Dear Dr. Maslow,
B”H we have three beautiful children. Shortly, they will stand under the tallis for Kol HaNearim, and we will stand alongside many other beaming parents, except inside, we are hurting deeply. For the past three years, we have struggled to grow our family. We had no issues conceiving in the past, and we can’t explain what is wrong. It is causing a lot of strife in our marriage. My husband thinks we should feel satisfied with the family we have. He says that fertility treatments are only for people who don’t have any children.
Am I being ungrateful?
Breaking on the Inside
Dear Breaking on the Inside;
You’ve perfectly captured the dilemma facing many couples with secondary infertility, which is your diagnosis based on what you’ve written. It may seem odd to have an infertility diagnosis after conceiving, but it is quite common. Studies estimate that more than 10% of U.S. couples experience secondary infertility and that stat is likely much higher in communities where larger families are the norm.
Secondary infertility can have several causes. The most important variable is female age. As we age, the quality and quantity of our eggs decline, leading to rising rates of infertility as the female partner ages. That being said, lots of young women with excellent ovarian reserve still experience secondary infertility. Sometimes anatomical issues arise either in the fallopian tubes or uterus due to prior deliveries or with time.
Additionally, men are not immune from the effects of secondary infertility either. Sperm counts and quality fluctuate widely over time. Unlike women, male fertility is exquisitely sensitive to environmental factors - so changes in weight, illnesses, surgery, smoking, or alcohol consumption can significantly impact fertility over time. So while conception may have been easy in the past, male factor infertility can still develop. Lastly, occasionally secondary infertility is “unexplained,” perhaps one of the most frustrating diagnoses I give out. However, unexplained infertility does not mean nothing is wrong, we know there is, or you wouldn’t be in this predicament. It means that the dysfunction is enough to prevent conception but too subtle to be picked up on our tests.
In most cases, secondary infertility is eminently treatable. Unexplained secondary infertility has one of the highest success rates, partially because the fundamentals of male and female fertility are all functional, and we know there have been past successes.
Regardless of the cause, secondary infertility is a legitimate medical diagnosis, and your desire to explore the cause of your infertility is entirely valid. It does not necessarily come with a commitment to pursue infertility treatment. The reality is that this infertility journey belongs to both of you. I suggest taking the time to learn about your diagnosis and then making an informed decision about which treatment options you are comfortable pursuing together. Sometimes the treatment is simple, and other times more complex. Either way, It can be empowering for you and your husband to explore what’s happening together.
Infertility, no matter the circumstances, brings up deep emotions and vulnerabilities. Secondary infertility has pain all its own. Feelings of shame and ungratefulness are so common, as is the uncomfortable disconnect with “appearing” normal but suffering a hidden pain. However, how we manifest our pain is as unique as we are. It is so common for couples to express their struggles in different ways. Couples may not always be on the same page when it comes to treatment, and I assure you it is not a reflection on you, your husband, or the quality of your marriage.
While I am not a therapist or marriage counselor by training, I have a lot of experience coaching couples through stressful moments. The opportunity to communicate about desires, fears, and boundaries is critical to feeling whole with what is happening to you as individuals and as a couple - whether or not you pursue treatment. If the years of stress and sadness have created a shell too thick to peel away, professional counseling may help you both come to a place of mutual understanding.
Whether or not you are blessed with the nachas another child under the tallis next year, it is my prayer that you are blessed with nachas ruach, understanding, and peace in your home.
Dr. Bat-Sheva L Maslow, MD, MSCR, is a reproductive endocrinologist and fertility specialist at Reproductive Medical Associates (RMA) of New Jersey’s Englewood and Basking Ridge locations. See www.rmanetwork.com/NJ for details or to schedule an appointment. Dr. Maslow is also an active member of the Orthodox community and addresses questions on the intersection of reproductive medicine and Jewish life. You can learn more about Dr. Maslow and her community educational projects on her website www.batshevamaslowmd.com and social media @blmaslowmd on Instagram.