Sunday is the day the country celebrates mothers, but for hundreds of women in Central Massachusetts, motherhood is something they’re struggling to experience.
“It is probably the worst day of the year for women going through infertility,” said Alice Domar, executive director of the Domar Center for Mind/Body Health, which is a division of Waltham-based Boston IVF, one of the country’s largest in vitro fertilization centers.
While there have always been infertile couples, the fact that many couples are waiting longer to try to have children appears to be driving infertility rates up among women 35 and older. In 1995, 8 percent of women 35 to 44 years old were infertile. In 2002, 15.1 percent were, according to the Centers for Disease Control and Prevention.
Even though the prevalence of infertility has grown — Boston IVF, for instance, did about 20 cycles of in vitro fertilization in 1986 and more than 2,500 in 2012 — it is still a subject people often keep to themselves.
“The majority of people going through infertility don’t tell anybody. The majority of women don’t even tell their mothers,” Ms. Domar said. That’s despite the fact that infertility can cause the same amount of stress and depression as a cancer diagnosis, she said.
Add to that an entire holiday celebrating motherhood — and one for fathers next month — and it can be hard to keep a stiff upper lip.
Sometimes, friends and family honestly do not know much about infertility treatment and what is involved. In vitro fertilization, for instance, is considered one of the more effective treatments, but it still has a less than 50 percent chance of working. It generally starts with a month of birth control for the woman to regulate her menstrual cycle, followed by 10 to 12 days of daily injections of hormones designed to increase egg production and prevent the eggs from being released too early, said Dr. Julia V. Johnson, professor and chairman of the obstetrics/gynecology department at the University of Massachusetts Medical School/UMass Memorial Medical Center.
During those 10 to 12 days, the woman must come to the doctor’s office about every other day for blood tests and vaginal ultrasounds to gauge how the eggs are developing. When they are ready, a doctor retrieves the eggs by inserting a needle through the woman’s vagina while guided by an ultrasound. It’s a short procedure, but it takes a couple of hours for the anesthetic to wear off, Dr. Johnson said.
Doctors combine the eggs with some of the husband’s sperm, which was either frozen previously or produced while his wife was being operated on. The embryos grow for three to five days in the lab, and depending on their quality, doctors will implant one or up to three in the woman’s uterus through a non-surgical procedure. Doctors are becoming more conservative in how many embryos they implant, which should reduce the number of multiples born through IVF pregnancies, said Dr. Kim L. Thornton, a reproductive endocrinologist with Boston IVF in Worcester.
Then the couple waits about 12 days to find out if the embryo has become a pregnancy. “That’s a terrible time, because you really want to know,” Dr. Johnson said.
There are facilities in Worcester for everything except the egg retrieval and embryo transfer, but that could change in a year, Dr. Johnson said. Reproductive Science Center hopes to open a lab here, she said. “We know that this part of Massachusetts really needs those services,” Dr. Johnson said.
For Camille A. and Matthew Graves of Brookfield, the process never worked out. She already had 16- and 13-year-old sons from a previous marriage, and after having her tubes untied and undergoing a few years of infertility treatments, the couple had had enough. In addition to the physical and emotional toll, the couple had racked up $41,000 in bills, because Ms. Graves’ employer fell outside the state’s mandate that requires most insurers to cover fertility treatments.
“Screw it, I’m done,” she thought late last year. She couldn’t stand any more shots, sadness or expense. “When you take all the drugs, you gain all the weight, you feel awful … and then the disappointment that comes with it,” she said.
She decided to get back in shape and tried P90X, the 90-day exercise program whose devotees include former vice presidential candidate Paul Ryan. On day 60, she realized she was pregnant. Her husband gasped. She was in denial for eight weeks.
She said the shots that are part of in vitro fertilization were tough, but she knows why people go through it. A pregnancy, she said, “It’s just a wonderful thing,” her face showing more joy than her words could hold.
She urged women to take a short break from trying to conceive if they’re feeling frustrated.
“Just start focusing on yourself and stop trying,” she said. “Even say, ‘OK, I’m going to focus on myself for three months.’ ”
Ms. Domar said she has heard many stories like Ms. Graves’, in which a pregnancy finally comes after women reduce their stress levels.
In the meantime, however, she had some tips for infertile women trying to get through Mother’s Day:
“If you have a mother or mother-in-law, focus on them or try to celebrate the two of you (you and your husband) as a family,” she said. Avoid places like church, the mall and family restaurants that are likely to be focused on Mother’s Day. Go to an R-rated movie, a spa or a very fancy restaurant — late. Feel free to skip family gatherings if it will just be too painful, she said.
“It’s honestly rubbing salt in the wound to see your siblings be ecstatic parents and your parents be ecstatic grandparents,” Ms. Domar said. Infertility patients, she said, “can basically say they’re under doctor’s orders to not do what everybody expects them to do … It’s really OK not to.”
She also had some suggestions for friends and loved ones of women grappling with infertility. “Don’t offer unsolicited advice,” she said, “because in all likelihood your loved one knows a lot more than you do.”
If someone undergoing treatment calls and says she has just found out she is not pregnant again, take her out for ice cream or wine, Ms. Domar continued. “And on Sunday, think about her, because it’s a really, really hard day.”
Erin Lasker, executive director of RESOLVE New England, a support, education and advocacy nonprofit network for people coping with infertility, hit on many of the same themes. “Some people need to stay inside and not see families celebrating together, while others may want to be surrounded by mothers and children to help feed their hope of celebrating the day in the future,” she said in an email. “I recommend doing what feels right for that person/couple.”
Ms. Domar had some encouraging advice about whether couples should discuss their infertility with others: While most couples do not, those that do have received mostly supportive reactions, she said. “People come out of the woodwork” with stories about their own or other people’s infertility, she said. One woman discovered her own sister-in-law had become pregnant only through in vitro fertilization.
There might be more people around you who have experienced infertility than you realize, she added, like a relative whose children ended up being six years apart.
Dr. Thornton said she tells people that “the overwhelming percentage of patients can become mothers.” Boston IVF’s goal is to have that child be genetically related to the mother, but there are also options such as egg donation and adoption. “One of our goals is to help people understand that they can build families, and sometimes you just have to pursue a different path,” she said.
Dr. Johnson, who discovered her own infertility after choosing to work in that area, pursued one of those different paths herself. Her adopted son is now 23.
“He’s a great guy,” she said simply. “For some people, it is the right choice.”