As I rapidly approach the end of my third trimester of my first pregnancy, I've been looking back and find myself amazed that we've gotten this far at all.

Until I started trying to get pregnant, I never had a serious reason to think that maybe I couldn't. Fertility issues don't run in my family. My mother had three children without issue. Other women in my family had just as many or more, often into their forties, without major complications. Like most young American women, the pregnancy-related crises of my late teens and early 20's revolved around a late or missed period due to stress and the possibility that I might be pregnant before I was ready. All that changed when I started actually trying to have a baby, and suddenly found I couldn't.

The Center for Disease Control believes about 10.9% of all women between the ages of 15-44 have impaired fecundity, or difficulty getting pregnant. In married women of the same age group, this statistic drops to 6.0%. Other studies have found much higher statistics, including one my own doctor quoted to me - that one in six married couples have trouble conceiving after over a year of having unprotected sex.

I spent a decade of my life taking birth control to avoid an accidental pregnancy. Discovering in my late twenties that I might not be able to conceive at all was like having a rug pulled out from under my feet. All my assumptions about my own body and self were thrown into flux, and plans I had assumed as a given for my future were suddenly in doubt. There was a lot of sadness, a lot of depression as my husband and I struggled to figure out what our options were, now that a much-hoped for child seemed out of the picture. Humans have a tendency to take our biology for granted, which is a mistake. Infertility changes everything, and so many people, including myself, never see it coming.

After over a year of trying to conceived through unprotected sex and timing my ovulation through various phone apps, my husband and I became eligible for fertility treatment through our insurance. The first steps of infertility treatment were awkward. I felt like a lab rat. We had numerous tests. Both of us had numerous vials of blood drawn - 12 in one session in my case - to test for chromosomal causes, vitamin deficiencies, anemia, etc. I provided urine samples and got my fallopian tubes flooded to test for blockages while my husband provided a sperm sample. All of our tests came back with no obvious cause for our fertility problems, leaving us with the frustrating diagnosis of "Infertility - unexplained".

It turns out that infertility can have a wide variety of causes. From Endometriosis, where uterine lining grows outside the uterus, to sperm allergies, where men produce antibodies attacking their own sperm, there are a myriad of causes that can be simple to solve or complex, depending on the issue or combinations of issues. Yet even with all of these known conditions, one in four couples suffering from infertility never has their diagnosis officially explained.


My family was luckier than most. Our insurance covered most early procedures, including the drug Clomid, which stimulates ovulation, and most of the Intrauterine Insemination (IUI) procedure, which inserted my husband's treated sperm sample directly into my uterus, bypassing the cervix. We ended up paying just $200 total for four months of fertility treatment, and were lucky enough to have success on our first round of IUI. Many couples aren't as lucky, and face several cycles of IUI, or IVF after that, which can be much more expensive. Without insurance coverage, one cycle of IUI usually costs between $300 and $800, if you are able to use your own partner's sperm (many can't) - and that's just for the procedure itself. Uncovered ultrasounds and medication can run the cost up to $1500 to $4000 a cycle. IVF costs are even higher, running on average $12,500 a cycle in the U.S. if your insurance doesn't cover it. And, of course, no one can guarantee how many cycles it will take for conception to occur.

My husband and I will never really know what caused our infertility. All of our tests came back with good numbers. Our doctor's office was more focused on following the likeliest protocol for success rather proceeding than more expensive tests that may or may not provide answers. Based on our quick success with IUI, I can hypothesize that perhaps I suffered from hostile cervical mucus, which would have prevented my husband's healthy sperm from reaching my healthy ova, but we will never know for sure, now.

A quick aside - if you have anyone in your life who has been married for several years, please do not ask them when they are planning on having children. One of the lessons of this journey has been that you never know what health problems someone else might be having. My husband and I spent four months of active fertility treatment, and a year and a half prior to that actively trying to conceive, with little understanding as to why our efforts were failing. I can't begin to explain the crushing sadness I felt every time a pregnancy test came back negative. I can't tell you how helpless my husband felt, watching my sadness and knowing of no good way to comfort me. Well-meaning friends, relatives, even co-workers would want to know why after several years of marriage we had chosen not to have children, and I didn't ever know what to tell them. Eventually I just started saying the truth. It's strange how no one ever wants to hear those awkward explanations, even when they were the ones who asked in the first place.


At last, I got lucky, and our treatments worked. Early detection over-the-counter pregnancy tests allowed me to first test positive at home three days before my period was due. Words don't do the feeling justice.

When you conceive through science and infertility treatments, the process is quite different than the "normal" pregnancy experience. We were labeled as "high-risk" and were closely monitored through our first 12 weeks of pregnancy. We had our first ultrasound at just 6 weeks to confirm a viable heartbeat, after two blood draws to confirm my hormone levels were rising as expected for a pregnancy. Our first ultrasound showed not one, but two heartbeats - and so my husband and I knew we were expecting twins at a point in pregnancy where many women have yet to even see a doctor confirming their urine test.


Our twins, at 6 weeks and 3 days of pregnancy, or approximately 3 weeks after conception. Pregnancies are measured by the date since the last menstrual period, but conception generally occurs approximately two weeks after that. Because we underwent IUI, we know the actual date of conception as well.

Because of science, I knew when I had heavy spotting at nine weeks that I had not lost the pregnancy - an ultrasound confirmed they were still viable. I was able to see two embryos moving and flipping at 10 weeks. At 12 weeks the doctor was able to rule out anemia as a possible cause of dizzy spells. The early diagnosis of twins allowed my maternal-fetal medicine specialist to recommend extra folic acid supplements in order to support proper development. At 15 weeks we knew which one was Baby A and which Baby B - meaning which was likely to be born first. At 17 weeks we were able to discover the sex of each fetus. At 19 weeks we breathed a sigh of relief to know that there were no major markers of disability present in either baby. At 28 weeks I was excited to know that both babies were head down, a sign that I could possibly deliver vaginally. At 31 weeks I became immensely frustrated to learn that one baby had flipped back into the breech position, dramatically raising my chances of needing a C-section, only to find at 32 weeks that he had flipped down back down, and I might be able to deliver vaginally after all.


My son's face, at 32 weeks. Weeks away from being born and already frustrating the heck out of his mother.

Which is the most remarkable part of conceiving by science - despite all the extra insight, the technology that has made conceiving and giving birth more exact, life is still incredibly unpredictable. I can get a 4-D ultrasound of my son's face, but my daughter refuses to cooperate and hides her face deep in my pelvis, turned away from any probes. I can know which way my children are facing at any particular moment, but my doctor can only give me about a 70% chance that they'll stay that way, meaning the day I go into labor I have no way of knowing whether I will need to have an operation or not. I can conceive two children after all, despite my greatest fears, and yet never truly know or understand what prevented the conception of earlier children in the first place.

I am installing car safety seats into my car this weekend, and starting to pack up my hospital bag. Babysitters and back-up babysitters are arranged for my older stepchild for delivery day. We have books on what to expect in the first year of life, we have books specializing in helping infants sleep, we have books on twins. We have bottles, socks, hats, diapers, wipes, and burp cloths. The "coming home" outfits are bought and washed. Things are slowly falling into place.


As we approach this final month, I think back on the science that has brought us this far, and will take us these final weeks. A large breech twin, which might have killed me centuries ago as I tried to give birth, can be delivered safely through surgery, if necessary. I will have medicine, if I want it, for the pain. There will be pumps to help me save breast-milk when I go back to work, or life-saving infant formula, if for some reason, my milk can't come in at all. There will be vaccines, and vitamins, and antibiotics to help survive those dangerous first few months. There will be a neonatal intensive care unit next to the delivery room in case of emergency.

But I am also appreciative that there are limits to this science, and some things it will never be able to tell me in advance. What color my children's hair and eyes will be. What my children's first words will be. When they will start rolling over, crawling, walking. Their first childhood quarrel with each other. Their personalities, and who they will grow up to be. The immense challenges, frustrations, failures, and successes they will face on this journey through life.

I am grateful to science for bringing us here, to a place I might have never otherwise reached. Ours is certainly not the strangest journey of reproduction, or even a particularly new one. Our children will not have three genetic parents, and did not require a donated womb. But still, I marvel every day at our journey, and the strange path that I never pictured us following. In earlier centuries, or even just decades ago, my children would never have existed. I will always be thankful for the numerous doctors, nurses, ultrasound techs, and the countless thousands that researched the medicines and technologies that made all this possible. But now I'm finally ready to forget all of that and watch my children become the same as every other newborn child - that commonplace miracle of life going on to the next generation.