I was recently invited to review a colleague’s file for promotion. In her file, a referee applauded the candidate’s ability to balance her work commitments with her constant support of her children. I would like to say that I was pleased to see her ability to balance work and family receive recognition in the workplace. I am ashamed to say that my reaction was much uglier. I was envious.
In defense of my jealousy, I’m on a lot of drugs. I’m in the middle of an in vitro fertilization cycle. It’s my fourth try.
Over the past five years, my husband and I have seen three reproductive endocrinologists in Canada and the United States in the hopes that they can help us have a child. I’ve completed four cycles of intrauterine insemination, three cycles of IVF, three embryo transfers, two surgeries, and the preparations (coursework and home-study) required to adopt a child. When we decided to start a family, my husband and I told each other we would not try anything extreme. We find this recollection amusing and extremely naive now. We realized that, for us, family was a core life goal. I love my career and I don’t believe that a person must have a child to feel complete, but considering the very real possibility that we will never have children makes me tremendously sad.
A startling number of Canadians – approximately one in six couples – experience infertility. Given that academic careers generally require a great time investment for training and establishing a program, I expect the number of faculty who have experienced, or will experience, trouble having kids is astounding. But nobody talks about infertility.
Fertility treatments are hard work
My life decisions are really none of anyone else’s business. I’ve been shocked at how many people are bold enough to ask me why I want kids or when. But for the record, I was 34 when my husband and I began trying to start a family five years ago.
We waited until we were in good places personally and professionally, and spent about six months trying to conceive before seeking a referral to our first fertility specialist. We were seen within six months of that referral. (In provinces that recently approved funding for one IVF cycle, the wait-lists and wait times have grown substantially.) At the outset, fertility treatment requires screening tests of both partners. Our results were normal. “Unexplained” describes about 25 percent of infertility, according to Somigliana et al. in a 2016 paper in the journal Human Reproduction. Initially, this news was reassuring (there is nothing wrong with us) but over time it became a problem (the experts can’t figure it out).
We started with IUI, a process that involves presenting concentrated sperm in the uterus at the time the egg is ready to fertilize. Drugs (oral or injection) could be used to facilitate egg growth. This process requires numerous cycle-monitoring appointments each week to track egg development and hormone levels. Women jockey in long lineups first thing every morning for these appointments. Each negative pregnancy test dropped my heart to my boots but I managed to maintain optimism. Tenacity in the face of failure is a fundamental skill for a successful academic.
After four IUI treatments over 12 months, and with our university drug benefits exhausted, my husband and I decided to bite the bullet and try IVF. Reputable studies show IVF is most often ineffective: live birth is achieved in only 29 percent of cases in Canada, according to Gunby et al. in a 2011 paper in Fertility and Sterility. For this reason, our doctors advised that we should be prepared to try IVF three times. Each attempt cost us about $15,000, plus the cost of drugs. And the long-term consequences of those drugs are unclear. Despite all of these risks, the treatment can result in creating an actual human being. The gamble seemed worth it to us.
In vitro fertilization happens in two stages. First, there’s hormone therapy to stimulate the ovaries to grow multiple eggs. The specialist carefully monitors the patient’s response to these injections (sometimes supplemented with oral drugs) and modifies dosages daily. Under-stimulation may mean a poor outcome; and overstimulation can be urgently dangerous for the patient.
Next, the eggs are surgically retrieved, then fertilized and grown outside of the body. The number of days required for the hormones to stimulate the growth of multiple eggs for retrieval varies for each woman.
Inside the ovaries, individual sacs containing eggs grow at different rates. Because the specialist aims to maximize the number of eggs within an ideal range of size (eggs too big or too small will not fertilize), the date of surgical egg-retrieval is decided with only two days’ notice. A different injection is delivered exactly 36 hours before the retrieval. It’s really difficult to keep a consistent work schedule during this phase.
If fertilization in the second phase is successful, an average of 70 percent of embryos don’t survive over the recommended five-day period in vitro. If you start with only a small number of embryos, you could lose them all. With hope the IVF is successful, progesterone is delivered either through multiple vaginal suppositories per day, or one daily intramuscular injection. This is prescribed immediately following retrieval. If you do make it to the embryo transfer, you wait two fretful weeks for a pregnancy test and if your result is positive, you continue taking progesterone for 12 more weeks.
During my phase-one hormone therapy, I felt headachy, foggy, bloated, nauseated and fatigued all day, every day. I had to wrangle cycle-monitoring appointments into my schedule nearly every day. I worked harder in all of my “free” time to maintain my productivity. I was utterly exhausted. For this first IVF attempt, my husband and I did not reveal this struggle to our department chairs because I was embarrassed; because it was none of their business; because I feared their judgment and because we didn’t want to deal with questions after a pregnancy test. Looking back, I didn’t want my department to think I couldn’t handle myself. I was completely demolished when I learned I wasn’t pregnant. And despite all the evidence to the contrary, I couldn’t shake the idea that my exhaustion contributed to the negative outcome.
We tried IVF again with a different drug protocol. This time, I confided in my department manager. I was the first in my university’s history to be granted a leave of one month for IVF. At the end of it, the pregnancy test came back negative – again. I returned to work with my tail between my legs. The university gave me a month to make a baby and I didn’t follow through. Though many of the next interventions I tried made me very sick, I never requested a leave or an accommodation again.
Investing so much time, money and effort drove us to want a child even more. So, my doctor eventually referred us to “The Best” in the United States. The Best quickly discovered that I have an unusual anatomical abnormality in my uterus that would not support a pregnancy. Essentially, we learned that our IUIs and IVFs (six treatments over three years), tens of thousands of dollars and all of our embryos had been for nothing. I was 38.
The Best recommended corrective surgery. Over the next year, I underwent the surgery twice while I continued all of my work responsibilities. Each surgery required a full month of drug therapy afterwards; I was very sick. Both surgeries were unsuccessful.
There’s no “easy fix”
After holiday celebrations with our family and friends, my husband and I used to promise each other on New Year’s that this would be our year to bring home our baby. We did this five times. This past New Year’s, my husband and I knew, for the first time in our relationship, that I would never give birth to our child.
We began our adoption process. Adoption is not an “easy fix” for the barren as some people have implied to me over the years. (For starters, the process exists to find the best caregiving option for a vulnerable child.) Most intended parents don’t have the time (we are not getting any younger) or money to pursue both fertility treatments and adoption. Your bank account may also force you to choose one route, neither of which has a good success rate. Adoption facilitators prefer that a candidate’s “fertility journey be complete” before they start the process.
The required home-study and coursework for adoption typically take one year before you can begin to apply to adoption agencies. A lifelong friend agreed to act as a reference for our adoption home-study. In the very next breath, she told me that she wanted to carry our child. I was absolutely stunned.
Months have passed since my friend offered to be a surrogate for our baby, and I remain overwhelmed. With her whole family’s determined support, we are in the middle of a new IVF cycle at a specialty clinic. This Hail Mary attempt is medically very aggressive and, physically, I feel like garbage.
Why I waited to start trying
Would-be reviewers of my life have asked me why I waited so long to start my family. Let this be the last time I feel compelled to answer this question.
First, I aspired to a successful career as a woman in science. In my 20s, I focused hard on eight years of graduate school and postdoctoral training. I was 30 when I completed my postdoc and took on a lectureship. Over my postdoc, my long-term relationship with a fellow graduate student fell apart as we tried to land tenure-track positions within a reasonable radius. At age 32, I married another academic. (Who else would I meet?) From the beginning, we wanted two kids.
Finding the right personal circumstances to start trying to have a baby took time – but so did arriving at the right time in my career. Professionally, I waited until it seemed like I could handle the demands of the academy. At least I didn’t wait until tenure (I was 37) to start trying.
The academy may shake its head in disagreement, but the underlying message to a woman in science – perhaps to any woman working in a profession – is that babies can wait until you are “established.” And sometimes that message isn’t so subtle: At an interview for a tenure-track position, I was asked whether I planned on having babies. This isn’t legal but in retrospect, I appreciate that this person was at least upfront with what they believed could be a barrier to my tenure.
I also allowed life and my job to take priority over planning for parenthood. Shortly after my husband and I married (I was a pre-tenure assistant professor), I became the primary caregiver for an immediate family member who was dying – an agonizing 18 months. During that same period, I was asked to pick up extra teaching for a colleague on leave. There is nothing special about this – we see faculty digging deep into their reserves of energy all the time. But by then, my husband and I had already started trying to conceive. The demands of caregiving and my workload-plus led me to delay my fertility treatments – and all the while my fertility potential continued to decline.
I deeply regret that decision.
I’m sharing this personal struggle in the hopes of finding a silver lining: that it might motivate even one person to prioritize family planning better than I did. I hope my story encourages young academics to consider the question of family well before biology makes the decision for them; and I hope that among my colleagues in academia, it builds awareness and compassion for the physical and emotional toll of infertility.
Many are waiting on the sidelines for me to finally accept that we cannot have a child: “You have so much to be grateful for,” and “You haven’t lost anything.” Truly, these words sting way more than the four injections I gave myself this morning.
I just completed my letter of support for my colleague’s promotion. I hope that my enthusiasm for her scholarly contributions shines brightly. I also just completed the surgical retrieval of my eggs for surrogacy. I anxiously await a phone call from our specialist’s office with news of whether our embryos have survived overnight. I am a woman in science and yet I find myself praying constantly for the survival of our embryos. In these prayers, I thank that higher power for my loving husband who is navigating this journey with me; for my extraordinary friend for giving us hope, one more time; and for the few precious colleagues I have entrusted with my story and my heart.
The author is an associate professor at a university in Canada. She requested that her article be published anonymously.
Postscript: The author learned, just prior to publication, that she and her husband are expecting a child. She writes: “We are cautiously optimistic that we will have a healthy pregnancy and we are all thrilled!”
Advice to my young colleagues
- The sex education curriculum doesn’t address the risks of waiting too long to start a family. The consequences of waiting are not binary: baby or barren. Waiting may also pose serious risks to the health of a baby and mom. (I have not mentioned the heart-wrenching experiences of losing a pregnancy, either.) In academia, it seems there is no good time to have a child – maybe there is no bad time either. I urge young women in academia to consider their decision on having children as one they should think of early and check in on regularly.
- Tenure is a wonderful achievement. Achieving it in the absence of other life goals, however, may not lead to a satisfying life for everyone.
- If you have been trying to get pregnant, consult your doctor early.
Advice to the academy
- If you work with more than six people, it’s likely you work with someone who has experienced, will experience, or is currently experiencing fertility issues. Caring about the success of our colleagues and trainees means caring about their successes beyond academia. Be open to discussions of life goals and how these fit in the professional context of academia.
- Ballooning class sizes, faculty attrition, continuous changes to the Common CV and the worsening state of research funding in Canada contribute to escalating demands on faculty. In the face of these challenges, note that women and men in academia may be experiencing the additional pressures (on time, money, and energy) of infertility during their pre-tenure years.
- Institutions need innovative approaches for modified leaves that allow for latitude and continued work engagement. Maintaining a full workload during key periods of fertility treatment may leave both the employer and employee dissatisfied. New workplace health models will likely benefit far more people than just those pursuing fertility treatments.
- Unions and associations should fight for more benefits for fertility treatment. When it came to supporting my husband and I through our treatments, our benefits were pathetic! Even if association members are not coming forward to demand these benefits, those who could use them exist in droves. I’ve waited in line for cycle-monitoring appointments with these people.
Advice to those trying to conceive or currently undergoing fertility treatments
- Stay away from ill-informed websites, online forums and would-be advisers. I realize now that conversations in which I found myself justifying our decisions were conversations with unsupportive people.
- Know that stress and fatigue do not cause infertility.
- You are in charge. Every physician we worked with had the very best intentions in offering the next option, but these options may not be right for you. Ask questions and take the time you need to make the right decision for you.
- Most important, I have the utmost respect for your courage, will and determination, and grace, too. Despite everything my husband and I have experienced, I believe strongly that hope is very important.