TTC: On the Other Side of NFP 

This is a post written in the midst of our infertility journey that I had not gotten around to publishing.

When Nick was hired by the Athenaeum (Cincinnati’s Seminary) in late February, I couldn’t have been happier. We had jumped into marriage trusting in God’s timing, and here was an answered prayer. After going out to dinner and celebrating, we began talking about the changes the new job would bring.

I was excited to move to Cincinnati, which had always been one of the two cities where I wanted to live. Nick was happy to be working for the Church and assisting the students at the seminary. We started looking at apartments and town homes, ready to be out of UD Student Housing.

As we discussed what we both felt to be a true start to our lives together, our discussion turned to children. Nick had a steady, stable job now, with amazing health insurance and a comfortable salary. Before that point, Nick was a graduate assistant at UD and we were living in student housing as part of his assistantship. I still had a semester left to finish my undergraduate. It was easy to see that we shouldn’t rush into trying to have children, though building a family together was one of the deepest desires of our hearts.

I remember the profound joy I felt when Nick and I decided to intentionally build our family together. In previous months, we had remained open, but we wouldn’t have said we were trying. At first it was easy to remain hopeful and excited each month, but after a few months of trying, it began to weigh on both of us.

Suddenly, communicating about my fertility became a big deal and a source of anxiety for me. I wanted to allow Nick the chance to initiate, but I knew he also needed to be aware of the changes in my cycle. I didn’t want to put pressure on either of us, but as the months passed I felt a growing sense of urgency and the need to take advantage of every opportunity. It was exhausting for both of us and it became a strain on our marriage.

In our marriage prep, we’d heard about the stresses of NFP. We’d heard about the difficulties of choosing to abstain during times of fertility rather than choosing a form of birth control. We’d heard that NFP could cause fights and at times resentment.

Everything we’d heard about the difficulties of NFP prior to our marriage was in the context of using NFP to avoid having. children (or TTA).

Clearly, we weren’t using NFP to avoid having children at this point in our marriage. It followed then, that there should be no difficulties caused by using NFP, no stress, no strain on our marriage.

We didn’t have to abstain at any point in my cycle! We didn’t need to worry anxiously about being pregnant when we weren’t ready! From the point of view of anyone that was currently trying to avoid having children by using NFP, we’d struck gold, and we should take advantage of this fun and exciting time in our marriage.

And while for a few months we felt that excitement and gratitude for our situation, as stress and worry about fertility mounted, the excitement and gratitude faded away.

Our marriage prep failed us. I realize that may seem to be a drastic statement, but I believe it’s true. When the couple you bring in to talk about NFP is the couple that “gets pregnant when the husband sneezes” (something the wife actually said while teaching us about NFP), the only side of NFP that you will hear about the crosses that come with NFP are those related to trying to avoid children. But there are a whole other set of crosses and struggles when a couple is trying to conceive (TTC) and it doesn’t happen. Even if the couple doesn’t ever meet the standards for being called “infertile” (6 months to a year of trying, depending on age as well as the doctor you ask) trying for two, three, four months is still stressful. It can still create issues that need to be addressed. The Church does newlyweds a disservice a when the struggles that come with TTC (and not just avoiding children) are not included in the marriage prep discussions about NFP.

I truly believed that trying to build our family would be a time of joy and excitement in our marriage. Sometimes, it is a time of joy and excitement. But other times, it can be a time of frustration, stress, and worry. It can drain Nick and me, although in different ways. It can cause tension and resentment between us, something we were not prepared to work through when it came to the intimate issue of building our family. As newlyweds that followed the Church’s teachings on sexual morality, intimacy was already new to us. It was already a struggle to communicate about issues related to intimacy, simply because we didn’t even have the language or the knowledge of how to do so—as is true of all newlyweds that choose to follow Church teaching. Now, because we were trying to have children, there was an added set of issues we needed to discuss with each other related to intimacy—on top of simply figuring out how to communicate with each other about intimacy in the first place.

I truly believe that had our marriage prep included a discussion on the tensions that can arise in a marriage while trying to build a family, that we could have dealt with some of these issues more gracefully. It would’ve helped to simply know that what we were going through was normal. It would’ve helped simply to know that we might expect some additional tension at times. We had learned things about arguing, finances, dating each other while married, compatibility, temperament, and love languages. We certainly didn’t follow through with everything we learned (and are still working on it, as are all couples), but simply having the knowledge was a great help to us. It helped us feel that we had at least some of the tools we needed to address the situations that arose between us. But when it came to building our family together—and intimacy in general—we did not feel that we had the tools we needed, and so we had to seek out the knowledge ourselves.

I know I am not alone in this struggle. I know of many married woman that say that they felt wholly unprepared for the struggles that came with marital intimacy. I have had numerous discussions with other couples about how the Church needs to be more upfront about issues that can arise with sexuality in a marriage as well as how to deal with them. I have read countless stories about women–and their husbands–who were utterly blindsided by the problems that accompanied trying to have children.

For those that have started trying to build their family, whether it be the first or seventh time, know that you are not alone in these struggles—whether it’s the first, third, or seventh month, or whether it’s been years, it doesn’t matter. There are always difficulties that accompany the TTC side of NFP. I believe this is the silent side of NFP, the side that people don’t talk about, because after all, Catholics can easily pop out ten babies. And we all know that NFP is all about creating happy families, because that’s what good Catholics do, right?  We all know that NFP is the natural option for family planning, and so it naturally follows that when you don’t abstain during fertile times, that your body will naturally do what it’s created to do!

These statements aren’t true, and yet within Catholic circles we seem to silently accept them as such. Trying to have a child isn’t as simple as checking in with your spouse monthly and deciding that yes, we are ready for a baby! Deciding that you are ready does not mean a baby will follow, and yet this was the impression that was given in our marriage prep–and the impression I believe is given among most Catholic circles. There were almost elements of the prosperity Gospel, since there was this idea that if you follow God’s plan for sexuality and don’t use birth control in your marriage, that God will bless you abundantly with children and shower blessings on your marriage. We should follow God’s plan for sexuality out of love for Him and because it respects our spouses. We should not be convinced to “buy in” to NFP by hearing the stats about how couples that use NFP have better commmunication, better experiences with intimacy, etc. We need to be honest with couples preparing for marriage about the difficulties that can arise with sexuality, trying to avoid children, and trying to have them—in so far as is appropriate and prudent for couples that are not yet married.

We reached a point in our marriage where intimacy was a chore and an obligation. Intimacy became a source of anxiety as I examined my chart and started feeling “it’s not enough if we want a baby.” I relied more and more on my understanding of health and cycles to try to optimize our chances for success—acting as if I could control whether we had a baby. I pinned the success of my health goals on two pink lines at the end of the month. I made Nick feel objectified and as if I was only interested in having a baby. I felt Nick didn’t care enough and didn’t understand what I was going through. It resulted in a myriad of issues that all came to a head around our first anniversary, pushing us to question whether we needed marriage counseling.

Thankfully, because we were able to recognize the issues that were disrupting and straining our marriage, we were able to develop a plan of attack to address these issues. We began having intentional, vulnerable conversations with each other about our struggle.  I was able to listen to Nick’s concerns and adjust the way I approached him and our fertility so that both of our needs were met. I began focusing on the many blessings in our marriage, and this ignited a new, deeper intimacy between us. We were able to do this because our marriage had a strong foundation in our faith.  Unfortunately, the same cannot be said of all newlywed couples in the Church that are experiencing this struggle.

We need to have frank, open conversations about the struggles couples can encounter in their sexuality, especially when using NFP for any purpose. I would strongly encourage those involved in marriage prep to have multiple presenters for the NFP talk, so that a variety of experiences, struggles, and blessings that come from using NFP may be presented. There is no singular experience of NFP or married sexuality, and the way we prepare couples entering into marriage should reflect that reality. When we avoid these difficult discussions out of a misplaced sense of propriety, we are doing a disservice to newlyweds. There is a difference between speaking imprudently about one’s very intimate experiences with one’s spouse and seeking to educate and inform those entering into marriage about the difficulties they may encounter.

Despite the Church’s beautiful teachings on Theology of the Body, speaking about the struggles and joys that accompany married sexuality still remains somewhat taboo. We remain silent so to avoid scandal, but in being silent, do we produce scandal by failing to adequately prepare couples for the realities of married life?

We cannot remain silent on these issues, and yet while these realities require frank discussion so as to adequately prepare couples, they also require a certain delicacy and restraint. These are matters of a deeply intimate and personal nature, and we must recognize and treat them as such. We must maintain the sacredness of the intimacy shared between the couple. Walking this fine line is certainly difficult, yet I firmly believe that it is a line we must walk if we wish to truly form couples in the Church’s teachings on sexuality.

We cannot continue to fail newlyweds. There is much that needs to be reformed in marriage preparation, and I strongly believe that the treatment of sexuality is one topic desperately in need of greater emphasis in marriage prep. If we are bold, yet prudent, in our discussion of married sexuality, we can address a myriad of potential issues before they even begin in a marriage. We can encourage those in need of healing from previous experiences to seek help. We can invite couples into the struggles and sufferings that married life carries with it, particularly with the use of NFP for any reason. Ultimately, in choosing not to be silent on these issues, we can raise up a stronger and more faithful Church, built upon the foundation of strong and holy marriages.

Infertility as Disease: Accepting and Navigating the Medical Side of Infertility

It was my first Mother’s Day mass after being married.  The previous month I had an experience where I was sure I was pregnant. I can’t explain this experience, and no test I took that month was positive.  But the next cycle did arrive later than usual and with more pain than normal.  During the consecration, my husband and I began to sob.  We felt a sense of loss that we couldn’t explain, a sense of deep heartbreak. And then during the blessing for mothers, the priest saying mass didn’t include Godmothers or spiritual mothers, so I didn’t stand up for the blessing.  And I cried even more, because I so wanted to be able to stand up for that blessing.  It was after that experience, that my husband and I decided to seek medical help for fertility because of my medical history. Making that decision was very emotional for me, because it meant opening up a very private part of our lives to medical intervention.

Infertility is not merely a cross or a struggle.  It is a symptom of an underlying disease. According to RESOLVE, about 12% of married women (1 in 8 couples) have trouble getting pregnant or carrying a pregnancy to term.  Of those struggling with infertility, approximately one-third is related to female causes, one-third related to male causes, and one-third is attributed to both or is unexplained. Trying to figure out what is causing this struggle has been a trying and long journey. Besides my hormone levels and pain, we have very few clues as to what could actually be behind our infertility.  The CDC lists numerous possible causes for infertility in women, including but not limited to Polycystic Ovary Syndrome (PCOS), improper function of hypothalamus or pituitary glands, obstruction of the fallopian tubes, abnormalities of the uterus, and endometriosis.  Infertility in men can be caused by varicoceles, diabetes, autoimmune disorders, heavy alcohol use, improper function of the pituitary and hypothalamus, and cancer treatments.  However, many of the causes of infertility remain unknown.  It is my hope that our scheduled consultation with a NaPro surgeon might give us some answers.  Sometimes a couple can be perfectly healthy in all respects though, and still struggle with infertility.

Infertility needs to be treated as any disease would be.  I am grateful for the experience I had with Napro-technology as a teenager.  Rather than simply handing me the pill, they showed me how to track my cycles.  I learned more about my body, my cycle, and how I was affected by my cycle.  I learned more about what should happen when my reproductive system is functioning normally. I took bio-identical progesterone timed with my cycle to help adjust my hormone levels. I learned from my experience with Napro-Technology as a teenager that I should expect medical care that respects my dignity and seeks to provide me with a treatment that addresses the underlying cause of my symptoms.

It was natural then, when we decided to seek medical advice for achieving pregnancy, that we turned to Napro-Technology (NaPro) again.  Developed by Dr. Hilgers at Creighton University, it is a system of treating infertility that is rooted in Catholic theology and modern science.  I am immensely grateful for my doctor and the doctors that trained him in this system.  NaPro is an alternative approach to infertility treatment.  Many treatment systems begin with trying to identify physiological causes of infertility, but then move into artificial reproductive technologies such as artificial insemination, IUI, IVF, and others. NaPro sets itself apart from other treatment systems because it uses knowledge about the women’s cycle and hormone levels based upon her fertility charts to treat her.

Unlike common suppressive or destructive approaches, NaProTECHNOLOGY works cooperatively with the procreative and gynecologic systems. When these systems function abnormally, NaProTECHNOLOGY identifies the problems and cooperates with the menstrual and fertility cycles that correct the condition, maintain the human ecology, and sustain the procreative potential. -NaProTechnology site

Since NaPro is rooted in Catholic theology, I know that none of the treatments recommended by my doctor will be contrary to Catholic teaching.  The Church teaches that the procreation of children should remain within the marital act.  Having experienced the heartbreak of infertility, I can understand why couples turn to artificial means for having a child, and they have my deepest sympathies.  We should not treat parents who have turned to artificial means of treatment harshly, nor should their children be treated differently, as their children have equal dignity.  That being said, for my husband and me, we know that these are not an option for us.  I see in treatments like IVF and IUI the same sort of approach that using the pill to treat all cycle issues results in–treating the symptoms and not the disease. This is precisely part of Dr. Hilger’s motivations for creating the system of NaProTechnology, after he observed a paradigm shift in the treatment of infertility.

“Until 1978, most of the effort in medicine in evaluating and treating women with infertility was placed in trying to identify and treat the underlying causes.  In 1978, in vitro fertilization produced a paradigm shift.  It led to a “skipping over” the causes and this continues up to the present time to be the foundational management approach.  In essence, this is a symptomatic or Band-Aid approach to treatment, not one that gets to the root causes.” -NaProTechnology site

Fortunately, NaPro is just as effective (and in some cases more effective) as IVF and it is less expensive.  Treatments used by NaPro involve hormone correction, fertility-focused intercourse, use of modern fertility medications such as Clomid or Metformin, and surgery to correct possible endometriosis, tubal occlusions, and other physiological issues. NaPro results in pregnancy in 38.4-81.8% of cases, depending on underlying causes (NaPro textbook, pg 691).  IVF, however has between a 20-40% success rate.

If you are struggling with infertility, there are options for you.  You don’t have to spend $10,000-$12,000 on fertility treatments.  You can seek treatment that helps you understand the underlying cause of your fertility issues. There is hope, and there are doctors that don’t use NaPro that take a similar approach.  I do know that NaPro isn’t for everyone, and that many Catholics approach NaPro as a miracle fix for infertility.  It can actually be hurtful to couples with this struggle when NaPro is approached as the “end all be all” infertility treatment.  The reality is that 20-60% of NaPro patients don’t get pregnant, depending on the underlying cause.  There is nothing that any person can do to guarantee a pregnancy. Sometimes that is hard to accept. The greatest blessing of using NaPro is remembering that children will happen in God’s time.  We cooperate with Him by seeking medical help and better understanding my fertility, but in the end, the Lord is in control.  It is God who creates and gives life.  And while I sometimes want to shout at the Lord, “Why not now, God?” I know that this suffering is not without purpose.  I know that His timing is perfect, though His timing doesn’t seem to match my plans.

Through it all, I learn to let go.

I let go of control, I let go of my pride.  I let go of my desire for having a child to be easy.  I am humbled each time I have to take medicine so that my body can do what it already should. For a time I would spend the evening crying after every blood draw, as they were a reminder to me that my body was broken. I now begin to look at every pill, every medication, every procedure as part of my labor. For after the fall of man, God said to Eve, “I will intensify your toil in childbearing; in pain you shall bring forth children” (Genesis 3:16).  I have come to understand that toil in childbearing is not limited merely to the actual birth of the child.  For those with infertility, it is all that they undergo in order that their bodies may function as they should.  It is all that they do to try to cooperate with God in procreation.  I still struggle with accepting the medicalization of this process.  It feels like medicine is invading something that should be very private and deeply personal.  I still struggle with the stress that comes with trying and hoping again each month.  But I have learned that when I hand these things over to Christ and say “Not my will, but thine” that I feel a sense of peace.

My husband and I are helpless in a sense–there is nothing in our power that we could do to guarantee that this month will be “the month.” But what we can know is that Christ holds us close to His Heart.  He walks with us as we try to walk with Him on the path to Calvary.  And when we reach Calvary, we cling to hope.

For we know that on the third day, there will be the resurrection.

 

This is the third post in a series for National Infertility Awareness Week. You can read the first two here: Gratitude: The Gift Amidst the Cross and here: Put Out Into the Deep 

Put Out Into the Deep

I remember sitting in the doctor’s office where I was shown a chart of normal hormone levels throughout a woman’s cycle.  The doctor told me, “These are the normal levels. These are yours.”  And as I looked at the second line, I realized that where my progesterone and estrogen were supposed to be gradually rising before dropping off slowly like a bell curve, that mine dropped down in a nearly vertical line.  I knew enough about ovulation and conception to know that successful conception and implantation for a baby would be rare at those levels. I then understood that the severe pelvic pain I felt after running and at other times resulted in part from these low hormone levels.  That was the reason I was there after all: the pain.  I was too young to worry about having a baby, and yet, it was at 16 that I found out, though it wasn’t explicitly stated, that for me, having a baby would more than likely necessarily involve hormone support.

The issues with the pain seemed to get better, and eventually I stopped the progesterone support for the pain. When I thought I was going to be a sister, or nun, the knowledge that my hormone levels were off and that having a baby might be difficult for me didn’t really bother me.  In fact, I used it as a sort of confirmation that I might be called to religious life.  I thought, “Well, since having biological children might be difficult for me, then perhaps God is calling me to a spiritual motherhood.”  Of course, I hoped that my levels had improved with age.  I hoped that it was just a passing thing that happened because my adolescent body hadn’t quite figured itself out yet.  And I hoped for those things all the more when I began courting Nicholas and knew that I would end up marrying him.

I remember the first time I told Nicholas about my experience with NaPro Technology as a teenager.  It came up because we were talking about NFP and children. I told him about how odd I felt learning NFP at 16 so that the doctor could figure out why I was feeling pain. And then I told him that I feared future struggles with infertility.  I told him my hope that the issue had resolved and my deep fear that maybe it hadn’t.  He listened, and though he too was wary, he assured me that God would carry us through whatever struggles we went through.  And so when we were married, we knew that infertility might be a struggle for us.  But we clung to hope that it wouldn’t be.

I remember my first “two week wait”.  Before then, I had thought that pregnancy just happened.  I hadn’t really considered the waiting that was involved.  I hadn’t thought at all about the wondering that would happen between that week of fertility and the week that the next cycle was due.  I hadn’t thought about all the hope that could build up in those weeks, only to be brought disappointment when the next cycle arrived. And I hadn’t thought about the fact that because these were cycles that a couple went through the same roller coaster of emotions each month.

This reality felt like a slap to the face.  I wondered why no one had told me about this stress during my marriage prep.  I wondered why infertility hadn’t been talked about either.  And I was angry that people talked all about the struggles of using NFP to avoid pregnancy, but didn’t talk at all about the emotions and struggles that come with trying to have a baby.

And sometimes, it felt like I was drowning in my emotions.

Nicholas wrote me a letter and handed it to me the morning of our wedding.  The final line read, “Let’s go get married, our children are waiting for us.” I want to sob even as I type that line.  Because now, I feel like I’m waiting on them. I feel like I’m waiting on God.

Charts cover my deep blue dresser next to green, yellow, red, and white stickers. They remind me that it is time to take the progesterone that is in the steel refrigerator downstairs and the estrogen in my small bathroom. Another glance reminds me that I need to go to the hospital today to get my blood drawn to check my hormone levels. I do this every month; it is now routine. I am now used to the needles, I am now familiar with which arm is the easy stick and which is the difficult stick, and I know when the nurse is struggling to draw blood without hurting me. There is a familiar script that the nurse and I go through. Often she comments that my blood doesn’t clot well. I laugh and tell her that my dad has commented on the same thing. Sometimes we talk about how I hate needles and used to faint when I was stuck with one, and then we both laugh as I tell the nurse that my father, an anesthesiologist, is afraid of needles.

I wish I could tell you that I am going to give an outsider’s perspective on National Infertility Awareness Week. I wish I could tell you that this hasn’t been my reality. I wish I could tell you that this has been easy for us. But since we were married in January 2016, we have been open to life. And no babies have come.

We started seeing a NaPro doctor in May, four months after our marriage, because of my previous medical history of low progesterone and low estrogen.  We found out that I was still dealing with that. And we hoped that it would be a simple matter of giving me the hormones that my body wasn’t making.  Maybe it still is and it’s just taking time.  Since then, I’ve started Clomid.  I’ve had an ultrasound to check for ovarian cysts. I’ve had an HSG to check that my fallopian tubes were clear.  And after talking to my doctor, we’ve scheduled a consultation with a NaPro surgeon for possible endometriosis.  It’s the only thing that seems to fit my symptoms at this point.

I get my blood drawn every month. I have a list of medications to take. And it feels sometimes that medicine is invading our bedroom and sometimes I just want to scream, “Enough!”  But that’s what infertility does. It makes you feel like you’re drowning. And yet, the waters we drown in are not without purpose.

One in eight couples struggle with infertility. Infertility is defined as the inability to conceive within a year or multiple miscarriages for women under 35.  NaPro Technology, a system of treating infertility in line with Catholic morality, defines infertility as the inability to conceive after six months of fertility-focused intercourse. Infertility is a disease, as there is something that is preventing the reproductive system from functioning as it ought to function. Couples can struggle with primary infertility (the inability to conceive a first child) or secondary infertility (the inability to conceive a child after a first has been born). Either way, infertility is a true cross that brings inconceivable grief. (I despise puns, and when showing this draft to my husband he remarked, “This is the saddest pun I’ve ever read.”)

And yet, I hear the call amidst the crashing storm, amidst the drowning waves of my emotions: Duc in altum. Put out into the deep.

And I am tempted to look at the Lord as Peter did and say, “Master,  we have worked hard all night and caught nothing, but at your command I will lower the nets” (Luke 5:5). I am tempted to look at Christ and seeing the strong wind surrounding me exclaim, “Lord, save me!” And yet, our Lord turns to us, “[stretches] out his hand and [catches us], and [says] to us, ‘O you of little faith, why did you doubt?'” (Matthew 14:31)

Christ is using this struggle to call me to a radical trust. I have been broken by this struggle, and that is good.  Because in my brokenness, I am able to turn to Christ more deeply. I am able to look at the Cross and say to Jesus, “Can you not see that I am drowning beneath the waters of infertility, tied down by the weight of this Cross?”  And Jesus smiles at me and lovingly says, “Yes, but the water you are drowning in is the sea of my Mercy. The Cross you carry is My Cross.  Your pain is my pain. Come to the water. Come and drink, and have new life within you. Come and drown in my mercy, and be renewed by it.”

It may seem counterintuitive, but I have found deeper life in my struggle with infertility. I have found a deeper desire to rely on my husband and on the Lord, something that is particularly difficult for me.  I want to have control.  I don’t want to rely on others or ask for help, because I often view that as weakness.  And while it is deeply humilating for me to say that my husband and I need medical help to have a baby, it also points to the deeper truth present in the Body of Christ: that we all have need of Christ and that we all have need of the other members of the Church.

Through it all, I hear one call, “Duc in altum—put out into the deep.” Peter went fishing, but caught nothing. Christ asks him to go deeper, to trust, despite the fact that they have caught nothing all night.

I await the day when I am able to put out into the deep, to trust the Lord’s Mercy with infinite hope, to believe in his promises, and then be rewarded as Peter. I want to look at Christ and say, “Lord, at your command, I will lower the nets. I will trust in your promises and your Mercy. I will trust that you have plans for my welfare and not for woe. I will trust that you have plans for a future full of hope.  I will stand at your Cross, I will be with you in this storm, and I will await the resurrection and the calm.” For after Peter put out his nets into the deep, “they caught a great number of fish and their nets were tearing.  They signaled to their partners in the other boat to come to help them. They came and filled both boats so that they were in danger of sinking. When Simon Peter saw this, he fell at the knees of Jesus and said, ‘Depart from me, Lord, for I am a sinful man.’  For astonishment at the catch of fish they had made seized him and all those with him.” Luke 5:6-9

All were astonished at the Lord’s greatness and mercy.  I await the day that I may walk out onto the water trusting in the Lord’s goodness, and be astonished by the abundance of graces, blessings, and gifts that He pours out upon me. And so each day, each week, each month, I step out of the boat again. I cast out into the deep again.  Sometimes I drown, and that’s okay. I try to imitate Peter in his radical trust, knowing that the Lord is good and He will answer me. For though I am carrying this cross with Christ and my husband right now, I know that there will be the resurrection.

 

This week I am going to be releasing a series of posts for National Infertility Awareness Week.  It is my hope that this series may provide comfort to those struggling with infertility, while being a tool for those who have friends or loved ones with this struggle.

You can read the second post here: Gratitude: The Gift Amidst the Cross