Lying on a gurney, staring up at fluorescent hospital lights, I decided: This is not how I want to get pregnant. Nothing had even happened yet. I was waiting to have a hysterosalpingogram (HSG), a procedure to see if my fallopian tubes were blocked.
I was pretty sure they weren’t blocked, as I told my gynecologist a week earlier, when she ordered the test. I had none of the symptoms of blocked fallopian tubes, like pelvic pain or heavy periods. She agreed, but said an HSG was unavoidable if I ever wanted to do in vitro fertilization, or even talk to a fertility specialist about trying it.
I’d already taken hormones to stimulate egg production and tried artificial insemination, to no avail. I wasn’t sure I had the temperament to withstand IVF, and all the injections, money, doctor’s visits and uncertainty it would involve. But I also didn’t have the luxury of rejecting IVF purely because the idea of it turned me off. I was 41 years old, and IVF is what you do when you’re 41, can’t get pregnant and are fortunate enough to have good credit.
According to my doctor, you don’t pursue IVF until you eliminate first-tier reasons for infertility. If fibroids (non-cancerous uterine growths) are the issue, for example, their removal might make IVF unnecessary. We’d done everything on the checklist except for an HSG, including blood work and a fibroid check for me, as well as a sperm count for my husband. Everything looked good “for our age,” doctors told us, using the painful prepositional phrase I’d hear so many times in the coming weeks.
The fact that I couldn’t get pregnant took a while to sink in. I’d spent the previous two decades trying very hard not to get pregnant, being diligent with birth control and, on two occasions, taking Plan B.
I wasn’t so naïve to think I’d magically get pregnant after 40 just by ditching contraception. But somewhere deep down, I clung to that possibility. I was, after all, one half of a healthy couple: I do yoga, I’m vegan. My husband has a great head of hair. I’d also heard just enough encouraging stories to plant the seed of optimism. My ob-gyn told me about a 43-year-old patient having an unplanned pregnancy. And Janet Jackson gave birth at 50, leading CNN to ask, “Is 50 is the new 40 for motherhood?” (The answer is no, CNN.) Jackson didn’t speak publicly about the details, but reproductive experts seemed to agree that it wouldn’t have been possible without IVF and a donor egg.
In real life, I didn’t know of anyone my age having an unplanned pregnancy. Quite the opposite: Friends who wanted children were waging uphill battles against biology that sent them tens of thousands of dollars into debt. Some faced miscarriage after miscarriage. Others never got pregnant at all. At first, the women I knew usually held out hope, buoyed by fertility clinics boasting exaggerated success rates. Then they’d come to the crushing realization that it’s really, really hard to get pregnant after 40, especially with your own eggs.
Friends who wanted children were waging uphill battles against biology that sent them tens of thousands of dollars into debt.
IVF is the most common type of assisted reproductive technology (ART), an umbrella term for infertility treatments that involve any removal or handling a woman’s eggs. It’s considered a relatively safe procedure, but there are still risks. In rare cases, women develop ovarian hyperstimulation syndrome after taking injectable hormones, leading to blood clots and kidney failure. And while IVF success rates depend on various factors, age is among the most important. A woman under 35 has a 38 percent chance of a successful pregnancy with ART, according to the Centers for Disease Control and Prevention. By 41, that success rate drops to 14 percent.
I spent my 20s and early 30s building my career and generally enjoying life. I wasn’t ready to start a family, and that didn’t change until I met my husband at 36. A few years later, we started trying to get pregnant. I didn’t feel old, but fertility-wise, I was ancient.
It became apparent that conceiving naturally wasn’t in the cards. Our initial plan — the “let’s just see if it happens!” approach — turned into devastating disappointment month after month. Even now, a few years later, it’s still painful and embarrassing to relive the feelings of helplessness that overtook that time in my life.
While infertility treatments are physically demanding, several studies suggest that the emotional stress of the whole ordeal is the primary reason many couples decide to give up. Even in Sweden and the Netherlands, where treatments are subsidized by the government, researchers found that between one-half and two-thirds of patients stopped the treatments due to “the psychological burden and sense of futility,” according to one report.
William Hurd, chief medical officer for the American Society for Reproductive Medicine, said that while everyone experiences stress differently, “you can’t underestimate it. The further you go [with fertility treatments], the more stressful it is if it doesn’t work. If it works, you’re done. Everyone is happy. If it doesn’t, some people have lost a major part of their self, what they believe to be their future, and that’s terrifying.”
Before we started trying, I thought that if we didn’t get pregnant easily, I’d just accept it. We’d be that childfree couple who travels. But when it didn’t happen, all I could do was cry.
Before we started trying, I thought that if we didn’t get pregnant easily, I’d just accept it. We’d be that childfree couple who travels. But when it didn’t happen, all I could do was cry. I burst into tears whenever I saw a baby or pregnant woman. My reaction surprised me. It’s probably why I went ahead and did the HSG, even though it didn’t feel quite right.
My husband gently insisted on driving me to the procedure, even after I pointed out that WebMD said I could drive myself. During an HSG, dye is injected into the cervix and an X-ray is taken of the fallopian tubes. According to multiple internet searches I did the night before the procedure, it’s “uncomfortable” and “lasts about five minutes.”
There’s no prep required. You just show up at an imaging center and bring your cervix. I showed up. I got undressed. I lay on the gurney and waited for the radiologist. None of it felt right. None of it felt like me. What if I got up right now? I thought. But I stifled the impulse. Just five minutes.
They were five long minutes. When the mustachioed radiologist I’d never met before crudely inserted a tube into my cervix, I screamed at him to stop. “Are you sure?” he said, peering over his glasses as if he knew better. “Don’t you want to have children?”
Maybe not, I thought. After all, if I can’t endure this brief test, how would I get through childbirth, let alone brave the emotional pains that come with parenthood?
The nurse showed more empathy, suggesting we try again, slower and gentler. I agreed, having already paid the $350. It hurt less the second time. Within a few minutes, the radiologist had inspected the image of my ink-dyed fallopian tubes and concluded that everything was normal. “Good luck,” he said, removing his gloves and leaving the room.
Dizzy with pain, I struggled to get up. After only a few steps, I felt my body start to crumple, and I passed out in a chair in the hallway. I came to moments later with my husband standing next to me and a stranger handing me water. There has to be a better way to do this, I thought.
The fertility specialist, a highly recommended, leader-in-his-field type, was kind but realistic. “The train is leaving the station,” he told us.
A few weeks later, we walked into the Beverly Hills office of a fertility specialist, where I noticed a woman who looked a few years older than I was sitting in the waiting room. Feeling a bit more optimistic about my pregnancy prospects, I let myself relax, as I held my husband’s hand and watched the exotic fish swimming in the giant tank next to us.
The woman, I found out later, was waiting for her daughter.
The doctor, a highly recommended, leader-in-his-field type, was kind but realistic. “The train is leaving the station,” he told us. He didn’t push IVF on us, but he did encourage it. He talked us through the process, somehow making it all sound plausible, even while referencing the dismal success rates he’d jotted down for us.
I noticed on his desk a plaque with the famous Serenity Prayer:
God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
Smart plaque for a fertility specialist, I thought.
The more he talked, the closer I moved toward acceptance. IVF wasn’t for me.
Of course, it’s so personal. Some people have unlimited funds and a high tolerance for low odds. Hurd emphasized the importance of having a plan before venturing into the world of infertility treatments, and not making IVF the be-all end-all: “If it does work, you’ll have a baby. But if it doesn’t, don’t look at this as a cliff. Look at this as the next step before something else.”
New procedures are on the horizon. Minimal stimulation IVF, one option with potential, is less invasive than traditional IVF and involves fewer hormones. Still, it’s only been tested in small studies. For those open to it, there’s also adoption, an avenue that some people prefer to pursue in tandem with IVF, Hurd says.
After my HSG, as the nurse cleaned up and I pulled myself together, the X-ray image of my fallopian tubes remained on a monitor to my right. “Is that me?” I asked the nurse. She nodded. I’d never seen my fallopian tubes before. They looked nothing like the clunky textbook diagram I remembered from health class. Instead, they were delicate: Tiny threads with teardrop ovaries daintily hung like a fragile chandelier. My eyes filled with tears. “They’re beautiful,” I whispered. She smiled.
I had to trust my instincts. There were other ways to have a family. I felt, for the first time in a while, the tiniest sliver of hope. My body wasn’t broken. It was just 41.