Sub- vs. In-fertility

Thank you all for your comments from the last post.  It’s nice to know I have such great friends out there praying for us :)

I’ve heard (and read, by scouring every website that comes from googling “average time to conceive” over these past months) that a couple is not considered infertile until a year of random intercourse has gone by without conceiving.  For those practicing fertility focused intercourse (read:  correct timing based on NFP knowledge) the time is reduced to 6 months.

Doesn’t that seem a little harsh to anyone else?  After 11 months you’re not infertile, but after 12 months you are.  Surprise! (aka source of all things official) says infertility is “the state of being unable to produce offspring; in a woman it is an inability to conceive; in a man it is an inability to impregnate.

Again, rather harsh to have this arbitrary and empirical cut-off of 12 months, huh? Especially considering many women trying to conceive are recently coming off hormonal contraception which clearly affects your fertility (not in my case, but still).

And I’m really not just harping on this to make myself feel better for where I’m at!  Just trying to define the difference between infertility and reduced fertility (or sub-fertility).

The term “infertile” should be solely saved for those without wombs and castrated men. There are people like this out there and they have no chance to conceive.  Ever. As much as I’ve gone through, I cannot imagine the pain these people feel at the loss of what never was and never could have been.  However, all of us with these parts intact still as at least some chance at fertility, however diminished given each of our situations (and some people do have significantly lowered chances).  [Can you even put yourself in their shoes and imagine how insulting it would be to one of them to hear a woman with everything intact complain about being infertile?  Essh, I’m so guilty.]

All the rest of us else are just playing an odds game.  Some have higher odds than others.  Some people get pregnant as soon as their husband looks at them!  And some have every medical reason stacked against them.  As Joy commented after my last post, someone has to be on the other end of the bell curve.  Someone has to be there to bite that statistical bullet.

I think I have the only husband in the world who actually thinks that the longer we try to conceive, the higher our chances of conceiving.  (Yes, I almost smacked him the first time I heard that.) But (once I calmed down) I started to get where he was coming from. Does anyone remember probability density functions from stat class? (Or am I really the only engineering blogger out there?)  Given a certain probability to conceive, the more times you flip that coin and don’t get your intended result, the more times you have under your belt and closer you are to getting that result.  We just don’t know how far away that result is.

He’s always been a half-glass full type of person.

I drew a little graph to illustrate (I know, I’m a nerd).  With every month you don’t conceive, you’re one month closer to the end goal because as impossible as it seems for us to conceive as an individual, the stats out there show that about 95% of people that try to get pregnant, will eventually get pregnant (85% will get pregnant within a year, and increases slowly from that).

The only catch is that while 95% of people do conceive, 5% never will.  I have to be the negative voice echoing in my husband’s ear that the asymptote doesn’t end at 100%, it ends at 95% because not everyone who wants to gets pregnant.  If only!  And I think that’s the crux of all the anguish women have who are trying to conceive, the waiting part.  At least people who are truly infertile do not suffer in that “what if?” purgatory.  Am I in that 5%?  I already won the 15% lottery, why should I not win the 5% too?

And I personally believe this is why we see all those “Just adopt and you’ll get pregnant!” stories.  There wasn’t really anything magical about adopting, those people were just on the tail end of the bell curve, and they decided to pursue other paths to parenthood than just wait it out.  My neighbor (appropriately named Sarah) didn’t conceive until she was in her 40’s, after years of trying and eventually giving up!  These people are who God uses to perform miracles, however improbable.

And while I know that a lot of good can come out of reproductive endocrinology and doctors who try to understand what’s preventing our bodies from conceiving and helping us (they have helped diagnose and treat very serious problems!), here’s where I think the infertility industry and mostly artificial reproductive technologies really do us sub-fertile women a disservice:  By claiming that you’re infertile after one-year of no pregnancies.  You KNOW they know I’m out there googling that and freaking out!  If it really is stress that’s preventing conception from happening – like so many people claim – do you think it’d be a good idea to put a time limit cut-off on something so huge as one’s ability to create life?  And I don’t just place blame the industry, they’re providing a service that our contraceptive culture is ultimately at the root of.  I just think the fertility industry is particularly evil for capitalizing on women who buy into their temptations of  motherhood (with lots of cash!) by taking advantage of women in their most vulnerable states.

I may sound really confident that its all going to be OK for sub-fertile women and that they should wait it out, but that’s not what I’m trying to do.   I’m really just trying to spread a little hope.  Its hard buts its an individual decision to wait it out, contemplate life, come to their own new conclusions in their altered life plan regarding how long to wait, decide which (moral) treatments to pursue, and whether or not adoption or fostering is viable path for parenthood for them.  As Sarah wrote, just because you’re told “it will happen eventually”, doesn’t mean that it gets any easier in the meantime (plus, we all fear that 5%).  But unfortunately this is something that each person has to work out between themselves and God.  The scariest part is that there isn’t anything anyone can do or say to take this suffering away.  This is our cross and believe me, its heavy, we could just do without this lifelong label of “infertile” to stress us out even more!

I’ll stop here and save why I think contraception and the contraception mentality does a disservice (in general, but especially) to subfertile women, for another post!

18 thoughts on “Sub- vs. In-fertility

  1. Bravo! Excellent post. I have a slightly larger definition of infertile than you do (I think that one can properly be labeled “infertile” when there is medically *no* possibility of pregnancy but most women would still have to wait until menopause to be declared “infertile”) but I completely agree that the term is overused and that it is not helpful. It can also contribute to a permanently negative attitude. Struggling with sub-fertility does shape one forever, but it does not need to turn into one’s entire identity. I want to cry when I see *pregnant* women still talking about themselves as infertile.

    “This is our cross and believe me, its heavy, we could just do without this lifelong label of “infertile” to stress us out even more!” You are so very right!

    • Oh whoops! Major oversight about not including those that have entered menopause. I really meant to do that. And I agree about those that haven’t conceived before they enter menopause, but it begs the questions how long have they been trying?, were they just trying right before entering menopause?, etc. that make the definition a little more tricky.

      And I’ve totally thought the same thing about pregnant women still claiming to be infertile! I feel like that would be the turning point when I would hit with the reality that “Hey, maybe I didn’t have a great definition of infertility to begin with…”

  2. Oh, and I forgot to say that I love your chart. I was a religion major, but at my college everyone had to take some sort of stats to graduate.

  3. This post is fantastic!

    I was infertile, we only had a 1% chance of conceiving prior to surgery, but did not know that until after surgery (during year 3). Had I not had the surgery I would have remained infertile.

    I almost failed school and I’m wondering how can you do stats on something if you don’t know the percentage of the “infertiles” fertility? I don’t think 1% would be considered subfertility. I totally promise I’m not being bold…just asking, you will catch on real quick, I’m not the sharpest tool in the box! ;)

    But that is where I think NFP is great because if after 6 months you are not pregnant, you can start exploring with the basic stuff…and that then blossoms from there.

    Most of the NFP doctors will not think you are crazy for wondering but just might not be aggressive. I think the aggressive part comes down to the patient. And there are those that get pregnant at the 2 year mark or whatever….I guess I’ve learned that it is easier just to take the bull by the horns and not wait but to investigate. ;) I spent 3 long years wasted waiting…To what could have been solved in 1 1/2 years early on had I had the right direction.

    But in the end it matters that I received the right direction! ;)

    I’m loving your posts on this…. ;)

    • In answer to your stats question, I guess the 1% chance you had to get pregnant is still a chance whereas “infertile” technically means NO chance. So yes, its a very, very small chance, but still a chance. I guess maybe “severe subfertility” or “severely reduced fertility” might be a better word choice. I TOTALLY understand that there are advances in medicine that make those chances increase drastically – like in your case surgery! (and like you said we should be thankful we have those advances in this day and age unlike previous generations!) I guess I feel that word “infertile” leads those to stop hoping and trusting in God and good medicine that works to SOLVE a person’s fertility issues, and turns them to ART to take control themselves. Does that make sense?

  4. I think a lot of what youre saying is awesome. I also think this is (in a round about way) the way my husband looks at it; he’s def a glass half full kinda guy when it comes to our fertility!! I like hearing things that boost my level of hope, even if it’s just a bit! ;) Thanks

  5. Wonderful post, and I particularly agree with not presenting the idea that there is no hope too quickly.

    My husband is a pediatric oncologist and unfortunately chemotherapy and radiation can result in reduced fertility ~ but he feels strongly that he should never tell someone that they will never have children unless it is medically impossible.

  6. Great post – I especially love the graph.

    We were recently told by a dr that our probability of conceiving in any given month was now around 2%. We’re ok with it though – we’ve decided to max out our chances at 100% (we hope) by adopting! ;)

  7. I love the definitions (and the chart – you’re not surprised, I know!). And I have to say this, it couldn’t have been easy teaching NFP to a couple who is completely trying to avoid pregnancy for the time being. And while I knew you were trying to conceive, never once did you let on how much you were struggling. I can’t thank-you enough for your kind heart(s – Mike’s too) to us. My heart is heavy for you both and I pray when we meet in October there is a baby on the way for you guys!

    • aww Rebecca, don’t worry about that at all! i totally get that NFP helps couples discern their appropriate family size and as long as its being used with prayer and thought, you can’t go wrong! every couple and their situation is different! plus even if you’re using it to postpone, you are still respecting your fertility! i have to admit when i hear couples that aren’t honoring that part of themselves AND they’re trying to postpone with a fear of children, it makes me a little sad :(

  8. I think you’re confusing the term infertility with the term barren or sterile.

    Infertility, with the prefix “in” means the “state” of being unable to conceive, as you shared from your dictionary definition. That state of being can last any amount of time.
    Just like anovulation, with the prefix “an” means the state of not ovulating, no matter how long that state may last.
    The fact that I was anovulatory for 7 months and then began to ovulate with medication and post-surgery, does not mean that I suddenly never was anovulatory.
    Just as for those who have conceived after years of infertility, the time that they struggled with infertility is not stripped away. And how about those who never conceive, but still have their uterus and ovaries?
    That 6-cycle standard of fertility-focused intercourse is specifically for those using CrMS, not just any NFP. And the reason for the “magic number” of 6 cycles is because 98% of couples with normal fertility WILL conceive within that 6 cycle timeframe while charting Creighton. It is a blessing for those charting CrMS that they can seek help for their infertility sooner than many other couples who may hear the dreaded, “Come back after 1 year” from their ob/gyn.

    • That is a very interesting point about a state of infertility being able to last for any amount of time. I think that you may be right, but it would also mean that we would have to say that *all* women are “infertile” most of the time (since they are unable to conceive for most of their cycles, no matter how perfect). And that seems to make the term much less meaningful.

      I know that each NFP system has its own rules, and have heard great things about CrMS, but I can’t imagine any competent doctor (yes, I’m optimistic) turning away a woman with 6 cycles of STM charts showing fertility-focused intercourse. Someone very close to me was able to easily start getting help after less than 6 cycles ttc with STM.

    • Interesting points. I had heard that it was any type of NFP because you can identify the fertile period, which means that you know when its possible for sperm and egg to meet as opposed to just having random intercourse. With random intercourse you would have wrong timing 50% of the time since there is an approximately 2 week a month (or 50% of the month) window to conceive. Anyway, while I have heard that Creighton is better at diagnosing fertility problems, it has the same success rate as other symptothermal methods which would also make me think that it has the same success rate in terms of getting pregnant.

      And I totally understand what you’re saying about the time of infertility not being erased once you are pregnant and from that perspective my definitions seem a little harsh. I am grateful for this gift, as you seem to be (especially from your blogs title!) I guess I’m just trying to look at fertility from an bigger picture that my view (and infertility doctor’s) typically allows for. Maybe it looks like infertility to me but maybe we’re about to conceive. On the other hand it looks like infertility for those 5% and it really turns out to be infertility if they do eventually reach menopause without conceiving. I guess I’m just trying to stay positive and not try to stress about figuring out what this giant picture is until its complete.

  9. I don’t mean to be combative by my comment, either. I just think of my infertility and that of all my friends here in blogworld (whether it has been overcome or not) as a beautiful gift from God and one of the most awesome crosses to carry. I would not desire to take that away, as painful as it can be.
    And to add, one can have the inability to do many things but that doesn’t mean that they can NEVER have the ability to do them. That’s where I think the distinction is between infertility and sterility.

  10. Pingback: Only a matter of time « Matching Moonheads

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