6 July 2011

The Infertility Hierarchy

There are a few things guaranteed to raise the blood pressure of a woman struggling with fertility issues.

There's the couple who "just fell pregnant, just like that", who giggle about how they "must just be like... really fertile". Then there's the couple who seem indifferent to the pregnancy and their baby, continuing to smoke and drink throughout who still manage to have a healthy baby (not that you would wish anything different, obviously, but when you're feeling guilty for that coffee you had just after ovulation it doesn't seem very fair). There are those who were just born lucky, who tell everyone the minute they fall pregnant and seem never to worry about it or imagine the worst. There are the people who assume you don't want a baby, and there are the people who not only assume they know what you want, but then have the cheek to question it and berate you for it.

But worse then any of those are the ones who confide that they too are struggling, who talk to you about "trying" and "waiting" and, when you are drawn in by the sense of shared suffering, tell you that it's been 3 months now and not even a sign...*screams a silent scream*

I am also one of "those women" - I have already been blessed with a beautiful, healthy child who, after years of trying, appeared by accident early in a relationship that luckily turned out to be stable. But I'm greedy and I want another. Not only that, I know that we don't have much time before Mr feels too old to care for a young child, so after 7 or 8 months I'm already impatient. The intensity of wanting hasn't changed, just because I am already lucky. If anything, the desire for a child is even stronger as I know time is running out.

I can't get over this feeling that I am a fake in the eyes of other women who have been trying for much longer, and that my pregnancy cancelled out the years of trying and that I now have to start from scratch and earn my right to post on the fertility forums again.

In the end I posted a poll on one of those forums asking how long into your TTC journey is it reasonable to say you have fertility issues. Just over 100 people voted, and the consensus was that if you have been trying for a year or more, then it is not unreasonable to describe yourself that way.

3-6 months
1 year
2-3 years
4 years or more

Reading the answers gave me real comfort. I classed myself as having issues (never as infertile, as it feels too hopeless) after 2-3 years of TTC, at about the same point as I got referred for testing. While a lot of people agreed, someone shared the following medical advice:
"Reproductive endocrinologists, the doctors specializing in infertility, will consider a couple infertile and eligible for treatment if:
  • a woman under 35 has not conceived after 12 months of contraceptive-free intercourse. Twelve months is the lower reference limit for Time to Pregnancy (TTP) by the World Health Organization.
  • a woman over 35 has not conceived after 6 months of contraceptive-free sexual intercourse."
"Alternatively, the NICE guidelines define infertility as failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology" 
So many women posted that they were sure they had problems long before they felt they could approach their doctor - I would have had more confidence asking for a referral if I had been aware of these guidelines.

There is certainly a hierarchy of infertility. Even when you acknowledge each other as infertile, there is an understanding that the longer you have been trying, the worse it is. It's an understandable and often justifiable snobbery, but I think it does sometimes leave women who maybe haven't been trying so long, and who are afraid of offending, out in the cold.

Infertility has so many facets that you really can't know what someone else is dealing with unless you can walk in their shoes. A woman who wants children, thinks there may be an issue but is not in a position to start TTC, could feel just as desperate as someone who has already endured many unsuccessful cycles.

Either way, I'm giving myself a break. This is my space, and my life and I won't be wasting any more of my time feeling guilty or a fake. Infertility is not a badge anyone should have to or want to earn and while I will probably still grimace inwardly at the "trying" couples, I will try to remember that in their minds, the suffering is very real.


  1. I think there is a difference between trying and it taking longer than you thought and infertility, as in infertility where you need medical help to conceive

    I know several people who have tried for a while but haven't charted or similar and assume that day 14 is ovulation and aim for that - which is all very well and good but for someone who ovulates on day 21 I know that it can be a long way away from being the right time

    For us we tried for 9 months before throwing acupuncture at it with Bigger and then got lucky quickly, tried another 5 months with Littler (but with hindsight mother nature held off letting us do something too stupid) and this time its been 6 months so sort of at the, yes its not easy but we're not into needing interventions

    I also think people underestimate that it does take time, especially when you've always tried to not get pregnant in the past

  2. I think that's it. At first we were "not not trying". When we first started really trying, my biology was decidedly shaky, so timing didn't really occur to me. With hindsight, I think sex was regular enough for it not to be a big issue, but it was only after a while and a fear that I'd always had that things weren't what they should be that I started to chart and really understand the process!

    Someone who charts and has timed everything right for 6 months is in a very different place from someone who is trying without knowledge of their cycle. I started off this time knowing there was a problem with my luteal phase so although my first baby was a long time coming, 6 months without being any closer to a solution felt a lot longer this time. This month has been much easier because I feel hopeful that acupuncture is the solution. Like yours, my last pregnancy was difficult, although we still don't know why. The older I get, the more I worry about the risks so it feels more urgent than before.

  3. I just had an interesting response to this post at Why Can't This Be Easy

  4. I'm with you. Post-infertility diagnosis (and decidedly un-pregnant), I can say with confidence that I knew long before a doctor told me I "qualified" for fertility treatments that something was amiss. I get the science that says be patient, but that doesn't mean I need to accept it. And I wish I'd been taken seriously by women in the trenches when I first suspected I was one of them.


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