Most upsetting to Debbie, an emotional and outgoing 36-year-old former dental assistant, and Tom, a quiet, boyish-looking 29-year-old litigation attorney, is that doctors can find nothing wrong with either of them. Infertility—which is defined as the inability of a couple to achieve conception after a year of actively trying to conceive—Is the plight of an estimated 2.4 million couples in the U.S. Many women also are unable to carry a pregnancy to live birth. In about one-third of the cases, the source of the fertility problem resides with the female; in another third, with the male. Of the rest, both would-be parents usually have some malfunction. More than half of all such couples can be successfully treated. But for the 3 to 5 percent who, like the Newells, have no explainable cause for their infertility, the odds are much lower—and their frustration much greater. There is no one to blame and nothing to fix.
For many such couples, the stress leads eventually to divorce, but the Newells' problem seems only to have brought them closer. In a courageous series of conversations with National Correspondent Lois Armstrong conducted at their Dana Point, Calif. home, in hopes of helping others deal with this sensitive problem, they talked about their difficult quest for a child.
Debbie: Having a family was something I always assumed would happen. It's something you don't think about twice. Tom and I got married in May 1980, and we stopped using birth control in January 1982 so that I would have a baby that September. I thought I would get pregnant immediately. As luck would have it, my period was late. I was really excited. I even went to have a blood test taken. The nurse called me the next day with the results, about an hour after I got my period. I should have known it wasn't going to be that easy. I had never been pregnant. True, I had never taken any chances, but in the back of my head I began to think maybe something was wrong with me.
I started reading up on conception and pregnancy. The books said you should try for a year before you have an infertility investigation. But I'm impatient, so after six months I went to my internist. He assured me that, from what he could see, everything was normal and suggested a sperm count on Tom. Tom said, "Fine." He knew it would make me feel better.
Tom: At that time I didn't think there was a problem. I'm the eternal optimist. But if there was a cause, we wanted to find out what it was.
Debbie: Tom is as involved in this as I am. He's been my support all along. I get concerned and nervous about things. He is much more relaxed. When his sperm analysis came back normal, we asked around and were referred to an ob-gyn who also treated infertility. I was over 30 and I didn't want any more precious time to go by.
This doctor did a physical exam and checked my hormone levels. Next he wanted to do an endometrial biopsy. They insert an instrument through your cervix and snip off a piece of uterine tissue and study it to see if you're ovulating. The test, which turned out to be quite painful, showed I was ovulating normally. So during my next cycle the doctor ordered a hysterosalpingogram, in which they insert dye into your uterus and fallopian tubes and then X-ray them to see if there are any blockages. I'd read about that being the most painful test of all, and I was really frightened, but I had a very gentle radiologist for that one.
Tom: Again the test showed everything was all right. At that time we thought that was a good sign.
Debbie: The doctor told us to go home and think good thoughts, but by November, three months later, when I got my period once again, I called Tom at work in tears. I told him we had to go to a specialist, not somebody who just dabbled in infertility.
Tom: The Orange County Medical Association referred us to Dr. Lawrence Werlin and Dr. Sergio Stone, who were working at that time at the University of California at Irvine, but we couldn't get an appointment until two months later.
Debbie: That Christmas I remember sitting at the dinner table with my family. I had high hopes that I was going to be pregnant. One problem with infertility is that you fantasize about everything, and I kept thinking that I wouldn't have to go to the doctor. I imagined calling him to say, "I'm going to have to cancel my appointment. I'm pregnant." But then I got my period. I got up from the table to check and I was right. When I came back, I started to cry. I heard somebody say, "Oh, she must have gotten her friend." My friend. Nobody calls it that anymore.
We went to the doctor on Jan. 4, 1983. There must have been 25 other people in the waiting room, but I felt better already. Infertility takes away a lot of your control, but by being there I felt I was doing something about the problem. Dr. Stone told us about ultrasound, where they use sound waves to measure the size of the follicle where the egg is developing in order to tell when you'll be ovulating. He said that would be used in combination with timed intercourse. About 24 to 36 hours before I was to ovulate, I got an injection of HCG (human chorionic gonadotropin), a hormone that helps kick the ripened egg out of the ovary. Then the doctors said, "We want you to have intercourse tonight and tomorrow night," or whatever times it would be optimum. It's sex by prescription, love-making turned into baby-making. There are times when you might want to have sex and you can't because you want the sperm count to be high enough when you ovulate in a couple of days. Then there are times when the doctor tells you to have sex, and you're not in the mood. You wait, then you get your period, and then you wait again. I'm the one who begins to feel the cramps each month and, to be honest, it's hard for me not to associate making love with failure, because each time we've failed.
We went through six months of timed intercourse, then eight months of intrauterine inseminations with Tom's sperm, which had first been washed to get rid of all the impurities. The first six months of this were without drugs, but when we had no luck, we then did a year of it while I was taking Clomid, a fertility drug that stimulates follicle growth and induces ovulation. During that time I also had a diagnostic laparoscopy where they inserted a viewing instrument into my abdominal cavity to see my reproductive organs. They said everything looked fine.
Tom: There was really nothing more we could do. We had been at it for two years, so we decided the only alternative we had left was in vitro fertilization. It took two months, but we were fortunate to get in to see Dr. Richard Marrs at USC. He felt we should go ahead as soon as possible.
Debbie: We had the in vitro done in March 1985. Physically I didn't suffer much, but emotionally it was very difficult. The first day you get your period, you alert the doctor's office. On Day Three I started taking two Clomid tablets a day. Then every day until about Day Eight, I received an injection of Pergonal, another fertility medication that also stimulates follicle growth. On Day Eight we started going to the doctor's office every day to have my blood drawn to check estrogen levels and for an ultrasound to see how many follicles were there. If you're not producing enough eggs, they stop the whole procedure. Between your ultrasounds and your blood work, you're on pins and needles waiting to hear the results.
Once the doctor determines that you have enough eggs, that the follicles are the proper size and your blood levels are correct for ovulation, you go to the hospital and have an injection of HCG. A few hours before you ovulate, the doctor does a laparoscopy to retrieve the eggs.
Tom: But the day before you're scheduled for the laparoscopy, they take one final blood test, and if they think you've already ovulated, they won't do the surgery. So that's another time they can stop the whole thing. A number of women started the same day we did, and we watched them gradually drop by the wayside. It was two weeks of heavy-duty stress.
Debbie: After they retrieve the eggs they fertilize them in the lab with Tom's sperm. You go home and they call you the next day to tell you if they've got some embryos. We had four, a whole family. You go in the next day for the transfer. I remember afterward the nurse said to Tom, "Say hello to your pregnant wife." Even though it may have been for only a few moments, it was the first time I was truly pregnant.
For the next two weeks, until you have a pregnancy test, you're on your own. Tom had to give me an injection of progesterone every day to maintain the growth of the endometrium, but otherwise you're just waiting. Each day you lie there and feel these little cramps and you think, "Is that a good sign or a bad sign?"
Tom: I tried not to think too much about it. I immersed myself in work. But when we got the call that the pregnancy test had come back negative, we were devastated. A lot of the optimism I had disappeared. I suddenly realized there was a possibility we might never have a biological child.
Debbie: I felt numb. I knew my odds were only one in four of getting pregnant, but it's hard not to get your hopes up when you have these embryos inside you and you've taken good care of yourself. We had four babies, no matter how small, and all of a sudden they were gone. The sense of loss was very real. I couldn't help thinking that it was my fault.
After the in vitro we didn't do anything related to infertility for almost a year. We avoided any sexual relations around ovulation because I didn't want to get disappointed again. That felt really good. There was no possibility I was pregnant, so the tenseness, the wondering about it, was gone.
I once read a quote from some doctor about how infertility patients are second only to terminal cancer patients in that they are willing to do anything anybody suggests. It's true. We had mistletoe over our bed for a year because I'd read that it was a fertility symbol. I ripped it down one day when I got my period. Somebody told us they'd gotten pregnant and the only thing they did differently was change their soap. I went all over town trying to find that soap.
Tom: All the disappointments have broken many a marriage. Since there is no problem that has been diagnosed with either of us, we can't get into pointing a finger and saying, "It's your fault; if I wasn't married to you, I'd have a child now," or the more prevalent, "It's my fault."
Debbie: The subject of infertility is difficult for a lot of people to handle. They say things like, "Don't you know how? I'll show you." They think infertility is sexual. It's not. It's medical. People ask my mother if I have children, and when she says, "No, but they're trying," they say, "They're trying too hard. Relax." They think if it's not physical it has to be in your head. People pooh-pooh it and say there are worse things that can happen to you. Yes, there are, but I feel like my freedom of choice has been taken away. I do not choose to be childless.
Holidays are real difficult, especially Christmas, because it revolves around children. We're fortunate we don't have a bunch of nieces and nephews running around, but someday we will. I have one older sister who has a daughter, 25, and Tom has a twin brother and a younger brother and sister. Because it's hard for me to be around people who are talking about children and pregnancy, we don't go to many gatherings. One of the few places where I feel comfortable is at our Resolve meetings. That's a national organization for people with fertility problems. We're co-presidents of our local chapter. The people we've met there are very compassionate. When my dog Portia, whom I had had for 16 years, died, we got the most support from our Resolve friends. They recognize loss and the need to talk about it.
It's difficult when Resolve friends become pregnant, though. One day I telephoned a woman I had gotten to know, and she sounded funny. I asked what was the matter, and she said she was pregnant. I remember feeling rushes of being thrilled for her and then immediately disappointed for myself. Our infertility had been the basis of our relationship. All of a sudden she had graduated, and I had been left behind.
In January of this year Tom and I decided to go back to the doctors again. We didn't want to look back someday and say, "What if we had tried this?" That's why we're willing to do whatever we can afford physically, emotionally and financially.
Tom: The in vitro attempt added up to about $5,000, and over the course of the last four years we figure we've spent about $20,000 more. When we first started, infertility wasn't covered by my insurance policy. Now they view it as an illness and cover 80 percent of the treatment costs.
Debbie: We went back to Dr. Werlin and started with ultrasounds, blood tests and inseminations again. During the second attempt it seemed that I either did not ovulate or that my ovulation was very poor. Dr. Werlin suspected a luteal-phase defect. He said that it was possible I was conceiving, but the eggs had not been implanting, and if that were the case, it was treatable. It was the answer to my prayer: a real problem with a real solution.
In order to find out what was happening, I needed another endometrial biopsy. It wasn't nearly as bad as the first, but unfortunately it turned up no answers.
Tom: In June we had a Resolve symposium, and a doctor spoke about something called the G.I.F.T procedure. It stands for "gamete intrafallopian tube transfer." Debbie would be under general anesthesia. They would take out her eggs and combine them with sperm from me, then put them back into Debbie's tubes, where fertilization would take place. Unlike IVF, they don't fertilize the eggs outside the body. It would be as if nature had taken its course.
Debbie: The more I heard, the more it seemed it was right for me. Mentally I felt very strong, so the next day I said to Tom, "Why wait?" We called Dr. Marrs, and I started on June 12, the third day of my cycle. From the 12th through the 16th, I took a combination of Clomid and Pergonal; then for the next five days there was nothing I could do but sit and hope enough follicles were developing.
The surgery was on June 22. The doctor came in and told me they hoped to get five eggs. I remember I wasn't that nervous. I had so much confidence in everybody. My first thought when I woke up was, "Never again." I felt sick to my stomach and was terribly sore from the procedure. Dr. Marrs came in and told me they were able to get all five eggs but that they were only able to transfer two into my left tube. The catheter wouldn't go into my right one. Either that tube is much narrower than they would like, or instead of being straight, it's wavy. I was disappointed but I thought it might be something new to investigate. They fertilized the three leftover eggs and then froze them so we would have three frozen embryos to use later.
I was in pretty good spirits the first week, but as time progressed I started cramping. I thought, "This just may be as close as I ever get." The results of our pregnancy test were due to be ready at 4 o'clock on July 8. Tom agreed to make that call. I stayed home all day and just sat there looking at the clock. A few minutes after 4, Tom called. The results were negative. I wasn't devastated, but I was definitely disappointed. But Tom sounded so sad, I thought I had to try not to be too depressed, for his sake.
We're going to wait a couple of normal cycles before we think about transferring the frozen embryos. In the end, though, I'm sure we're going to turn to adoption. It doesn't cure infertility, but the child is just as real.
My biggest fear in all of this is that I'm going to grow older and never know the answer. Everything's dragged on so long, because I've always wanted to experience pregnancy and giving birth. It's difficult for me to let go of that. I'm getting closer to accepting that it's not going to happen, but there's always that little bit of hope.
- Lois Armstrong.
Debbie and Tom Newell have been trying to have a baby for almost five years. During that time they have submitted to almost every procedure and test that medical science has to offer, from timed intercourse and fertility drugs to artificial insemination and in vitro fertilization. They have endured the tactless remarks of strangers, the well-meaning advice of friends and the gamut of emotions: guilt, anger, hope, fear.