in our court.  That’s nice but what it often turns into is no contact or little meaningful contact.  Send us an email every once in a while.  Invite us out.  Ask how things are going.  If you don’t understand something, ask.  Pretend to be interested. Acknowledge our situation.  Because while you think you are doing the right thing by letting us have space, it feels like we are ignored.  Like we’ve become lepers.   Even if you don’t know what to say, a heart-felt, “wow, your situation sucks and I’m really sorry” would go a long way to helping the infertile feel like part of the human race again.  Because infertility does suck.

I hope these suggestions help. I’m infertile and always will be; this is the one week of the year I am allowed to be.  Here are a few other, better perspectives on NIAW:

• Don’t Ignore: The Secret Life of the American Infertile
• What to Expect When You’re Not Expecting
• What If? (this is post in support of NIAW by a supporter.  She gets it!)

 

Debating Personhood

Today, Mississippians are at the polls voting on Amendment 26, an amendment that is ostensibly anti-abortion but has far-reaching implications for women’s reproductive health, including banning some forms of birth control and possibly prohibiting IVF because it defines life as beginning at fertilization.

I don’t live in Mississippi, but I’m watching this vote because what one state is able to enact can spread to other states.  On a macro level, I’m appalled because we are in 2011 and enacting this amendment takes women’s rights back to at least the 1920s and possibly further.   Really?  Is this amendment necessary?  Who are these people? With the country in such dire straits economically, is this effort what legislators should be focusing their energy on?  A quick Google search finds that Mississippi has a troubled education system that could benefit from legislative attention.  One site declares Mississippi the worst state in the nation for science education, which is perhaps no surprise given this amendment.

What the amendment is really doing by granting an embryo the status of a person is taking away a woman’s personhood. Your embryo’s right to be born is more important than you are.  What is this loathing towards women?  Why the animosity towards letting a woman have any control over herself and her health?

On a micro level, I’m very worried about this amendment’s implications for IVF.  IVF treatment requires the creation of multiple embryos.  If this amendment is passed, does this mean that doctors will be required to transfer all embryos created to a woman, resulting in an Octomom situation?  If the embryos fail to implant and grow, will the woman be prosecuted for a hostile uterus?  If a couple has frozen embryos like we do, will they be required to place them for adoption (yes, embryo adoption exists) if they do not with to use them?  The amendment’s supporters dismiss concerns and say the details will need to be worked out once the law is enacted.  That this amendment has been written with such simplicity is terrifying and illustrates a classic case of unintended consequences.

It is perhaps a contradiction to be infertile and pro-choice.  Unable to have a child but longing for one, yet still supporting a woman’s right to choose and make decisions for herself.  You might think that infertiles would welcome amendments like Amendment 26 because it will create more children, children who might be placed for adoption–you know, the answer to all of our infertile problems because everyone knows that infertility and adoption are a perfect fit.  But I don’t think that way because I value my liberty.  I value my free will and my ability to make decisions for myself and my family.  I value my personhood.

Today’s CNN article on Amendment 26 highlight’s one pro-life couple’s lack of support for the amendment: their infertility.  They had their son through IVF.

“It is a concern, but a bigger concern for us is to not be able to have children,” said Robin Carpenter. “If it means that I’m labeled a murderer, but I am able to have children, it’s a risk that we’ll definitely take.”

The desire to have children might label this woman and others like her a murderer if they need to use fertility treatments.  How ironic that a law that seeks to ensure embryos personhood could result in no children for infertile couples.

Please, Mississippi, before you vote, stop and think.  Show the nation that you have good sense and defeat Amendment 26.

A few other perspectives on Amendment 26:

• Mississippi’s Initiative 26 Personhood Bill Horror Movie (Mel, Stirrup Queens)
• Bracing Myself (Keiko Zoll, Hannah Wept, Sarah Laughed)
• Mississippi (Jen at This is More Personal)
• Dear Mississippi (Marty at Don’t Take the Repeats)
• On Personhood and Schrodinger’s Cat (Magpie Musing)

Deep Freeze

This was a banner week for fun stuff arriving in the mail. In addition to my diploma, another piece of paper arrived this week:

Very important communication from our clinic

Time to make the annual decision about what we do with our 5 frozen embryos!  It turns out that storing embryos is sort of like a magazine subscription or Costco membership: you have to renew annually.  We were offered a few choices: store them for another year, donate them or destroy them.

Unlike renewing a magazine subscription or membership, however, our decision required a witness.  Guess decisions involving human tissue require a little more effort.  If it were an online form, I bet we would see screens like “Are you sure?” Yes. “Are you really, really sure?” Yes. “Are you absolutely, positively sure?” followed with “This action cannot be undone.”

We chose to store them for another year (it wasn’t ever up for debate). 

Stay cool, totsicles.  Hopefully we can use you eventually.

The Beautiful 312

Celebratory cognac after positive beta

Beta day was September 27, a Saturday.  For the previous two weeks I had seesawed between hope, optimism, despair and conviction that the cycle had failed.  J and I knew we would try again–at least one more time–before moving on, but I knew that a negative on our blood test would hurt like hell and mean more waiting.  And when you have been at this for 3 years, a good bit of that time has been spent waiting, and the last thing you want to do is more waiting. 

That morning we got up and drank our coffee on our back porch while waiting for the phone call from the clinic.  We figured it would be early afternoon, so we distracted ourselves by somewhat histrionically going through the songs on our iPhones and assigning songs as ringtones to friends and family members.  I still chuckle when I think of some of the ones we picked.

The call came around 1pm.  And it was positive.  “Beta is 312,” the nurse told us.  A very decent beta number based on what I had read.  After getting off the phone with the nurse, F called and we congratulated each other.  She sent me pics of the positive pregnancy tests and told me that she had been testing positive since about 7 days past transfer.  J and I just looked at each other in shock.  It was positive!!!!  Something had worked!  We had never heard those words before. 

Next thing I knew, J brought in the bottle of Remy Martin cognac that had been sitting in our bar for years.  It was very good cognac and there was only a little left…J had sipped on it for years.  We had decided to save the rest of it for a special occasion, but there hadn’t been one.  However, here it was now.  I hadn’t cried yet, but I almost cried when I saw the bottle and the glasses because of the symbolism.  THIS was our special occasion.  Even though it was barely afternoon, we each had a very healthy snifter of the cognac.  Hey, it was a special day!    We called our family and then decided to get out of the house to celebrate by going to the local outlet mall (yes we lead thrilling lives).  Everything seemed so surreal.  I confess that I was ecstatic for about 5 minutes before worry over the next beta, two days later, set in.  That would be the true test for me b/c the next beta would indicate if our numbers were increasing properly.

But September 27 was a wonderful day.