Detours on the Fertility Journey

I could tell that Amy was upset when I opened the door to my waiting room. A 38-year-old nurse, working at an ICU, she was usually cheerful, despite the stress of her job and the challenges of dealing with infertility over the past two years. Today, however, she was visibly shaken.

“I got the results this morning,” she told me as soon as we sat down. “Of the measly four eggs they retrieved, only three fertilized, and the screening showed that none of the embryos were normal. All this time and money for nothing!” Amy, like many women her age, had a diagnosis of diminished ovarian reserve. The quality and quantity of her eggs, and therefore her chances of getting pregnant, were shrinking. She’d had two previous in vitro fertilization (IVF) cycles, in which she’d injected herself for weeks with a cocktail of medications to release multiple eggs, so they could be clinically retrieved and mixed with her partner’s sperm in the lab, in the hope of growing healthy embryos.

With the first cycle, one of four embryos was healthy and able to be transferred into her uterus. She got pregnant on that try but miscarried at 10 weeks. Her second IVF was similar—only one healthy embryo—but that transfer didn’t result in a positive pregnancy. Most younger women produce 10-12 eggs or more with one IVF cycle. At her age, even with the wonders of science on her side, Amy was starting to feel like a failure.

And still, in yet another feat of modern medicine, her journey could continue. The next step would be turning to an egg donor, which would dramatically increase her chances of conception with a healthy child. While we’d discussed this possibility before, the reality of it was hitting home, along with the new set of challenges it would bring.

While consoling her on the most recent loss, I commented on how her reproductive story—the part of her self-narrative related to building a family—was changing once again. A loss precipitates every shift, but then a new chapter opens up. The more profound the shift, the deeper the emotional response, of course. For Amy, using a donor was a wonderful option, but before she could embrace it, she needed to grieve the part of her narrative that was entwined with a biological connection with a child. Other infertility patients I see in my psychotherapy practice face different losses as their narratives shift and turn.

Although hope and love propel most people through the physically, emotionally, and financially taxing process of infertility treatments, the journey is made even more arduous by the sense of isolation and secrecy that often surrounds it. In the last decade, we’ve made remarkable developments in reproductive medicine, but the losses that will always be part of this journey still aren’t readily acknowledged—despite the fact that an estimated 48.5 million couples worldwide experience infertility every year, and more than 20 percent of all pregnancies end in miscarriage. For women over 40, the rate of pregnancy loss is as high as 45 percent. Almost 12 percent of women in the United States alone, approximately 7.4 million women, have received treatment for infertility in their lifetime.

With more people delaying the start of a family now than in the past, those numbers will continue to increase. My hope is that a clearer awareness of the mental health effects of pregnancy loss and difficulty getting pregnant will begin to take root. We’re starting to see this in the national media—during the COVID-19 pandemic, so many women spoke out about the consequences of closing fertility clinics that New York Governor Andrew Cuomo deemed them an essential medical service. We’re also starting to see more and more mental health professionals focusing on this area of practice. In the last few years, the demand for training in this specialty has boomed.

Why Is Our Reproductive Story So Important?

When someone’s family member passes away, an outpouring of condolences and support usually follows, but with a miscarriage, a failed IVF cycle, or simply another month gone by without a pregnancy, women and their partners often suffer an unacknowledged pain, which deepens feelings of anxiety, depression, and isolation. Plus, the chronic nature of infertility can leave people stuck in those states and full of shame. Although many think only the arrival of a baby will erase the psychological distress, true healing comes when we recognize the role our reproductive story plays in our sense of identity and can understand it as an evolving, shifting narrative, no matter what the end may be.

Male or female, gay or straight, whether we have children or not, whether we want children or not, we all have a reproductive story. It’s a universal human narrative, which stretches beyond generational and cultural boundaries, and begins when we’re children, as we observe our caregivers and think about what it might be like in that role. These thoughts may be in our conscious awareness—I’ve always wanted to be a parent and knew I’d adopt; I became a teacher because I wanted summers off when I had kids; I like kids, but I never wanted any of my own—or they may live in our unconscious, only to surface when the narrative is challenged in unexpected ways. I’ve been a fertility counsellor for 25 years, and though the available options for building a family have changed, the basic reproductive stories of most my clients, who want children, have not.

The beginning of Amy’s story was not unlike many I’ve heard. She reminisced about playing house with her brother when they were children, trading off who got to play parent and who’d be the baby. Sometimes, they’d use action figures, stuffed animals, and even painted rocks to add to the family they imagined caring for. Of course, her reproductive story evolved as she got older. When she started babysitting as a teenager, she recognized the real work of caring for a child. In college, her desire to care for others developed into her nursing career. It even played a role in her choice of romantic partners: when she first met her husband, one of the things that drew her to him was the thought in the back of her mind that he’d make a good father one day.

Most therapists might recognize a reproductive story as developmentally interesting, but many don’t think to explore it with their clients. Some may even equate an inner sense of wanting to be a parent with something akin to wanting to be a photographer or an engineer. People can have many passionate visions for life, including being a parent, but many are surprised to find how central a reproductive story is to the heart of their being. When it goes awry, it often feels as if their whole self is damaged, rather than a particular biological body part isn’t working right.

The impact on personal relationships can be devastating. While many couples come together in this crisis, many others drift apart. Tensions mount, for example, if one partner wants to keep trying for a baby, despite the toll it takes, while the other wants to stop. There’s no way to meet in the middle on this, as might happen with other problems.

Other relationships take a hit as well. As friends and peers start to become parents, infertility can make people feel like they don’t fit in anymore. Adding to the sense of isolation, many blame themselves or perceived past indiscretions, as if a malevolent form of karma is at work. In the case of a previous unwanted pregnancy and abortion, some women have expressed feeling guilty and undeserving of another child, even if those feelings were never present before.

Whether it’s a pregnancy loss at 24 weeks or six weeks, a chemical pregnancy, or a regular menstrual cycle indicating another failed attempt at pregnancy, many people struggle with profound feelings of grief and loss. In the LGBTQ community, people may not be affected by infertility, but are nonetheless faced with the unique challenges that can go hand in hand with the immense promise of using assisted reproductive technology (ART) to have a family.

For women, regardless of sexual preference, part of this challenge comes when their biological timetable for having children doesn’t mesh with other timetables in their life, like pursuing advanced degrees and establishing careers. Amy’s story fits this pattern to a tee: after graduating from college and working for a few years, she decided to go back to school for her nursing degree, where she and her husband met. Neither of them was ready to start trying for a family until they felt settled in their jobs and financially secure. By that time, Amy was 34, which is considered old by reproductive measures.

In some ways, advances in reproductive medicine encourage delays in childbearing: the technology can feel like insurance against age factors for women. This was definitely true for Amy. When things weren’t happening “naturally,” she and her partner were excited to delve into their other options using IVF. Now that using her own eggs wouldn’t work, donor technology, the next chapter in her story, would provide yet another chance. While exciting to have this option, losing the hoped for genetic connection to a child can be a difficult shift; and while the odds are high that the process will work, there’s no guarantee.

That’s why more women are now freezing their eggs before they reach Amy’s age, for when they’re ready to have a child. This represents another advance in reproductive technology. While we’ve been able to freeze and defrost sperm consistently for many years, eggs were considerably less stable and often disintegrated when thawed. Beyond that, the growth of human gametes derived from other cells in the body is currently being studied, continuing to push the field in new directions, with tons of ethical and legal questions lagging behind.

When people are considering ART and feeling overwhelmed, I often sit with them and map out all their options. We look at what’s important to them and what they’re willing to forego. For some, using one’s own gametes is essential, but this limits their options to IUI or IVF. For others, the experience of carrying and birthing a child is of paramount importance, and they’re open to not using their own gametes, in which case they can explore using egg, sperm, or even embryo donation.

If pregnancy is not an option, people can choose surrogacy (either with their own or donor gametes) or adoption. Some couples who can’t use both their own gametes would rather use neither; their options are adoption or embryo donation. Given all the choices available today, creating a decision tree can be an essential therapeutic tool.

My Reproductive Story

When I think about the very beginnings of my own reproductive story, I have to go back to my parents. They were high school sweethearts and married soon after my mom had graduated. I arrived on the scene when they were 22 and 24; they divorced three years later. As an adult, I know there was more to the demise of their relationship than their ages, but for a long time I held on to the belief that they were simply too young to have a family together.

I must have accepted that reasoning while my grandmother, who took care of me, tried her best to explain what was going on. So at the ripe old age of four, I decided that I wouldn’t get married until I was 25 and wouldn’t have a baby until I was 32. As it turned out, I did get married at 25 (these days, even that seems very young), and amazingly, we did start trying when I was 32. But that’s where the story of what I expected to happen fell apart.

After trying for six months, I finally got pregnant and had my first miscarriage at eight weeks. Six months later, my second miscarriage was almost identical. Although my doctor didn’t seem alarmed, he told me that if I had another miscarriage, he’d run some tests—you needed to have three in a row to raise a red flag. “For the time being,” he said, “Relax. It’s probably an infection.” He prescribed some antibiotics and sent me on my way. I felt anxious, frightened, and very much alone.

We kept trying for a while, but nothing happened. Then we sought advice from a different doctor. Aside from finding that one fallopian tube was blocked, which reduced my chances of conceiving, everything appeared to be physically normal. Emotionally, however, I was truly a mess. It felt like everyone around me was pregnant, had a young child, or was working on their second. Time was ticking; I was desperate. I would’ve been a perfect candidate for IVF, as it bypasses the fallopian tubes, but the technology was only beginning to emerge back then. Also, there was virtually no emotional support available for what I was going through.

My sense of shame and self-blame was overwhelming, and it felt as if no one—not the family I talked to, the friends I confided in, sometimes not even my husband—seemed to understand the depth of my despair. Fortunately, after a long search, I found a therapist who helped a lot. She had two young children, something I envied, but she’d also experienced a miscarriage and could relate to my pain. This is not to imply that therapists need to experience reproductive trauma to treat it, but a solid working knowledge of what it entails is essential.

The next three years were filled with more testing, more tears, some surgeries, but no baby. During that time, I decided to return to school for my PhD in clinical psychology. Outside of classwork, my first year was quite eventful: I had my third miscarriage followed immediately by a pregnancy that produced our son, with no interventions.

I remember asking my OB if I needed to be seen by a perinatalogist, since I assumed this would be considered a high-risk pregnancy given my history. But he said no, everything was normal. By my second year of grad school, I’d decided to devote my clinical training to helping others with reproductive trauma.

When Things Go Wrong

Unlike one-time traumatic experiences, infertility can last for years, and it can wear away at a person’s emotional, financial, and physical reserves. To make matters worse, women are often given the off-putting advice that if they’re struggling to get pregnant, they’re just thinking too much about it. It’s a damaging and continually perpetuated myth that if you stop worrying so much, it’ll happen.

Shawna, a dental tech undergoing her third cycle of IVF, decided to tell her boss the truth about why she’d had to take so much time off work recently. “I thought if I was honest about my fertility issues—that I had to go in for daily ultrasound monitoring and bloodwork—that he’d understand,” she said, sobbing. “Do you know what he said? He said that if I just took a vacation, I’d come back pregnant! He said he gave the same advice to one of his patients and it worked. He’s a medical professional! How could he be so ignorant? Does he think this is all in my head?”

Shawna was clearly shaken. “It must feel as if nothing makes sense anymore,” I responded. “The one place you felt confident, at work, helping other people, feeling like a team with your colleagues . . . I can imagine how hard it must be to go to work with comments like that.” It was important that she felt validated by me.

Shawna nodded as I passed the tissues to her. “Well, I can’t quit. I need the money. Fertility meds are so expensive, and my insurance doesn’t cover any of it. My belly is bruised from all the injections. And it’s not just work; I’ve been having a hard time with my brother and sister-in-law as well. We’d been so close, but now that she’s pregnant with their third baby, she’s doing nothing but complain about it. I’m sure she doesn’t feel well, and I can imagine how hard it is with two other little ones. But it’s not as if they don’t know what we’ve been going through to try to get pregnant.”

“You must feel alone in this,” I replied.

“Yeah,” she nodded. “Even when I talk about it, I don’t think they get it.” I could see her tension ease as she was able to vent and feel understood. “I’m getting sick of having to explain how emotionally difficult this all has been. People seem to minimize it all the time.”

Sadly, Shawna’s experiences are typical. In this brief exchange, she’d delineated the toll that infertility and its treatment were taking on her: the blow to her self-esteem, the cost of the treatment, having to inject herself daily, having to miss work for appointments, the loss of trust with people close to her. How can we help clients get through it? How can we address the unique grief and loss that accompanies infertility?

Even when caring people in our clients’ lives validate and support these losses, it can be difficult to grieve while continuing to hold out hope for the next attempt. Add to this complexity the fact that, despite how deeply the losses are felt, they’re somewhat intangible and a natural part of the reproductive process. All this gets even more challenging to process when the highs and lows, from enormous hope to devastating despair, are repeated month after month, cycle after cycle. Often, that’s when the journey becomes traumatic.

The Loss List

Samantha, 42, is a researcher at a prestigious university. She and her partner have been trying to conceive for the past five years. Although accomplished and recognized in her career, she feels like a failure. “The one thing I want to do is have a baby. I know some women don’t want kids. In fact, there was a time when I thought I might be one of them, but that’s no longer true! I just worry I realized it too late. I’m angry my doctors never really talked to me about this earlier. I’m angry my body has betrayed me now. I heard all that ‘biological clock’ talk from my mom, but I always brushed it off; it sounded so old-school. Now, I feel like everyone’s wondering what’s wrong with me when I tell them I don’t have kids. I’m wondering the same thing!”

Clearly, this negative cognition and self-blame was affecting her sense of self and fueling the deep depression her doctor had noticed, prompting his referral to me. “It’s my fault that we waited so long,” she told me one day. “I think Peter blames me; he’s better off finding someone else to have a family with.”

“You’re very thoughtful,” I countered, “and not impulsive. You wanted to do what you thought would be best for your family. We don’t know if your younger eggs would’ve made a difference, but we do know that beating yourself up over it won’t help. We need to figure out a way for you to treat yourself with compassion, grieve what’s lost, and then heal so you can find a new way forward.”

Together we made a list of the multiple losses she’d experienced: being pregnant, experiencing childbirth, and having a baby were top on the list. But what also plagued her, and many clients I see, was an unnamed sense that her identity as a woman somehow rested on her having a child. Of course, one’s female identity can take many forms, regardless of whether we have children and what bodies we inhabit. But this brought us to another of Samantha’s core beliefs: that her body had betrayed her, and I added losing trust in her body to the list.

“Unlike how you’ve often accomplished goals, you can’t will your body to get pregnant,” I reflected. “I also think that losing the spontaneity and intimacy with Peter might go on the list. Trying to conceive naturally at home is very different than being in a clinic with medical personnel intervening.”

Samantha nodded. “This all makes me feel like I’m sick, not normal. That should be on the list, too.”

“What about the worry that other people are looking at you critically?” I asked. “Lots of women I work with feel as if they no longer fit in, as if it’s kind of a race; the successful parents are out in front while they’re in last place. You’re not used to feeling like that.”

Samantha got tears in her eyes. “So many friends don’t feel like friends any more. The ones who don’t have kids, don’t really understand what or even why I’m going through this. And the friends who are parents—just last week we found out we weren’t invited to our friends’ kid’s first birthday party. They apologized, saying they didn’t think we’d want to come. That hurt,” she said.

Creating this list helped Samantha make her losses concrete; it revived a sense of control over what felt so overwhelming and normalized her experiences. It also allowed her to identify the magnitude of the losses and recognize the necessity to grieve, not just for what had passed, but for her vision of the future.

Using the Reproductive Story to Heal

By the time fertility patients reach us for therapy, they’re smack in the middle of a reproductive story that’s already full of uncertainty, hopelessness, and sorrow. Sadly, they often feel as if they’re going to be stuck in this chapter forever, especially if their reproductive doctor is suggesting yet another treatment, another try. Holding on to hope in the midst of despair makes for a strange combination of feelings, often adding to people’s confusion and inability to resolve this trauma. But the beauty of a reproductive story is that it has a beginning, a middle, and an end—and it can serve as a tool in treatment to help clients move toward it, whatever the end may bring.

Trina began therapy with me after three unsuccessful IUIs, using donor sperm. She and her partner, Aster, then turned to IVF, got pregnant on the first try, but had a miscarriage at six weeks. They were going to try again, but she knew she needed support to get through it. Aster didn’t have the same feeling as Trina about using her own eggs and being pregnant, so the decision to have Trina go through the treatment was easy, although the process became emotionally wrenching with each loss.

In the beginning, I listened to her current stressors, as well as what having a child meant to her. Then, to uncover the foundation of her reproductive story and find out what core beliefs were being disrupted, I asked about the dynamics of her family of origin.

“I remember being so thrilled when my sister Sara first came home from the hospital,” she said. “Mom let me hold her right away. I was only five, but I remember this feeling filling up my chest, like a balloon, that I would take care of her, no matter what. Growing up, I always looked out for her. I did everything first, and paved the way for her to follow our whole lives—going to college, moving to another city, falling in love, getting married.” As she spoke, we came to realize that this was fundamental to her core beliefs: she was the trailblazer and caregiver, but not anymore. Infertility robbed her of being the first to have a baby.

Sara had recently given birth, sucking up all the attention that accompanies a first grandchild. “I’m happy for her, but I’m also devastated. That was supposed to be me,” she admitted.

“This is not the way you thought your story would go,” I replied. “You must feel awful having mixed feelings about Sara and your new niece.”

“I feel like I’m going crazy,” she cried. “One minute I’m okay, so happy for her, the next I’m weeping uncontrollably. Aster’s always there for me—God, I can’t imagine going through this with anyone else—but she’s just not experiencing things in the same way. And my parents—I don’t want to bring everyone down. They’re so ecstatic. They’ve been supportive of me and Aster, of course, but all they want to do is talk about the new baby. They send me a new picture of her every day!” I reassured her that this was grief. And this kind of grief, because it’s disenfranchised, is complicated to manage.

What people who have experienced infertility and reproductive loss crave is recognition of their trauma, especially since the impulse of caring people around them may be to push it aside. It’s readily assumed that if we don’t dwell on it, the sadness will go away, but actually the validation of the trauma is what most helps the healing process. I suggested that Trina talk with her parents and let them know her dilemma. “We know that a daily photo of the baby is too much for you. Maybe you could let them know how much you’re hurting?”

This was the middle of her story, I told her. It might feel like the chapters are writing themselves in a frenzied hurricane of sadness, uncertainly, hope, and grief, but in the end, she’s the narrator. She controls which words are chosen to describe what’s happening and how it’s processed and understood as a whole story. Using the narrative as a therapeutic tool puts clients back in the driver’s seat of their stories as we help them make decisions about next steps.

Trina and I talked about the fact that although there are no culturally recognized rituals to assist infertility patients in the grief process, marking an experience in some way can often help people move to the next chapter of their story without getting stuck. A ritual can be like a chapter break in a book, something to open a space and indicate that it’s time to pause, breathe, and process before moving a next step.

Reproductive technology has been developing at lightning speed since Louise Brown, the first IVF baby, was born in 1978. And these days, next steps can seem endless and rife with exhausting questions. How and when do I explain this story to my child? What will other people think? Do we even let other people know what we’re doing? These are all important questions I help my clients work through.

Trina didn’t feel she was at the end of her reproductive story yet, but she did feel it might be important to create a ritual to help her close this chapter before moving on to another try with IVF. I described what some other clients had done as a way to make meaning through the difficult process. One woman decided to go out for a nice dinner when her menstrual cycle began each month—not as a celebration, but as a way for her and her partner to stay connected through the disappointment. Others planted gardens to mark losses along the journey. Another lit a candle for her baby, who was born still, every year on the day it happened.

“What do you think would be meaningful for you? Do you think it might help to keep a journal or create something to commemorate your losses?” I asked Trina.

She paused for a while. “Maybe I’ll write a letter. I don’t want to lose all the dreams I had for that baby, all the feeling I had in those short six weeks.” We agreed that having something physical and concrete, something she could save and look at in the future, would help her remember and move through her grief. Given the many distractions in our fast-paced life, people often worry that they’ll forget. Writing a letter like this creates a new memory as the story continues.

The end of a reproductive story won’t always include a child, and it’s important to remind our clients that although the road to reaching this final chapter may have included much grief, it can also engender a great deal of growth. Our job is to remind clients of this growth and the larger character development in their life beyond their reproductive self.

Sometimes it can help to try on different endings. An open-minded exploration of possibilities for the future can make seemingly impossible decisions more manageable. Trina and I explored the what-ifs. What if she stopped going down the road of reproductive technology? What if she and Aster decided not to have a child? What does it feel like now to be childfree, and what might it feel like in 10 years? Twenty years? What if they decided to adopt? This is a way to start to take back control. As Trina put it one day, “I can’t know exactly how my story will end, but I get to decide how to write the final paragraph.”

As is often the case, something positive and meaningful can occur out of trauma if processed in therapeutic ways. This doesn’t mean the story always has a happy ending, but it does mean we can use it to grow. In fact, many of my clients who’ve experienced reproductive trauma decide they want to help others going through similar experiences. One couple made memory boxes for parents who had a loss at the hospital where their daughter was born still. One woman took to Facebook to educate the general public as to what to say, and what not to say, when someone is struggling to conceive.

Indeed, there’s a growing online community, which didn’t exist when I was in the midst of my own struggles, that my clients find helpful to connect with. Being able to read about other people’s stories and the options they chose provides so much support. RESOLVE: The National Fertility Association began with one person. In 1974, Barbara Eck, a nurse struggling with her own infertility, set up a support group in her home after experiencing difficulties getting the help she wanted. Now RESOLVE not only runs peer-led support groups around the country, but advocates for healthcare cover­age and infertility research at the state and national level. Organizations such as American Society of Reproduc­tive Medicine offer trainings for therapists, physicians, researchers, nurses, and other medical staff wanting to expand their knowledge of reproductive medicine. This specialty is growing as more people are coming out of the shadow of shame and seeking interventions and support.

It’s hard for me to believe, but my son just turned 30 years old. Much of the trauma and pain of my journey to conceive has been resolved: a lot heals after having a child as the work of parenting begins—which is good for our clients to know. And yet I was surprised by how many emotions were stirred for me in writing my own reproductive story here. It brought back vivid memories of doctor appointments and procedures, of sitting on the couch alone in despair, of watching the child-centered world go on without me—almost as if it all happened yesterday. It reminds me that even when you’re long past reproductive age, the story lives on in hidden ways.

Being a parent hasn’t always been easy. Even now that my son is an adult, I worry all the time. But in spite of all the sleepless nights and emotional ups and downs, I’m so grateful to be his parent. When he was about 10, I remember asking him if he thought he wanted to have kids some day. Without hesitation, he said he wanted two: Hannah and Alex. I relish the thought of grandchildren now, but I know better not to ask at this point. That part of the story is still waiting to develop, and I look forward to it, however it may unfold.

Male Partners Have a Story Too

Getting poked and prodded and injected with hormones, women certainly seem to bear the brunt of medical procedures when it comes to infertility. But the statistics are equal when it comes to medical diagnoses: male-factor infertility accounts for about 40 percent of cases, and combined or unexplained infertility makes up 20 percent. And even though 90 percent of my clients are women, their partners obviously share the grief and pain that can go hand in hand with infertility treatment.

Reproductive trauma is generally swept under the rug for women, but it’s even more common that men’s feelings get overlooked in the process. Often, the partners of someone experiencing reproductive trauma are relegated to playing the role of coach: We’ll get through this; don’t worry. And they frequently cope with the emotional challenges by trying their best to find solutions to problems. They want to make it better, but because these feelings can’t be “fixed,” many partners end up with a deep sense of helplessness and shame, which can lead to depression.

Men may struggle as much as women with loss and dramatic shifts in a reproductive story, but they may exhibit their grief differently. I’ve heard many stories over the years from my female clients about partners who end up isolating, getting angry, or throwing themselves into projects or work. One man, after coming home with his wife after a pregnancy loss, took a sledgehammer to the bathroom. Although it was on their to-do list to remodel it, his need to vent at that particular moment was overwhelming, and he didn’t feel he could share his feelings with his wife, who was going through her own grief.

The differences between how partners cope and grieve can lead to misunderstandings at a time when nerves are already frayed. More often than not, a male partner who comes to my office will begin by saying something like, “I’m just here to support her.” And when we start to discuss next steps in the infertility journey, he often makes his own wishes secondary, saying, “It’s her body; I don’t want to tell her what to do.” This may seem thoughtful, but many women I’ve worked with have told me it makes them feel abandoned, burdened by the enormous decision they’re making on their own.

Especially in the middle of a difficult journey, my goal is to help these couples work together as a team. When decisions are made together and both partners’ emotions are acknowledged and shared, the relationship is likelier to be sustained, whatever the outcome of the journey.

Terms To Know

Assisted reproductive technology (ART). Procedures by which gametes or embryos are used to enhance the chance of pregnancy. The most common ART procedure is in vitro fertilization.

Chemical pregnancy. A pregnancy that’s confirmed by a blood test but doesn’t develop.

Donor eggs. Eggs harvested from one woman to use in an infertile woman, also known as oocyte donation.

Donor sperm. Sperm from a fertile man used to assist in creating pregnancy.

Egg freezing. The process of removing eggs from ovaries and freezing them unfertilized for future use.

Embryo donation. Embryos that have been created from one couple and donated to help another person or couple have a child.

Infertility. Failure to conceive or carry a pregnancy to term. Primary infertility refers to those who have never had a child; secondary infertility refers to those who can’t conceive after a healthy pregnancy and birth.

Intended parent or intended recipient. An individual or couple experiencing infertility, or those in the LGBTQ+ community, who are seeking assistance in becoming a parent.

Intracytoplasmic sperm injection (ICSI). If the sperm can’t penetrate the outer layer of the egg, ICSI can be used to help fertilize it by injecting a single sperm directly into the egg.

Intrauterine insemination (IUI). A procedure to place sperm directly into the uterus, bypassing the cervix.

In vitro fertilization (IVF). A medical procedure in which eggs are retrieved from a woman’s ovaries, mixed with sperm in a laboratory, allowed to grow for three to five days, and then returned to the woman’s uterus.

Ovarian reserve. The quantity and quality of eggs in a woman’s ovaries.

Preimplantation genetic testing (PGT). A test to determine the health of an embryo before transferring it to a woman’s uterus. There are two different types: PGS determines the number of chromosomes in the embryotic cell, and PGD tests for specific markers for a disease, such as cystic fibrosis.

Surrogacy. An arrangement where one woman carries and gives birth to a child for another woman or couple. Gay men must work with a surrogate or become parents through adoption.

Third-party reproduction. All ART procedures in which more than the intended parents are involved. It refers to the use of eggs, sperm, or embryo donors to create a baby.

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