Caroline Morgan Courtney was born on Oct. 23, 2012. Her parents can’t imagine life without her.
Each day is full of smiles and giggles. When she is excited, she gently waves her arms and sways back and forth, as if dancing to a joyful song only she can hear. Caroline seems to enjoy every moment of her young life. It’s as if she knows just how hard it was to get here.
For my wife, Amy, and me, the path to parenthood was far more difficult than we expected. Like many others in a growing population of couples, we chose to pursue our careers, travel and enjoy our personal freedom well into our 30s. When we decided to start a family, we discovered that we needed help. It took three years before our sweet Caroline came to be.
Of the approximately 4 million babies born in the United States last year, Caroline was one of more than 61,000 conceived with the help of in vitro fertilization (IVF), according to the Centers for Disease Control and Prevention (CDC) in Atlanta. Some IVF parents get more than they expected. Currently, about one in four IVF pregnancies produce multiple births, because two, and occasionally three, embryos are transferred to boost the odds of one surviving.
Fertility clinics in the Merrimack Valley are bustling with a wide range of patients. There are people in their 20s with physical or genetic issues that impact their ability to conceive, gay couples that are willing to pay out of pocket for a donor egg or sperm to have a child, and single women who want a baby but have run out of time to find “Mr. Right.” But the most common visitors to these clinics, according to the CDC, are couples who waited until their mid-30s to early-40s to start a family, when a woman’s natural ability to reproduce is starting to wane.
“Fertility, on average, declines in the early 30s, and significantly after 35,” says Dr. Kristen Wright, a fertility specialist with Reproductive Science Center of New England, which has 12 clinics in the region. “Our bodies are at their best to reproduce in the teens and early 20s. Certainly in modern society we don’t deem many teens to be ideal mothers, but unfortunately what is ideal culturally isn’t the best time biologically.”
One reason for this, according to Dr. Joseph Hill, a specialist at Fertility Centers of New England who has taught at Harvard Medical School, is that a woman’s eggs become more prone to chromosomal abnormalities after age 35, reducing the chance of conception and increasing the possibility of miscarriage or birth defects.
Despite these statistics, an infertility diagnosis often comes as an unexpected blow.
“Women still feel young, they still have a regular menstrual cycle, they’re not prepared for the inability to conceive,” says Patrice Kellogg, a nurse practitioner with Women’s Health Care in Newburyport. “It often takes them by surprise, typically because they spent years and years preventing pregnancy.”
The sudden realization occurs that the dream and expectation of motherhood isn’t guaranteed.
“When you’re a little girl, you play with dolls and just expect that one day you will be a mom,” says Erin Lasker, executive director of RESOLVE New England, a nonprofit that advocates for and supports people facing infertility. “It makes you feel like your body is not doing something it should be. So you feel like a failure.”
That stigma causes many women to avoid seeking treatment. Hill says many make the appointment for an initial consultation and never show up. “Unfortunately, many women suffer in silence,” Hill says.
For couples willing to take the leap, the process is long and arduous — especially for women, who must take daily hormone shots and get regular blood tests for weeks, before and after the embryo is transferred, only to take a pregnancy test that could very well come up negative.
Success rates vary, and each clinic’s results are posted on the CDC’s website. Overall, according to the CDC, success rates for a single IVF in 2010 went from 41.5 percent for women under 35, to 22 percent for women 38 to 40, and down to 5 percent by age 44.
The women who get bad news often believe no one can understand the depth of their sadness, even their husband or partner. Many find respite in support groups online or in person, or through one of hundreds of infertility blogs.
Lasker, who went through six unsuccessful IVF cycles before she and her husband eventually adopted a son, became involved with RESOLVE New England through its support groups. “Seeing people in a room dealing with something you are [dealing with] is powerful and can make a big difference to give you the strength or hope to figure out a way,” she says.
The good news is that the science gets better every year.
“A decade ago, a good program had a success rate of 30 percent,” says Hill, whose clinic was one of the first to utilize a new tool called an EmbryoScope to improve fertilization. “Now, 30 percent is not that good a program. A good success rate is over 50 percent.”
And IVF isn’t the only way. Some prospective parents turn to donor eggs or sperm, or find a surrogate to carry the baby to term. And many clinics now offer women the opportunity to freeze their eggs in their 20s and save them for later in life.
Despite many miserable days going through four failed IVF cycles, persistence paid off for my wife and me on the fifth try. But even then, it was far from easy.
Caroline had a twin, and we were told there was a 95 percent chance that both would survive. At 11 weeks, one baby’s heart stopped beating. At 26 weeks, my wife showed signs of preterm labor. Doctors said the survival rate was 80 percent if Caroline was born that night. At 39 weeks, our baby arrived.
Despite many tears and days filled with doubt, we would do it all over again. Thanks to my wife’s strength and resolve, with some help from modern science and a good insurance plan, we have our sweet Caroline, who made it all worthwhile.
Maybe Neil Diamond said it best: The good times never felt so good.
Odds of a live birth resulting from a single in vitro fertilization cycle:
Age Success rate
Under 35 41.5%
*Centers for Disease Control and Prevention, 2010 data