My leg bounced nervously as we sat in the waiting room at the fertility clinic for the first time. I gripped my husband’s hand harder, hoping for strength and comfort from his grasp. What would they find? Should my husband come back to the room with me? What would we have to do to be able to get pregnant? I quaked inside at the thought of the physical vulnerability I knew I would experience in the exam room. I hate this. I hate this. I hate this. This is not the way a baby is supposed to be made.
The effects of infertility are multitudinous. Physical, emotional, social, spiritual, marital. It can easily consume every thought, every decision, every relationship. If you pursue treatment, it invades your calendar, your bank account, your bedroom, and your body. And yet it often remains a hidden struggle, concealed by the very nature of the topic. We may watch characters on our screens talk about sex, but for most of us, words like semen, intercourse, and menstrual cycle are extremely uncomfortable to talk about in our personal lives – and especially all three together! Perhaps we will share a broad statement to a best friend, in an undertone like we are confessing some deep, dark sin: “We’re having trouble getting pregnant…” But rarely does someone say, “we’re having trouble getting pregnant, and here are the specifics of how this is consuming my life.”
But infertility is not sin. Neither is it uncommon. The Mayo Clinic reports that about 10-15% of couples are infertile, with infertility being defined as “not being able to get pregnant despite having frequent, unprotected sex for at least a year.” Nor is infertility just a woman’s problem. One third of infertility problems are caused by the woman’s body, one third caused by the man’s, and a third by both or for unknown reasons. Nor is the dictionary definition of “infertility” the sum of the challenge. Infertility refers to the inability to conceive at all, but “recurrent pregnancy loss,” simply meaning two or more miscarriages in a row, is also common. For the sake of brevity, I will use the term infertility in this article to refer to both.
I have had multiple friends who pursued fertility treatment and had success birthing beautiful babies through that route. I have also had multiple friends who, when faced with infertility, decided not to pursue treatment and remained childless. And I know a few couples who pursued fertility treatment but were still unable to have biological children. Some of those couples pursued embryo adoption; others pursued domestic adoption. Each couple who walked the path of infertility had their own story and reason why they made the choices they made, and each reminds me that no two infertility stories are the same. But one aspect is similar for all: it is painful. It is one thing to decide not to have children; it is another thing entirely when you are unable.
Our own story includes all kinds of attempts at treatment. We got married when I was 35. For a variety of reasons, we waited a year to try to get pregnant. The biological clock is a real thing, and at age 36, mine was ticking loudly. We found ourselves in my OB’s office after trying on our own for a year. She started me on letrozole, a fertility medication, and gave us a referral to a couple of fertility clinics. So started our three-year journey through fertility treatment. Those were some of the most painful years of my life. The exhausting emotional cycle repeated every month: hope rising, only to crash in tearful despair with yet another negative pregnancy test.
Initially, the cause was unexplained. Over time, my bloodwork changed to provide a cause: “diminished ovarian reserve.” In other words, I was too old. At age 38, my body was already moving towards menopause. But we kept trying. Over those three years, we tried fertility medications, two surgeries, IVF, IUI, IVF stimulation drugs coupled with IUI, acupuncture and herbal prescriptions, diet changes, and stress relief exercises. We called the elders to pray over us and anoint us with oil. We sent out prayer requests to an ever-growing list of people who prayed for us to be able to have biological children. Before facing this issue, I had no idea what some of these acronyms meant. And I never thought I would do some of the other treatments. (Needles stuck all over me? No thank you!)
During this season, I was working full-time and was also in grad school… seminary, actually. It is ironic but honest to say that I resisted being pulled to the Scriptures as I walked this path, yet God kept putting His Word in front of me. As part of my master’s degree project, I was writing an in-depth Bible study on the story of Jacob from the book of Genesis. Jacob’s life shows many struggles we still encounter today: family dysfunction, sibling rivalry, injustice in the workplace, and … infertility. As I researched and wrote, I was forced to face a question that haunted the back of my mind: does God care about my infertility? Is it truly suffering, or am I just not getting what I want?
In Hebrew storytelling, the central portion of a narrative is often the climax of the story, and in the Jacob story, the center of the narrative, Gen. 29:31-30:24, is the birth of his sons. You may remember that Jacob married two sisters, one whom he was tricked into marrying and the other whom he actually loved. Hemming in the birth narrative of Jacob’s sons, Genesis includes two very intentional details. The section begins, “When the Lord saw that Leah was hated, he opened her womb, but Rachel was barren” (29:31, ESV). It ends, “Then God remembered Rachel, and God listened to her and opened her womb” (30:22, ESV). In the middle of the section, after Leah has birthed four sons and Rachel remains barren, this little exchange is recorded between Rachel and Jacob:
When Rachel saw that she was not bearing any children, she became jealous of her sister. So she said to Jacob, “Give me children, or I’ll die!” Jacob became angry with her and said, “Am I in the place of God, who has kept you from having children?” (30:1-2, NIV)
I was writing this study while in the midst of fertility treatment. What was I to do with the clear communication in this Scripture that God is the one who opens and closes the womb? Should I just give up because God is going to do what God is going to do? Is it that he is God, and I am not, and I have to just suck it up because I’m not in control? Does God care how I feel about it, or is he just impersonally looking down “from a distance,” as Bette Midler sang in the ‘90s – impervious to my grief?
I continued to work on the study of Jacob’s life, and I came to the part most familiar to many people: Genesis 32, when Jacob wrestled with God. He was in a climax of personal crisis (unrelated to fertility), and he wrestled with a man by the shores of a river in the dead of night. In that climax of personal crisis, God showed up. God came to him and wrestled with him, not to dominate him, but to bring him to a place of blessing. God was not looking down from a distance, and He was not impervious to Jacob’s pain. I felt the invitation to wrestle with God myself.
As I grappled with God, I needed a bigger picture of infertility in the Bible – and of God’s response to it, one which Jacob’s story does not really tell. But Jacob’s family history is steeped in infertility, going back two generations. Jacob’s grandmother, Sarah, was infertile until after menopause, when God miraculously opened her womb to give birth to his father, Isaac. You can read the story of how Sarah and her husband, Abraham, grappled with infertility in Genesis 15:1-18:15 and the birth of Isaac in Genesis 21.
In Genesis 15, Abraham talks back to the Lord in his wrestling with their infertility. “O Sovereign Lord, what can you give me since I remain childless… you have given me no children; so a servant in my household will be my heir” (Gen. 15:2-3, NIV). I can hear and feel Abraham’s grief as he argues with God. I hear and feel echoes of bitterness, echoes of disappointment with God. After all, God had promised Abraham many years before that he would become the father of a great nation. And, perhaps, even accusations: “Sovereign Lord…you have given me no children!” What did God think about Abraham’s complaint? He did not strike with lightning or ignore him or condemn his impertinence. Instead, God responded to Abraham’s with compassion and hope. “This man [the servant] will not be your heir, but a son coming from your own body will be your heir. … Look up at the heavens and count the stars – if indeed you can count them. So shall your offspring be” (15:4-5, NIV).
Jacob’s grandmother was not the only barren woman in his ancestry who birthed a son. Jacob’s mother, Rebekah, was infertile for 20 years before she conceived twins: Jacob and Esau. Twenty long years of waiting and grieving and longing. As it was obviously long before the days of ultrasounds, when she finally and unexpectedly got pregnant, she probably did not know she was pregnant with twins. Genesis 25 tells us that the babies “struggled together within her.” Her natural response was one of fear. Who knows if she thought she was having a miscarriage or if there was something else she suspected, but she clearly felt something was wrong. The literal Hebrew says, “if it is thus, why am I – ?” Her words sound like a gut-wrenching cry: “If it is going to be this way, why did I even get pregnant?” Or more succinctly, “Why me? Why?” Instead of fully despairing, she “went to inquire of the Lord.” He did not respond, “What’s wrong with you, Rebekah? Don’t you have any faith?” He did not reply, “Don’t you trust me?” He did not assert, “I can do whatever I want. I do not need to answer to you. I am God; not you!” Instead, he answered. His answer may have made her scratch her head in the moment, but He was not demeaning, despairing, or unsympathetic. Instead, He gave her a prophecy of the future of these children. God responded with compassion and hope.
I treasure the permission God gives us to talk with Him. I had many arguments with God as well, conversations that were filled with grief, anger and accusation, disappointment, and hopelessness. “God, I don’t want to be the age of a grandma by the time I become a mom for the first time!” “God, you commanded people to be fruitful and multiply! We are just trying to obey you!” “God, don’t you care about us? We serve you! We have given our lives to you and for you!” “God, we aren’t Abraham and Sarah. We have no promises of becoming a great nation or of you blessing the whole world through us. We aren’t the first forefathers of a covenant people who would eventually birth Jesus. I have no reason to hope that you would give us biological children. I get it; we just aren’t that important.” And yet, I was surprised to hear the Lord respond to my own grief and fear with compassion and hope as well. As we stumbled our way forward, He made Himself more real to me. He also responded with hope. I never heard Him audibly speak, but I felt clearly that He was telling me, “I have children for you – children whom I have known from before the foundations of the earth; you just don’t know where they will come from yet.”
Does God’s response of compassion and hope mean that we should sit tight and wait without trying to do anything – without pursuing treatment or adoption? Well, everyone’s story is different. Looking back at Abraham and Sarah’s story, as the years went by with no child, Sarah and Abraham did not remain inactive in their infertility. Genesis 16 says that when Sarah was 75 (after they’d been in Canaan for 10 years!), she said to Abraham, “The Lord has kept me from having children. Go, sleep with my maidservant; perhaps I can build a family through her” (Gen. 16:2). This practice is essentially the legal way the ancients would attempt workarounds for infertility. The common practice was that in wealthy households, the mistress’ servant would be “given” to the master of the house as an egg donor and surrogate mother. The child born to the servant would then be counted as the mistress’ child. This same practice occurs in Jacob’s marriages as well.[i]
This brings up an additional layer of grappling with God in infertility: ethics. Should we use a tool just because it is possible and available? One of the ways my husband and I wrestled with pursuing fertility treatment was in the desire to push back against the Fall of Man. If Jesus has redeemed us and called us to live in redemption, then is it not part of our role as redeemed humanity to push back against the Fall in every way? And if we can do that through God’s gift of modern medicine, and we can afford to pursue that option, then should we not do so?
The world of reproductive medicine has many, many different choices. The decisions can become completely overwhelming. Our society tells us that if you can do something through science and medicine, then you should do whatever options are available to you. The options in fertility treatment can make it seem as though we can make it happen; we can be in control of our own reproduction. But I had to grapple with God in the reality that He is still the one who opens and closes the womb – even with modern medicine that feels like sci-fi at our disposal. My husband and I had to decide some major ethical questions along the way.
Are we willing to use fertility medications like clomid or letrozole that might produce multiple babies in the same pregnancy, thereby potentially endangering either the mother or one (or more) of the babies? Are we willing to use IUI or IVF, which requires a “semen collection,” usually requiring the husband to masturbate at the clinic in order to ejaculate? Will he use the materials provided to “help” him – materials that we would typically describe as porn? Are we willing to pay $10-15k to pursue IVF? Are we willing to go into debt in order to do so? If we pursue IVF and are able to get embryos that make it to the blastocyst stage (able to be transferred to the mother’s womb), are we willing to do genetic testing on the embryos in order to “discard” the ones that may have genetic abnormalities? (At what point does life start? At what point do we get to make the call to end that life?) If we get more embryos than the number of children that we want, what will we do with the remaining embryos? Will we allow them to be adopted, knowing that we may have biological children out there in the world somewhere at some point? Will we allow the embryos to be thrown away? Will they just sit in the freezer until Jesus comes back? What if we can’t get embryos, even with IVF? Will we use an egg donor or a sperm donor, knowing that the resulting child will be the biological child of only one person in the marriage? Is that essentially allowing some other person into our marriage? If the woman can’t carry a pregnancy, are we willing to use a surrogate mother? Is that essentially allowing another woman into our marriage?
The ethical questions in fertility treatment are dizzying. At what point does pushing back against the Fall become idolatry – a willingness to do anything we have to do in order to have biological children? Once you get into treatment, it can be easy to forget that there are any ethical issues and to simply do whatever next step the doctor puts in front of you. We had to be in real, regular conversation with God and each other about each step of the process. Where would we stop? Where would we not? Why? We didn’t always talk to God as much as we should, and when we did, we didn’t always do it well. At one point, we had to meet with our Ethics professor from the seminary, a kind, godly man who knows both of us, so that we could come together about a particular decision. He encouraged us and grieved with us, but he also helped us step back and see our different underlying motivations, bringing us back to an ethical underpinning about life that we both hold to be true: life begins as conception.
To be honest, I never thought I would pursue fertility treatment very far down the path. I have been interested in adoption since I was in my 20s, and I had always feared the pain of pregnancy and labor. So, I was surprised by the intensity of desire to have a biological child after I got married. My husband and I are cross-cultural in our marriage, and I found that I had a gutturally deep longing to have a child who would be a product of us – of our cultures, our opposite appearances (I am a redhead; he is Mediterranean), our personalities, and our love. And I was not making this decision alone; when you are very intentionally deciding about children, the decision must be shared. Early on, my husband submitted to my desire to go ahead and start trying to get pregnant, even though he did not feel ready. By the end, I was submitting to his desire to continue another round of treatment when I was ready to move on to adoption. We did not do the process perfectly. There are decisions I would have made differently in our journey if I could go back and do it again.
In Genesis 17 and 18, the Lord told Abraham that Sarah would have a child “by this time next year.” The absurdity of the idea made both Abraham and Sarah, separately, laugh privately to themselves. And the Lord, ever having a sense of humor, said, “You shall name him Isaac,” which means he laughs! I imagine this naming had a double meaning. First, that Abraham and Sarah laughed at the Lord and disbelieved. It may have been ancient times, but they did know how a woman’s body works! Women did not get pregnant after menopause any more then than now! But second, I imagine that God gave them this name for their son in delighted anticipation of the joyful laughter that they would experience together in having a son and watching him grow.
I do not want to tie a pretty bow on this story. So often in our journey, people would tell us triumphant stories of pregnancy in infertility. But others’ stories are not a guarantee that our story would turn out that way, and it often felt like a trite attempt to slap some hope onto us when we were in the dark night of the soul. I came to a new understanding of the adage in Romans 12: “Rejoice with those who rejoice, weep with those who weep.” Oh, how painfully hard it was to rejoice with someone when they got pregnant. And how hard it was for others to simply weep with us, even when they had no reasons in their own lives to weep. It reminds me of other places in Scripture where God speaks of or to barrenness. In Proverbs 30, the writer acknowledges the weight of grief in infertility: “There are three things that are never satisfied, four that never say ‘Enough!’: the grave, the barren womb, land, which is never satisfied with water, and fire, which never says ‘Enough!’” The barren womb is like the grave. To answer an earlier question, yes, infertility is suffering. And the Bible acknowledges this. God knows the depth of grief that infertility brings.
And yet, in Isaiah 54, God tells Israel, “Sing, barren woman, you who never bore a child; burst into song, shout for joy, you who were never in labor! For more are the children of the desolate woman than of her who has a husband.” Compassion and hope. Those two responses can only come as a response to grief and hopelessness. God cannot respond with compassion where there is no pain. God cannot respond with hope when we have everything we want. I came to a whole new level of maturity in Christ as I wrestled for hope, as I longed for a different story than the one we had. Could I believe that even if God never gave us children, knowing Him would be even better? Could I hope for more than just a different story for our lives?
Eventually, I came to my own place of surrender. Like Jacob clinging to God even as he was crippled, not willing to let go unless the Lord blessed him in his deepest point of weakness, I slowly unclenched my fists from the story that I wanted and began to trust the Lord for the story He was writing for us. It took years. It involved intense pain and deep grief. It stripped me to a new place of humility and weakness. And there I met God in compassion and hope, a sweetness that came as God walked paths of suffering alongside me instead of watching from a distance.
[i] It is worth noting that the Bible never actually accounts children born in this way as the mistress’ child; the children are always spoken of as the children of the servants, and we know the servants’ names. Sarah’s servant is Hagar; she bore Ishmael. Rachel’s servant was Bilhah; she bore Dan and Naphtali. Leah’s servant was Zilpah; she bore Gad and Asher. This practice is not prescriptive of the way we should act, but rather simply descriptive of what happened. In the case of Abraham and Sarah, Genesis tells us it led to millennia of ethnic warfare between the Arabs (descendants of Ishmael) and the Jews (descendants of Isaac). In Jacob’s case, the sons birthed by the servant women were included as the heads of their own tribes in Israel.