“The Talk”: Life Lessons Years Later
This is a face of infertility.
Your neighbor down the street. An avid hiker. A dog lover. A travel adventurer. A business development director for a children’s hospital. A kitchen experimenter. A curiosity seeker and question asker.
Infertility is a taboo topic. From our early elementary years, we all bear the scars of having — or the more common experience — receiving the “talk” from our parents. For me, it was disguised as reading a bedtime story. But instead of a dreamy story with woodland creatures cooing me to sleep, I was ambushed by drawings of large naked men and women and pages of information on smiling, small squiggly animals, that I would later find out are sperm.
Follow this experience with sexual education classes in middle school and high school, culminating in my high school teacher playing a VHS of a live birth and then rewinding it to see our horrified reaction as we watched the baby go back into the vagina, and you can correctly assume that I was instilled with fear of sex and the outcome it could have.
As I reflect on the evolution that many of us go through in learning about s-e-x, one lesson is clear as day: Have unprotected sex and you will get pregnant.
Of course, this lesson didn’t come with actual biologically-based information. Like knowing that a woman has to be ovulating, releasing an egg down the fallopian tube, for sperm to even have a chance at fertilization. Or, that the fallopian tubes need to be clear to allow the sperm to reach the egg. Or, that the sperm need to have a high enough percentage in motility and morphology ratings to even have a chance at making the arduous swim to the egg. Many factors go into what I thought at the time was such a simple process.
Infertility is defined by as the inability to conceive after 12 months of unprotected sex. Wait. Our lessons from elementary, middle, and high school were wrong? 12 months. Does this surprise you? How many of you tried for 12 months, even if the outcome resulted in a pregnancy? Congrats! You now have a new medal to hang on your wall. 1st place in infertility award!
When most people think of infertility, there tend to be two assumptions, a) that this happens so infrequently; I don’t know anyone who has experienced this and b) there must be something wrong with the woman.
Wrong & wrong.
According to the CDC and National Institute of Child Health, infertility affects 1 in 8 couples. 12% of couples. This is the same probability as correctly guessing the toss of an eight sided die, correctly guessing the flip of a coin three times in a row, or the chance that you’ll have an odd number of cereals in your bowl three mornings in a row. Of these 1 in 8, the cause of infertility is equally divided between male infertility, female infertility, and combined male/female infertility or unexplained infertility.
Let’s not forget him. It’s not just infHERtility. Male infertility can be related to congenital (present from birth), acquired or idiopathic (arising spontaneously with unknown cause) conditions. The World Health Organization lists these potential causes for male-factor infertility:
- Obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. Blockages are commonly due to injuries or infections of the genital tract.
- Hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles.
- Testicular failure to produce sperm, for example due to varicoceles or medical treatments that impair sperm-producing cells
- Abnormal sperm function and quality. Conditions or situations that cause abnormal shape (morphology) and movement (motility) of the sperm negatively affect fertility.
Female infertility can also be related to congenital, acquired, or idiopathic conditions. The World Health Organization lists these potential causes for female-factor infertility:
- Tubal disorders such as blocked fallopian tubes
- Uterine disorders which could be inflammatory in nature (such as such endometriosis), congenital in nature (such as septate uterus), or benign in nature (such as fibroids)
- Disorders of the ovaries, such as polycystic ovarian syndrome and other follicular disorders
- Disorders of the endocrine system causing imbalances of reproductive hormones.
I was diagnosed with Polycystic Ovarian Syndrome (PCOS) at age 17. I had all the typical symptoms — absent period, excess weight, excess hair growth (hirsutism), and dark patches of skin on my neck and armpits (acanthosis nigricans). For years, no specialist was able to diagnose me appropriately. One night, my Dad was watching a show on rare disorders with the highlighted condition miraculously being none other than PCOS. Within weeks, I had more testing completed, including a vaginal ultrasound to look at my ovaries. Low-and-behold, the ultrasound image looked like swiss cheese. Many small cysts on my ovaries combined with my blood work = PCOS.
With PCOS typically comes infertility. Since my body didn’t naturally induce a period, it was likely that I wasn’t ovulating on my own, and even if I was, due to the vast number of cysts I had in my ovaries, I may not produce a mature egg. Therefore, when my husband, Saul, and I finally decided that it was time to take pause on buying last-minute trips to Colombia for fun long-weekends, and start considering creating a family, I knew I would need fertility support to make this a reality. Little did we know at the time, that we would be 1 in 8 not only due to my PCOS, but male-factor infertility as well.
I started the familiar process for many women with PCOS: medicated cycles. I would take medication (Clomid or Letrozole) for the first 12 days of my cycle. This medication supported the growth of my follicles, in turn, hopefully maturing an egg that could be released. The medication was combined with frequent ultrasound monitoring to ensure my follicles were growing appropriately. Once they reached an optimum size (16mm — 20mm), I would give myself an injection to induce ovulation. My husband and I would then have precisely timed sex. Romantic, right?
After a few rounds of this process with no success, my provider suggested Saul get fertility testing himself. After the unpleasant (or pleasant…you decide) experience of “giving his sample” and having a testicular ultrasound, we had the results that would dictate the next 12 months. At birth, Saul had an undescended testicle. Typically, this impacts sperm production by about half, which was the case for Saul. The motility (movement) and morphology (structure) of his sperm were normal, if not above. However, his count was categorized as low.
The two of us just won the award for “dream time of infertility.” We were dealing with both female and male-factor.
The next 12 months brought more diagnostic testing, failed medicated Intrauterine Inseminations (IUI), and In Vitro Fertilization (IVF). I’ll walk down that road with you in another post.
It’s important to talk about infertility. The prevalence rate is high, yet due to the taboo nature of sex, and thus infertility, it is minimized. Not only does this allow resources and support to be limited (another story for another day), but supports the continued hush-hush approach and thus, underrepresentation. During our journey, I only spoke with 4 females about their infertility journey. Those who go through infertility in any form, should not bear the burden of education while also trying to express the deep emotional, physical, and psychological impact that infertility causes. Just as it is no one’s fault to be diagnosed with multiple sclerosis, cystic fibrosis, cleft lip/palate, or scoliosis, it’s no one’s fault to be diagnosed with PCOS or an undescended testicle, resulting in infertility. There should not be shame associated with the process, and we should all seek to learn more.
So, to my high school sexual education teacher, thank you for teaching me how to put a condom on correctly, about the revolting impact of STDs, and making me fear my baby will revert back inside of me during birth. Through my own teaching, I have broken free from the shackles of the lesson that was seared into my mind: Having unprotected sex will result in pregnancy. Invite me in sometime; I can help break the shackles for some of your students too.
If you would like to learn more about our journey, and donate to a good cause, please head over to our GoFundMe page.
