Infertility, Miscarriage, & Adoption

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1. Facing the No-Baby Blues

"I think I just need to relax," I told my ob/gyn after my annual examination. "We're putting in long hours with our youth group, I work full-time, and my husband just finished seminary." I had believed the myth that the cure for infertility is relaxing.

"How long have you been trying?" he asked.

"About 18 months." He rolled closer and spoke gently, "No. Perhaps it's time to 'stop relaxing.' We can try a few simple procedures; the pace is up to you."

I did not know then that I had already met the textbook definition of infertility: the inability to conceive or carry to term after one year of unprotected intercourse. (Some patients say it's also the chance to determine mood by a thermometer, hear every home remedy imaginable, and endure bankruptcy in injectable form.)

Since I cringed at the idea of joining the one in six Americans of childbearing age with fertility problems—people I considered "obsessed with getting pregnant"—I left his office and stayed away for another 18 months. "If God wants us to have kids," we told ourselves, "He'll make it happen."

When we returned to the doctor, we began a journey which would take us through three years of no conceptions followed by eight early pregnancy losses and then three failed adoptions in our quest for a child.

God's grace and some information drove us forward. First, we learned that infertility is usually a symptom that something is physically wrong. Perhaps there's a thyroid problem or an infection. In 95 percent of cases, doctors find a diagnosable medical problem. Second, we learned that for those entering medical treatment, about 65 percent go on to give birth; for those avoiding treatment, the number drops drastically. Medicine and faith do not have to be mutually exclusive.

So we started the process of Love Life by Calendar Rule (which brought about as much joy as a mopping floors). A few times we had to "get together," then rush to the doctor's office to learn whether our bodily fluids were "hostile" to each other. We turned into pincushions, stuck with daily injections either to help me conceive or keep a pregnancy going. And we fought with our insurer, who lumped our heartbreak in the same category with tummy tucks.

The emotional toll astonished us. "The depression and anxiety experienced by infertile women are equivalent to that in women suffering from a terminal illness," says Alice Domar, Ph.D., director of the Behavioral Medicine Program for Infertility at New England Deaconess Hospital in Boston. Why? We're not talking about a new living room set here. We're talking about a child—a child who might make daisy chains, throw her arms around us, even throw up on us. It's not that we were "stuck on genetics," as some accused. Proverbs 30 told us this drive, this longing, was normal. God included the "barren womb" in His description of four things which are never satisfied.

I always hesitate to tell our "sad story" because I don't like to engage in what I call the Suffering Olympics—going for the gold in competing over who's hurt the most. Many people have endured much worse. Yet during that decade (which ended—thank God!—in the miracle of a successful adoption) the Lord taught us these and a few other things that helped us:

Infertility involves a normal grief process. The loss is intangible, but it is real. First there's denial. One woman insisted, "I'm not infertile; I'm just having trouble getting pregnant!" Other responses include crying, bargaining, depression, anger, isolation, and resolution. Look at Hannah (1 Samuel 1); she exhibited almost all of these.

Unfortunately, infertility is a grief cycle within a grief cycle: the monthly cycle of hope and despair interrupts the greater grief process, often leaving couples wondering if they will ever stop hurting.

Spouses grieve differently. Because infertility occurs during the childbearing years, it's often the first major loss husbands and wives experience as a couple. It can be a shock to discover they grieve differently. Many researchers have concluded that gender-based differences significantly complicate the crisis. One sociologist observed that, in general, "Wives saw their husbands as callous and unaffected by infertility while husbands saw their wives as 'overreacting' and unable to put things in perspective. While wives felt their husbands were unwilling to talk about infertility, some husbands wondered what there was to talk about." In another study, half of the infertile women said their infertility was the hardest thing they had ever experienced; only fifteen percent of their husbands said the same thing.

Yet it's not always she who feels more pain; in some marriages, he does. And infertility is not a "woman's problem." Its causes are about evenly split between the genders.

One solution to the emotional disparity is for both partners or the one feeling more emotional pain to connect with a support group or find an Internet buddy. Some psychologists estimate that even happily married couples should expect only about 25 percent of their support to come from their spouses. The rest must come from family, church, friends and support groups.

Remember: children are a gift, not the gift. When people quote verses about children being blessings from God, it's easy to feel you're being punished. Of the thousands of infertility patients we have talked with, I've met only one person who told me she's never wondered whether God was punishing her (She was an atheist.) Children are among God's many blessings, but they are not the only blessing.

Read up and speak up. As believers, our bodies are temples of the Holy Spirit. So we must manage them well. Christian ethics here require thought and investigation. Will the clinic show respect for your convictions? (Most will.) If you do high-tech treatments, will you limit the number of potential embryos to those you are willing to carry to term? Take responsibility for your treatment.

Let God strengthen you. This is most important. Keep asking yourself, "Do I believe God is good?" and "Will I trust Him?" Resist the temptation to cry out, "My stupid body!" knowing God made you fearfully and wonderfully in love, mysterious as His reasons may be. When Job hurt, he fell on his face and worshipped. Worship your Creator in your pain. He cherishes you.

This article first appeared in HomeLife.

For more information on infertility:

Drawing on Glahn’s decade-long struggle with infertility treatment and Cutrer’s medical expertise, these books explore the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives.

Infertility Companion

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility

Biblical Topics: 

2. A Hearts Desire: Encouragement for Couples Facing Infertility

Why Does It Hurt So Much?

A couple sat to eat lunch with me after I had spoken at an infertility symposium. As we began to talk, I asked the wife, “When you grieve over your infertility, what is your greatest loss?”

She didn’t have to think about her answer. “It’s the loss of a dream; my heart’s desire is to have my husband’s child and raise it together.”

I turned to the husband and addressed him. “And you?”

He looked at her, then back at me. After hesitating a moment, he spoke to her gently, and stroked her arm, “Don’t take this wrong, honey, but…” Then he looked at me. “It’s the loss of my wife—she is not the same woman I married. Infertility is really taking a toll on us.”

“You’re normal,” I assured them. After enduring a decade of infertility treatment that included multiple pregnancy losses, three failed adoptions, and an ectopic pregnancy, my husband and I had talked to numerous couples. And I recognized their stress, which—though different in each couple’s case—was still a normal response to an abnormal experience.

Infertility is hard stuff. In fact, “The depression and anxiety experienced by infertile women are equivalent to that in women suffering from a terminal illness,” says Alice Domar, Ph.D., director of the Mind/Body Center for Women’s Health in Beth Israel Deaconess Medical Center at Harvard Medical School .

Why is it so difficult? We’re not talking about buying a new living room set here. We’re talking about having a child—someone who will throw her arms around you, even throw up on you. The idea of conceiving child as the product of two people’s love is a precious dream, and a deep longing. Thus, what a comfort it often is for couples to discover Proverbs 30:16, which tells us that a “barren womb” is among four things on earth that are never satisfied. The intense desire to have children is part of the way God structured the world. The drive, the longing, that “unsatisfied” feeling—these are part of the design.

What Causes Infertility?

Infertility is the inability to conceive or carry a child to term after one year of unprotected intercourse. There can be many causes, but don’t believe the myth that “infertile couples just need to relax and they’ll get pregnant.” In ninety-five percent of cases, there’s a diagnosable medical reason. About sixty-five percent of couples seeking treatment eventually have a biological child, but the percentage drops significantly for couples choosing not to pursue medical treatment.

“It seems there are as many causes of infertility as there are people,” says Dan Underwood, who has a low sperm count. “Some of our infertile friends have antibody problems, some don’t ovulate, some have tubal damage. In about a third of couples, both husband and wife have fertility problems. A lot of people think it’s a ‘women’s issue.’ But fertility problems are just as common in men as in women. The hardest seems to be when it’s unexplained. That happens about five to ten percent of the time. It’s tough to go through treatment month after month when all the tests indicate there’s nothing wrong.”

The number of couples diagnosed with fertility problems appears to be on the rise due in part to delayed childbearing and sexually transmitted diseases. Environmental factors may also play a role.

What Can Couples Do About It?

Couples today face a variety of options for satisfying their desire to parent, depending on how comfortable they are with them.

Medication – In the case of a thyroid problem or infection, medications are often the solution. For women with ovulation problems, fertility drugs can help, too. Some couples believe it’s wrong to use “unnatural means” to treat fertility problems. Others see taking medication as the equivalent to using chemotherapy to treat cancer or insulin to treat diabetes. Those choosing to use drugs should be monitored carefully by skilled medical personnel.

Surgical intervention – Diagnostic surgery can uncover hidden causes of infertility. And corrective surgery often helps. Surgeons may, for example, correct fallopian tube blockage or endometriosis, which affects the uterine lining. In men, surgery can reverse vasectomies or repair structural damage and varicose veins in the testicles.

High Tech Options – Most Christians believe it is ethical to use artificial insemination, in vitro fertilization, and other high tech procedures, provided doctors mix sperm or eggs of the spouse (as opposed to a donor) and take precautions to honor life even at the one-celled stage. Couples using in vitro fertilization should consider limiting the number of eggs fertilized to the number of babies they are willing to carry to term. This keeps them on the ethical high ground of avoiding selective reduction of “excess” embryos or pregnancies in which six or seven babies vie for the available resources in utero. Some couples opt for freezing embryos in this case, but others such as myself have reservations about cryopreservation, feeling that it takes unnecessary risk to the embryo and that it presumes on the couple’s future.

Embryo adoption – A Christian woman I know had three embryos implanted in her uterus and five frozen following an in vitro procedure. After she had triplets, she faced emergency surgery to remove her uterus. That left her with three choices—destroy the additional embryos, find a surrogate to carry them to term, or find someone willing to adopt the embryos.

Embryo adoption is relatively new—developed in response to the more than 100,000 embryos that sit cryopreserved, suspended indefinitely in frozen oblivion. The Snowflakes Embryo Adoption Program works like a full-service adoption agency connecting couples wanting to carry frozen embryos with couples not wanting their frozen embryos destroyed. At the moment this costs about $6,000. However, some Internet services charge less than $75/month for couples on both sides of the embryo adoption equation to advertise and connect with each other. It is left to the couples to negotiate the details after that. No matter what you believe about the ethics of cryopreserving embryos, embryo adoption is an option that is emerging as an alternative to destroying them.

Adoption – Pharaoh’s daughter adopted Moses. A family member adopted Esther when her parents died. And God calls all those who believe in Christ his children through adoption. Thus, the Bible draws a beautiful picture for us of the adoption relationship.

However, adoption is the solution for only one of the many losses in infertility—the loss of the ability to parent the next generation. Most experts encourage couples who pursue infertility treatment to exhaust medical options before pursuing adoption, as the two experiences require working through separate sets of losses. This is why so many infertile couples find it aggravating when their friends encourage with, “You can always adopt.” Some couples deeply grieve the loss of a jointly created child, the pregnancy and breastfeeding experiences, and a continuing family line. For them, adoption will never fill these voids. However, once they reach the “resolution” stage of their infertility, other options look more appealing. Only then can adoption become a wonderful solution for the longing and the loss.

This article first appeared in ParentLife magazine.
Check out these books by Sandra Glahn and William Cutrer, M.D., which also explore pregnancy loss:

Infertility Companion

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility

Biblical Topics: 

3. A Journey through Miscarriage

"A person's a person no matter how small . . ."

—Dr. Seuss, Horton Hears a Who

Six hundred thousand U.S. women experience miscarriage each year.

One in every 50 couples trying to have children experience multiple miscarriages.

As many as 120,000 couples each year suffer at least their third consecutive miscarriage.

Typically, when a couple faces a pregnancy loss, they find themselves constantly analyzing what they could have done differently. They chide themselves with "I shouldn't have used that disinfectant," or "I shouldn't have gone camping." "Grandma told me not to lift my arms above my head, but I did."

To better understand some of the anguish, we need to begin with some medical facts.

What causes it? There is no evidence that excessive work, reasonable exercise, sexual intimacy, having been on birth control pills, stress, bad thoughts, nausea, or vomiting are responsible for miscarriage. The most common reason for pregnancy loss is random chromosomal problems. Knowing this, people often say, "Miscarriage is God's way of taking those children with serious birth defects." This is both cruel and unhelpful. At a time like this, logic doesn't help. It only raises more questions: "So why couldn't God take this child before I found out I was pregnant?"

Other factors include uterine structural imperfections, environmental causes, infections, blood incompatibility, and immunologic problems. While a single pregnancy loss is more likely the result of chromosomal abnormality in the fetus, maternal factors are thought to trigger repeated losses. But in most cases, the specific reason remains unidentified. Nevertheless, it is extremely difficult to convince a woman who has lost a pregnancy that she could not have somehow prevented this tragedy.

What are the types of pregnancy loss? In the case of a biochemical pregnancy, the "pregnancy hormone" (hCG) is detectable in the blood. In a biochemical pregnancy loss, the pregnancy has ceased to develop in the early weeks. A so-called "blighted ovum" occurs when the placental portion of the embryo develops, but not the fetus. Using the term "blighted ovum" is both sexist and inaccurate, as it blames the female (ovum), when technically, once fertilized, it isn’t an "ovum" any longer. "Miscarriage" is a more appropriate label.

And the case of an ectopic or tubal pregnancy, the embryo implants in a fallopian tube or extra-uterine site, necessitating removal, if possible, before the tube ruptures. An ectopic pregnancy can be life-threatening to the mother, and is virtually always fatal to the child. There are the rare instances of implantation on the intestines (abdominal pregnancy) and occasionally a baby can make it, but this is very risky and highly unusual.

Unfortunately, it is currently impossible to take an embryo from the tube and "re-implant" it into the uterus. Well-meaning people who suggest prayer and waiting upon God to "see if the pregnancy will ‘migrate’" are misguided. This is the equivalent to telling someone with crushing substernal chest pain to pray and wait for the pain to move. If cholesterol plaques clog your arteries causing a heart attack, hopefully you rush to the emergency room for angioplasty or bypass. An ectopic pregnancy is just as dangerous to a mother’s life, and close medical observation is required. In addition, the embryos don’t move from the tube to the uterus.

Although seventy-five percent of miscarriages occur before the end of the twelfth week, they can occur at any time during the gestation period. Some couples experience added grief because they've believed the misconception that "once you get past the third month, you're home free."

Why do we feel so terrible about it? Depending on personality and background, each person's response differs. Men and women in general have different feelings about these losses as well, with women tending to feel more of a bond with the lost child. The intensity of pain depends on a number of factors, the most significant of which is the psychological investment in the pregnancy. Often the longer couples have been trying to conceive, the greater their sense of loss.

According to one psychologist, the wave of grief often crests between three and nine months after the loss, although some report that it takes between 18 months to two years for the scars to heal. And the healing process can be disrupted by other life difficulties.

Those who have experienced failed IVF cycles, failed adoptions and the loss of one or more children in a multiple pregnancy have identified many of the same feelings as those who have miscarried.

If you are called upon to support someone who has just lost a pregnancy, the key here is not to be the "answer person," but to provide time, empathy, patience, informed care, compassion, kindness and the encouragement to talk without trying to find solutions. Ethics here require the appreciation for the sanctity of life—respect for the life lost, concern for the pain, and the need for healing through community.

For more on pregnancy loss:

Books by Sandra Glahn and Dr. William Cutrer, The Infertility Companion and When Empty Arms Become a Heavy Burden

Check out www.hannah.org (Hannah's Prayer), a Christian online support organization for couples experiencing infertility and pregnancy loss. Sandra Glahn serves on their advisory board.

Other books by Glahn and Cutrer:

For a fast-paced medical thriller that explores embryonic stem cell research, check out Lethal Harvest, our best-selling Christy fiction finalist in the mystery/suspense category.

Deadly Cure, the sequel to Lethal Harvest, explores adult stem cell research and postpartum depression.

False Positive, another compelling story, touches on sanctity of life issues including RU-486.

Biblical Topics: 

4. Baby Blues: The Second Time Around

Couples with Secondary Infertility Face Unique Challenges

When Charla and Bob Boyl tried to have a second child, they were shocked to discover they had a fertility problem. The Boyls have plenty of company; at least one in twelve couples of childbearing age experience secondary infertility. They have one child, maybe more, then find that after a year or more of trying, they have been unable to conceive or carry another pregnancy to term.

Fort Worth fertility specialist, Kathleen Doody, M.D. says, “Secondary infertility appears to be undertreated. Research reveals that while half of all couples diagnosed with primary infertility pursue treatment, only one fifth of couples with secondary infertility seek medical help.”

“Primary and secondary infertility patients experience almost identical medical problems and treatments,” says Dallas physician, James Douglas, M.D. “We look for the same causes. In addition, childbirth can leave fertility problems behind. And naturally couples are older when they try to have children again. The chances of conceiving per cycle drop off drastically in the upper 30s.”

Psychologists confirm that both primary and secondary infertility evoke feelings of guilt, denial, anger, depression, and frustration. But differences exist, too. Secondarily infertile couples are at an in-between place. The fertile population generally perceives them as having no problem because they have a child. And when they are with primary infertility patients, they often feel too ashamed to ask for support for fear childless couples will resent them.

Debra, who returned to fertility treatment after having a high-tech baby, says the second time she felt a different kind of pain: “Now that I have one child I’ve exchanged the anguish of having no children for the pain of knowing exactly what I’m missing the second time.”

Another mom finds that an activity as common as picking up her daughter from kindergarten brings unexpected grief: “You notice you’re the only mother who is not pregnant, carrying an infant, or holding a toddler’s hand,” she says. “Your child asks why she’s the only one in her class with no brothers or sisters. You listen to everyone in your play group discuss how far apart they want to space their children, and then you watch them conceive according to plan. Meanwhile, you continue with temperature charts, medications, and doctor visits. You wonder if your child will be emotionally scarred by your deep desire to have another. You struggle to answer friends and relatives who comment, ‘Time for another, isn’t it?’ Or worse, you answer those you’ve told you’re infertile who say, ‘At least you have one child; you should feel grateful.’”

“It’s nearly impossible to explain to someone who feels their family is complete why you grieve for the phantom child,” says Charla. “People try to tell us we should feel satisfied with the child we have. I compare it to how I feel about my mother. She died a few months before my daughter was born. I feel grateful to God for giving me a wonderful mother, but no matter how grateful I feel, it never takes away my longing to be with her. Gratitude never replaces longing.”

Secondary infertility often brings an overwhelming jolt with the realization that dreams may never materialize. One mother says, “Many of us grew up with a vision of our family as a Mom and Dad and at least two children. I think about my daughter and wonder if she will ever know the mischief of sisters caught with Mom’s make-up, the frustration of having to share her toys, and the confidences which can’t bridge generations. When we get old and start acting funny, who will she call to say, ‘We’ve got to make Mom stop wearing t-shirts to Neiman’s. I watch her now with two sets of eyes,” she continues. “One set watches her as any mother would. The other struggles to memorize every stage.”

Daniel’s mother, like most, feels guilty about her inability to give her son a sister or brother, recounting a recent experience that made her cry: “Three neighbor kids were teasing my son, saying, ‘If we didn’t live next door, you’d have nobody to play with.’ I called their mother, and she told me her kids felt jealous because my son had more toys. She had explained to them that while Daniel had lots of toys, they had sisters and brothers—something Daniel didn’t have.”

Guilt may take other forms. Studies show that many moms and dads with fertility problems criticize themselves about the quality of their parenting. They may wonder if some curse has been cast on them for being terrible parents the first time. When their child misbehaves, they may think, “No wonder we’re not supposed to have another.”

Along with guilt often comes fear. Many parents worry their children will be lonely, lacking family connections. They may become overly protective or unusually ambitious for their single child. They may also worry that their only child will die or bear the sole burden of caring for them in their old age.

Add to this the expense. Few employers’ health plans cover infertility. Companies often label such treatments “elective,” placing them in the same category as cosmetic surgery. Yet more than 90 percent of fertility problems stem from a diagnosable medical cause.

Many couples find that secondary infertility also complicates the adoption question. They worry about real or perceived equality in homes with a biological/adoptive mix. Some agencies turn away couples with a biological child, and many have a ceiling on parental age.

“Couples confronting secondary infertility need empathy and validation of their pain,” says therapist, Judy Calica. “They need the freedom to grieve their losses and they need support in resolving their crisis.”

And crisis it is. Stacia, describing the emptiness she feels over being unable to conceive again, says, “This is the most difficult thing I’ve ever dealt with. I know I will always feel like I’m just not finished.”

This article first appeared in Dallas Family.

For more information on infertility:

Drawing on Sandra Glahn’s decade-long struggle with infertility treatment and Dr. William Cutrer’s medical expertise, these books explore the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives.

The Infertility Companion: Help and Hope for Couples Facing Infertility

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility

Biblical Topics: 

5. When Everyone Says the Wrong Thing

Whenever I sit in a room full of quiet fertility patients, I’ve found a quick way to get the conversation started. I simply ask, “Has anyone ever been insensitive about your infertility?” At first they give me the “duh” look, indicating that the stupidity of my question is on par with, “Has Oprah ever been on a diet?” But after that momentary pause, they stumble over each other with anecdotes.

Is there a way to keep control when someone asks, “How can you miss something you never had?” instead of tongue-slicing back with, “You mean, like your brain?” It’s tough; but yes.

1. Realize we do it, too. A single friend had confided in me her agony over remaining unmarried. Weeks later, I found myself later crowing to her about my husband’s spontaneous gift of flowers. How insensitive! When my neighbor got the flu, I caught myself asking, “Have you been taking Vitamin C?” How annoying! I wanted them to understand I meant no harm. Yet how difficult it is sometimes to give away the same grace we want from others.

2. Let yourself feel frustrated. Consider Job. It seems the old patriarch grew tired of hearing his friends’ “blame the victim” explanations for his sufferings. So he lashed out with, “Surely wisdom will die with you!” (Job 12:2). Can’t you just hear his sarcasm?

Frustration in the face of insensitive remarks is not necessarily a sign of unspirituality. Remember Paul’s exhortation to the Ephesians: “Be angry and sin not.” (Eph. 4:26).

3. Train the trainable. For some, like the guy who asks if you want him to “show you how it’s done,” the only reasonable answer is Miss Manners’ firmly-stated “Why would you ask something like that?” For the rest, there’s more hope. Identify those you consider teachable; then share with them what you need from them.

4. Gripe in the Spirit. Go ahead and throw a private temper tantrum. Hannah cried to the Lord when the co-wife in her home mocked her with fertility-related barbs (1 Samuel 1). Remember that Christ knows how it feels to receive senseless insults.

5. Ask for supernatural grace to return evil with good. “Growing in grace (2 Peter 3:18) includes growing in giving away grace,” says my mentor, Elizabeth. The apostle’s advice dovetails with another scripture: “If your enemy is hungry, give him food to eat . . . “ (Proverbs 25:21). This verse immediately follows a description of would-be comforters: “ . . . like vinegar on soda is he who sings songs to a troubled heart (Proverbs 25:20). Think there might be a connection? I do.

This article first appeared in HomeLife Magazine.

For more information on infertility:

Drawing on Glahn’s decade-long struggle with infertility treatment and Cutrer’s medical expertise, these books explore the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives.

The Infertility Companion: Help and Hope for Couples Facing Infertility

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility.

Biblical Topics: 

6. Frozen Embryos: Ethical Considerations

What can we do about all the frozen embryos slated for destruction?

Avoid cryopreservation of embryos – First, we need to avoid the waste of more embryos by counseling couples pursuing assisted reproductive technologies to limit the number of eggs fertilized to the number they’re committed to carry to term. With in vitro fertilization procedures, each mature egg is placed in a separate dish. So in the case of abundant eggs, embryologists can limit the number of eggs exposed to sperm. Generally when couples request this, clinics honor their ethical desires.

Perfect the egg-freezing process so that gametes – sperm and eggs – are frozen instead of embryos. Currently freezing sperm is commonly done, but scientists are still working to improve the egg-freezing process.

Encourage embryo adoption. At the moment, such a service costs about $6,000. However, some Internet services charge less than $100 to connect couples and let them work out the details.”

William Cutrer, M.D., and Sandra Glahn, “Of Ethics and Embryos,” Light, (Fall 2000), page 5

For more information:

Infertility Companion: Help and Hope for Couples Facing Infertility
Drawing on Glahn’s decade-long struggle with infertility treatment and Cutrer’s medical expertise, this book explores the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives.

Biblical Topics: 

7. "I'm Pregnant": How to Break the News to Infertile Friends

Tears burned in Kathy’s eyes. It was painful enough to cuddle with her nieces and nephews when she and Kevin longed for a baby. Then, as the family circled the holiday dinner table, her sister exclaimed, "Kathy, I haven’t had a chance to tell you—I’m pregnant again!" All of the relatives stared at their plates. Kathy said later, "I was the only one who didn’t know. I’m sure she was excited about her good news, but my sister did an awful job of telling me she was expecting."

Tears burned in Kathy’s eyes. It was painful enough to cuddle with her nieces and nephews when she and Kevin longed for a baby. Then, as the family circled the holiday dinner table, her sister exclaimed, "Kathy, I haven’t had a chance to tell you—I’m pregnant again!" All of the relatives stared at their plates. Kathy said later, "I was the only one who didn’t know. I’m sure she was excited about her good news, but my sister did an awful job of telling me she was expecting."

To the infertile couple, a pregnancy announcement can feel like losing a game or missing a promotion—despite their good wishes, depression and disappointment linger. A sensitive friend may wonder, "How should I tell my infertile friend that I’m pregnant?"

1. Break the news yourself.
Betsy said, "Kate hurt me by concealing her pregnancy." She explained that she didn’t want to upset me, so she waited until word got around. Her news was easier for me to handle than the fact that I heard it from someone else. When the woman who told me said, ‘Didn’t you know? I thought everybody knew,’ I felt left out and humiliated. Yet mostly I felt insulted—did Kate think I would commit suicide over it?"

2. Tell them in private as soon as possible.
Including an infertile friend among the "first to know" makes her feel important as the member of an elite group. It also gives her time to adjust to the idea before she must smile though the public announcement. Louise said, "When I hear a baby announcement in a crowd, I feel the social pressure to be as gracious as Queen Elizabeth while everyone searches my face to assess what feelings I’m hiding behind the facade. I appreciate being forewarned."

Sharon told her friend, "I know this will be hard for you to hear, but I wanted to tell you before we announce that I’m pregnant. I’ll be telling everyone late next Wednesday, so if you want to slip out early, I’ll understand."

3. Have the attitude that pregnancy is special.
Sometimes by trying to keep from "rubbing it in," happy couples minimize their joy and communicate begrudgingly, "Don’t be jealous of us because this pregnancy is an inconvenience." Yet the idea of an "unwanted pregnancy" seems especially unfair to those with deep yearnings for child.

Lori confided, "Our friends announced they were expecting at a time when I was especially discouraged about our infertility. They emphasized that it was a ‘mistake,’ making it sound like they were taking their child for granted. That attitude upset me."

4. Expect the news to hurt.
Dee said, "I deliver the opposite of what people expect. If they expect me to take it hard, I appreciate their sensitivity so much that I can be happy for them. When they expect me to jump up and down, I’m not as positive because I feel like they’re expecting too much."

Two of Joy’s friends announced their pregnancies within 24 hours of each other. When Gina was the third, she hugged Joy and cried, "I wanted so much for you to be first." Her sensitivity made it easier for Joy to be happy for her.

5. Consider making the announcement in a letter.
Sometimes the most thoughtful way to announce your news is by sparing your friend the face-to-face confrontation. Dropping her a note lets her recover from the painful feelings before she must say anything.

Ruth’s best friend had been trying to conceive for five years. When Ruth discovered she was pregnant with her third child, she wrote, "We are expecting again. I wish I were there to hug you—I don’t know if that would even do any good. I know you’ll be happy for us, but I know it’s painful, too, and that’s okay. Please continue to be honest with me—I want us to be able to keep sharing like we always have. We know our friendship is strong enough to handle it."

When Susan finally conceived after sharing the mutual bond of infertility with a co-worker, she knew her friend would feel isolated. Finally she sent a note that said, "I’ve written this to you three times. I keep tearing it up because it’s too hard to say. The fact is, infertility is just plain hard. I want you to know I had a positive pregnancy test this week. Call me when you feel like it. Believe me, I’ll understand." Her friend ran for the phone.

Rabbi Michael Gold, author of And Hannah Wept says, "A couple having a baby must share their good news with infertile friends in as sensitive a way as possible. I will always remember a beautiful phone call from a woman in my synagogue who had just given birth to a healthy baby boy. She told me that although she and her husband were overjoyed, they kept thinking of us. They knew that calls like theirs had to be hard for us, but they were praying that we would be blessed with a child soon. Her words brought tears to my eyes.

© Sandra Glahn. This article first appeared in Dallas Child.

Check out books by Sandra Glahn and Dr. William Cutrer, which also explore pregnancy loss:

Infertility Companion

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility

Biblical Topics: 

8. In Search of the Stork

When Heather Patterson hadn’t conceived after trying 18 months for a second child, she consulted her physician. At 32, she dropped her jaw when he told her she had begun early menopause. “I cry a lot now,” she said. “Especially when I receive baby shower invitations.”

When Heather Patterson hadn’t conceived after trying 18 months for a second child, she consulted her physician. At 32, she dropped her jaw when he told her she had begun early menopause. “I cry a lot now,” she said. “Especially when I receive baby shower invitations.”

In longing for a child, Heather has plenty of company, as researchers estimate that one in six couples of childbearing age experience infertility. Infertility is defined as the inability to conceive after a year of unprotected intercourse or to carry a child to term.

Of those seeking treatment, roughly half eventually conceive. For those who seek no medical intervention, only about 5 percent achieve pregnancy. So for many patients, the advice to “take a vacation” serves as an irritant.

The pain.

“Most patients describe infertility as a roller coaster of up-and-down emotions,” says Susan Claerhout of RESOLVE, a national infertility support organization. Susan experienced a miscarriage followed by years of trying to conceive. “Miscarriage is a compressed loss; failure to conceive is a drawn-out loss. You have hope during treatment followed by that monthly reminder that you’ve failed. You give up your privacy as you endure poking and prodding; you experience “love by the calendar,” which can destroy the greatest of romances; you loathe Mother’s Day; and with most couples, one partner feels more of a longing to have children. ‘Being at different places’ can be agonizing. People think stress causes infertility; actually, most of the time, infertility causes stress.”

Infertility rates sixth among 43 major life stresses, according to some psychologists who study infertility. “Yet the rest of the world doesn’t even acknowledge it,” says one of the Rutgers researchers who conducted the study.

Patients typically experience a “grief cycle” in which mentally healthy patients move from denial to sadness, anger and depression and then eventually to resolution. “Infertility was a grief cycle within a grief cycle for me,” says Mary McLaughlin, a patient treated for unexplained infertility. “The monthly cycle of despair followed by hope fell within the larger grief cycle, leaving me wondering if I’d ever be free.”

Mary eventually adopted. Afterwards her doctor discovered a minor infection that she and her husband kept giving each other. Following a round of antibiotics, she conceived. “I understand that only 5 percent of women conceive after adopting. That’s the same percentage as those who seek no treatment,” she says. “But I’m amazed at how many times people assume my adopted child served as a placebo. They used to say, ‘Adopt and then you’ll get pregnant.’ Part of me hurt that my story gave people ammunition for hurting my infertile friends.”

Even though modern technologies have improved the chances of having a baby, nearly half of those who undergo treatment remain childless. These couples ultimately face the question of when to stop.

“Often people accuse patients of ‘baby craving,’ as though couples believe their genetics are superior. They don’t understand the longing that drives couples to stay in treatment. How can you place a value on creating a child together?” says Susan, who stopped trying several years ago. “Nevertheless, it’s time to stop when it hurts more to go on than it does to quit.”

The causes.

Causes of infertility include immunological abnormalities, delayed childbearing, failure to ovulate, structural damage to the reproductive tract, low sperm count, and sexually transmitted diseases, to name a few.

Though many consider it a “women’s health issue,” men and women actually share medical diagnoses equally: roughly 30% of infertility’s causes are in the female, 30% in the male, 30% are shared by both partners, and 10% of cases remain unexplained. Uterine infection or scarring following childbirth can also create problems, and the odds of conceiving her cycle drop drastically in the upper 30s. So couples “trying again” may face increased difficulty.

The options.

Physicians encourage women under 30 to try for a year before seeking help. Those approaching their mid- to upper-30s may want to cut that time to six months. And though couples with multiple losses still have good odds of having a baby, after two or three miscarriages, they should seek medical evaluation.

Few health plans cover treatment unless doctors list specific diagnoses. For example, companies may cover tests for “endometriosis” or “polycystic ovarian disease,” but not “infertility.” Many insurance plans label infertility “elective,” lumping it in the same category as cosmetic surgery. One patient gave up a career in public relations with a company whose plan excluded infertility for a minimum-wage job with an organization offering the benefits she needed.

Women generally consult their OB-GYNs first. “Many physicians say they are experts in infertility when they are not,” says Theresa Venet Grant, co-founder and public information director for INCIID (International Council on Infertility Information Dissemination, Inc.). Samuel Marynick, M.D., an endocrinologist at the Baylor Center for Reproductive Health suggests that some OB-GYNs understand and can evaluate infertility well; some cannot. Most OB-GYNs know nothing of male infertility. He suggests, “If you have been with a physician six to twelve months and don’t have a diagnosis or a pregnancy, it seems reasonable to pursue another option.”

Reproductive endocrinologists now offer a growing number of treatments.

Fertility drugs. Doctors may prescribe fertility drugs when tests reveal a hormone imbalance in either male or female. And recently the odds of overcoming recurrent pregnancy loss have improved with medicines which treat immune disorders. Unfortunately, some medications come only in injectable form and require constant monitoring. And because some drugs “hyper-stimulate” ovaries to produce many eggs, they increase the risk of multiple pregnancies.

One cycle on the stronger medications can run into thousands of dollars. Some couples lacking insurance go to Mexico or France , where they can purchase medications legally for a fraction of the U.S. cost. Daily consultations, blood tests and sonograms add to the expense of drug treatment.

Some studies associate ovarian cancer with two commonly-used medications. In reality researchers found only one additional case of cancer in every 6,395 women treated for more than one year with Clomid. And many doctors suspect that the condition which caused these women to need drugs may have been the cancer link, rather than the drugs themselves.

Surgery. Diagnostic surgery can uncover hidden causes of infertility. And corrective surgery may not eliminate infertility, but it often helps. Surgeons may correct fallopian tube blockage or endometriosis, which affects the uterine lining. In men, they may repair structural damage and varicose veins in the testicles.

Intrauterine insemination (IUI). In this procedure, the doctor uses a catheter to place specially-prepared sperm directly into a woman’s uterus. Couples using a donor’s sperm run only an extremely low risk of AIDS, according to Gary Ackerman, M.D., a reproductive endocrinologist at UT Southwestern. The most careful programs freeze sperm for six months and then release it only after the donor has been re-tested for the virus. Each cycle of IUI costs several hundred dollars.

In vitro fertilization (IVF). IVF has become more common since the first “test tube baby,” in 1978. Louise Brown’s father’s sperm fertilized her mother’s egg in a tissue culture dish. Within 36 hours scientists transferred the fertilized egg to her mother’s womb, where it grew. This procedure offers hope for women with blocked tubes.

Today assisted reproductive techniques (ARTs) have many variations. For example specialists may mix sperm and eggs in the fallopian tubes to encourage fertilization in its natural environment. Or egg and sperm may “meet” in glass, and then be transferred to a healthy fallopian tube, where an embryo can travel to the uterus as it would in a normalconception. Various micromanipulation procedures are available for overcoming male factor fertility problems.

A woman who produces no eggs but who has an intact uterus can opt to use donor eggs. Because the process of freezing eggs is unperfected, this involves synchronizing her cycle with the donor’s, whose ovaries are stimulated with fertility drugs. Reproduction care givers then retrieve the eggs, expose them to sperm and transfer resulting embryos to the recipient’s uterus.

One relatively new technique involves injecting one sperm directly into the egg. This helps men with low sperm counts or with sperm that are too weak to penetrate the egg. Specialists generally recommend ARTs only after couples have exhausted other reasonable options. It can be expensive ($10,000+), and physicians recommending it for their patients usually point out the high odds of failure.

Surrogacy. This involves using another woman’s uterus and her egg (traditional surrogacy) or the couple’s embryo (gestational surrogacy). One clinic estimates the average cost at $50,000, and the legal headaches dominate media coverage.

Reproductive technologies continue to evolve, creating ethical mine fields while offering new hope.

“I appreciated the sensitivity of my friend who sent a note breaking the news to me that she was finally pregnant,” says Heather. “She wrote, ‘Infertility is so difficult. Call me when you feel like it. Believe me, I understand.’

“I’m glad she got out. I ran to make the call.”

This article first appeared in Dallas Family.

Hannah’s Prayer is an online Christian support organization for couples experiencing infertility, including pregnancy loss. Check out their web site at www.hannah.org.

For more on infertility and pregnancy loss, check out

Infertility Companion

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility

Biblical Topics: 

9. Infertility Tries Patients Patience

Last week was Mother's Day. And once again I watched a lot of people around me hurt.

Mother’s Day, like all holidays, can be difficult for some. Those who have lost or are estranged from parents or children feel tinges of pain on the day set aside for honoring mothers. Yet the infertile find Mother’s Day particularly painful. For them it serves as a reminder of the gift they long to have but that continually evades them.

Last week was Mother's Day. And once again I watched a lot of people around me hurt.

Mother’s Day, like all holidays, can be difficult for some. Those who have lost or are estranged from parents or children feel tinges of pain on the day set aside for honoring mothers. Yet the infertile find Mother’s Day particularly painful. For them it serves as a reminder of the gift they long to have but that continually evades them.

The subject of infertility is surrounded by many myths. So we'll look at some questions/answers that help us put a few of them to rest:

Are infertility and sterility the same thing?
Infertility is not sterility. Infertility is the inability to conceive after one year of unprotected relations and/or the inability to carry a pregnancy to term (600,000 women miscarry in the U.S. each year). Secondary infertility is the diagnosis when couples who have had one child (or more) are unable to conceive or carry to term again.

What causes infertility?
Common causes of infertility in the female are ovulation or hormonal problems, endometriosis, anti-sperm or anti-embryo antibodies, blockage that prevents eggs and sperm from meeting, and structural or functional problems with the uterus or cervix. In men infertility is caused by poor sperm penetration or maturation, hormonal problems, and blockages of the male reproductive tract.

Is infertility on the rise?
Yes. The number of couples diagnosed with fertility problems is on the rise. Delayed childbearing and sexually transmitted disease are partially responsible. Environmental factors may also play a role.

Is infertility a woman’s problem?
The diagnosis “infertility” is shared about equally between men and women. About 30 percent of infertility problems are due to female factors, 30 are due to male factors, and 35 percent are a combination of both. The other five percent are unexplained.

Don’t infertile couples just need to relax?
Infertility is not caused by stress—but it causes a lot of stress for many couples. Ninety-five percent of the time infertility is due to diagnosable medical factors. More than sixty percent of couples who seek medical treatment will eventually have a biological child. The percentage is much lower for couples who do not pursue assistance.

Isn't it true that if you adopt you’ll get pregnant?
No. Adoption is not a cure for infertility. The chances of an infertile couple conceiving are unaffected by adoption.

Aren't couples going through infertility at least "having fun" trying to have a baby?
Fifty-six percent of couples experiencing infertility report a decrease in the frequency of their intimate relationship. Both women (59%) and men (42%) report a decrease in their level of satisfaction, and infertile couples overall report having five times the sexual difficulties of fertile couples.

About one in six couples of childbearing age experience fertility problems. If you have friends who are infertile, the best way to encourage them is to refrain from giving advice, especially if it involves one of the above myths, and instead to "weep with those who weep."

For more on infertility, listen to my Mother's Day (May 8, 05) conversation with Neil Tomba in Dallas: http://www.nbctexas.org/media/various.htm

Biblical Topics: 

10. Multiple Choices: Navigating the Moral Mine Field

We didn’t put much thought into the "right and wrong" of what we were doing. We wanted a baby and either of us probably would have sacrificed anything for success.

How many to fertilize, what to do with "leftover embryos," whether we’d consider using a donor, destroying embryos without thinking—answering those questions beforehand saved us lots of stress in the midst of IVF.

We didn’t put much thought into the "right and wrong" of what we were doing. We wanted a baby and either of us probably would have sacrificed anything for success.

How many to fertilize, what to do with "leftover embryos," whether we’d consider using a donor, destroying embryos without thinking—answering those questions beforehand saved us lots of stress in the midst of IVF.

Consider how the two Christian couples quoted above handled their fertility treatment quite differently. Some couples give no thought to the hidden landmines and charge ahead unprepared. Others, feeling the Lord’s leading to stay out of the "ethical minefield," end treatment when the doctor recommends fertility drugs. And then there are those who, armed with good maps drawn from scripture, pursue medical treatment and closely monitor their care in striving for the "safe" zone. It is to this last group that I’ll direct my comments.

How do we make God-honoring choices while staying in treatment? We begin by understanding that each unique individual is made in the image of God. It is wrong to take human life (Exodus 20:13)—and an embryo is a human life.

How do we know this? It’s really not too hard. Life begins at the single moment when egg and sperm unite, DNA aligns, and the resulting being begins to function as a coordinated organism. Some infertility specialists (those who have no problem discarding embryos) argue that if we’re so silly as to treat tiny embryos as persons, we should also treat tiny sperm as persons because they’re alive, too. Yet a sperm is not a human life—that is, it is not a being that functions as a coordinated organism. It has only half of the DNA necessary for human life, and it has not united with a human egg. As one expert explains it, "Human embryos are living human beings precisely because they possess the single defining feature of human life that is lost in the moment of death—the ability to function as a coordinated organism rather than merely as a group of living human cells…. Dead bodies may have plenty of live cells, but their cells no longer function together in a coordinated manner. We can take living organs and cells from dead people for transplant to patients without a breach of ethics precisely because corpses are no longer living human beings. Human life is defined by the ability to function as an integrated whole—not by the mere presence of living human cells."

An understanding of when life begins and a commitment to respect the dignity of all human life is essential when making decisions in the infertility lab. It impacts the choices we make relating to multiple follicles, multiple embryos, and multiple transfers. Following are some guidelines.

Stop if you get too many follicles in a non-IVF cycle. The whole point of taking ovulation-inducing drugs is to stimulate a woman’s follicles, those fluid-filled sacs that contain one ovum apiece. During an unassisted cycle, a woman’s body normally regulates the process such that only one follicle matures and releases its egg (ovulation). But fertility drugs override that regulatory mechanism, allowing maturation of up to forty follicles. Multiple follicles mean potential multiple embryos.

To avoid high-order multiples, as mid-cycle approaches, medical personnel must monitor follicles daily via ultrasound. A high number of follicles means a heightened risk of multiple births. If hyperstimulation occurs, the responsible move is for the couple to abstain from sexual intercourse (or IUI) and/or for the doctor to stop administering hormones for that month. (In the case of a patient on clomiphene citrate, the patient has already taken all the medication for that cycle, so abstinence is the only option, though it’s extremely rare for such hyperstimulation to happen on Clomid alone.)

If no sonograms are done, the couple has no idea how many follicles are present. That means they can have a positive pregnancy test before they even know they have the potential for multiple pregnancies—as happened in cases of both octuplets and septuplets. According to ABC News, "While only one or two multiple births have hit the headlines in recent years, more than 80 cases of multiple births of quintuplets or greater now occur in the United States each year. In fact, the country’s birth rate for triplets and higher multiples has nearly quadrupled since 1971." Why? More people are using ovulation induction medications, many of them unmonitored.

Bottom line: If you’re taking fertility drugs, make sure your doctor monitors you appropriately via ultrasound so you know the number of follicles you’re dealing with and can make decisions accordingly. If you end up with too many maturing follicles, despite the cost invested—sometimes in the thousands of dollars—patients need to give serious consideration to the heartbreaking choice of canceling the cycle.

Avoid the creation of multiple embryos. Let’s say you’ve taken clomiphene citrate during an unmonitored cycle, followed by a positive pregnancy test. Your HCG levels have skyrocketed. And when you go for your first ultrasound, the doctor visualizes seven embryos on the screen. Now you face an agonizing decision: should you abort some of the babies in hopes that the others will have a better chance of being born healthy (not to mention minimizing the risk to your own body)? That is what most medical teams would recommend.

Two couples who profess faith in Christ have faced similar situations—one the parents of octuplets (one of whom died) and the other the parents of septuplets. Their difficult choices to carry their children to term rather than taking human life in utero have demonstrated that "it can be done." Yet the best ethical solution here is to avoid getting into this situation! Don’t let the number of mature follicles come as a surprise after conception. And certainly avoid the mentality that says, "We’ll take the risk because we can always reduce later if we get too many."

Though about 37 percent of births using advanced reproductive technologies (ART) are multiples (31 percent twins, 6 percent triplets or more), in vitro fertilization actually allows for more precise management of the number of eggs fertilized. After the doctor aspirates the mature eggs from the follicles, each is placed in its own petri dish. Thus, it’s relatively easy to limit the number of embryos created by directing your medical team to expose only the number of eggs to sperm that you can safely carry to term in that cycle in the event that all embryos implant.

Couples may find themselves facing enormous dilemmas if they do not consider the ethical ramifications of their choices ahead of time and choose accordingly. Imagine being in the situation this patient described:

I was shocked when our doctor aspirated more than thirty eggs from my ovaries and exposed them all to sperm.

Avoid multiple embryo transfers. The couple suddenly faced with multiple embryos in the IVF lab (and this should never come as a surprise!) has little choice but to ask the doctor to transfer several embryos to the wife’s uterus and cryopreserve the rest. Yet it’s best to avoid cryopreservation. The freeze/thaw process is hard on sperm because many of them die; the same is true with eggs. Based on embryo survival rates, it appears that the freeze/thaw process is hard on embryos, too.

Depending on what you read, you’ll find that some clinics have a 50 percent thaw survival rate (half of the embryos survive). Others quote between 60 and 70 percent (at best three-quarters survive). Clinics with higher rates often freeze only the "higher quality embryos" in the first place and discard the rest. Thus the numbers can be deceptive as clinics with higher ethical standards (those that freeze even the "lesser quality" embryos rather than discarding) may have lower "success rates" as a result of their higher regard for human life. This poses a moral dilemma:

I met with my doctor about IVF. He wants to fertilize as many eggs as we can—transfer three and freeze the rest. I told him my concerns about freezing. He said the ones that make it through the thawing process are the ones that would most likely survive naturally anyway, but that it’d be unusual if we have any to freeze. He wants to start immediately, but I’m still uncomfortable. My husband wants to do it the way the doctor recommends. But why won’t my doctor respect what I am saying? I think, "Let’s just set our boundaries." At least I won’t have the moral regret.

Until thaw and conception rates improve following embryo freezing, couples should consider avoiding cryopreservation by having fewer eggs fertilized, even though the financial cost may be higher as a result. That is, they may have to try more IVF cycles with smaller numbers of embryos.

Several clinics in England now focus on natural cycle IVF. It’s less expensive without the ovulation induction medications, and while the odds of success in each cycle are lower, couples can try numerous times. Also, some overseas clinics now limit transfers to one embryo per IVF cycle. In Sweden, transferring a single embryo is the overriding rule, with only one in ten transfers allowing transfer of two embryos.* In the U.S., transferring three to five or more embryos is common, though we are seeing a trend toward transferring fewer embryos selected for their higher quality (read: discard or freeze those of "lower quality") with more cell divisions.

While cryopreservation has its problems, it’s still more ethical to freeze embryos (taking risks with human life) than to discard them (destroying human life). But sadly the common practice of cryopreservation has led to 400,000 embryos now sitting in liquid nitrogen. Consider the following true scenarios that have resulted from cryopreserving numerous embryos:

My husband and I had several embryos transferred to my uterus and a bunch frozen. I conceived twins from that original transfer, but then I had major medical problems during the delivery. That made it impossible for me to carry any more pregnancies. The cost of a gestational surrogate: fifty grand!

We’ve had six kids now through IVF, but we still have three more frozen embryos. So we’re going back for one more transfer...

We have three embryos still frozen after four IVF attempts. We long to quit treatment and we’re broke, but if we do embryo adoption, another couple could end up with our biological child while we’re still childless!

Couples with several frozen embryos can face some tough choices. Respecting the sanctity of human life means giving all embryos a chance to live rather than letting them thaw and die—eliminating the options of destruction and research. (Though it might sound noble to donate an embryo for the furtherance of science, it is unethical to take one life as a means of trying to improve the quality of another life.)

To give every cryopreserved embryo a chance means transferring thawed embryos to the genetic mother, entering into an "embryo adoption" agreement, or procuring the services of a gestational surrogate.

My co-author, William Cutrer, M.D., often notes that an embryo is not a potential life; it is a life with potential. Couples will find that some, if not all, members of their medical team will have this reversed. While sensitive to the fact that clinics are usually evaluated on the basis of their success rates (and our needs may impact those rates), we must also stand our ground as consumers needing to make decisions that line up with our belief systems. Forty years from now, when our doctors have all retired, we’re the ones who’ll still be living with our multiple choices.

© 2003 Sandra Glahn, Hannah's Prayer (HP) Advisory Board Member. This first appeared in HP's July 2003 newsletter.

For more information:

Infertility Companion .
Drawing on Sandra Glahn’s decade-long struggle with infertility treatment this coauthored book explores the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives.

Biblical Topics: 

11. Of Spiders and Reproductive Technologies

One of my favorite seminary courses was a media arts class in creative writing. Near the beginning of the semester, the prof gave us an assignment to write something relating to spiders or webs. Having just read Proverbs 6:6 (“Go to the ant, you sluggard; consider her ways and be wise”), I came up with the following:

Why does He tell us to go to the ant?
Why not the spider who toils all night weaving web in time for morning dew?
The ant—he hustles to maintain; but spider—she spins, a pirouette of beauty in her work. Isn’t she more like Him than he?
Like the woman in fine purple, she toils, her hands grasping the spindle.
Along with some heroes from B-rated movies, we think of black widows, deception, the kill. But spider is regal. She’s far underrated.
Why does He tell us to go to the ant?

My professor wrote a reply that fascinated me. What I had read as a limit—go only to the ant—he urged me to observe through new eyes: “Why do you assume He means you to observe only the ant?” Dr. Grant wrote. “Perhaps He means for you to start with the ant, then let that lead you to other observations. Why make God’s instructions limiting here when they aren’t intended as a prohibition but rather as a springboard to further discovery?”

He asked a question that struck at the heart of my worldview. Is God ultimately a rule giver or a life giver? Do I see limits where there are none, making His words red and blue when perhaps they’re varying shades of purple? And do I categorize rigidly as sinful/acceptable issues that might more properly be categorized as wise/unwise?

In his award winning work, The Mystery of Marriage, Mike Mason observes the apostle Paul’s discussion about celibacy vs. marriage and notes that no hard-and-fast rule is given stating which is better in every case. Then he observes that our Lord was concerned “not just to give advice but to withhold it. His way was not always to provide answers, but more often simply to create a climate of moral and theological questioning such that a true searcher could himself hit upon the right answer.”

Such is our Wonderful Counselor that in many cases He would prefer for us to make decisions based on love, which looks different in different circumstances, than to make a hard, fast rule which applies to every circumstance.

My experience in discussions about surrogacy is that most people of faith respond immediately with “that is wrong.” And I was one of them. Yet what about couples who have already allowed the creation of “excess” embryos? If they want to donate one of their embryos to a husband and wife who are unable to have children, isn’t a gestational surrogacy arrangement the moral high ground compared with donating the embryo to science for dissection?

I have found instructive this prayer by Susanna Wesley: “May I adore the mystery I cannot comprehend. Help me to be not too curious in prying into those secret things that are known only to thee, O God, nor too rash in censuring what I do not understand.”

Biblical Topics: 

12. Positive Adoption Language

When my daughter, Alexandra, arrived home from school today, she told me one of the girls in her class didn't "get" adoption. Apparently this fellow student looked down on Alexandra and asked, "Why don't you go back to your old parents?" Sadly, when Alexandra tried to explain, she didn't get far.

Almost ten years ago, Gary and I rejoiced over the arrival of the girl—an eight-month-old, dark-haired, blue-eyed baby—who came storming into our lives. (Alexandra does nothing subtly.) Her adoption is a fact of her life that we discuss openly and with enthusiasm. And we do so using positive language—adoption vocabulary chosen to assign the maximum dignity to the way our family has been built. It is language that has helped us to eliminate some of the emotional overcharging that for years has helped perpetuate the myth that being part of an adoption means that one has somehow missed out on a real (or, as in today's case, old) family experience.

Here’s how that looks in our house.

We avoid saying “our daughter is adopted.” Phrasing it in the present tense suggests that adoption is ongoing. When it is appropriate to refer to the fact of her adoption at all, we say, “Our daughter was adopted,” referring to the way in which she joined our family.

When people ask if she is our natural child, we affirm that she is—the alternative being that she is our unnatural child. As she describes it, “Mommy’s tummy was broken so I grew in her heart instead.” We refer to her genetic family as her birthparents. Everyone has birthparents, but not everyone lives in the custody of his or her birthparents.

People often want to know if we have ongoing contact with our daughter’s birthparents. The answer is yes, we have an open adoption. At this point people often shudder, confusing open adoption with shared parenting. I have never met our daughter’s birthmom, though my husband has. But we know her name and her health history and we exchange cards on Mother’s Day. We speak respectfully about our daughter’s birth parents as those in a unique group of fewer than one percent of the population who make such a loving choice.

Is our daughter “one of our own”? Certainly. We kiss her boo-boos when she hurts, we laugh when she’s funny, we pray with her. We drag ourselves out of bed in the night when she’s sick. We help her with her homework. We are her parents, and we love her as much as any parent could love a child. The very institution of marriage demonstrates that one can love as family a person to whom he or she is not genetically related. My sister, who is the biological mother of one daughter and the adoptive mother of another, insists that genetic ties are no stronger nor enduring than adoptive relationships.

Today’s birthparents do not surrender or release or relinquish or give up their child to adoption, except in rare cases of involuntary termination of parental rights due to abuse or neglect. Instead birthmoms and dads “make an adoption plan.” They recognize that they are incapable of giving their biological child all that is needed for his or her well being, so they proactively choose a life for that child which demonstrates selfless love.

Some prospective parents choose to adopt a child from another country. Formerly this was referred to as foreign adoption, but “foreign” often has negative connotations: “I got a foreign object in my eye”; “His thinking was foreign to me;” “Don’t possess foreign substances.” So the preferred label is international adoption. (In the same way, we now refer to students who come to the United States seeking education as “international students” not “foreign students.”)

We describe parents who have chosen to adopt sibling groups, older children, or kids facing unique challenges as parenting special-needs children. This is preferable to saying their children are hard to place.

We refer to our friends’ children who were adopted not as “their adopted children,” but simply “their children.” Adoption is a way children join a family, but the modifier “adopted” is unnecessary as an on-going label. (As adoption expert, Patricia Johnston, points out, we would never describe little Jimmy as Tom and Meg’s “birth-control-failure child.”)

We didn't rescue our daughter. If anyone was rescued, it was Gary and me... rescued, for example, from seeing dust particles in the sunlight as signs of filth when the child in our home perceived them as bubbles. So much beauty we were missing....

Speaking of missing beauty, that's what happened to Alexandra at school today--her classmate mistook beauty for loss. Fortunately, our daughter knew better.

Each year in the United States, more than 120,000 children join their families through adoption. In ancient history, Moses lived in an adoption arrangement, as did Esther. Paul says God has adopted us into His family.

If adoption is a metaphor for how God views us, perhaps we can find ways, dignified ways, to express that truth and, as Crosby, Stills, Nash & Young would say, teach our children well.