When our first attempt at trying to conceive again failed, Realist Maxi was far from discouraged, though not in the “Let’s just try again way.” My prevalent perspective during this time was to evaluate our options. Did it matter to me whether or not this baby grew in my body? Did it matter if this baby was biologically related to me? Was my goal to have biological children or to become a parent? If I couldn’t become a parent the traditional way, how much would it cost using other methods? How much was I willing to invest in becoming a parent?
And after I found my own answer to all of these questions, what was Ben willing to do?
When I was in my teens, I thought fertility was a simple issue. If your period never came, you could not have biological children, but you could adopt if you wanted to. If your period did come but you struggled with getting pregnant, you could do IVF. Of course, IVF was very expensive, and it would seem better for the world, certainly less selfish, to just adopt a child who needed a home instead of working so hard to bring children out of your own body.
This perspective is of a younger Maxi who never imagined she would struggle with fertility herself and have to answer the questions above. The following will discuss the options I investigated given my struggles with fertility.
More than IVF
First, there are many more methods to improve one’s fertility than just invitro fertilization (IVF). In fact, there are so many methods available, I will not attempt to list them all here. For instance, if the fertility issue is related to a woman’s production of eggs, she can take medicines like Clomid to increase her egg production. Another fertility treatment option is intrauterine insemination (IUI) where eggs are not retrieved, but the sperm is prepped and concentrated before being placed in the uterus.[i]These medicines and IUI are a much cheaper option than assisted reproductive technology (ART) like IVF and ICSI. Intracytoplasmic sperm injection (ICSI) is similar in many ways to IVF but only requires one sperm for the insemination procedure, which can benefit men who have low sperm count or quality.
Since these fertility treatment options address different problems, one has to first discover what could be causing infertility. Infertility testing can be invasive and overwhelming, and more importantly, it does not guarantee answers. Many women are unfortunately given the diagnosis of “unexplained infertility.” I am at least fortunate in finally learning that adenomyosis is the culprit of my fertility struggles.
These range of fertility treatment options can also be used together. For instance, a woman diagnosed with adenomyosis might have a few shots of Zoladex, and once her cycle returns try IVF. This was not an option presented to me, and I am not sure I would have taken it if I had known. The average success rate of assisted reproductive technologies (ART) like IVF and ICSI is about 33%, with this number varying based on the age of the woman.[ii]
This number may be negatively impacted by the presence of adenomyosis. Results are inconclusive, but Asif, Henderson, and Raine-Fenning (2014) explain that “The largest and best-controlled studies on the effect of adenomyosis on ART suggest a detrimental impact on miscarriage and ongoing pregnancy rates.”[iii]Also, Tamura et al. (2017) write that “The present results suggest that ART might not necessarily be required for the first‐step management of infertile women with adenomyosis.”[iv]In other words, adenomyosis may make ART less effective, and at this point, it is not recommended that doctors suggest IVF or other ART options as a first-step for women with adenomyosis. This may be why my doctor wanted to see the impact Zoladex had on my fertility before suggesting further treatment.
For me at least, there did not seem to be any support for the idea of trying ART at this point. Depending on what procedures or medicines are involved, the price can range from several thousand dollars to tens of thousands. The price is also dependent upon the number of cycles it takes to become pregnant. Given the uncertainty and cost of these procedures, which would not be covered by my current insurance, I was not motivated to try them.
Adoption
One of the things that surprised me about adoption was the cost. While adopting from foster care may only cost a couple thousand dollars that can potentially be regained through federal programs, adopting independently can range from $15,000 – $40,000. The average cost with an adoption agency is around $40,000, and adopting a child from abroad can be equally as expensive. For very good reasons, it is not easy to adopt a child, and in many cases, it is not cheap either.
Despite the cost, if my goal was to become a parent, then I would likely choose a private adoption agency to help with the process. I think it would be a lot more work and stress to do it independently, especially since I do not already have a specific child in mind. For the foster care option, I do not think it is designed for people whose goal it is to become parents. I think the foster care system is designed for people who have a good, stable home that they could share with a child who is in need of one. In other words, foster care is something I would consider doing in the future but not because I felt it was my cheapest path to parenthood.
So, I knew I was certainly open to adoption, but the question would be a matter of timing. I still wanted to go back to school to get my doctorate. Does that mean I should wait to consider adoption? I don’t think many pregnant women considering adoption would want to give their child to a poor graduate student. Also, would I be able to afford going back to school and the costs of adoption at the same time? It didn’t seem likely. However, it felt somehow unfair that if my body didn’t allow me to have children, then I would have to wait until I was secure in my career and finances to become a parent.
Even when I am financially secure and have the help of an agency, it will not be easy to find a match. There are questions about the race of the child we want to adopt. Would we adopt a child that was of Asian descent? African descent? Both? Would we be open to other races? And what did we mean by Asian and African descent? I felt fairly confident that a Jamaican-Chinese mix would be hard to find, so was I prepared to deal with the constant question of “Oh, is that your child?” As it was, people often did not realize that Ben and I were together. I find myself often having to say things like, “Oh, he’s my husband,” in situations that people would normally just assume we were married if we were both of the same race. At the cash register, even though we are both using the same cart, I still have to tell people that all of our stuff is together.
The other factor with adoptions are the biological parents. I wondered if Ben and I would appeal to a mother deciding which of the many interested couples to entrust her child to. Would a woman of black or Chinese descent want to give up her child to an interracial couple? Also, would that mother want to remain a part of the child’s life? Was I ready to deal with this child’s questions about “Who am I?”
There are so many more questions to ask oneself when considering adoption, like whether the mother allow us to be in the room when she gave birth. Adoption would be a long process, and things could fall through at the last minute. A mother could always change her mind. Did I have the emotional stamina for this process? Did Ben? What would his parents think about us adopting? How would they view an adopted grandchild?
The list of questions never ends.
Surrogacy
There are two types of surrogacy: traditional and gestational. Traditional surrogacy involves the sperm of the father-to-be and the egg of the surrogate, and gestational surrogacy involves the sperm and egg of the parents-to-be. With the aid of ART, I can literally put a Ben-Maxi baby in another woman’s uterus and have her complete the pregnancy. These days gestational surrogacy is encouraged for heterosexual couples because it is less legal trouble. The surrogate has a harder time legally laying claim to a child that is not biologically related to her. Traditional surrogacy averages around 50,000 dollars, but gestational surrogacy averages around 100, 000 dollars.
100, 000 dollars.
It could be more or less depending on the agency, the State, and other laws around surrogacy. For instance, in Canada, it is not legal to pay surrogates for carrying one’s child. So, surrogates are in short supply. In California, surrogates are in high-demand, so they have higher compensations. On average, a surrogate may be paid about $4,000 a month from the time a pregnancy is confirmed until delivery. There may be additional expenses as well if you want the surrogate, for example, to have a diet of organic fruits and vegetables. Essentially, as a teacher, I’d be paying someone a year’s salary to have my child. The agency and lawyers would get the next year’s salary.
That is a lot of money for me. Did I mention my wanting to go back to school? Even if I didn’t, $100, 000 was not a small sum. You could buy a small house in Georgia for that price. However, a house wouldn’t love you the way your child would. If people can spend several hundred thousand dollars on material things like cars and homes, surely I could spend 100,000 on my desire to become a parent, right? But Ben and I wanted two children. $200,000? Could we afford to clothe and feed those children after having them?
Even if we decided we could afford these costs, the question again became when. After I finish my doctorate? The problem with waiting until then though would be that my eggs at 35+ years-old would not be as good as my 28-year-old eggs. The same for Ben’s 40+ sperm. So, should we freeze some eggs now? I then came to learn that you could freeze embryos. This is where they have combined the egg and sperm in the lab, and then freeze the embryos that were successfully formed from the union. Some research suggests that embryos freeze even better than just eggs alone, though other research suggests that this improvement is not significant enough to be meaningful.
Freezing embryos meant that even if something happened to Ben or I in the years it took me to complete my education, we could still potentially create a Ben-Maxi baby through surrogacy. Of course, some people warn against freezing embryos because you may not be with the same partner in X-number of years. Others say that if you decide you do not need the embryos, getting rid of them is more ethically complicated because an embryo is actually a living thing. It becomes the question of, “When does life actually start?”
Realist Maxi went through all the options and asked question after question. One question would lead to many, many more. After a while, I realized I needed Ben’s input. I needed him to put some limitations on what he was willing to do so I could minimize my options and all the questions that came with them. However, Ben was with Optimistic Maxi, and he just wanted to try again for now.
I sent him a few resources though as I needed the help. I needed him to pull me out of the hole I was digging for myself. I needed him to see that Realist Maxi needed something more tangible than hope to hold on to. I wasn’t suggesting that we stop trying again, but adoption and surrogacy weren’t just things you could do at the snap of a finger. We needed to start asking ourselves these questions. We needed to start saving.
The hope would always be there that I could carry a child myself.
It would always be there. It did not need to be cultivated. It did not need to be researched. I wanted to be a mother, and I would keep trying.
** The featured image is of a coloring book I bought to help me destress. Adults should color more.
[i]You can go to this site to learn more about infertility treatment options: https://www.webmd.com/infertility-and-reproduction/guide/understanding-infertility-treatment
[ii]You can get more details about the success rate at different clinics, in different states, and for different procedures at https://www.cdc.gov/art/artdata/index.html
[iii]The full-text article can be found here: https://www.omicsonline.org/open-access/adenomyosis-and-its-effect-on-reproductive-outcomes-2167-0420.1000207.php?aid=32948
[iv]The full-text article can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715885/
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