On the one-year anniversary of our becoming a couple, I sat down with my boyfriend Wes to talk about dealbreakers. If he felt fundamentally differently than I did about what he wanted from life, I needed to end our relationship before we became even more attached.
I had two conditions: I wanted children, and it was important to me to raise them as proud Jews.
Even as a child I loved the biblical story of Shifrah and Puah, the Israelite midwives who defied Pharaoh's orders by delivering slave babies in secret. These brave women were perhaps the first recorded example of passive resistance, risking their lives to ensure the survival of healthy Israelite babies. We Jews have always been a people who’ve kept our traditions alive through our progeny—and defiantly so. From generation to generation, genocide to genocide, we’ve refused to be eliminated. This epic resoluteness was part of my family history: My father, the child of Holocaust survivors, was born in a postwar refugee camp in Germany—like a phoenix rising from the ashes of European Jewry.
But as important as Jewish cultural continuity was to me, it was secondary to my own emotional need to have children. I adore children. People have always told me what a great mom I’d be someday.
Now I was aiming for that “someday” to be realized.
* * *
Wes agreed to my conditions, and three years later we were married. A couple of years passed. Our love for each other kept growing. Everything seemed perfect, and we both began to feel that internal pull to start a family.
We decided to try but not tell anyone of our decision. Our loved ones would worry if it didn’t happen right away, and, of course, if it did happen, it was bad luck to talk about it until after the first trimester.
The first month went by. Nothing. Maybe we didn’t time it quite right.
The second month went by. Still nothing. I started Googling and learned that most couples don’t get pregnant until after three months. Phew!
Month three went by, then four and five. I became very worried. Why couldn’t I get pregnant? I was only 29 and healthy. To learn what the problem was, I would have to wait an entire year. Doctors won’t start testing a woman under 35 for infertility until after a full year of trying, because, statistically, 85% of couples become pregnant within a year. That’s only 5% more than the 80% who become pregnant within six months—but, they reason, when you’re young and have plenty of good fertile years, why not wait in case you are in that 5%?
They don’t take into account the torturous pain you feel after every month of failure.
* * *
I started reacting differently to pregnant women and moms pushing strollers. Whereas I used to smile warmly at women with swollen bellies and make funny faces at tots, I now turned away with a scowl. Every woman with child appeared to be mocking me.
I began to see the biblical story of Sarah and Hagar in a new light. When Sarah is unable to conceive with Abraham, she instructs him to build a family through her maid Hagar, who becomes pregnant immediately. Soon after, Sarah mistreats Hagar, who is cast out with her son Ishmael into the wilderness.
I had always thought that Sarah’s ill treatment of Hagar and Ishmael revealed weaknesses in her character. She was fickle, jealous, and cruel. But experiencing my own deep yearning to become pregnant, I understood why Sarah wanted to banish the woman who, for her, had become the embodiment of her inadequacy. Hagar’s increasing joyousness in her growing belly became Sarah’s daily reminder of what she wanted so badly and could not have herself. While I would not condone Sarah’s behavior, I realized how her natural feelings of inadequacy and jealousy could have made her a different person. The same thing was happening to me, though I’d like to think that in her shoes I would have acted differently.
* * *
I needed to be proactive. What could I do to facilitate becoming pregnant? I spent every free moment researching online.
Web searches said exercise was important, but only in moderation, so I cut down my yoga days from five to three a week. Too much coffee and alcohol were big no-nos, so I limited myself to one cup a day and three drinks a week. I ate pineapple core for five days following ovulation, a home remedy women swear by in the blogosphere. I bought kits to analyze my urine for the ovulation hormone and a special thermometer to monitor my basal temperature every morning upon waking—body temperature rises slightly during ovulation—and these confirmed that I was ovulating normally. I was also able to enter all this information on an app so we knew which days were ideal for baby-making. I was doing everything right.
Month six went by. Nothing. I couldn’t take it anymore. I was going insane.
Wes sat me down and told me I had to talk to someone. Our secret had to be shared.
So I called my mom. After a good cry, I felt a lot better.
* * *
My mom and I decided I needed to call my doctor and insist she run some preliminary tests. A week later, I sat across from the physician as she told me it was probably just stress; she’d seen it a million times. I knew this was true for some couples who’d had trouble conceiving, but the explanation didn’t feel right for me. Besides, it just made me feel guilty for being stressed, which stressed me out even more.
The doctor ordered three blood tests: one to determine my thyroid hormone level (both overactive and underactive thyroid function can impede the ability to conceive), a second one to see if I was ovulating, and the last to evaluate the quality of my eggs (some eggs do not multiply even if fertilized). She also ordered a semen analysis for Wes to determine his sperm count (the amount), motility (ability to move), and morphology (shape—an abnormal head or tail will affect the sperm‘s ability to penetrate the egg). If everything came back normal, she recommended that we keep trying for six more months.
I left the office with an immense sense of relief, believing I was finally taking action to solve the problem.
I had no idea, then, that this would only be the beginning of months of doctors, tests, triumphs, heartbreaks, and, above all else, uncertainty.
* * *
Two weeks later, my test results were in - everything normal.
There was no news yet about Wes’ results. I called the doctor’s office. Something was not right. They weren’t saying what, but he needed to be retested.
Two weeks later my doctor asked for Wes’ phone number. She couldn’t talk to me. My heart sank.
Wes’ second sperm sample did not contain any living sperm, a condition known as azoospermia. She told him not to despair. It did not necessarily mean there was no hope for biological children. Modern medicine had come a long way in treatment of male factor infertility. Wes needed to see a urologist.
* * *
The urologist began with basic imaging tests and blood work. Two weeks later, Wes was notified that the results were in and he needed to see the doctor—not a good sign. When the news is good, they tell you on the phone. When it’s bad, they tell you in person.
Sitting in the urologist’s office together, we learned that Wes had tested positive for Y-chromosomal microdeletion, a family of genetic disorders in which the Y chromosome is missing a gene or genes. This factor alone can have varied levels of severity for male infertility, the doctor told us, but combined with his azoospermia, we had virtually no chance of conceiving children naturally. If we went the route of in vitro fertilization (IVF), combined with intracytoplasmic sperm injection (ICSI), whereby a single sperm is injected into each mature egg, we had a 10% chance. I’d have to go through multiple hormone treatments and medical procedures involved with an IVF egg retrieval - and there was still a high probability they might not find viable sperm in Wes to fertilize my eggs.
This news brought us to our darkest hour. We had a lot to think about. There was more than one way to become a parent. We could adopt. Could we love a child with whom we did not share DNA? Yes. There are so many parentless children in the world who need loving families. Adopting a child would certainly fulfill our desire to pass on Judaism to another generation.
But becoming an adoptive parent did not address one of my most primal desires: to experience a life growing within my body. I remember as a small child telling my mother how lucky I was to be a girl. My brothers might be parents someday, but they’d never get to nurture a baby within for nine glorious months.
I believe there is also something deeply Jewish about this desire. The ability to create a human life is among the most concrete ways one can express b’tzelem Elohim, to be made in God’s image. Giving birth is a holy act of creation.
The kabbalists say that in order to create the world, God had to contract and make space within God’s self. To me, this concept, known as tzimtzum, embodies motherhood. It is an act of love to make space in your body for an independent being. I wanted this experience.
We also considered artificial insemination using donor sperm. The resulting children would not be biologically related to Wes, but I would be able to fulfill my lifelong desire of natural birth. However, Wes wasn’t any more ready than I was to relinquish the experience of creation. If there was any chance he would be able to contribute to this worldly form of Genesis, then we had to try together.
* * *
We sat down with doctor number three, the reproduction specialist, for our first IVF consultation. He explained the process and then looked at our lab tests. “Wes,” he said, “I see you had two semen analyses: the first with four living sperm and the second with none.”
“Four living sperm?” I burst out, absolutely giddy. The doctor looked at me like I was crazy. This would normally be considered bad news, but I felt like we’d won the lottery. This meant that Wes’ body produced viable sperm. We still needed IVF and ICSI to conceive, but our chances had jumped from 10% to 60%. For the first time in months, things were looking up.
* * *
I contacted my insurance company and learned that laws mandating infertility coverage differ from state to state. In our state, there is no mandated coverage for IVF; however, our insurance plan would cover advanced infertility treatment up to $10,000 in a lifetime (excluding more than $4,000 for prescriptions), which was about the cost of one IVF cycle. If the first attempt didn’t work or if we wanted more than one child, all costs would be out of pocket.
Financially, we knew we were lucky. Some couples did not have the means to make IVF a possibility. We’d be able to move forward because of our insurance, additional support of family members, and credit cards we planned to borrow against.
I believe the Jewish community also has a supportive role to play. Everyone has heard of Birthright: the free trip to Israel, but why not Birthright: the right to give birth? We need to come together as a community to support Jewish couples who can’t afford these treatments. One of the first instructions we are given in the V’ahavta, arguably among the most holy words in the Torah, is to “teach them diligently onto thy children.” Think of how much stronger our Jewish community would be if Jewish philanthropists made the command to “be fruitful and multiply” their cause.
It is also imperative that we end the silence surrounding infertility. Practically everyone knows someone who has gone through infertility treatments, but no one opens up about it. Only after I became vocal about our struggle did three friends tell me they either had IVF or are going through it now. The inability to conceive is not shameful; it’s a condition as ancient as our people. Our community needs to hear the voices of our Sarahs, and to give our mothers, daughters, wives, and sisters the support, body and soul, they require and deserve.
* * *
To prepare for our IVF cycle, Wes and I had countless blood tests. These led to doctor number four, the endocrinologist, to get my thyroid level below 2.5 mIU/L to meet IVF protocol; and doctor number five, the genetic counselor, to advise us if we were carriers for any rare genetic diseases.
Every step of the way was full of pitfalls and life-and-death decisions.
When you test for every ailment and deficiency, you’re bound to learn a few terrifying medical things about yourself you couldn’t possibly have imagined. A week before my first IVF treatment, we discovered that I was a carrier for CPT2 (carnitine palmitoyltransferase 2), a genetic disease once considered rare but now known to be quite common in Ashkenazi Jews. This would normally not be a problem, except that Wes had a muscle biopsy years ago which led doctors to believe he suffered from the same condition. A lab would look at all of Wes’ genes to determine whether he had it, and it would take six weeks to learn the results. If he tested positive, our children would have a 50% chance of being born with CPT2. Did we want to wait for the results or proceed with IVF and do further testing if necessary after conception? Ultimately, with the help of the genetic counselor, we decided that because I was a carrier for the most mild form, even if Wes carried two affected genes and I became pregnant, our child was unlikely to have the debilitating variety of CPT2. We decided to go ahead as planned.
Next came the IVF injections. Every day I had to take multiple injectable hormones designed to stimulate my ovaries to produce up to a year’s worth of eggs in one month. We’d fertilize as many eggs as possible to increase the chances of producing healthy, transferable embryos.
The night of my first injection I was terrified. I’d always been afraid of needles. After inserting the syringe into the fat under my belly button, I could not push down the plunger. I was shaking. My face was white. I almost fainted. Luckily, Wes was by my side and carefully pushed the plunger in for me.
The hormones left me bloated, sleepy, emotional, and confused. One day I left the house with my pants on backwards and didn’t notice it until I got home.
Both Wes and I started wearing necklaces with chai, the Hebrew word for life. These amulets reminded us that everything we were going through was for life.
* * *
Finally, the morning of my retrieval arrived. I was sedated for the procedure. When I woke, the nurse told me they’d extracted eighteen eggs. The number eighteen is chai in Hebrew—it felt like a sign!
Eleven of the eighteen eggs could be fertilized, and seven of them developed into embryos. We knew we’d lose some more in the five days between the retrieval and the embryo transfer, the procedure in which growing embryos would be implanted in my womb.
The wait was unbearable. As I willed our little potential babies sitting in a petri dish to multiply, a verse sung in synagogues after the Amidah came to mind:
May the words of my mouth
And the meditations of my heart
Be acceptable to you
My Rock and My Redeemer.
O Lord prepare me to be a sanctuary
Pure and holy, tried and true
And in thanksgiving, I'll be a living
Sanctuary for you.
Ve-asu li mikdash
Ve-a-nach-nu ne-var-ech Yah
May-atah ve-ad o-lam.
As I voiced these words, I felt I was preparing myself to be a holy vessel in which to carry the most precious cargo imaginable.
* * *
The day of our embryo transfer finally arrived. Two perfect packages were ready to be implanted, and two almost perfect ones would be frozen. If the first group did not stick, the second would be thawed and implanted. They could also be used in the future to expand our family. Based on the quality of our embryos, the doctor told us we had a 70% chance of becoming pregnant this round and a 30-40% chance of twins.
Wes and I held hands and together recited the sanctuary prayer one last time. Then I followed the doctor into the procedure room.
* * *
Six weeks after my first IVF injection, Wes and I sat in the exam room for an ultrasound. The doctor asked how I was feeling. “Nervous,” I said. On the screen, an image of my uterus began to emerge. I noticed something - a little splotch with a faint pulsing. My eyes began to well with tears. One of the embryos had implanted! The doctor adjusted the machine, and we heard our baby‘s heartbeat for the first time.
It was a shehecheyanu (deep gratitude) moment we will treasure the rest of our lives.