Certain married couples in churches across America share a bond of suffering. It is invisible and often goes undetected by other Christians. It is not exactly an illness, but it can rack, at least temporarily, both body and spirit. It does not occur because of social oppression, but it can and often does leave its victims feeling isolated, angry, and grief-stricken. Its emotional impact seems to hit hardest when everyone else is celebrating: at Christmas, Mother’s Day, baby showers, or family reunions. It is a condition that is aptly called “barren.”
Real Grief
Paul and Barbara began feeling the heat of social pressure to start a family after four years of marriage. They led a large Christian campus ministry where younger couples were having second and third children. “One influential leader thought it was a sign of God’s blessing to have a quiverful of children,” Barb recalls.
Barb underwent corrective surgery three times and suffered two miscarriages, but the most difficult aspect of the problem was its unexpectedly harsh emotional impact. For the first five years of her infertility, Barb choked off relationships with friends. “I could not share this burden with anyone,” she says. “My peer group so valued children as a reward and so stressed that God will give you the desires of your heart that I could never admit that we, the leaders, were experiencing a barren field.”
Paul maintained more personal equanimity, but experienced strain on their marriage. “There were times when I felt I could not tolerate another tirade on the baby situation,” he remembers. Their bottled-up emotions burst at inappropriate moments, such as a Christmas gathering with Barb’s parents, younger brother, his wife, and their toddler. Seeing a child’s delight at Christmas ruined the holiday for Barb. She told her mother, “I’m never coming home again.”
Incidents like this leave the infertile wondering whether they are losing their grip on reality. The couple actually grieves, although no one has died. They may want to put an end to intrusive medical procedures, yet they cling to the hope that maybe they will get pregnant—next time. Exploring positive alternatives to biological childbearing may seem as impossible to them as searching for an alternative to breathing air. Yet avoiding alternatives and harboring unrealistic fantasies create mounting frustration and stagnation in their lives.
People who are childless not by choice confront a double-barreled emotional challenge that is simultaneously a crisis (every 28 days) and a chronic condition (as months and years go by). Therapists have developed models of infertility that resemble the well-known stages of acceptance of death and dying. These include surprise, denial, isolation, anger, guilt, depression, and grief. Some believe it is necessary for the infertile to adapt to their condition in the same way people who become chronically ill learn to cope. Others liken it to the sorrow and uncertainty a family experiences over a soldier missing in action.
The death of a couple’s dream child surely hurts less than miscarriage, stillbirth, or a tragic childhood death, but it is a sustained and hidden hurt. All too often, the emotional impact of not being able to reproduce is compounded by flippant or insensitive reactions from friends and relatives. “Just relax” are two words the infertile wish they could banish from the language, because that bromide is prescribed so often. Relaxing is not a cure for infertility. Other well-meaning souls tell childless couples, “Adopt—then you’ll get pregnant” or, “Take a long vacation.” The prayer life of the infertile may be called into question by those who inadvertently model themselves after Job’s would-be comforters.
A common presupposition of Christians who marry is that they will raise a family together. This is strongly reinforced at church, to the point where an infertile couple may seriously question whether their marriage has any purpose or fulfillment without children. While it is true that a Christian couple should remain open to the possibility of children, unless they feel strongly called to a pursuit that precludes child rearing, more thorough church teaching on marriage could clarify the issue.
A pastor would readily advise a doctor’s visit to a person with a tumor or broken bone; because so many cases of infertility have identifiable physical causes, he should not hesitate to do the same in this instance. Unfortunately, because of the mysteries surrounding conception, a common reaction among Christians is to focus entirely on spiritual solutions. “God can work miracles,” one church leader told an infertile woman. Like clouds without rain (Jude 12), those are empty words indeed.
Barbara Eck Menning, founder of a national infertility support organization called RESOLVE, points out that having children is often a major life goal. If that goal is blocked for an extended period of time, a serious developmental crisis can result, making the couple feel like perpetual adolescents. Linda, a 32-year-old, confirms this. “A major concern and source of frustration for us has been the tendency to short-circuit our plans, thinking that ‘surely by then I’ll be pregnant.’ I have not wanted to become so wrapped up in a career that I close the door to motherhood, but that mindset just spills over into an excuse for not doing anything well.”
Most couples report that the wife has a greater personal struggle because she is the one missing out on the physical experience of childbearing. She may have grown up with the expectation that becoming a mother would be the main source of her own self-identification and fulfillment. Whether or not she is physically responsible for the infertility, she may assign blame to herself. Janet, the mother of two adopted children in Kansas, said, “At first, I feared Barry regretted marrying me, but he reassured me all the time that this was not true.” Men frequently say their feelings about infertility go unexpressed, while they concentrate on addressing their wives’ emotional needs.
Understanding Infertility
Carol and Dan were married in 1983, when both of them were approaching their midthirties, and they intended to start a family right away. After several months with no conception, they visited a doctor. Dan had three semen analyses done before a diagnosis was confirmed: male sterility, due to a congenital condition leaving Dan without any sperm. As he struggled to comprehend the doctor’s pronouncement, Carol flew into action, contacting adoption agencies and collecting application forms.
The bleak prospect of long waiting lists cooled Carol’s frenzy, and she began considering artificial insemination with sperm from a donor. “I was not 100 percent comfortable with it,” she says, “but it was the only medical option for us. One of my great sorrows will be to miss the experience of pregnancy.”
Dan opposed the idea. He could not tolerate the thought of friends and family congratulating them over an event in which he had no part. “I felt as if I’d be the only loser,” he says. “And what would we tell the child? As long as there are other people around who know the child was conceived by a donor, it is deceitful to raise that child without telling him of his true parentage.”
Because of Dan’s reservations, they abandoned that possibility. Their difficulties were heightened by the fact that infertility was indisputably linked to one partner. Carol explains, “When one mate has a definite problem, the other one tries to go easy on him, to spare him. Sometimes I felt I really could not share my sadness or frustration. That has been the hardest part for me. I have had to learn how to allow him to help me through this.”
A couple is usually considered infertile if no conception occurs after one year of unprotected intercourse. If the woman has never been pregnant, the condition is known as primary infertility. If the couple is unable to conceive after one or more successful pregnancies, it is called secondary infertility. The term sterile is used if one partner has a diagnosed, irreversible physical condition, as in Dan’s case, that prevents the couple from producing a fertilized egg.
Physicians estimate that as many as one out of every six couples in the United States struggle, at one time or another, with infertility. In a church with 200 members, approximately 15 couples could be suffering in silence over involuntary childlessness.
The fertility rate, or the number of births that occur for every 1,000 women of childbearing age, appears to be on a long-term decline in the United States. There are a number of reasons for this: More couples are getting married in their late twenties and thirties, childbearing is being postponed while women work outside the home, and the use of certain contraceptives can impair fertility. The increasing incidence of sexually transmitted disease is one of the fastest-growing causes of infertility.
Women reach their peak of fertility at around age 24. Fertility declines slowly after age 25 and rapidly after age 30. Infertility is widely considered a “female problem,” but in an estimated 30 percent of the cases, the trouble is with the male. Another 30 percent are traceable to the female, and most of the remaining 40 percent result from a combination of factors. Between 5 and 10 percent remain undiagnosed.
The treatment of infertility is a rapidly expanding medical specialty that presents childless couples with a bewildering array of choices. Usually, the wife is instructed to take her temperature each morning upon waking and chart the results. In this way, the couple may predict with more certainty when an egg may be fertilized. This subtle intrusion into a couple’s most intimate moments is just the beginning.
Semen analyses are performed, and a regimen of other tests measure physiological compatibility, hormone levels, and a host of variables that affect conception. Before long, the couple’s sex life becomes something other than an expression of mutual love; it is a regulated, prescribed antidote to the condition that besets them.
If surgery or drug therapy is not the solution, an ever-expanding range of technical alternatives is available, including artificial insemination, in vitro fertilization, and high-risk options such as contracting with a surrogate mother.
How Churches Are Helping
At Menlo Park (Calif.) Presbyterian Church, monthly support-group meetings for eight childless couples have continued for over a year following a series of classes on infertility. Cynthia Lovewell, a registered nurse who experienced infertility herself, developed and coordinated the six-week series along with LeRoy Heinrichs, an infertility specialist and member of the Menlo Park church.
A curriculum filled with outlines and worksheets for the class invited active participation from couples who attended. They were asked, at an initial informational meeting, how long they have been searching for a resolution to infertility, how members of their families are reacting, and whether they are considering adoption.
Weekly discussions of different aspects of infertility followed, led by church members or staff with expertise in the field. The sessions covered “Problems in Reproduction,” “The Emotional Aspects of Infertility,” potentially helpful medical interventions, the results of choices infertile couples make, the spiritual dimensions of infertility, and an overview of adoption choices. Couples were urged to write answers to two take-home questions: “What are you doing to help yourself during this stressful time?” and “List all the resources available to you that could possibly assist you in your present situation.”
Husbands and wives also were encouraged to keep a notebook or journal chronicling every appointment, treatment, or suggestion they received. They were challenged to spell out exactly their current plan of action. Provocative questions about God’s timing and the spiritual lessons of denial were posed, as well as practical details about pursuing adoption. One year after the spring 1986 class, three of the original eight couples were expecting babies and one was pursuing adoption. The other four continue toward resolving their infertility within the supporting network of a caring Christian community.
Sensitivity on the part of a pastor and heightened awareness throughout a congregation are two ingredients that speed the emotional healing of the infertile. Often, the single most helpful act on the part of a church leader consists of simply introducing the infertile to one another. They begin to realize, finally, that they are not alone. For both couples mentioned earlier, support from fellow believers helped them stabilize their feelings and sustain their commitment to each other and to the Lord.
After Carol and Dan had received their diagnosis of irreversible male sterility, they began meeting with a group of infertile couples at their church. Carol, unable to articulate her grief, left the room in tears month after month, but she continued to come. “The news was just so fresh,” she recalls. “I knew I needed support, but at the same time, the meetings made the problem all too real.”
Their pastor spoke to the group one month about the Bible’s perspective on marriage and family. Afterward, Carol and Dan prayed with him in the church sanctuary. “Having someone acknowledge that our infertility is a genuine problem was so important,” Carol pointed out. Together, she and Dan reached a decision to pursue adoption possibilities, after Carol learned from others in the group that “adoption is a way of having a family, not a Tylenol for the grief of infertility.” Less than one year later, they brought home a newborn boy, adopted through a Christian adoption agency in their state.
The day-to-day trauma of infertility is difficult, and it can be compounded by certain events and holidays in Christian circles. A pastor’s special sensitivity on these occasions can make the difference between a couple opting out of church fellowship and remaining vitally involved. Key occasions are Mother’s Day, infant baptisms or dedications, and child-centered holidays such as Christmas. One church inaugurated an Abraham and Sarah fund at Thanksgiving, inviting couples who were thankful for the gift of children to contribute to a fund to assist the infertile with adoption expenses.
Heightened sensitivity on the part of pastors and church leaders will filter down to the congregation at large and help eliminate unthinking comments challenging the faith or anxiety level of the childless. And the pastor who gains rapport with the childless may find them an invaluable resource for church duties that harried parents cannot handle.
Infertile couples are not the only ones who benefit from church initiatives designed to encourage them. A spirit of compassion and sensitivity is fostered when the pastor acknowledges the pain of childlessness, and members of a congregation may grow closer as they learn to share ongoing sorrow as well as joy. Adoption or foster care can become an area of opportunity for ministry, even among couples who are not infertile. And the church gains enthusiastic, active members as it reaches out to childless couples verging on disillusionment.
For Paul and Barb, resolution came after ten difficult years. “I finally felt something die within me,” Barb says. “What died was the burning desire and drive to have children. Maybe it was the acceptance point some refer to in the steps of grieving. I felt a new sense of purpose and a renewed relationship with God. I discovered what I should have known all along—that he does not work in response to my desires and wants. He works according to his will.”
Paul and Barb remain child-free, but they have filled the void they so feared in their lives. Together, they run a retreat center in rural Ohio for former members of religious cults. Barb works at a center for mentally retarded adults, and counts it a special blessing when the people she works with call her “Mommy.”
For Barb, in particular, the support of Christian friends was critically important in keeping her grounded in Scripture and in touch with the community of believers. Infertility, she says, “created a spiritual havoc of re-evaluating our faith, our relationship with the Lord, and how prayer works.” She now sees that “those times of spiritual dryness were all a part of purifying us and making us into the kind of people God wants us to be.”
This article is adapted from the recently published book entitled The Infertile Couple, by Beth Spring (David C. Cook).
The Alternatives To Infertility
Years ago, childless couples could adopt a baby through a public social service agency free of charge, and in less time than it would take to carry a pregnancy to term. Today, that public agency may have a waiting list of up to seven years long. Couples who turn to private agencies discover they must wait an average of one to two years for placement, and pay a fee averaging $6,500, according to the National Committee for Adoption.
At the same time, clinics offering high-tech alternatives for the infertile are flourishing. How can concerned Christian leaders assist infertile couples through the maze? There are several basic options infertile couples may consider, and each one raises ethical and economic questions.
1. Artificial Insemination by Husband (AIH). Insemination in a doctor’s office is often recommended when a man’s sperm count is low, and and it offers approximately a 20 percent chance of pregnancy. Protestant ethicists generally approve AIH, while Catholic teaching opposes it because it separates intercourse from procreation.
2. Artificial Insemination by Donor (AID). This technique is the same as AIH, but sperm from an anonymous donor is used. Catholic teaching opposes AID, and Protestants tend to view it with caution. It introduces a “third party” into the marriage bond, critics point out. Most AID parents do not tell their children how they were conceived. AID would also permit single women to opt for childbearing.
3. In Vitro Fertilization (IVF). The wife is given hormones to stimulate the production of more than one egg. The eggs are harvested and then mixed, in a laboratory, with sperm from either the husband or a donor. Eggs that become fertilized are placed in the woman’s uterus. Ethical questions about IVF include its costliness (more than $5,000 each time), the waste of extra fertilized eggs (or “pre-embryos”), and the likelihood of experimentation on laboratory-grown embryos.
4. Embryo Transfer. The husband’s sperm is used to artificially inseminate a “donor” woman, and the resulting embryo is washed from her uterus and implanted into the infertile wife. This is a highly experimental technique that is not generally available because of the risks to both the donor woman and the embryo.
5. Surrogate Motherhood. The case of Baby M in New Jersey has crystallized a heated public debate over the use of legal contracts to retain surrogate mothers. As Mary Beth Whitehead, the New Jersey surrogate, discovered, a contract cannot reckon with maternal bonding and a change of heart.
6. Adoption. Despite an extremely short supply of healthy American infants, adoption remains a preferred alternative for many infertile couples. Ethically, it is far different from surrogate motherhood, because the conception of the child is not premeditated. Also, the birth mother has the legal right, after the baby is born, to change her mind.
7. Remaining Child-free. In the whirl of activity and anxiety over infertility, a couple may lose sight of an obvious solution: adapting to life without children. Difficult questions about God’s purpose for marriage need to be addressed, and clear church teaching on the worth of marriage partners—despite their infertility—would help.
By Beth Spring.
