Fertility and regret

What would I tell my younger self?

I recently met up with a friend who I hadn’t seen in a few years. She was just starting her first round of IVF after a few failed IUIs. She said, “There really needs to be a re-education about all of this. I always thought, if we have trouble conceiving, there’s IVF. But, it turns out that, at my age, there is only a 28% chance of success with my first transfer and only a 50% chance of a baby overall!”. (She was referencing the SART database, which, if you haven’t already, I recommend checking out.)

I’ve had the same thought many times before, as have many of my colleagues. Clearly there is a lack of understanding about the limitations of reproductive science in our society. But, as I think about it more, what information could I have had that would have actually changed my thoughts and behaviors around family building? I’m not sure.

Of course, my experience is uniquely my own and parts may not represent yours or resonate with you. But, I do often hear the thoughts and beliefs that I held as a young woman reflected in the comments of my clients and others I work with in this space. So, I will use my personal story here as a starting point to explore this question.

My story

Although I didn’t realize it at the time, my fertility journey started in my teens. At seventeen, I was diagnosed as anovulatory — my ovaries don’t release eggs without medical intervention. The reason for this has never been clear. Eventually, I was put on the pill to regulate my hormones and that was that. However, I have a very distinct memory of my last appointment with my doctor before heading off to college. She said, “Well, just don’t wait too long to have kids”. I nodded solemnly, somehow understanding this was the appropriate response. But, in my head I thought, “What?! But, I’m going to be like you. I’m going to go to medical school and have a career.” I promptly decided that her comment was best ignored and went on with my life.

As a young adult, my thoughts about family building were more or less, “Sure, ya, I want kids — someday — but only with the right guy”. However, I also wasn’t very serious about finding the right guy. My energy was focused on my studies and my work. Dating was an afterthought — just having some fun.

When I did ask my doctors about the consequences of my anovulation, I was always told, “I wouldn’t worry about it. You are young and healthy. It’s nothing that a little medication won’t solve”.

Fast forward to my 30’s. I had found and married the right guy. Our peers were starting to talk about having kids and it seemed like it could be a good time for us too. So, as our friends ditched their birth control and started tracking cycles, we booked an appointment with a reproductive endocrinologist. After a round of tests, the doctor concluded, “You’re anovulatory but you’re young and healthy. Some Clomid should do the trick”. Well, after 6 years, plenty of Clomid and Letrozole, a handful of IUI’s, 3–4 rounds of IVF (I honestly lost track), a miscarriage, and more stress and pain that I could have possibly imagined, our son was born.

The need for education

I often hear women say something like, “I know everything about how not to get pregnant. It never occurred to me that getting pregnant could be hard!”. It is easy to see why they say this. Most high school health classes present a cursory overview on how a baby is made and then focus on safe sex. The implicit message is that unprotected sex will lead to pregnancy. While this may hold some truth for teenagers, it ignores the natural changes in egg number and egg and sperm quality that cause a swift decline in fertility over the following decades. (By age 30, a woman has only about a 20% chance of getting pregnant each cycle and this drops to about 5% by age 40.) So, education about fertility should be better. Not because young people should be worried about it but because they deserve to be able to make informed decisions, just as in any other area of their health or life.

Medical professionals play a role here too. Perhaps, if my doctor had explained the reason for her suggestion that I not wait too long to have children, I may have paid more attention. And “I wouldn’t worry about it. It’s nothing that a little medication won’t solve” is not an empowering response as it minimizes a concern and fails to educate or invite further discussion.

But is education enough?

I just keep thinking back to that 19 year old me heading off to college. Clearly, I felt a tension between my dreams and my doctor’s advice. In response, I employed the classical defense mechanism of avoidance — I pushed away the uncomfortable thoughts and feelings and focused on what I felt I could control. Thinking back, it now seems obvious that this tension came from a strongly internalized belief in myself and my peers that having children forestalls opportunity. (It is not hard to imagine how we might have learned this. Just think back to health class and the perils of teenage pregnancy.)

Throughout our 20s and 30s, my peers and I doubled down on our focus on what we felt we could control. We believed that if we made “good” decisions and got into the “right” program or got the “right” job and found the “right” guy, everything would fall into place. And, someday, when we were ready — when we felt “settled” or had “arrived” — we would turn our attention to having a family.

Now, I am 40 years old and have a 3 year old son. I have multiple advanced degrees and certifications, have held a number of exciting positions, and run my own business. Yet, I still don’t feel settled or arrived. However, I’ve come to understand that someone like me is never settled because there is always more to do. I also now see, clear as day, that I am not fully in control of my life. Often, I can only control how I respond to things around me. (Hello 2020!) And finally, I now realize that having a child doesn’t forestall anything. Rather, it shifts things. Don’t get me wrong, children change your life and make some things much harder. But, the idea that they prevent personal or professional growth is overwrought. You will figure out how to do all that is important to you.

So, I fear that more education and information about fertility alone, may only lead young people to feel greater tension and perhaps cause stronger avoidant behavior in some. I think we also need different societal values and conversations around women and reproduction. We need a society that celebrates the complexities of life and women’s capacity to thrive in multiple roles at once. A society that visibly and tangibly supports women with affordable childcare and flexible work cultures. A society that champions our ability to lead a Zoom meeting while attending to the needs of our toddler who has climbed into our lap rather than suggesting that perhaps we are overwhelmed.

What about regret?

I often hear clients express regrets, “If only I knew how hard infertility would be I would have…” Others are wrestling with very hard decisions that they worry they may one day regret. So recently, I did some thinking about my own regrets.

Do I have regrets? Oh yes, plenty. But, I actually don’t regret any of the thoughts, attitudes, or choices that I’ve shared here. I am sorry that my husband and I had such struggles. Infertility challenged and changed us. But, I am proud of who we are now and don’t regret that experience.

I do regret the unauthentic decisions that I have made. The decisions that I made because they “made sense” or fit with the external beliefs that I had learned even though, deep down, something about them never felt right. Decisions like choosing to stay in a training program that wasn’t working for me because “I’m not a quitter” or taking a job that looked great on paper even though my gut knew something was amiss, or staying with a particular fertility doctor even though it felt like a bad fit from the start.

So, what would I tell my younger self?

I think I would say “live authentically and remember with compassion”. Yes, if you choose to delay family building, it may be challenging. Maybe more challenging than you can imagine. But there will always be challenges because, no matter how hard you work or how good your decisions are, things will happen that are out of your control. The key, I think (I admit I am still sorting this out for myself) is to make each decision as it comes in a way that feels authentic to who you are. Yes, you may look back and disagree with your choices. You may even feel anger for things that happened. But, if you feel that you made each decision with the information you had at the time in a way that felt authentic to who you were then, you will be more able to see the good that came out of it alongside the bad and less likely to feel regret. And, maybe, just maybe, in doing so you’ll contribute to the creation of a society that celebrates the complexities in all of us.