Choosing Intertility Treatments
by Fiona Young-Brown
To repeat an old, overused clich� America is facing an epidemic. This epidemic has been rising steadily through the 1980s and 1990s and now has reached an alarmingly high rate. At least, that�s the impression one would get from the popular media over the past twenty years or so. Browsing the bookshelves, one can find a range of titles including What to Expect When You�re Experiencing Infertility, 50 Essential Things to Do When the Doctor Says It�s Infertility and I Got Pregnant, You Can Too: How Healing Yourself Physically, Mentally and Spiritually Leads to Fertility. All seem to suggest the same thing: you can overcome infertility if you follow the right advice.
For women and couples facing the stressful decision of which treatments to try, these books and magazine articles can be confusing and misleading. How do couples decide what to believe and what to dismiss as media scaremongering? How important are those magazines on the supermarket shelf? What about the advice of doctors? Family? Friends?
Despite media reports, the overall prevalence of infertility in the US has remained stable for nearly a century. In the popular press however, journalists talk about it as an epidemic racing out of control. Popular magazines present it as the price women have paid for their liberation, for establishing careers and seeking sexual pleasure. They refer to endometriosis as �the career woman�s disease� because it occurs in women aged 25-40 who have not had children.
I could not discuss how women choose �treatments� and whether to have them, unless I first mention what these �treatments� are. I am often hesitant to use the word �treatment� since there is nothing that treats infertility in the sense of curing it. What fertility-related technologies do offer is the hope of temporary or short-term relief, hopefully long enough to achieve conception. The treatments couples may choose range from Clomid, a fertility drug, often the first treatment tried and the least expensive, sometimes called the �Valium of Infertility�; to Intra-Uterine Insemination (IUI) and more expensive techniques such as In-Vitro Fertilization (IVF). As treatments become more expensive (a single live birth using IVF can cost between $40,000 � 70,000), they also become more time consuming, carrying with them higher risks of adverse side effects. Possible side effects include a higher chance of miscarriage and hyperstimulation of the ovaries, which can lead to multiple births. Treatments also disrupt one�s regular routine; many women quit work to avoid prying questions from co-workers. Since it places such a major psychological strain on daily life, the decision to try a treatment is not one to be taken lightly by a couple.
Choosing between fertility treatments or where to receive treatment is even harder when one considers the range of information available and the conflicting statistics about success rates for each. Figures range from a less than 20% to as much as 50% chance of achieving a pregnancy, depending on which treatment or combination of treatments you try. Searching on the Internet, one finds statistics from a live delivery rate with IVF that can go from 5.3% to 25%. The rates given in the glossy brochures or made available on the Internet are often very different to the figures used in everyday communication with the patients. Doctors give the impression that one�s chances increase after multiple attempts. They seem to be quite happy to let the patients go on to the next treatment, happily believing the odds will be greater this time.
With such a variety of �success rates� available, it is not surprising that studies of fertility treatments have repeatedly used the gambling metaphor to refer to chances of a live birth. Some couples seek alternatives such as adoption early in the treatment process. To opt out at such an early stage may be relatively unusual: it is hard to tell since it is quite difficult to locate women who have opted out. Many women and couples regard adoption as the end of the road when all else has failed. For most, it remains the back-up measure. Adoption also forces the would-be parents to consider whether it would be better to have a child that is related to them genetically at least 50% or not at all.
Many of these other couples find themselves caught in the �Jackpot syndrome�. Like the slot-machine addict who believes the next quarter will win a fortune, they convince themselves that the next attempt will be the one. One such couple finally gave up after 26 inseminations because they were drained, emotionally and financially. Other couples have tried as many as two hundred fertility drug injections, all of which have failed, yet they cling to a fading belief that the next one has to work.
Often the woman will blame herself for an attempt�s failure. She will convince herself it failed because of something she ate or did; that long run, the party where she drank two glasses of wine. It is easy for doctors to say that infertility is �a couple problem� and that no one is to blame. That is of little comfort to the one person in the couple who does blame themselves and who feels extreme guilt, often the woman reacting to a number of factors around her that appear to make infertility the woman�s problem. Each monthly period brings with it another mourning period for another failed attempt and the child that never was, but still they refuse to give up.
Financial constraints are an important influence in the decision-making process, along with time, psychological and physical considerations, but the question here seems not to be, �How much can we afford, still leaving enough to provide for the baby when it is born?� Rather, some couples are asking, �What is the absolute maximum we can borrow?� This becomes a vicious ongoing cycle of �just one more try.� (Most couples believe their chances will improve with each consecutive attempt). They tell themselves they have nothing to lose and many misunderstand the chances of success, likening the odds to tossing a coin. Doctors apparently do little to discourage this naivete despite the fact that patients can only take losing out so many times.
Financial costs can often help to decide even whether to begin treatment, particularly for lower-working class and non-white women. Women may find that even if a physician accepts them as �suitable potential parents�, they are still unable to receive treatment because they cannot afford to meet the exorbitant costs. Buying a baby or the chance to have one does not come at a price readily available to all and insurance companies can be very reluctant to help, a source of great frustration for doctors and couples alike.
Adoption may be considered parallel to or separately from other treatments. If IVF or AI fails, there is the reassurance of the adoption process. There is also the small risk that you may finalize adoption plans and simultaneously discover that you have conceived. Some women consider adoption as an alternative to the pain and heartache of repeated failed treatments.
Some say that they just know when it is time to move on, either to another treatment, to adoption or to turn their back on any dreams of a child. Most women need to feel a sense of closure, to know that one period of their lives is definitely over and that they are free to move ahead. A woman eventually reaches the stage where she says �enough is enough� and puts an end to treatments for a variety of reasons: financial difficulties, problems at work, being tired of repeated medical consultations that intrude into and take over her personal life. The time comes to decide what the woman or the couple really wants. Do you want to be fertile or be a parent? Modern western society continues to look upon women who opt not to have children as somehow deviant, or in denial. A woman who decides at the age of twenty-three that she wants children is not challenged; she is �normal� and there is no question that she knows her own mind. A woman of the same age who decides the opposite can not know what she is saying.
Choosing infertility treatments is often much harder than choosing any other form of medical treatment. Trial results remain vague and inconclusive, as do details of side effects. Meanwhile, financial and psychological costs are usually much higher than most women could anticipate. Cultural, religious and family values are also important considerations to be borne in mind. If the media works more closely with the medical professions, they can represent infertility more accurately. This would help break down some of the cultural barriers and stigmas. The language of infertility is a language in itself. All women must have equal opportunities to comprehend this language. Poorer women and women of color in particular need easier access to the knowledge that will help them to make more informed decisions about treatments available to them.
Fiona Young-Brown is a Life Coach. Although she specializes in helping executive women lessen stress and reprioritize their lives, she has also worked extensively in the field of infertility reasearch. Find out more at http://www.fionayoungbrown.com/
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