Defining the Beast: What is Infertility?

Infertility is lived in many forms. We have to understand and define what it is and what it isn't before we can build context for how to deal with it. In the narrowest of contexts, the mainstream medical definition reads as follows, regardless of the source you use for the definition:

But what about recurring miscarriage? And what about stillbirth? And what about the obvious glaring fact that the Catholic view of fertility only exists in the context of a man and woman together...so there isn't any female or male infertility separate from the couple's infertility? As you can see, mainstream medical definitions do nothing to underscore the broader religious context. And the narrow view used to define infertility medically has actually has limited our current understanding of what the cross truly is. 

Infertile couples live in a perpetual state of longing for children.

We can agree as Christians that the primary desire of every couple is to be fruitful. Accepting children lovingly from God can be a big part of that fruitfulness, but it's not the primary means by which couples unite themselves to each other. As Catholics, we believe that marriage is both unitive and procreative. That means there will be people called to many different forms of unitive love and procreative love. And the ways in which that loves manifests will be rich and diverse.

But let's talk about how most people understand entering into marriage: as a calling to begin family life. When we look at the growth of our family in marriage, it's a natural want to include children in that growth. For many couples, the children don't come. Or the conception happens and then a miscarriage follows. Or a pregnancy is achieved and is relatively uneventful and then the child dies right before birth. Or worse, the child is born and dies shortly thereafter. The common anguish shared amongst all of these different parents in these scenarios is that they longed for their shared love to grow their family in a tangible way. Being denied the ability to grow your family cuts at the very heart of our human urges and needs. Inside every single person, regardless of whether are in touch with this desire or not, is a desire to be fruitful. Wanting children is one natural (and very common) manifestation of fruitfulness in marriage.

It's too "simple" to say that infertility only affects the couples who don't conceive in a year. We leave out the immense pain of the couple who had a child, but then struggles to ever conceive again. In fact, we also leave out the people who were born with genetic conditions that left them without the capacity to procreate at all. And we leave out the couples who can't conceive and can't adopt. Just adopt, they say. Not everyone can. Imagine being infertile and being unable to qualify for adoption. The pain and anguish! (We'll ignore the fact that adoption is a separate calling right now...but rest assured we will revisit that topic this week).

If we simply defined infertility using parameters that include everyone who struggles to get and keep a baby in their arms, we would begin to understand the complicated topic of infertility much better. And we would be reaching our arms around the topic much more completely than by using the mainstream medical definition. We'd also be the only group of people including those couples who met, fell in love, and married later in life...which is a group of people that the medical definition entirely excludes.

And at the end of the day, isn't that what the entire topic of infertility is about? Including the people that feel excluded and left wanting! Defining the beast by measuring its reach. Qualifying the longing to quantify the prevalence.

Infertility, at its core, is about living in the longing and being denied the ability to bring about tangible growth from the love you share with your spouse.

....and that's something that requires grieving to process. So without further ado, let's define the beast and let's include everyone who ought to be inside the definition of infertility:

There are a couple of different ways to define primary infertility. We believe that it's more than just the obvious. And that's mostly because we live in the grey area between this category and the next few we'll be defining.

Primary infertility definitely describes the couple who has never conceived. They've never gotten a positive pregnancy test. They've tried for months and it's just not happening. Generally, using 6 months of fertility-focused intercourse will get you this diagnosis. And when we say "fertility-focused intercourse", you need to know what that means inside and out. You know exactly when you are fertile and you are using those days (before, during, and after estimated ovulation). Couples who have primary infertility know that they can't get pregnant every day of the month. They know that there is a small window of time each cycle when it conception is possible and they know how to find that window and use it. When they are doing this diligently, there is no reason not to expect pregnancy to occur. Whether it's a problem with the woman's hormones or the man's motility, or any number of combinations of minor dysfunction involving the shared reproductive tracts of the couple... after 6 months of trying, a couple can be considered infertile medically speaking. Good doctors will investigate possible causes, run tests to try and identify issues, and treat things as naturally and supportively and therapeutically as possible to help a couple overcome primary infertility.

Some couples will live their entire marriage with this kind of infertility and they will never experience anything but a lack of children coming from the unitive love they share with each other. It is not appropriate to tell someone experiencing primary infertility to just adopt. Adoption is a separate calling - and most importantly - not everyone will be able to (or be approved to) adopt. The diagnosis and treatment of primary infertility is extraordinarily invasive in every sense: physically, mentally, and emotionally. It will take a giant toll on any couple who experiences it and pursues medical avenues to treat and cure it. The calling to adopt is also extremely invasive. It is reasonable to expect a couple to want to explore their infertility and treat it according to their conscience as a married couple, within the framework of Catholic teaching. To put that in plainer language - not every couple will take (or be able to take) every measure to investigate their infertility in this category. The married couple themselves must decide what is best for them in terms of approaching this. With that said, the Catholic Church is very clear about the ethics of treating infertility and the ethics surrounding the individual treatments. A married Catholic couple must form their consciences within that framework. You can read more about what treatment is licit from an official Catholic resource here.

It is common for a couple experiencing primary infertility, whether it lasts almost 6 months or lingers for their entire marriage, to mourn the absence of children in their marriage and to navigate and process all of the stages of grief as a result of it. The cycle of grief can begin and end each cycle and repeat any number of times. The loss of tangible growth to a family is processed very similarly to the death of a family member. The pain never goes away, regardless of the passage of time.

Miscarriage is defined as the loss of a baby who gestational age has not yet reached 20 weeks. Couples who experience miscarriage may also be experiencing primary or secondary infertility. Typically, a couple experiencing miscarriage with no living children before the loss are considered to be in the secondary infertility category. In the vein of inclusion we are using as we define things though, let's explore this through the lens of primary infertility as well. Many couples who have experienced the tragedy and pain of miscarriage and have no living children would actually consider themselves to be experiencing primary infertility, despite the formal definition. This is more a representation of the longing they still hold for children (as well as a lack of understanding how to live their role as parents with no child to hold).

You could be a newlywed couple and conceive on your honeymoon, lose your child through spontaneous abortion (that's what the medical world actually calls a miscarriage) before the child reaches 20 weeks, and because you still don't get a baby in your arms like we talked about above...you might process this like primary infertility. Your doctor might call your condition secondary infertility. Neither is wrong, in our eyes. The most important thing is that people should seek to understand and meet the couple where they are on this topic, not argue the rightness or wrongness of the moniker they identify with most.

Many married couples who experience these early losses don't have a real sense for their own role as parents. It doesn't change the fact that they are parents though! Just know that the grey area of understanding on primary and secondary infertility usually intersects with the topic of miscarriage (and stillbirth and infant death). Medically speaking, the formal distinction can be of importance for treatment purposes. It is important to let your doctor to know whether conception has ever occurred in your marriage when you are receiving infertility treatment. Let's put that grey area to rest for now though and move on to the child involved in miscarriage:

Nothing about a miscarried child is different in dignity than in a living child. The longing to be parents remains for those who have lost a child. But the child themselves is whole, distinct, unique, and completely equal in dignity, soul, and person to any living child. It is difficult to remember for parents who never had an ultrasound or heard a heart beat on doppler. We might be eager to draw distinction at the steps and phases of growth, saying that the further along, the greater the tragedy. But truly, if we respect life in all stages - we must recognize that the unborn child is equal to the tangible life we understand, hold, and cherish. In the same way that Catholics are called to hold faith in things they cannot see or touch, we are called to respect the life of unborn children equal to those who are living.

Miscarriage can be defined as a singular loss, or as we'll expand on below, it can be a recurring condition. Conception isn't necessarily what these couples long for so much as safe gestation and delivery. It is natural to find yourself questioning the reality of your pregnancy and grieving the personhood of a soul you never met. The most comforting thing I can think of on this topic: the cells of a conceived child actually remain in a mother her entire life. Scientific research has found fetal cells in the hearts and brains of the mothers who conceived them. We literally hold them in our hearts and minds forever. There is no figurative about it.

Miscarriage is distinctly different in definition from stillbirth. While the dignity of the child is equal in both situations, stillbirth (as we'll discuss below) is a term used to describe the loss (spontaneous abortion) of a child that is 20 weeks gestational age and beyond. The name for the loss is merely a temporal description, not a distinction that one child was more or less based on when they were lost.

It is common for women who experience miscarriage to feel like their bodies have betrayed them, that they are a "death trap", and to feel and process all of the stages of grief. For men, it is common to be confused and conflicted in how to process the loss. It can also be difficult for men and women to understand each other's grief and to support each other through the loss.

Those who have conceived a child and are unable to conceive again are said to be experiencing secondary infertility. We discussed above that (medically speaking) the outcome of the pregnancy itself is not how a person reaches this diagnosis. Many people will process this diagnosis only in the context of having a living child, followed by infertility. It is not wrong for a couple to do this, and people should aim to meet the child where they are.

Similarly to primary infertility, but maybe even stronger in religious circles...a married couple may find that people urge them to adopt when they don't go on to conceive other children. Others will assume a couple is "done" having children. Still others might wrongly think the couple is contracepting. The fact remains that it is no one's business but the couple on how large or small their family grows. And for those who want more children, secondary infertility can be a deeply painful experience because of all of the unsolicited judgment, advice, and suspicion that may surround them.

Infertility is a symptom of an underlying health condition. It is either the direct result and outcome of a disease or a symptom of the onset of disease. In no other realm of medicine would we offer such strident and painful judgments, opinions, or terse comments.....yet we do with couples experiencing infertility. While this issue is not unique to secondary infertility on its own, one of the things that strikes me the most about secondary infertility is that we actually witness the onset of a problem and we see the symptom manifest in infertility. Infertility has been likened to cancer in how seriously the patient manages it physically, medically, psychologically. So why the judgment? Would we ever tell a person struggling through chemotherapy that they must have done something *else* to make their hair fall out? Would we tell someone suffering from cancerous tumors that "it'll be ok, just relax and everything will resolve itself!". No. Flat No. BIG FAT NO.

It is common for a couple experiencing secondary infertility, whether it lasts almost 6 months or lingers for the rest of their marriage, to mourn the absence of additional children in their marriage and to navigate and process all of the stages of grief as a result of it. The cycle of grief can begin and end each cycle and repeat any number of times. The loss of an ability to grow their family cuts deeply. They long to provide siblings for any living children. In fact, their living children may compound the cross by begging for siblings. Even if the infertility is able to be overcome in some way, the pain from that phase of life is not completely resolved at the advent of additional children. Deep wounds leave large scars. Having one child is no solace for the family you feel God calling you to grow. There is no comfort for a couple experiencing secondary infertility and their experience is as raw as any of the other forms of longing that we've already discussed.

In the realm of fertility as a whole, ectopic pregnancy is one of the most feared situations any married couple can encounter (and rightly so). Ectopic simply means "in an abnormal place or position". We often think of ectopic to simply reference a tubal pregnancy. It's nowhere near that simple though. Ectopic pregnancy can mean any pregnancy that implants in the wrong place, whether it be outside of the uterus, in the fimbria, in the tube itself, on the cervix, or any number of other combinations. There are clinical observations of implantation occurring on other organs in the pelvic cavity. And because the ovary itself is not connected to the fimbria, it's always possible for the egg to migrate elsewhere. Many things can increase/reduce your risk for this to occur.

Tragically, most of the time these pregnancies are not viable. And they pose great danger and risk of hemorrhage and death to the mother. Any time implantation does not occur as expected, there is a grave medical risk to the mother. But in all situations of ectopic pregnancy, it is generally considered fatal to the baby. Yes, you will hear about the one-off miracles where a baby somehow gestated outside the womb for the entire pregnancy and lived. But it is not the majority experience, or even likely to occur. It is the exception. And when the implantation occurs in the tube, it must be dealt with immediately to prevent the mother from tube rupture and massive internal bleeding.

Couples will often first have the joyful experience of a positive pregnancy test, followed by an ultrasound that does not show any gestational sac. Or depending on where implantation has occurred, the mother might be nauseated or experience sharp stabbing pelvic pain. It can vary by couple, but it can also vary from pregnancy to pregnancy as ectopic pregnancy is something that generally predisposes someone to experience it again.

Christians are faced with unique pain, ethical dilemmas, and heartache in this form of infertility. From a Catholic medical perspective, no doctor in good conscience can directly attack the child in treating the mother's health. In fact, many Catholic doctors will seek to find a heartbeat in determining how to proceed in treatment of the condition for the mother. Why does this matter? Many doctors feel that certain medical treatments for the mother might not be permissable if the baby is still living. As a Catholic, the doctor will want to proceed in the manner that is safest for the mother....but also in a way that they aren't compromising their commitment to protect life at all stages. It's a difficult area, to be sure. But suffice it to say, no doctor wants to actively kill the child to save the mother...but sometimes treating the mother results in the death of the child. The intent and approach matter. A lot.

Theologians and ethicists will refer to the treatment of ectopic pregnancy as needing to follow the principle of double effect. If the good medical treatment of the mother in danger of death (as all ectopic pregnancies endangers the life of the mother) results in the death of the child, then that is considered licit. And beyond being licit, that's considered the standard of care for a Catholic. If the medical treatment is focused on killing the child directly for the purpose saving the mother... that doesn't meet the ethical test.

Suffice it to say, I offer these situations not to stem a debate on the use of certain medications or the emergency treatment of a mother at risk of severe hemorrhage or death. And certainly not to question the treatment anyone received in the past. And I never my thoughts as a form of judgment on how the situation was managed in your own care, if you are reading this as a survivor of this terrible situation. I offer these words merely as a way to have the conversation about the pain of ectopic pregnancy (something I've never personally experienced). When we define something and put any boundaries on that definition, there is a human tendency to impart bias and judgment on it. You will encounter a lot of disagreement regarding the topic of ectopic pregnancy even amongst Catholics, and certainly amongst Christians worldwide. The thoughts I've shared here are the result of research and interaction with Catholic ethicists and priests and medical doctors in the search for truth on this topic.

Men may feel completely helpless in the treatment of their child and wife in this medically emergent situation. And perhaps the rawest part of this topic is that we now know that prior contraceptive use can be directly related to changing how fast the egg travels through the tube and it can majorly increase the risk of experience a tubal pregnancy because of that. The slower the egg travels, the more likely it is implant in the tube. There are a variety of things that impact a woman's risk for ectopic pregnancy though. That's just one of them. Lord have mercy on these children and their mothers.

These couples conceive children (whether conception comes easily for them or not!), but they never get a child in their arms. Whether the loss is a result of miscarriage or stillbirth (remember that time is the only distinction between those two words), most couples will identify with this definition of infertility at more than one loss in their marriage. Recurring really does imply that it has occurred more than once. That said, you will often hear RPL (the acronym used for this) used to identify couples who have had a massive number of losses. 5, 10, 15, 20. Lord, have mercy for how these couples carry this brutal cross.

Medically speaking, recurring pregnancy loss as a diagnosis is usually given at 3 losses.

Now let's take a moment to discuss mainstream medicine's approach to infertility. It's pretty horrifying, when we look at it in the context of this specific topic. In mainstream medicine, you generally have to have 3 losses before a doctor will do a work-up on the woman to identify any issues that might need treatment. That's right, you would technically already be in the recurring loss category by the time a doctor even paid attention to your infertility. Am I the only one who is horrified at that?? I can't be. In the world of Christians and all who believe in the dignity of life from natural conception to natural birth.........we have to push ourselves to do better than this. There is no unexplained infertility, folks.

There is always a reason for loss. You might just not know why the loss is occurring. Is it immunological? Biological? Physiological? Genetic? Antibody related? Blood type related? Implantation related? Lining related? Velocity of egg transportation related? Sperm motility related? Cervix related? Hormonal biochemistry related? Thyroid related? Adrenal related? Hypothalamus or pituitary related? Is it the result of disease? Organ malformities? Virus? Unknown pathogen?

The only answer may be that there is one and we don't know it yet.

And maybe more confusingly, is that we aren't guaranteed to find the answer even if we exhaust all modern technologies and procedures available to us. Even if our means are extraordinary and we have the emotional capacity to stay the long, painful course....we just aren't guaranteed answers. What might be simply low progesterone from a deficient organ formation of the corpus luteum in one person, may be a complex tubal occlusion in another, and may be an unfortunately placed defect in the myometrium in another. There won't ever be one reason for RPL amongst all who experience it. And more frustrating is that it isn't always the same reason in one couple. Each pregnancy is unique and in a handful of losses (Lord, have mercy), it can be a different reason for each child's death.

The one answer we do have as Christians is this: a couple is not required to seek all medical treatment needed to find the answer. As Catholics, we form our consciences based on the framework of church teaching and we pray and discern what is best for our own marriage. The answer will look different couple by couple, year by year, and the answer may be revisited and wrestled with over and over.

Couples who experience the pain of stillbirth are those who conceived and carried children for most or all of a normal length pregnancy. From 20 weeks through delivery, any loss of a child is typically referred to as stillbirth. There are many reasons why a child would fail to thrive or die in utero, some of which can be diagnosed and some of which cannot. Many of the details surrounding stillbirth are still a mystery. In fact, maybe couples experiencing this brutal cross that ultimately leaves them with no baby in their arms tend to relate to couple experiencing RPL, as discussed above.

As with miscarriage, the child is unique and distinct regardless of their gestational age or the rate at which they developed in the womb. Some couple will experience the loss of a stillborn child at exactly 20 weeks. Others will have later losses. Still others may lose their children right before or during delivery. Regardless of the temporal details involving the child (no loss is more or less tragic because all children are equal in dignity!), it is a heavy burden for the parents.

Stillborn babies are often referred to as born sleeping. It's a beautiful way to describe them, in my opinion. Perfectly formed babies, with features clearly of their mother and father, born into eternal life in a state of permanent sleep....it's a fitting way to replace the word "still", isn't it?

Often times, doctors will use fetal tissue to try and determine whether there is a genetic or infectious reason for the loss. Many times, there is something discernably wrong upon careful inspection of the placenta or umbilical cord. Perhaps the child was unfortunately strangled by a twisted or wrapped cord. Perhaps the cord disconnected from the placenta itself. Or perhaps it was too short or tore open. There are many reasons for stillbirth at all stages from 20 weeks to delivery.

The sad reality about stillbirth is that there often is no identifiable cause. And by that, I mean that current medical science just isn't able to pinpoint the reason for death. It is hypothesized that a tremendous amount of stillbirths are the results of pathogens that we just can't detect with current technology. Yet other scientists think that stillbirth is the result of hormonal issues (namely that thyroid is more often to blame than we currently think).

Couples that suffer stillbirth have finished nurseries, sat through baby showers and opened presents for the child they waited for patiently. They celebrated positive pregnancies and were in awe for months at the beauty of their child in utero, as they watched him or her move on the ultrasound screen. It can be difficult to describe the loss when all of the parts of the lead up to parenthood have been lived except the part that involved rocking the baby in your arms.

Stillborn babies, unlike miscarried babies, are often administered the sacrament of baptism in the Catholic Church. This often occurs at the bedside of the mother after labor, given the emergent nature of the situation. If there is even a possibility that the child could have taken one breath after birth, then baptism is appropriate. Priests will deal with these details directly with the couple, and specific to the actual circumstances. Stillborn babies - like miscarried babies - deserve a Christian burial. These burials can be their own mass or they can occur at the graveside. Different diocese will deal with each situation according to its own circumstances. 

The parents of a stillborn baby deserve to mourn this loss like any immediate family member's death. And the people who surround them should rally in support of the complicated weeks, months, and years ahead. There is no end to the suffering that parents experience at the death of a child. They come home from the hospital with new life ahead of them, but not the one they dreamed of and prayed for like parents of living babies. As a form of infertility, stillbirth is often misunderstood. We dispel the fact that a lack of conception is the only form of infertility by reminding people that the parents of stillborn babies have a lot to teach us on the topic of infertility.

Infertility sometimes manifests itself in a child that is born alive and dies soon after. Many couples who experience this unique kind of loss are in the RPL category as well. They may have also experienced miscarriages before it. As horrific as it is to lose one child...these parents often lose many. And yet it can be the exact opposite as well. A couple can have several healthy children and go on to have an unexplained infant death. 

Medical science has a long way to go in understanding, identifying, and preventing infant death. Treatments are leaps and bounds ahead of where they were in years past, but we still do not have the capacity to prevent all infant death. Part of the double edge to that sword is that diagnostic measures taken to identify adverse outcomes in pregnancy are sometimes used to recommend inducing abortion. As Christians, we know that there is no choice: all life is precious and to be protected. There are no ifs, and, buts, or medical details that could change that objective Truth.

The use of diagnostic tools in trying to identify maternal and fetal risks can be incredibly invasive. And at the same time, these kinds of procedures and tools that are meant to proactively diagnose issues often carry heavy risks of miscarriage, stillbirth, and fetal death. Many Catholics will say that they believe the risks outweigh the benefits for them. Things like amniocentesis and uterine culturing during certain trimesters can provide some information, but they come with risks of injury or death to gestating children. Couples must discern for themselves, against the framework of church teaching, how they manage those risks.

More confusingly, some couples have no adverse diagnosis prior to birth and still lose their child. There are truly not enough answers for the questions involving infant death. This is a hot topic for scientific research, however, and even just this past week there was a breakthrough in SIDS research. SIDS is a form of infant death that scientists have now correlated to inner ear dysfunction. It will be interesting to see if future research determines causality in that connection so that doctors can develop ideas for treatment and preventive medicine. With that said, some infant death is related to genetic dysfunction, physical deformity, or developmental delay. Some infant death is the result of immunological issues, infection, or can be related to maternal disease.

The parents of infants that die are a grieved population. They suffer in silence, like all infertile couples, unable to grow their family and keep a baby in their arms. There is no way to exclude their loss and grief from that of all other couples who experience infertility and live in the longing.

Infertility exists in many forms and when we seek to understand the pain and suffering of those who experience it, we realize that it encompasses a much larger population of people than we might have first imagined. And the infertile that are suffering among us do it mostly in silence. By having the conversation, we are breaking that silence a little. Let's keep the discussion going... 

This post is the third in a series on infertility. If you'd like to read from the beginning, click on the picture below to read the original post in the series where all of the posts will be linked.

3 Ways to Pray with a Broken Heart

In the moments when we suffer - through loss, tragedy, trauma, or loneliness - God is never far from us. We know this. We've been told this, and reminded of this, and it's supposed to be a comfort to us. Unfortunately, none of that guarantees that it will feel easy to talk to Him when we suffer. If you've been in any of the powerfully painful situations I just mentioned, you can probably relate to how difficult it may be to have a dialogue with Him. You are angry, upset, and wanting to take it out on someone, something, and in some way. You want to exhaust yourself with the power of your grief, but you also want to plead for a different truth to your situation. If God could just show you a miracle right now! He could if He wanted to, you tell yourself.

And then you convince yourself that He isn't listening, because there you still are, broken-hearted, exhausted with the burden of an ugly truth, and unable to face it. For many, myself included, this can be a crucial moment when our conversation with God begins to break down. No matter how much sense it makes to keep our broken hearts close to God and aligned with the sufferings of Christ in our own misery... these tend to be the moments when we push God away. We tell ourselves that we can't handle it anymore. God isn't listening anyway, we reason.

I'll just pull myself up by my own strength of will. I'll push through the pain. I'll find an answer. With logic. And effort. And determination. We all do this kind of bargaining. For some, this stage of "powering through the grief" can last years. For others, it can happen within the hour of finding yourself on misery's doorstep.

But at some point, aren't we are forced to deal with the Truth? Not our "truth", but rather His Truth. We are not capable of making sense of His Plan. We can't understand with human emotion and human minds how to reconcile tragedy and loss and trauma and loneliness without Him. So how exactly do we do find God in moments like that? And how do we navigate a life that is simultaneously filled with joyous moments and grievous tragedies? How do we pray with a broken heart and find God in the seemingly smothering and immovable sea of our own suffering? 

Here are 3 Ways to Pray with a Broken Heart that help me in dark moments. I hope you find them helpful as well. If you do, share this with others.

1. Jesus is Our Prayer

"There is no other way of Christian prayer than Christ. Whether our prayer is communal or personal, vocal or interior, it has access to the Father only if we pray "in the name" of Jesus. The sacred humanity of Jesus is therefore the way by which the Holy Spirit teaches us to pray to God our Father." 

This is what we learn from the Catechism. It makes sense to tell ourselves (remind ourselves) that our access to God is through His Son - especially when our hearts are broken. Invoking Jesus' name is the easiest way to call Him within us. That means so much that I can hardly put more emphasis on it. Imagine the broken-hearted woman who weeps at the death of her child. Is she capable of anything but calling out to Jesus in pain? Imagine the injured survivors of a tsunami pulled out to sea. Are they capable of anything but calling out to Jesus in their dire moment of need? The name of the Son of God is a prayer itself. When we are praying in dark moments and uncontrollably weeping and incapable of even standing, we need only to invoke His name and it becomes our entire prayer. He hears us. God the Father hears us. The Truine God weeps with us. And no perfectly fitted rhyming verse that is dutifully called to memory supersedes the power of a simple prayer. All we have to do is say His name. Jesus. Jesus. AMEN.

Yes, that imagery paints a powerful picture - pulled out to sea, with your calls in earshot of no one but God, wading through dangerous debris as you weep for what once was. And you might be thinking how so few moments in life are that stripped down and dark and desperate that we might have no other power in us but to say the Name of God over and over in our pain. True. (And you thank merciful God for that.) At the heart of all prayer in times of need - the kind that sucks the strength from our knees and the air from our lungs...the kind that is so powerful that we are completely overcome - it's a powerful reminder that we aren't performing for God. We aren't praying complicated prayers in hopes that He'll listen only if we get them right or say them with enough repetition. That helps me in my darkest moments. God suffers with us. The Author of Compassion. We are not alone, even in our darkest moments when all we can manage is to utter His name. Jesus is enough. He is our prayer. 

Let's dig deeper on that Catechism quotation though, because there is a lot of meat in that simple sentence. Communal. Personal. Vocal. Interior. These are all ways that are called out as ways to pray.

2. Get Back to Basics

When you are raised Christian, you are often taught to pray at bedtime...on your knees with your hands clasped together, kneeling at the side of your bed. But how many of us pray like that as adults? How often are our conversations with God even out loud anymore, let alone said at the foot of our bed with prayerful hands? My point: Go with what you know. Pray the way you were taught to pray. And if no one ever taught you to pray - take a moment to kneel by your bedside, palms clasped together, with your head bowed. How often do we hear someone say "God hears the prayers of children loudest"? Then what makes us think that our adult broken hearts need to aspire to more? What makes us think that a more complicated prayer is better or the goal? I'm not saying that we need to reduce our conversation with Christ to a litany of requests that might be better aimed at Santa Claus. The maturity of our prayer doesn't come from the form it takes though. Get back to basics. Do what you know. Pray with your broken heart at the foot of your bed. Yell at God - He can take it. ("The righteous cry out, the LORD hears and he rescues them from all their afflictions." Psalms 34:18). Give Him everything that broke your heart. Every last bit. What you will find is that peace and a little bit of certainty will find you right there at the foot of your bed when you do.

But what about the beauty of litanies, petitions, novenas, chaplets, Saints, and all the rest you forgot?! Yes, yes, yes, there is immense beauty and comfort to be found there. Let's talk about how the broken-hearted can use them to find God in dark moments.

3. Let the Saints Pray with You

Let me first say that you don't have to be Catholic to pray Catholic prayers. Remember that catholic means "universal". All who call Christ into their hearts are joined by that shared Truth. And one of the beauties of the universality of being Christian is that we have amazing examples of suffering available to us through the holy saints. There are people who lived before us (and among us!!) who really get our pain in a human way, without being divine themselves (and honestly sometimes that is easier to relate to in dark moments because the divine suffering and Passion of Christ can seem so unreachable). Use that gateway of understanding as a way to find Jesus through your pain. For nearly every instance of suffering, there is a human saint known to us. They all came into existence just like us. They suffered just like us. They failed just like us. And they were purified through their pain and deep suffering by a merciful God who heard THEIR prayers. When we pray with broken hearts and we give God our suffering, we are saying YES to drawing nearer to sainthood ourselves. Let it be done unto me! When we pray for the favor of God by asking others who have suffered to pray for us, we are uniting our pain with those who understand. It's not us vs. the world, in another clear defeat. It's all of us with a shared suffering speaking at once. Take a moment to look up the "saint of suffering" or the "saint of infertility" or the "patron of loneliness". There are gobs of them - waiting to intercede with God on your behalf. Let them help amplify your broken-hearted prayers to Christ. The amazing thing about the saints is that they often are associated with specific prayers. You don't even have to find the words yourself! Sometimes God gave them directly to the saint with detailed instructions on exactly what to say and do in difficult times! St. Faustina is a great example of this with her Divine Mercy chaplet and story. There are so many others.

Let structured prayer help you find an inner peace that is hidden underneath your misery. Let it help connect you back to what you already know. Those prayers can be simple verses from the Bible or they can be structured into several day long prayers (that's what a novena is), or they can take the form of a rosary (just a couple of prayers, said in repetition, highlighting Christ's suffering - it's not hard to say a rosary and you don't have to be Catholic to try!). There is comfort to be found in the Word of God, but oftentimes when we are hurting, the empathy of someone who has suffered similarly to us can be helpful. It's a shortcut to find God again through the pain. Use the saints and the prayers they bring us. They are real human examples of God talking to us directly. Listen to that Voice.

Lastly, you don't need the perfect words. There is purpose to this suffering, even if you can't see it. And God has already redeemed it. Remember this: The LORD is close to the brokenhearted, saves those whose spirit is crushed. (Psalm 34:19, NABRE)

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Whatever way you choose, know that you aren't praying alone. My family prays for broken hearts daily. We have a specific devotion to those struggling with infertility, but our prayers our broad enough and specific enough to be including you and your struggles too. If you have shared your pain with us in any way, you are prayed for each day. If you are suffering in pain, illness, loneliness, tragedy, with loss, and any number of circumstances...we're doing our part here to help carry the burden a tiny bit. How do you pray with a broken heart? Tell us in the comments - we can always use your inspiration!

Finding Meaning in Suffering

This weekend has been difficult to say the least. I find myself a mix of numb and wanting to find meaning in all of this. It can't all just be endless, dark suffering. I already know what letting yourself go down that path does and I worked hard to get back from it the last time we had a miscarriage. I can't bring myself to accept this feeling for months on end right now. So I did what I always do and I try to search for meaning in suffering. I used to just go straight to the Book of Job. It's an easy read when you are pondering a pestilence in your life. Or rather, it's an easy target in the Bible. 

Lately, I haven't been going there though. I've been looking to the feast of the days that I suffer. Finding meaning in our faith has been more enriching than reading about the torture Job endured (again). And I'm learning more about myself and my relationship to the Holy Family in doing so, for what it's worth. It certainly isn't an easy effort. But I have found more meaning in it than just meditating on the rosary or praying a novena or reading a specific Scripture. Or maybe it's just that it feels like less of a selfish endeavor? I don't know.

That's actually one of the beautiful things about our faith - the diversity of the teachings. We have so many places to go to find God, don't we? Even in a moment like this, I find myself drawn to Him and wanting to understand where I fit in His plan. And no amount of 'fitting' means anything without understanding the origin of Christ's passion.

So a-feasting I went.You might want to go grab a cup of tea. This ain't gonna be a short read. Nor is it gonna to be fun. I guess a small part of whatever is left of me right now hopes you might also find some meaning in suffering and that the effort I put into trying to understand this will help you too. I had to at least try. So without further ado... here's what I came up with:

Feast of the Holy Cross

September 14th was the Feast of the Holy Cross. As Christians, we celebrate an instrument of death. We set aside a whole day just to celebrate the implement used to torture the Son of God. Maybe that seems strange, but given what I was doing yesterday…suffering my own body and the death of possibility…it makes perfect sense to me.

There is mystery in both infertility and the cross. Christ made His cross a source of life for the world though, and that is why we make time to celebrate it. There is nothing but the pain of death for us without the cross. We are the grain of the wood in the cross and it is very much a part of us in all that we do. So as much as I want to say that there is no meaning to be found in the void that infertility leaves in my life (and the pain that it so constantly brings), I know that all things are redeemed already. If we are all a part of the cross, that means God didn’t forget this pain. Not even this pain.
 
I am the cross and the cross is mine. When I was born, I became His through baptism. But even in that moment of cleansing, I was marked with the cross on my forehead. A symbol of death painted across the fresh, chrism-scented skin on a newborn baby…

And it doesn’t end there. I was taught how to greet the Lord every Sunday as a young child. You dip your fingers into the font outside the sanctuary and you cross yourself in the name of the Truine God. You literally reclaim your baptism with a symbol of the instrument of death by anointing yourself before you prepare to worship. And you repeat this as a preparation for every prayer you pray. Everywhere we go in our daily lives through the years of Christian Catholic life, we are putting on Christ through the cross in this motion. Do we always stop to think of why we do it though? Do we realize we are welcoming suffering with this act?

I can certainly say that I am not conscious of it 100% of the time. But I was conscious of it 100% of yesterday. I was helpless from the profound pain and truth that the cross represents. And as I sat there, feeling like all hope had been ripped from me and that all the power and strength and resolve in my weary soul had been crushed, I somehow became aware that the cross is not supposed to be a source of death to me. How can hope be dead, when Christ conquered the cross? How can there be no redemption from infertility when Christ rose from the dead so that I might live? How can I be dead inside when I’ve been redeemed by God?

In every way, it began to make me feel like the cross was my only protection from this sorrow that I felt. Do you remember the antiphon we sing at the moment of baptism? “You have put on Christ, in Him we have been baptized. Alleluia, Alleluia!”. I started to think of the cross as shining armor in that moment when for some reason this antiphon popped into my head – Christ’s redemption is literally something I could wear. Why hadn’t I thought of that before? (said the girl who has plenty of Catholic jewelry – not the least of which are crosses, medals, prayer beads…). I’m brilliant, y’all. You know, like a 5 year old who thinks they just invented something because it just occurred to them for the first time in earnest. Annnnyyyway.... Just like the priest so broadly signed a cross onto my forehead as a newborn, I started to understand the meaning in my own pathetic suffering. With that realization, I quickly make the sign of the cross and wept until I had no tears. And that took hours.

Speaking of gut wrenching sorrow…

Our Lady of Sorrows

How apropos is it that today is the Feast of Our Lady of Sorrows?? Great, now I have to figure out how to connect (once again) to a mother figure and understand her pain at losing her child… while I mourn a child that I don’t have. JUST WHAT I WANTED TO DO TODAY after I’m left with the soreness in my abs (from weeping) of someone who did 1000 crunches yesterday.

Don’t get me wrong, I get that the Blessed Mother suffered intensely and grieved the brutal torture and death of her Son. And maybe it’s a good thing that I find myself basically incapable of connecting to anything but her suffering right now. Mary and I have a weird relationship. Suffering is the only thing that really helps me connect to her. It’s not for lack of praying, but it’s also a reason to keep praying. That’s where Mary and I are anyway.

So Our Lady of Sorrows. What are we celebrating? Yesterday was a celebration of an instrument of death – so I suppose today is a celebration of gut-wrenching agony. Times seven. Because that’s how the Bible rolls…

The Bible provides seven sorrows, to be specific. These are:

The dark prophecy of Simeon

The flight of the Holy Family into Egypt

The loss and discovery Jesus in the Temple

Mary meeting Jesus on His way to Calvary with the cross

Mary at the foot of Jesus on the cross during crucifixion

Mary holding Jesus after He was pierced by the lance and taken down from the cross

The burial of Jesus

It’s not just suffering Jesus’ death that this feast is celebrating. It’s so much more. It’s a veritable pain buffet that spans Jesus’ entire life. We’re reminded that motherhood *is* suffering in this feast day. And there are real examples that modern day mothers can certainly relate to in these seven examples (ask any parent who has lost a child in a store in the blink of an eye…).

But it has to be more than that. I have to believe that this is a day that highlights the essence of female suffering and that it is not about physical motherhood as much as it is about the nature of being a woman. Are we not meant to suffer? As I look up images of Our Lady of Sorrows, I notice that Mary’s heart is often depicted with swords piercing her heart. I can relate to that feeling right now. And yet I have no child in my arms. How can I relate to anything Mary suffered?

I’m also finding that in previous years, this feast was known as Our Lady of Compassion. And I think most of us know the Latin derivation for the word compassion is ‘cum’ and ‘patior’ (literally: to suffer with). So maybe I find not a mother to look at in Mary so much as I find someone to suffer with me. I don’t know. We’re not there yet. She’s the master of willing it to be done unto her according to God’s will – and I am most certainly not. I wish I could say I was, but who among us has reached that in their infertility journey – especially a couple years into it?

The one thing I do understand about Mary though…is that she joined in with the suffering. She knew it had to happen. She knew Christ would be taken from her beyond her own power, just as He was given to her. And she joined herself to that reality and suffered it with Jesus.

The only thing I can understand in this moment is that joining my suffering (the suffering that I feel in the utter emptiness and hopelessness of my own barren womb) to the suffering of Mary may be the only way that I can understand today’s feast. I'm mourning a lack of being able to suffer as a mother. And it kind of messes with my head to think of it that way right now.

I think it’s a more powerful statement to admit *I'm not there yet* on this topic as a Catholic than to pretend I have some bigger understanding of this than I do. Someone needs to hear that today and I don’t know who it is. All I know for certain is that Mary saw redemption win with her own eyes. She saw her own flesh and blood defeat death. And that inspires a kind of hope that is much, much bigger than the pains of my infertility. At least - it should.

Speaking of seeing redemption win…
 

Let Me See Redemption Win

Truth be told, when I returned from Switzerland and France in the beginning of September, already a week into the dreaded 2WW, I was overjoyed to learn that I had been crowned to be this month's Adopt-a-Blogger. We felt like it was a life preserver sent from above to help us when we needed it most. After all, it had taken all of our strength to find the courage to TTC this past cycle. Prayer and grace were what we needed to sustain us through the waiting.

I was starting to see and feel some very reliable pregnancy symptoms. I found myself thinking and hoping and praying that this was the month that IF died and I was prayed into pregnancy. And all of you, my generous friends and readers, joined me in prayer to that effect. The timing just seemed perfect. Everything seemed perfect. I was amazed that we had found the courage to TTC again after so many losses, so it was amazing to be feeling like such a huge and long-prayed-for-miracle might be coming to life all at once. DH was convinced this was it. And the symptoms kept coming. It all seemed too good to be true. 

And it was.

I'm drowning. And it's happening painfully and slowly and I can't even help myself out of it. It doesn't seem to matter how often I converse with God, or how often I meditate on the mysteries of the rosary, or how many novenas I pray, or how often I just sit in silence with Him...there are no answers being given. No directions being given on how to take a left turn away from this pain and emptiness. No encouragement on how to soldier through it. There's just this giant echoing silence. I'm worn. Even before the day begins.

Christ, I long to understand Your plan for my life. I want to understand the purpose of this suffering. And I find myself praying this week more that You would rob me of the deep longing to be a mother than anything else. If Your plan is to leave my arms empty and to never know the joy of children, then I wish you would just make that clear and take this from me. If you have already redeemed this intense suffering that I'm lost in, let me know the struggle ends. 

I know You can give me rest.

I know You can mend a heart that's frail and torn.

I know that all that's dead inside me can be reborn.

I'm just too weak and life won't let up.

I'm crying out with all I have left. My prayers are wearing thin.

I've lost my will to fight.

I'm worn.

Every single lyric in this song could have been sung by my own heart.

 

Beyond Ugly

Yesterday I had a complete meltdown. Complete with big, fat, ugly tears and a temper tantrum lived out on the internet in a secret facebook group...typed furiously with wet, salty fingers. It came with that wind-sucking feeling in your lungs and that sense that nothing would ever be ok...no matter how long or how hard I try...

I lost my flipping mind yesterday for what seemed like a very specific and acute reason. I've been waiting for my doctor to weigh in on my salivary adrenal cortisol results for over three weeks.

Anyway, that's what prompted my big, fat, ugly meltdown yesterday. Or so I thought.

A few hours into my own personal melodramatic, tear-stained, wind-sucking misery that came out of nowhere, I magically got my period. Happy CD1! Love, My Body. So that made me look at things in a different light. First, it's clear that things are moving in the wrong direction. The kind of uncontrollable panic and flip-outs that used to be a big (and regular) part of PMDD and PMS haven't been on the scene for a while now. I guess that run is over? As I sit here with hypothyroidism and impaired adrenal functioning (read: I'm low in the morning, lower at noon, lower in the evening, and high at night right before bed)...... I now know they are a big part of what causes these symptoms. There have been months where we got my hormones to sub-optimal (a big improvement over my usual) and my thyroid was fine and I didn't lose my mind. Conversely, there have been months where my hormones were atrocious and my thyroid was fine and I really struggled. I get that it's a big loop and it runs downhill when things are bad in one area.

I'm downhill.

Thankfully, just the knowledge that CD1 was the scape goat for my meltdown helped. It shouldn't, of course, but it did. I'm tired of my monthly cycle feeling like being strapped into solitary confinement. And yet, knowing that hormones were to blame made it easier to process. Maybe I'm not actually losing my mind...maybe it's just my hormones. Again. Wait, when is it NOT my hormones??

I think I might have welcomed the logic stopping there. You know, before I got a giant, itchy rash all over. Sigh. Little else makes me panic as much as a giant, itchy rash. My brain instantaneously moves into complete freak-out mode when I get unexplained rashes. Because fevers are next (which it was). And hospitals are next (which it thankfully wasn't). And abscesses are next (which it thankfully wasn't). And lots of bad medical care is next (which it thankfully wasn't).


My brain knows that bicycle ride better than it knows how to find its way home. How is it possible that I have spent so much time, so much effort, so much money, so much time in prayer, and assigned so much hope and faith to the conquering of this problem and I still sit here, festering in it? How is it possible that my best effort isn't even close to good enough to conquer this? Have you ever felt the anguish of something like that? Because that's what this IF or SF or whatever you want to call this sad journey of mine felt like yesterday.

So in my meltdown, there were a few angels that jumped in front of the panic bus and stopped it like Superman crumpling the asphalt behind his magnificently rooted feet. People online instantly rallied in prayer. One person looked up naturopaths. One person sat with me in private messaging and talked me through the tears and suffered with me. I was reminded of the double novena I had just signed on to do. I prayed my two novena prayers for the day. And I sat there in awe afterward as I felt filled with a little bit of peace from praying with such a broken heart. The words didn't wash over me - they washed through me. Like a waterfall.

 'O Sacred Heart of Jesus, for whom it is impossible not to have compassion on the afflicted, have pity on us miserable sinners and grant us the grace which we ask of you, through the Sorrowful and Immaculate Heart of Mary, your tender Mother and ours.'

'We trust to your gentle care and intercession, those whom we love and who are sick or lonely or hurting. Help all of us, Holy Mother, to bear our burdens in this life until we may share eternal life and peace with God forever.'

For now at least, I need to accept that I am the sick, lonely, hurting sinner that is in need of prayers. And as much as I want to not be...and as much as this uncomfortable exercise of living my deepest hurts out loud is grueling...I know that I am slowly finding healing from making the effort a priority.

I suffered in silence for a long time. It didn't help anything. So I sit here this morning feeling hopeful. Hopeful because God is allowing me to experience healing to my pain-riddled and weary heart through prayers. Hopeful because my pain, lived out in the the ugliest way I can imagine - publicly - is being met with love and charity and grace and hugs from people who know what it's like to be breathlessly infertile. Hopeful because I am definitely going to hire a naturopath to give these hormones and this thyroid and these adrenals another look. Hopeful because I know Christ lives in this hurt with me. And hopeful because I'm not willing to waste any time lost in God-less agony. I spent years stuck there and if it's anything I've learned from those years of illness and pain - it's that God is easier to find in those moments than at any other times in my life. So I have to remember to look for Him and say hello and weep at His feet. I'm pretty sure he's waiting for me to do that anyway.

Waiting for GOD-ot

Psalm 39:7 "And now, LORD, for what do I wait? You are my only hope."

“The tears of the world are a constant quantity. For each one who begins to weep somewhere else another stops. The same is true of the laugh.” ― Samuel Beckett, Waiting for Godot


It seems to me that there is a lot of waiting associated with hope.

I can't help but look at our fertility struggles as a time for reflection in what we're really expecting to encounter at the end of this journey. I believe in a God that gives generously, despite how wicked we can be as humans. I also believe in a God that promised me He would come get me from this broken life on Earth if I obeyed him.

In my more whimsical moments, I imagine the entire process of infertility as a Samuel Beckett play. We know we can't leave - because we're waiting for someone important. He said He'd be here. And we can't help but talk on and on ad infinitum like a bunch of blabbering sillies - expecting that it'll do anything but pass the time. It's not going to change the day of His return. In fact, the obsessing might even make it pass more slowly, like trying to pour cold molasses. Oh the wonders of post peak philosophies!

After my last post, which I felt was necessary to paint a picture of how my reality has been formed and written over the years (trust me that was the abbreviated version with a lot less guts and horror than it could have included) - I realized that I want to lay a road map that reminds me of the things I've overcome, the glory I've found in God in the process, and the missteps I've made along the way. I want to learn how to have the courage to face any days ahead that don't seem like they are filled with the promise of His return. And I want to remind myself that tunnel vision and a focus on my own wants above His are where I often get lost.

Roots...

The three generations of women before me on my mother's side were blessed with unquestionable fertility. When they wanted babies, they had them. Similarly, the generations of women on my father's side experienced the same gift from God - and not one of those women had fewer than three children each. I, however, in all my middle-child-have-to-be-different-wonderment, am the 4th generation exception to this on both sides of the family. All of my family's infertility rests on me. It's just as lovely as it sounds, promise! :)

I live a life surrounded by the only thing I ever really looked forward to....children. Literally everywhere. And most of the time, climbing all over me like a jungle gym! When I was younger, people used to see how I interacted with their children and rave about what a wonderful mother I would be 'some day'. That message has definitely changed over the years though. I remember exactly when that message changed too - and where I was standing when it did:

A dear friend of mine and I were at a friend's wedding years ago (both still single at the time). We were mingling and enjoying the hustle and bustle of the cocktail hour at the reception. Everyone was having such a wonderful time. An older woman that we recognized from Church came up to us and remarked at how beautiful the wedding ceremony was. We agreed in short order. It was beautiful. The woman proceeded to pleasantly lambaste us both (my friend particularly) on not being married and not making childbearing important enough in our youth. "Were we even serious about having children?" she interrogated. We were both dumbfounded. It was too much for my friend - she had to excuse herself. And as I stood there, a bit shell shocked at the comments that has just danced out of this woman's mouth, she continued to remind me how arrogant it was of me to think that I could 'have babies forever' and that waiting so long to get married 'was a disgrace in her day-and-age'. I don't remember much after that. I think maybe I politely rubbed her shoulder and clinked glasses with her and thanked her for her concern. How else do you receive a person like that in charity?!

Anyhow, the message was certainly changed now. It was clear that not being married was thumbing my nose up at my future dwindling chance at children. Let me tell you though, getting married didn't help the social commentary. Now the question is 'why haven't you two had kids yet?' and 'what exactly are you waiting for?' and gems like 'you know how to make babies, don't you?'. Yes, yes I do. Thank you for asking. I'm glad we cleared that up.

 So what does all of that have to do with waiting? And more importantly - what does it have to do with hope? Just like Estragon and Vladimir, I do think there is purpose in the waiting. I think that anticipation is a part of the process by which we learn to hope. And I think the conception of hope is never rooted in instant gratification. It's never packaged neatly with a bow and hand delivered. Hope, like faith (and most virtues) is something that I know I have to work for to find and have and keep and grow and share. Our dreams for a family that includes a baby in our arms has to be rooted in the hope that God loves us and has remembered us and that He blesses us with His will. And right now, His will seems to include a little more waiting on our part. We aren't asked to understand it, but we are asked to abide by it.

I remember reading Waiting for Godot in high school and how silly a book I thought it was. Revisiting it as an adult didn't have to involve rereading it. It did involve living it though! So Lord, I wait for You. And if you happen to have an extra baby hanging around before Your next visit, you can send him or her (or both) my way. I promise that I'll take really good care of them.

But I know that if I am blessed enough to stop weeping over the emptiness and inadequacies that infertility brings with it, that it might mean another woman has taken my place in the waiting line. So instead of weeping, I'm going to try to do a lot more laughing. Because Samuel Beckett said so.

I shall leave you with the real answer on where babies come from and hope that laughter finds you as well.... :)