This is the tenth installment of Barren Advice. You can ask questions that are fertility or non-fertility related.
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I'm having a bit of a crisis of confidence, of the how-infertile-am-I-*really* variety (warning - all this may just be the Clomid talking). I've always been averse to medical intervention for anything that isn't a clear and specific injury or illness. In the realm of infertility, there seems to be a lot of ambiguous or conflicting information. For example, take luteal phase length supposedly anything under 10 days is too short, and yet I can plug in "Short Luteal Phase (<10)">
Although I do appear to have ovulation problems and DH's s/a was less than optimal, we haven't been trying all that long (about a year), so it's not clear how much these things are reducing our odds. How do I sort out which reproductive issues are definitely a problem and really do require medical help, versus those that doctors think are probably a problem but don't really know for certain?
--Kate of "No Blog" Fame
The heart of this problem comes with linguistics. Infertility is a bit of a misnomer. A large portion of those diagnosed as infertile are actually subfertile. After all, if you were not fertile at all, there would be nothing one could do to help you along. It would be like trying to grow a flower in concrete. Some people in the community are the equivalent to concrete (and I say this in the most loving way)--nothing they could do would give them the ability to become pregnant. Either they are completely sterile and do not produce any sperm (and this is different from a low sperm count which also isn't getting anyone pregnant) or they are missing necessary reproductive organs such as their ovaries or uterus. The rest of us are actually more accurately subfertile. We're more like poor soil--add some nutrients, change the seeds you're using, adjust some details--and, hopefully, plants will grow.
And that is what makes this suck so hard.
If we were infertile, we could make neat decisions. We could accept our limitations and we'd know the right time to move on. But we're not. We're subfertile and that's where things get grey and we enter an analogy akin to gambling. How many IVF cycles should you do with your eggs? What if the next one was the one that would have worked? What if we had held off one more cycle before starting treatments--could we have gotten pregnant and avoided all of this? Too many questions linger like that when the boundaries aren't clearly defined and it's hard to walk away from the table once you start gambling. Because that's sort of the allure of gambling--there's always the chance of the next time.
Therefore, I think a lot of this has to do with what type of stakes you're comfortable laying on the table: not when life is good and you're at the casino for a lark; but if you were playing for something really important to you. Are you the type who would rather watch the game for a bit and figure things out and decide if you really want to enter? Are you the type who jumps into the game and places everything you've got on the table, even before knowing whether the dealer is working with blackjack or 5-card draw (can you tell that everything I know about poker I learned from Intellivision)?
Let's strip the analogy away and ask this question: are you the type who feels it's worth the risk of losing time or chances in order to work on the problem sans treatments? A lot of people feel this way and many are successful. If you try enough times, chances are, you will win. You're not guaranteed to win because the statistics remain the same each time you try. If you have a 1 in 4 chance, you will still only have a 1 in 4 chance, but you'll have it 15 times. Please don't ask me about this fuzzy math.
Or are you the type who needs this to happen for your own sanity. Please do not disregard mental health--your soul, your emotions, your heart need to be given as much care as your body. Separating them is detrimental to your whole. Therefore, if you would treat an ulcer, you should also treat the stress that caused the ulcer (if stress caused the ulcer). If infertility is affecting someone emotionally, I think it's worth treating all medical issues--the reproductive health and the mental health. Sometimes, treating the infertility by default treats the mental health issues.
I once asked my RE how my mother got pregnant with me when she couldn't get pregnant with treatments (yes, I'm an off-cycle baby) and he explained it this way. Every subfertile woman creates perhaps one or two good eggs every once in a while. They may have happened before we started trying or they may happen when we're 41. We just don't know. It is the perfect cycle where egg quality and uterine lining come together. If you are having unprotected sex every single cycle around ovulation; never taking a month off, you will hopefully catch that egg and have it fertilized and implant. And you will carry it to term. That's how people become pregnant after adoption or how they become pregnant after stopping treatments. Or how they become pregnant naturally after 8 failed IVF cycles.
Some people are willing to wait for that cycle. Some people luck out and inadvertently find that cycle. And other people are not willing to sit around for something that may or may not occur. I didn't fall into the first category, I am here on this earth due to the second category. But my heart feels best (and this is personal for me) with that third category. That's how I chose treatments. I don't know if it's helpful to hear how someone else reached the decision to plow ahead.
No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely. I would love people to add how they decided whether or not to enter treatments.
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