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Worcester Telegram & Gazette, Monday, December 4, 2000
By Geraldine A. Collier, Telegram & Gazette Staff
Couple's struggle to
start a family is shared with others
Kristen Magnacca saw her friends through their first pregnancies, but when many of them expanded their families for a second time, she couldn't hold back the tears.
When others asked when she and her husband Mark were going to start their own family, she couldn't talk about the bitter frustration the couple felt over their lack of success in having a child.
Women share details of their pregnancies with each other, but neither they, nor their husbands, often talk to others about fertility problems, about the condition of her Fallopian tubes or his low sperm count.
And even as they went through the emotional roller coaster of assisted reproductive technology for three years, the Upton couple was discouraged by Boston area fertility clinicians from talking to others who were taking the same torturous path to parenthood.
"I think the fertility clinics feel that you might get upset if you hear that someone sitting next to you has achieved a positive pregnancy test and you haven't," said Mrs. Magnacca, explaining why confidences are discouraged.
But Mrs. Magnacca, a vivacious, outgoing woman, felt inspired, not discouraged, by someone else's positive pregnancy test. "If the person next to me could achieve a positive pregnancy, then I felt I could, too," she said.
Now Mrs. Magnacca is talking to others through a book, "Girlfriend to Girlfriend: A Fertility Companion," written for all those women, as well as their husbands, who are entering the assisted reproductive technology world without any knowledge of what they are facing.
"If you are not in the game, then you don't really know what it is all about," said Mrs. Magnacca.
"When you are in that world you know things that other people who are going through it know," added Mr. Magnacca, "but that no one in the outside world can really know."
It's a cool, clinical world, a solar system away from the intimacy of a bedroom, a world which is sometimes physically painful and terrifying, often embarrassing and humiliating, and always fiercely demanding of time and commitment.
"I have been doing this for so many years, and I am still amazed at the strength of all the patients who come here and regroup, after they fail and don't get pregnant, and start all over again," said Dr. Veronica A. Ravnikar, director of the Division of Reproductive Endocrinology at UMass Memorial Health Care and professor of obstetrics and gynecology at the University of Massachusetts Medical School.
"Sometimes, it takes five years or more, depending upon whether they take breaks or if miscarriages or ectopic pregnancies occur or they have a stillbirth," she said.
No couple expects to have difficulty conceiving, and the Magnaccas, who had been together for two years, believed a child would be the natural outcome of their getting married. But pregnancy didn't happen.
Infertility -- the medical world defines it as the inability to conceive after 12 months of intercourse without contraception -- affects about 15 percent, or one out of six, couples in the United States.
At 33, Mrs. Magnacca -- who had devoted her 20s to successfully building a preschool and day care center, through which passed hundreds of other women's children -- felt as if time was running out for her. "There was this great urgency to become a mother," she said.
When a reproductive endocrinologist who had been recommended to her couldn't see her for three months, she rushed, instead, into an appointment with a friend's doctor, an obstetrician-gynecologist.
"I assumed that a physician who sees women through pregnancies ought to know a great deal about how women become pregnant," said Mrs. Magnacca. Not only was she wrong, but the physician turned out to be "Dr. Wrong," an insensitive doctor whose knowledge about infertility was very limited.
However, he did tell the couple that Mr. Magnacca's sperm count was too low, and moreover, his sperm were poorly formed and couldn't swim. A urologist who examined Mr. Magnacca found that an enlarged varicose vein carrying extra blood was allowing few sperm to survive or flourish. Surgery would take care of the problem.
"A lot of males associate low sperm count with a loss of fertility," said Dr. B.G. Parulkar, who works with infertile males at the Fallon Clinic and St. Vincent Hospital at Worcester Medical Center, and also directs the male infertility and sexual dysfunction program across the city at UMass Memorial Health Care.
Many men believe, said Dr. Parulkar, that if they cannot produce a child, they then have failed as men. "It is devastating for the couple."
And men, like women, don't talk about infertility. "If you have a heart or asthma problem, you will talk to everyone, but with infertility, people don't talk. They keep it hidden to themselves," said Dr. Parulkar. "But, when you start turtling up, bigger problems happen. And wives and husbands feel they are letting each other down."
Discouraged with "Dr. Wrong," Mrs. Magnacca set up an appointment with the Boston-area reproductive endocrinologist she had passed over the first time. And he turned out to be "Dr. Right," not only sympathetic to the couple's plight, but also knowledgeable about infertility problems.
Now it was Mrs. Magnacca's turn for surgery, an operation to remove a large cyst sitting on her Fallopian tubes, as well as some endometrial matter, a medical problem that her doctor had missed.
Then, with Mr. Magnacca's sperm count normal and Mrs. Magnacca's Fallopian tubes open, the couple, on advice from their physician, decided to try intrauterine insemination. One of Mr. Magnacca's sperm would be placed through Mrs. Magnacca's cervix into her uterus, a clinical, somewhat mechanical procedure, but one which would, along with fertility drugs given Mrs. Magnacca, increase her chances of getting pregnant.
And she did.
Then the bleeding began.
The embryo had implanted itself, not in the uterus but in the Fallopian tube, where it could never develop. Bleeding excessively and in severe pain, Mrs. Magnacca was rushed to UMass Memorial Health Care -- University Campus, where Dr. Ravnikar performed emergency surgery on her.
"We were not, in any way, prepared for this part of the journey," said Mrs. Magnacca, although couples going through assisted reproductive technology are more at risk for bad outcomes than the average couple.
Although intellectually Mrs. Magnacca knew there was no way the embryo could have developed, she mourned for the loss of a baby; for Mr. Magnacca, it was a setback, not any different from other setbacks they had experienced.
And their different views of the ectopic pregnancy started to tear their marriage apart. But going through assisted reproductive technology had always demanded more of Mrs. Magnacca than her husband.
"It's a different situation for a woman than a man," explained Mrs. Magnacca. "When a woman is in the cycle, you have to go and give morning blood; you have to have a morning vaginal ultrasound; you wait for your instructions; you have nightly injections. All the preparations, all the making of the baby, encroaches on your whole day. He could get up, have a cup of coffee and go off to work. He had his responsibilities, but it wasn't an every moment, every hour, every day process for him."
With pressures dividing them instead of uniting them, the Magnaccas chose to enter a mind-body stress reduction program aimed at couples in their situation. Talking about their feelings, expressing their emotions, they came to understand that they could view events differently, such as the ectopic pregnancy, but they could still be supportive of one another.
And while they were still focused on the goal of becoming parents, they decided that there was more than one way of doing that. Adoption became a serious option.
"It took the desperation and the pressure away," said Mrs. Magnacca, "and I knew that if the baby came through me or to me, it was the baby we were supposed to love and nurture."
About nine weeks after the ectopic pregnancy, much to the Magnaccas' joy and the surprise of the fertility specialists, Mrs. Magnacca became pregnant without medical intervention. Nine months later, on Sept. 21, 1998, Nicholas Armand Magnacca entered the world. "Girlfriend to Girlfriend" by Kristen Magnacca, published by 1st Books Library, is available only through Amazon at www.amazon.com for $15.95, or through the publisher at 1stbooks.com for $9.95.
For more information
Those contemplating assisted reproductive technology can get more information, as well as the names of physicians and fertility clinics, from Resolve, a nationwide organization based at 1310 Broadway in Somerville. The group works with couples having infertility problems. The national headquarters' number is (617) 623-0744 and the organization's Web site is www.resolve.com. Resolve's state chapter can be reached at Resolve of the Bay State, PO Box 541553, Waltham, MA 02454, or at (781) 647-1614 or on the Internet at www.resolveofthebaystate.org.
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