News

I am overflowing with joy to announce that DH and I have become the parents of newborn twins through the blessing of open domestic adoption. Please keep their birthmother in your prayers, as she is grieving. 

Though we are overjoyed to become parents at last, we have had to deal with on-going financial struggles with our adoption agency, whom we have reported to the attorney general in our state. 

I am looking forward to continuing to blog here about infertility, adoption, the ethics of adoption, adoption agencies, and our experience with adoption, if I can do it in a way that manages to protect the privacy of both the children and their birthmother. 

If you are a regular reader of this blog and would like to see a picture, please drop me an email. 

I am still infertile, a member of that great sisterhood whose bodies don't make babies. I continue to pray for all of you on your journeys and discernments, and I hope to keep up with you via your blogs. As I will never mommy-blog, I do hope you'll keep up with me, even though I have as they say, crossed over.

Expecting--just a little bit

One of the hardest things about infertility is the lack of social acknowledgement. When someone announces a pregnancy, communities respond with heartfelt congratulations, with showers. My friends tell me that when they are visibly pregnant, strangers smile and offer congratulations.

Infertility, in contrast, is surrounded by silence. When I first told my friends and family, I got lots of sympathy and offers of prayers. But when the period of TTC stretches from months into years, people follow my lead. And since I never seem to want to talk about it, my friends never bring it up.

After years of silence, I was unprepared for the following:

My distant uncle and his wife were in our city were business. They had missed our wedding and wanted to meet DH, so after work, we headed over to their hotel for drinks. After an hours or two of chitchat, my aunt asked, "So, I was so happy to read in your Thank You card that you guys are saving for adoption! How's that going?"

So I told her that the very next day, we were going to send in the initial application form. My aunt and uncle both beamed and said, "Congratulations! We are so excited for you!"

I was completely caught off-guard by this. I am so used to disappointment and its attendant silence, that I couldn't believe someone was actually congratulating us on our plans to build our family.

I know that adoption is not a sure thing for us, and I know that there are probably many more plunges of the roller-coaster in our future, but I couldn't help but think that DH and I are slightly, just a little bit...expecting.

The Land of the F*cked

A recent series of posts at Airing the Chapel stirred up quite a bit of controversy. Airing observed a pattern in the replies: fertile women who never question Catholic leaders versus infertile women who do. I'm not at all interested in rehashing any of the debates over on ATC's blog (though I would be happy to discuss Augustine anytime), but I was struck by this division. On infertility blogs, I'll often hear people described as fertile and infertile. For example, "My fertile best friend came over yesterday," or "There's another infertile who works with me who...."

Infertile women seem to live in a different reality from everyone else. Our bodies don't work the way they should. Sex does not lead to pregnancy. For some of us, the normal process of menstruation is excruciating. For others, our cycles are completely unpredictable; our bodies are beyond our control. (The other day, I walked past the condoms at CVS and marveled that there is all this stuff designed to prevent pregnancy. I can't imagine ever again being in a position where I would fear getting pregnant. I barely remember what that was like, to feel like sex was this awesome thing that could actually bring a new person into the world.) 

So I can see why some of us feel like humanity is divided into fertiles and infertiles. But upon reflection, I think there is a division, but it's not between fertiles and infertiles. There are the folks who marry the love of their lives in their 20s, avoid pregnancy when they need to, get pregnant when they want to, and have healthy children. They live, or seem to live, in a land of sunshine and rainbows.

And then there are the rest of us, the inhabitants of what Anne Lamott calls "the land of the fucked." Those of us who wander for years longing for romantic connection, wondering why there seems to be a partner for every other woman, but not for us. Those of us who are stricken with cancer. Those of us who find ourselves married to abusive, alcoholic partners and who must choose between our most sacred vows and our safety. Those of us who get married, get pregnant, and find ourselves parenting children with developmental disabilities, or far worse. And of course, those of us who planned to have children, only to find it's not as easy as we were always led to believe. 

We, the inhabitants of the land of the fucked, ask the hard questions. We live at the margins of normalcy, in the grey areas. We make tragic choices. We hunger for compassion, only to find that the sunshine and rainbows crowd recoils from us. 

We frighten them because we know the truth: the separation between the two lands is a mere line in the sand, not a fortified wall. Anyone at any time could end up in the land of the fucked. Healthy living, prayer, good choices: these things offer no protection. Rather than face this reality, it's much easier to turn away, to take turns as Job's comforters, or to offer empty advice, "Just relax and it will happen."

No, it won't. But it would be better for you, emissary from the Land of Sunshine and Rainbows, to believe that it will. 

It was always in the back of my mind

I have an aunt who was infertile. When my periods started, along with the severe pain, my mom told me that Aunty V had also suffered from terrible cramps her whole life. When she was in her 50s, they found stage IV endometriosis; she had a complete hysterectomy and a bowel resection. Whenever I was doubled over with pain from my period, my mom would reflect that Aunty V had suffered the same way. And so, at the tender age of 13, I began to worry that I too would be infertile.

When I was 24, I met the man I wanted to marry. Unfortunately, he didn't want to marry me. He didn't think "we" were ready, but I really thought that meant that he didn't think I was ready. When I finally left him, a week before my 27th birthday, I remember thinking "My time is running out. I might never be able to have a baby."

Growing up with the specter of infertility has proved surprisingly advantageous in coping with actual infertility. I saw how my aunt and uncle lived rich, full lives. They traveled the world; they did all kinds of charity work. Though my extended family is dispersed all over the world, they found time to visit all of the branches of the family at least once a year. Their home is filled with beautiful artwork that they wouldn't have been able to afford if they had children. My aunt and my mom are both amazing cooks, but for my mom, who had to put dinner on the table, cooking was drudgery. For my aunt, who always had the option of going out to eat if she wanted, cooking was a passion. I saw first hand that infertility is not a death sentence. Living child-free can open you to the world.

Like many immigrant parents, my parents always emphasized education. My dad's sister never went to college because my grandfather believed that educating girls was a waste of money. My dad saw how his sister had to marry someone with no interests or social skills, because it was her only way to survive economically. My dad didn't want that for his daughters. He always told us that if we had an education and a career, we wouldn't have to get married unless we wanted to. Even when I was a teenager, I added in my head, "And if I can't have children, I will always have my career."

I've been thinking about this recently because I've been realizing that in many religious sub-cultures, women are supposed to be mothers first and foremost--not only mothers, but mothers of six, eight, ten children. While motherhood can supposedly be understood spiritually, many girls in these communities grow up with dreams of having big families, staying at home to nurture and educate their children, and then enjoying their grandchildren in their later years. For many people, this works out just fine, but for others, including us infertiles, life doesn't go according to plan. With one in six couples struggling with infertility, we need to do a better job of preparing our girls for a Plan B (no, not that one).

Girls need education. They need to be able to envision larger horizons and more creative futures. They need to develop talents and capacities unrelated to motherhood. Most of all, girls need to hear that motherhood is only one of several wonderful possible ways to love and serve one another.

Treatment for Infertility: When are the costs too high?

Jen at This is More Personal recently stopped blogging for the best of reasons: in December, she and her husband adopted a baby girl.

Jen's struggles have helped me so much in my own journey. After one round of IVF, which resulted in a chemical pregnancy, and a few canceled cycles, Jen and her husband decided they couldn't take any more. Jen's experience put words to something I had been thinking for a while: IVF has emotional, financial and physical costs that are rarely, or perhaps never, acknowledged by the medical profession. Reading through Jen's narratives of her IVF journey made me clearly see that IVF would break me. The stress of spending $15K on a twenty percent chance of getting pregnant, the mood swings that come with high doses of hormones (for whatever reason, I'm extremely sensitive to all medications), the anxiety of being constantly poked and prodded.....I knew I could not do that. The emotional, financial and physical costs of IVF would be too high for me.

(This actually had very little to do with most religious arguments against IVF. I'm not convinced that the unitive and procreative purposes of marriage should never be separated. As for the destruction of precious embryos....what was my body was doing with my embryos every month for a solid year? I was unlikely to produce dozens of eggs, and a couple embryos would probably have been safer in the hands of a competent embryologist than in my inflamed womb.) 

So instead, I turned to alternative therapies. I had always had a healthy diet, but for a solid year, I eliminated alcohol, sugar, refined grains, fried foods, and caffeine. I ditched exercise that I loved, like swimming and intense yoga and instead stuck to the brutally boring Fertility Yoga. I took my temperatures every single morning, stressing out when I ovulated a few days early, because of course, women with DOR "always" ovulate early (except when we are completely asymptomatic). I meditated, I prayed. I structured my days around what supplements I needed to take and when. My entire life became about trying to get pregnant.

It didn't work. Eventually, I realized that these alternative therapies also have high costs. When you give up activities and things that used to give you pleasure in order to get pregnant, and you don't get pregnant, month after devastating month, you begin to lose your soul. Eventually, I realized that I could not continue to live that way; even if I did eventually get pregnant, didn't my child deserve better than the person I had become: jealous, bitter, joyless?

So, I've stopped. I need to update my supplements page, because beyond a few vitamins for basic health, I've stopped taking them. I still do Fertility Yoga, but I also swim and go to Ashtanga Yoga once a week (even in the luteal phase). I'm still staying away from fried foods, because they really do make me feel sick, but if I feel no immediate benefit to eliminating a certain food, I just go ahead and eat it (in moderation).

More joy in my life makes it easier to face infertility, and the fact that I might never get pregnant. Because really, nothing--not even motherhood is worth my soul.

Infertility Vacation

I have had a lovely three months. No TTC, no charting, no obsessing during the 2WW.  After a year of thinking of myself as "the infertile one," I once again learned to see myself as a human being. Part of this was a tiny bit of self-delusion. I could almost tell myself that instead of being the couple without children, that we were the couple without children--yet.

But still, it was really good for me to have this time away from TTC. For one thing, after about a year of struggling with very low libido, my sex drive came back in full force after the surgery. I don't know whether this was because my body changed after the surgery, or because there was no pressure to have sex at a certain time on a certain day. Or maybe it was because we hadn't had sex in months by the time DH came home after working away, so I was just starving.

It was so wonderful to have sex just because we wanted to have sex and to reconnect with the idea that sex is pleasurable! and fun! Who would have thought? 

Another positive change was that now that for the first time in about a year, I'm enjoying my work again. Despite the constant drama at work, I really do enjoy what I do and I feel like I make a contribution to my field. 

The most positive thing is that overall, I have learned to love my life as it is. I enjoy good food, a loving husband, making music, my career, working out (I have so much more energy now that I'm not fighting iron deficiency all the time!), pets, church and prayer. I almost don't have time to enjoy everything. While I would like to be a mother and to grow our family, I no longer feel so desperate to have a child. I'm sure the dark times will come again, but for now, I am at peace.

A while ago, I read on a blog that "Infertility should be thought of as a terminal illness. Instead of destroying your body, infertility destroys your spirit." The blog has long vanished from the interwebs, so I don't know what became of the 29-year old whose ovaries had suddenly, inexplicably, and inexorably shut down. 

My advice is as follows: Don't let it. Don't let infertility destroy your spirit, steal your identity, and define your life. I was perilously close to spiritual death by infertility when stepping away from TTC saved me. 

Do what you have to do: adopt, commit to living child-free, focus on your career, hobbies, exercise. Whatever it is you have to do, do it. Just don't let infertility steal your soul. 

Separation Anxiety

My mom left today.

There is something abnormal about the way I process separation from my loved ones. The tiny prick of melancholy most people feel when a loved one goes home after a visit is an ocean of grief for me. When I was a child, I would beg my mother not to go shopping without me. I would imagine her death in a car accident; I would imagine her funeral; I would imagine being raised by my father. Twenty-five years later, my mother is not only alive, but well enough to care for me in the aftermath of my surgery.

And twenty-five years later, when she leaves, I sob as if I'm never going to see her again.

Sometimes I worry if my separation anxiety, which happens when DH leaves to work far away, or whenever I leave my family after a visit, will prevent me from being a good mother--the kind of mother who encourages her children to spread their wings, to take risks, and to explore the world outside of home. I will be the mother clinging to her child and howling on the first day of school while the kid looks around uncomfortably and says, "Jeez, mom. I'll be home at 4 pm!"

I wonder if my children will grow up fearful and anxious. And then I think that maybe it's best that I'm infertile, because I'm not sure I can handle the emotional rigors of parenting.

I know I need to work on this, but I don't know how.

I don't know what therapy or processing would make this grief more in line with reason and thus easier to bear.

Wedding Bells

Thanksgiving Day, DH and I went for a long walk around my parents' neighborhood. Long in duration, not in distance as I am still not up to walking more than a tenth of a mile at a stretch. I caught a glimpse of our shadows; I was clinging to him, walking slowly and unsteadily. The band I wear to protect my incisions made my torso look substantially thicker than it is. In shadow, we looked like a couple in our seventies.

It struck me that DH and I have only been married a year and a half, but I feel like we've been married twenty.

We never had a formal church wedding. DH has been married before to a woman who left him after fourteen months with no explanation or even a good-bye. We were engaged and waiting for his annulment when my adenomyoma was diagnosed and the recommendation from the doctor was to postpone surgery until after I was done with childbearing.

We got married immediately, in a court-house.

We are still waiting on DH's annulment. Apparently, in the diocese where he filed, the wait is three years. (The priest at DH's parents' church told us it was eight to ten months.) We haven't even seen a "thank you for your application" form letter. DH is done with Catholicism. Reliving the worst thing that ever happened to him only to be met with silence and indifference broke his relationship with the Church, and I'm not sure it will ever be fixed.

Meanwhile, I was learning that I could not go through the worst thing that's ever happened to me without the Sacraments. I could not go without the Eucharist. I could not have my surgery without the anointing of the sick. I started going to an Episcopalian church. That church has been my rock these many months.

DH and I will be married in that church this winter. In front of God, our extended families and our friends, we will promise each other that "for better or for worse, for richer or for poorer, in sickness and in health," we will be husband and wife.

I'd say we've already had more "worse, poorer and sickness" in one and a half years than many couples have had in twenty. I know that when I hear DH say those words, I will be thinking that through infertility, through pain, through surgery, through depression and through despair, DH has stood by me.

Infertility is NOT God's will

Several months ago, another infertility blogger was lamenting the loss of the children she will not be able to bear. A commenter rushed to assure her that infertility is a part of God's plan for her. (I'm heavily paraphrasing here.) I've heard this kind of explanation for infertility, and although it is always well-intentioned, I find it to be unsatisfying and problematic.

In the Catholic tradition that has shaped me, the purpose of the reproductive organs is to procreate (and of course, to enable sexual pleasure). My uterus and ovaries do not function the way they are supposed to because of illnesses--adenomyosis and diminished ovarian reserve. Disease, cancer, pain--these things are not caused by God. In the Catholic tradition, they are called natural evils. Evil, by definition, cannot be the will of a good God.

Sure, sometimes these things prompt cultivation of virtues of patience and trust. But just as often, such trials turn us into bitter and jealous people. I do not think I am a better person for being infertile. The burdens on me this past year have been in many ways more than I can bear. (I don't talk about my job here, but it has been its own cross.) I have thought about leaving DH; I've had fleeting thoughts of suicide. I've spent days wrapped in resentment of my seemingly-happier sister who's just starting a life with her new fiancé. I've fantasized about being fired from my job. I know that I have a choice about what kind of person I am, but I promise you, it wouldn't even have been possible for me to sin in these particular ways without the unrelenting stress of infertility, my job, and DH's unemployment.

Of course, this raises the classic question of theodicy: If God is good and all-powerful, then why does he permit natural evil at all? Why Hurricane Katrina? Why were the Haitian people who've already suffered so much struck by such a devastating earthquake? Why did my cousin die of breast cancer, two months after her 30th birthday?

Rabbi Kushner argues that God has set up the best of possible worlds, even though it doesn't look that way to us. Augustine says that the fault is not with the world or with illness, but our tendency to rebel against God's will. Though each of these answers is better than "God is trying to teach me something" or, even worse, "God is punishing me for something," I find each of them unsatisfying.

I don't have a satisfying answer to this question. I have come to believe that there is no satisfying answer to this question. Instead, I believe in God's power to draw good out of evil and to make grace possible even in the midst of evil. And I believe in my responsibility to make something good out of my infertility, whether that be making room in my heart and in our home for a child who needs parents, or devoting my child-free time and energy into leaving the world a better place than I found it.

It might be unsatisfying, but it's the best answer I'll ever get.

True and False with my RE

Dr. S, world-famous endo surgeon, has very different opinions from my RE about my fertility. Let's evaluate what she told me in the course of my consultations:

1. "I don't think your adenomyoma will affect implantation."

Dr. S says: FALSE! Although adenomyosis, unlike endometriosis, is not considered a cause of infertility, in my case, there is so much tissue, all balled up in one place. "It definitely could be affecting implantation."

Comments: This was my perspective all along. This was why I sought out an RE in the first place, so she could take a look at my MRI, evaluate the size and location of the adenomyoma and tell me whether it would affect fertility. Instead, she never even looked at the MRI records I had sent to her. She saw the adenomyoma during my hysteroscopy, but she didn't seem to think it would be a problem. F--- her.

2. "Laparoscopy is a bad idea for you. It will aggravation your ovarian reserve issues."

Dr. S says: FALSE! This is only true for women who have very large endometriomas on both ovaries. He knows I don't have such a problem, because none of my multiple pelvic ultrasounds, MRIs, nor hysterosonogram has ever shown any evidence of endometriomas on my ovaries. "In any effort to protect a woman's ovaries, REs often prevent women from getting the treatment they need."

Comments: My RE issued a blanket recommendation apart from the specifics of my case. DOR = avoid laparoscopy like a cloud of tobacco smoke. In reviewing the literature about laparoscopy and DOR, many of the articles emphasize that preservation of the ovarian function is entirely dependent upon the skill of the surgeon, something my RE never mentioned to me. Which is why we're traveling to ____________, rather than having my surgery locally.

My RE is one of the best in the country. Although only in her 30s, she is on the editorial board of the top journal of reproductive endocrinology. She is the recipient of a prestigious NIH fellowship. In other words, she's no small potato.

And yet, she seems to be making decision by virtual of a decision tree.

Diminished Ovarian Reserve? It's hopeless. Do not get a laparoscopy. Head straight to IVF.
Adenomyoma? Never affects fertility. Don't worry about it.

The particulars of my case, my adenomyoma, my ovaries, my (possible) endometriomas, were of no interest to her.

Of course, the most devastating things she said about me, she didn't say to my face: She told my pelvic pain specialist that I have a one percent chance of spontaneous pregnancy. Even though I ovulate every single month.

But she's been wrong about so much. I'm going to bet she's wrong about this.

Dark Night of the Soul

The day the nurse called to tell me that my FSH was high was among the darkest days of my life. I cried for weeks. But through that time, I had the most remarkable feeling of being loved through my grief. I felt the love of God, and the love of my dear husband, who unequivocally stated over and over again that even if we could never have biological children, he wouldn't want to be married to any other woman. I remember sitting in my favorite place at work, grading papers on a Saturday afternoon and just feeling flooded with love.

Masters of spirituality such as John of the Cross and Theresa of Avila call that experience of God's closeness and love consolation. The feeling of God's absence or silence is called desolation, or the dark night of the soul. Consolation and desolation happen independently of your emotional state, or of what is happening in your life. My period of consolation coincided with one of the saddest periods of my life. 

At the moment, I am in a period of desolation. Unfortunately, this desolation is coinciding with DH losing his job, my waning faith that I will ever get pregnant and, at the moment, horrible PMS and the knowledge that I am not pregnant.

I am finally ready to try Natural Cycle IVF but we do not have the money. We are not paying down debts; we are not saving money for adoption. DH has been looking for jobs, but every lead has come up empty. 

In truth, he lost his job months ago, but I was sick of thinking and writing about infertility. I just couldn't write about having to come up with a new plan all over again. And every plan requires thousands of dollars that we don't have. 

Above all, I am tired. I am tired of being positive, of swimming against the temptation to despair and depression. I am tired of the never-ending roller coaster of hope and disappointment. 

Every month, I think, "Perhaps things will change this month. Maybe we'll finally conceive. Maybe DH will get a job this month." And each month, nothing changes. We do not conceive. DH does not find a job. 

Nothing ever changes.

Death by Google

Diminished Ovarian Reserve
DOR success stories
DOR natural pregnancy
DOR symptoms
improve ovarian reserve
improve FSH
improve amh
adenomyoma infertility
adenomyosis pregnancy
adenomyosis infertility treatment
adenomyosis infertility surgery
adenomyoma surgery pregnancy

To cope with anxiety, some people drink. Others eat. Having been deprived of both, I google.  I google and google and google. I google the same search terms over and over again.

This has helped me to a certain extent. I know more, have found a few blog buddies, and have all kinds of theories about my conditions which I will share with you in future posts.

However, for my anxiety, it does nothing.  Nothing.

Somebody stop me.

Returning to the scene of the crime

I'm not doing so well.  I arrived at my parents' house for a visit Tuesday, and my period started Tuesday evening, which was no surprise, since we missed the egg this month.  Wednesday was my monthly day of hell, which I initially thought was not going to be so bad. Hadn't I been keeping up with my supplements, my fertility yoga, the centering prayer? Wasn't I feeling less stagnant than usual?

But then I called my RE's office to schedule my hysteroscopy, and the nurse told me to avoid all blood-thinning medications: aspirin, NSAIDs, etc. I was already doped up on Aleve, so she told me not to take any more. I thought I was over the risk of vomiting, so I had a light dinner with my parents.

Then the Aleve wore off. I took Tylenol, but, to put it indelicately, it didn't do shit. Stabbing abdominal pain, severe aching in my hips and knees, and vomiting followed, plus very heavy bleeding. I took one of my specially-compounded Valium suppositories, and continued to vomit. I took another. No effect. I finally gave up and took an Indocin suppository, which is an NSAID, but I just couldn't take any more. Ten minutes later, I was asleep.

The pain was excruciating, but worse was the accompanying despair. The deep sense of failure of not being pregnant. The hatred and disgust that my body was doing this to me again.

I missed DH, who couldn't come home with me because of work. My mother was on hand, emptying the vomit bucket at regular intervals and directing me to rinse my mouth with water, but her presence was a mixed blessing. She never knew how to comfort me when I was a child. When I was a teenager, suffering with the same damn cramps (which were longer in duration but less intense) she told me that I would feel better if I moved around.

She now understands how very abnormal this is, and I know it's hard for her when she has to see me like this, but she's no better at comforting me. I learned long ago how to comfort myself, but when I'm in that much pain, I just can't. My despair at failing to conceive finally spilled out, but her response was to remind me that we're "going to adopt anyway" and maybe I should just tell DH that I want a hysterectomy now, and that I should just "think positive."

I told her that that was Gospel of Prosperity bullshit and that I didn't want to hear anymore of it. She got the message.

That was two nights ago, but the effects of the physical and emotional trauma still remain. I thought it would be better to come home for my day of hell than to stay alone at home. But now I wonder if it's the best thing for me to be back at home in the house where I felt so alone growing up experience the same medical condition.

I wonder how long I can keep doing this, going through this monthly hell.

I can't have surgery to remove the adenomyoma, because it might scar my uterus closed. I can't conceive, possibly because of the adenomyoma.

How long before I call it quits forever?

By Any Means Necessary?

How far would I go to have a child?  The desire to have a child entails the willingness to go through the misery of morning sickness, first trimester fatigue, the excruciating pain of actually giving birth, the risks to my health.  I would be open to having a c-section if necessary for the health and safety of my child.

I've restricted my diet, given up alcohol and caffeine. I spend time every morning organizing supplements. I choke down concoctions of wheat grass and Chinese herbs.

I've endured a saline hysterosonogram. I am having a hysteroscopy in two weeks. If I could have a laproscopy, I would have one.

These are minimal interventions. If pregnancy doesn't result, the recommendation is for a round of injectables, followed by IVF.  The side effects of the "minimally invasive" fertility drugs that my RE has recommended include headaches, mood swings, abdominal tenderness, ovarian cysts. Many women report that the IVF drugs permanently change their bodies. They also carry the risks of hot flashes, cysts, and Ovarian Hyper-Stimulation Syndrome.

The risks of many interventions are also financial. Many women with diminished ovarian reserve cannot get pregnant with their own eggs. They must use the eggs of a donor, often with a price tag of $35,000.  A cheaper alternative is to ask a friend of family member to donate for you. Would I be willing to watch my sister inject stimulants in the hopes that she has eggs to give me?

Some women with adenomyosis cannot carry a pregnancy to term. To bear their own, biological child, they must use a surrogate, another womb on loan. A popular option is to go to India, where a woman will bear your child for far less than the going rate in the US.

Is it all worth it, once we have that child in our arms? Is any intervention, procedure, or transaction okay, as long as we can parent? When do we decide to call it quits?

How far would you go to have a child?

Infertility before infertility

"How long did it take you to conceive N?" Asking my dad about my little sister's conception was pretty awkward. But I had a reason for asking.  Diminished ovarian reserve tends to run in families.  I was always sure that my ovaries were fine; I was conceived five months into my parents' marriage, when my mother was 36. She had my one and only younger sister when she was 41. I thought this boded well for me, until I thought about the four years between me and my sister.  What 38 year old postpones a second child?

Awkward pause. "You and your sister are four years apart," answered my dad.

"I know, but did you try for all that time or...." Did I really want to pursue this line of questioning?

"You and your sister are four years apart," my dad repeated.

"So, um, you tried that whole time?"

Yes, they did. They tried for two years before they were successful. "Your mother went to the Marian shrine in [country of origin] and prayed for a baby. And then she got pregnant again shortly after that."

When my parents were struggling with infertility, or as my dad would say, taking a long time to have a baby, there were no FSH tests and ultrasounds. Because they knew they had been pregnant before, they just kept trying until they were successful, when my mom was 40.

"So sometimes, it just takes a long time," my dad continued. "Remember Auntie R and Uncle N? They took five years to have a baby. They spent thousands of dollars traveling to Marian shrines all over the world. They even went to Lourdes. And after five years, it worked!"

There you go. In the age before IUIs and IVFs, the only thing to do about infertility was to pray. Rather than spending thousands of dollars on medical interventions, you could spend thousands of dollars on a pilgrimage.

Sometimes, I think about the couples who spend their savings on a chance at having child, only to walk away with their arms empty. I think about the couples who have had multiple rounds of IVF, all failures, only to conceive naturally months or years after they've given up. Sometimes I wonder if after all this medical intervention we are any better at controlling the vagaries of conception than we were when the only treatment for infertility was prayer.

But I did everything right!

In When Bad Things Happen to Good People (a book you'll be hearing about a lot on this blog), Rabbi Harold Kushner tells the story of a couple who lost a child in a tragic accident.  When he goes to visit them, the couple looks at him and says, "Rabbi, we didn't fast on Yom Kippur this year." It takes Kushner a second to realize what they are saying: they think that God took their child as a punishment for not fasting on the day of atonement.

The idea that God punishes wrongdoing by killing children, giving people cancer, and causing various fatal accidents is called the theory of just retribution. With the exception of a few fundamentalist Christians (Michele Bachman, I'm looking at you), most people reject this idea.  We know that God didn't give our aunt breast cancer as punishment for her sins. We know that the tornado that struck the high school prom wasn't punishment for the kids sleeping together on prom night.

I reject the just retribution explanation for my fertility struggles. It's not because I slept with my husband before we were married.  Or because I used contraception. If you think it is, look at all those teenagers who get knocked-up without any problem at all!

But despite the fact I reject the theory of just retribution, I do have my own version of it.  It goes like this:  But I've lived a very healthy life!  I don't drink or eat to excess.  I barely eat sugar.  I have never smoked. I don't eat processed food. I eat ridiculous amounts of vegetables. I exercise regularly, but moderately. I don't even drink coffee, for God's sake!

I did everything right.  This shouldn't be happening to me.

The theory of just retribution is so hard-wired into all of us that we can't quite reject it.  Instead, we have merely substituted health for morality. Healthy food (whether it's vegan or Paleo or gluten-free) is the new kosher. Unhealthy people are punished with infertility.

This attitude is common among the fertile as well.  In this egregious example, a blogger thinks that she got pregnant so quickly because she worked so hard, "reading books, changing eating habits, exercising, not smoking, not drinking, doing tests, taking care of health problems, doing dental work, taking prenatals etc," in short, "doing more" than other people who are trying to conceive.

Um, no. She got pregnant quickly because she was lucky. Some people are just more fertile than others. While some things do adversely impact fertility (smoking, sugar, caffeine, alcohol, etc.) many people who live healthy lives are infertile, while many sugar-gobbling, coffee-guzzling lushes get pregnant with no trouble at all.

Why do we hang on to the theory of just retribution, despite all the evidence that this is not how the world works?

My theory is that it's comforting to this that if we work hard and do everything right, we will be protected from infertility. Conversely, it's frightening to think that infertility (or for that matter cancer)  could strike any of us, for no reason, despite all our efforts and healthy habits.

I've been on enough fertility forums to know that some people get pregnant after making a bunch of lifestyle modifications: diet, exercise, Chinese medicine, herbs, vitamins and supplements. Still others go the Western medicine route to get pregnant. But some people, despite all of their efforts, despite tens of thousands of dollars in fertility treatments, never do get pregnant.

The frightening truth is that we have limited control on whether we ever get pregnant.

The frightening truth is that a lot of really big things in our lives are ultimately beyond our control.

The frightening truth is that this is the human condition.