What to expect when you’re expecting when the miracle doesn’t happen

The age at which a woman becomes unable to conceive varies from person to person. We’re born with a finite number of eggs (about 200,000), and as the quantity diminishes every month, so too does the quality. They break down and start looking old, just like the soft skin around our eyes. We ovulate about 500 good eggs over the course of our reproductive lives (unless we’re not ovulating) and the rest die naturally.  When we run out of eggs, we stop menstruating and enter menopause. (Here’s a great explanation that I found online.)

The joy of motherhood

I’ve wanted to get pregnant a second time since my daughter was about a year old (and I was 42). I adore her and have so much fun being a mom. Her baby years flew by in a blur and I desperately want to live them again. I’ve made so many parenting blunders and I want a chance to try new ideas. I had normal new-parent frustrations and I want the chance to show myself and everyone else what a pro I am now.

But I didn’t start trying right away, mostly due to financial fears. We conceived our daughter when I was 40 after only three or four months of trying the old fashioned way. My husband’s grandmother conceived his mom at age 45. I thought that when I wanted to get pregnant, I would. I was wrong.

Trying to conceive in my 40s

When I was about 42 1/2 I talked to my husband about having a second child. “Let’s just try till my birthday,” I said.

Our attempts to conceive were somewhat half-hearted. My husband, bless his heart, is ready, willing and able to give it the old college try any time I give the green light (even though he’s also perfectly content to raise just our one beautiful child). The problem was me. My libido evaporated after the birth of our daughter, and it became hard for me to instigate intimacy. Gone are the newlywed days of sex ten times a week – the exciting way we conceived our daughter. Four years later, I still put her to bed each night and usually fall asleep doing so. When I move to our bed a couple of hours later, the desire for sex is almost always trumped by the desire to get back to sleep. Armed with ovulation tests, though, I tracked my cycle and did my best to ensure we at least had a couple of sessions of well-timed intercourse every time I saw the LH surge. I was only successful about half the time.

When my birthday came, there was no question we’d keep trying. Because of the lack of sex drive, I felt that I hadn’t given it a fair effort. I pushed off the deadline to New Year’s and renewed my dedication to achieving the goal.

Professional help

The New Year came and went, and last June I turned 44, still trying. Not ready to give up on the dream, I changed my mind about leaving it to fate, finally talking to a doctor to find out if there was anything I could do to improve my chances of conceiving.

My OB-GYN ran a few blood tests and ordered a hysterosalpingogram. The blood tests check hormone levels and show how many eggs are in the ovaries. Not the number, but what they call the ovarian reserve. The hysterosalpingogram shows whether the path from the uterus through the fallopian tubes to the ovaries is clear, both for the sperm to meet the egg and for the egg to travel and implant. After reviewing my results, the doctor said my reserves might be low and one of my fallopian tubes might be blocked.  I clung to those maybes. He said there was nothing to indicate I couldn’t get pregnant but if I wanted any help it was time to talk to a fertility specialist. At 44 years 8 months old I told my husband I had taken it as far as I wanted to, that if we couldn’t do it on our own it just wasn’t meant to be; that we couldn’t afford fertility treatments anyway; that I was afraid of running the risk of conceiving multiples. I was ready to start giving away all the baby gear (and did). I was done trying.

I made the appointment with a fertility specialist two days later. I decided in advance, prior to discussing options with an expert, that I wanted to try intrauterine insemination. That’s where they take dad’s sperm, optimize it and shoot it straight to where it can fertilize an egg. Since one fallopian tube was blocked, my husband and I figured we’d give it two rounds to ensure that we had a shot at an egg coming down the right tube.

Reality

The fertility specialist didn’t beat around the bush quite as much as the gyno had. She kindly explained that I have virtually no eggs, and if there are any lurking around in there, they’re very likely not viable. She could tell all of that from my blood tests, but just to be sure, she also did a transvaginal ultrasound looking for egg follicles. She couldn’t find even one.  She said my file paints a very normal picture for someone my age.

“It’s what we’d expect to see in peri-menopause.” Wow. Did she really have to go there? I’m still trying to plan out my daughter’s preschool experience. I’m not quite ready to embark upon The Change.

She concurred with the first doctor that my left tube was at least partially, and possibly completely, blocked. She also pointed out a fibroid (which I already knew about) and an unidentified something else in my uterus that may or may not be blocking the path or interfering with implantation. My husband produced a zillion highly motile sperm but with low morphology, meaning fewer sperm are of a healthy, normal shape and able to fertilize (an issue rather easy to address, I gather).

To break it down in plain English, if one of the few healthy sperm was able to swim around the obstructions in my uterus and find an egg (which probably doesn’t exist) to fertilize, and the egg fortuitously chose my right fallopian tube for its journey, and it was able to successfully implant in an unobstructed spot in my crowded uterus, the egg would probably turn out to be not viable because of age and would therefore miscarry. But if it were viable there’s no reason I couldn’t get pregnant. Nothing in my tests says I can’t get pregnant.

Statistically, my chance of conceiving is 1%. In other words, it could happen but it’s very nearly 100% certain that it won’t. No medical procedure or drug will change my chances. For me, intrauterine insemination would not give better odds than good old-fashioned intercourse.

Conclusion: Apparently, with almost no trouble at all we miraculously located and fertilized my last good egg when we conceived my daughter. Or something pretty close.

In-vitro fertilization

The doctor almost sold me on in-vitro fertilization before our hour-long consultation was over. She said (prompted by my inquiry about something that until yesterday was not an option) that with a donated egg and my husband’s sperm, I have an excellent chance of achieving a healthy, successful pregnancy. In fact, I even have time to think about it because most women remain candidates until age 50 or even a little beyond. She also said that the $30,000 price tag could be cut by about one third if I agreed to share one batch of harvested eggs with another couple because we could split the costs associated with the egg donation.

And now I know that if I had $20,000 I would write the check. Unfortunately, I don’t. And although we are not in bad shape financially, we have just enough debt that I’m not comfortable taking out a loan to cover the cost. Come back in four years when our car and mortgage are both paid off and you’ll find a woman who would be happy to take on a loan of that size. But today it would be a struggle. And only compounded by depression if we had to make the payment on a failed attempt.

“Be grateful.”

Of course many peoples’ first response to my predicament is that we can and should at least be grateful for the child we have. And that’s true. And we are. She is as perfect a child as can exist. In fact, she is the reason I want another. The experience of her has been the source of such joy that I want to do it again. I want to do it more.  I want to do it longer. I want to keep being a mom to a little tiny person and I can’t because she is growing and changing so fast that the experience is flying by at a zillion miles an hour and I can’t seem to grab onto it long enough to fully savor.

Acceptance is tough. I got a late start in life. I met my husband at 39, got married at 40 and celebrated my 41^st birthday by giving birth. I’m not ready to be the age I am.

I wish I had known when my daughter was born that I was just about out of eggs. I wish I had known that the chance of a 45-year old conceiving naturally is virtually equivalent to winning the lottery. I wish I had known how much I would want that second child and that I would ultimately reach a level of confidence that a second child might leave us broke but everything would work out somehow.

Today, I know, I have an opportunity to find ways to savor experiences. This “no” that I didn’t want to hear is strong inspiration to never prioritize anything above my family, to focus on the moments, to stay in the present to whatever extent I am able. I will do all of those things, but they don’t diminish the disappointment, the sadness, the frustration and the powerlessness I feel over the death of a dream.

===

Update – three months later…

Unwilling to let the issue go, I decided to continue gathering information. And I pretty much decided that if I could get that second child for $20,000, I would do it. I was ready to cash in a retirement account (not a great idea) and go for it. Unfortunately, it’s not quite that simple. If you know anyone who’s been through fertility treatments, you already know that few people can plop down $20,000 and walk away with a newborn. It’s not that easy.

Even under the best circumstances, whether naturally or with medical intervention, every fertilized egg does not successfully implant into the uterus and become a fetus and later a child. Indeed, even if a viable, healthy embryo is placed directly in the uterus, the success rate for pregnancy is between 50 and 60%, with 65% being the best case scenario at very successful fertility practices. So for those who can afford the attempt and who are good candidates, it’s still somewhat of a roll of the dice.

I found a fertility practice in the Boston area that sells a frozen donated eggs package deal for $42,000. For that amount they agree to perform as many rounds of thawing, fertilizing and egg transfer as it takes to achieve a live birth. A single round (with the 50-65% chance of success) costs $18,000. Unfortunately, $42,000 is too far outside my fool’s budget and $18,000 is too much for me to comfortably gamble, even for the best odds. I could not bring myself to look at loans.

Acceptance is a process, not an event. I get better at it over time. I do not like being told no, and I do not react well when I can’t get something that I really, really want. This is life. In a few weeks my delightful daughter will turn 4 and I will turn 45. I have the world’s best husband. God willing, the three of us have decades of good years ahead of us. I will emerge from this disappointment with a smile because how could I not? I do love being a mom, after all. 🙂