If you've never stood alone with your husband in a reproductive endocrinologist's office, undressed from the waist down, you've been spared one of the unsexiest encounters a married couple can share: the fluorescent lights that turn your naked skin a mothlike gray, the queasy smile on your beloved's face, the sudden fear that, starting this second, your body will never again be his instant aphrodisiac. All because, after months or years of trying the old-fashioned way, you are still, frustratingly, not pregnant.
This is how babies are made for a growing number of American couples — and not just for the over-35 set, either. A recent survey by the Centers for Disease Control and Prevention found that, while a tenth of women ages 40 to 44 had booked an infertility-related appointment within the past year, the vast majority seeking treatment — 34.8 percent — fell into my 30-to-34 demographic. Surprisingly, over a fifth of those in their late 20s had also sought medical assistance, which includes advice and acupuncture, as well as ramping up the ovaries for days with potent hormone cocktails, followed by an intrauterine insemination (IUI) — the so-called turkey-baster method, in which sperm are whisked into the uterus via a plastic catheter. For me, it meant all of these things. When none of that worked, it meant ponying up $10,000 for in vitro fertilization (IVF): harvesting 23 of my eggs, introducing them to my husband's sperm in a petri dish, and having two of the resulting embryos placed back inside of me. Conspicuously absent from this protocol were frilly bras, candles, or, well, sex. Which got me wondering: As more women seek out high-tech methods of getting pregnant, what's become of the lowest-tech tool of all — the libido?
Our first night of unprotected sex was delicious. After 15 or so years of meticulous birth control, I tossed my Pill pack into the trash, both of us getting off on the fact that we were finally adult enough to put our bodies together and make a new one. Afterward, I lay awake, imagining a fleet of one-celled creatures coursing through my uterus.
Our lack of success didn't ruffle me much in those early months. Eventually, I bought an ovulation-predictor kit. I began taking my temperature daily at 6 a.m., charting my numbers in a little black notebook. A copy of Taking Charge of Your Fertility supplanted the novels and magazines that once littered my bedside table.
It was high time we got a doctor to look under the hood. But when I raised the topic of infertility treatments, my husband, J., avoided eye contact. So I did what any woman with a ticking biological clock would do: I cut him out of the loop. I found a reproductive endocrinologist and went alone to his office. I submitted to blood tests and vaginal ultrasounds that revealed cysts on my ovaries. I cried when I learned that my only hope of ovulating was to inject my abdomen with synthetic hormones every night for weeks. Hoping to preserve some semblance of sexiness in our bedroom, I told my husband nothing — except for the occasional, "Baby, the doctor needs you to come in for a semen analysis tomorrow at 7 a.m."
The story is all too familiar to Dr. David Keefe, chair of the department of obstetrics and gynecology at the University of South Florida College of Medicine. Keefe is also a practicing psychiatrist, and his couch sags under the weight of couples who've struggled to get pregnant without letting their beds go cold in the process. "The husband may not want a sperm test, so he might say, 'I got someone pregnant in college,'" says Keefe. "She answers, 'I had an abortion in college.' There's a sense that someone must be to blame for this."
My husband and I didn't throw barbs. Our tension was more insidious: After our first insemination attempt failed and we planned to try again, I began to resent the fact that I was the one booking the appointments, trekking to the doctor's office several mornings before dawn, lingering in waiting rooms, and getting blood tests and ultrasounds while J. slept peacefully.
Soon, our evening routine entailed syringefuls of synthetic follicle-stimulating hormones that I injected into my belly for weeks until I could feel my outsized ovaries jostle when I walked. This made any X-rated activities uncomfortable at best, downright painful at worst. The progesterone suppositories that followed — inserted every night at bedtime — rendered sex too messy to contemplate. More than that, they literally depressed me, inciting cravings for lasagna and midday naps. When I mention this to Keefe later on, he says that "progesterone is metabolized by the brain to a compound that's 10 times more sedating than a single Valium. So you might feel lethargic, bloated, and possibly constipated." None of which my own doctor had told me — but all of which explains why, between day one of each treatment cycle and the pregnancy test four or five weeks later, my husband and I had sex maybe twice.
J. and I called a time-out and considered adoption. For three months, we forgot about the drugs and the lab tests. We flew to the Caribbean. We had lots of sex. And then we braced ourselves for one more go — this time with IVF. I kicked off my cycle with two weeks of Lupron injections, which chemically puts you into menopause and attempts to get your estrogen levels down to zero. After my doctor placed two fragile embryos into my womb, I left the clinic with instructions: No hot baths, no alcohol, no sexual relations until we determine if you're pregnant or not.
Baby-making as a roadblock to intimacy: The idea could make for great sketch comedy if it weren't so depressing. "I used to say to patients, 'Don't worry — your sex life will come back,'" says Alice Domar, Ph.D., director of the Domar Center for Mind/Body Health at the Boston IVF clinic. But according to a survey examining couples 10 years post-treatment, "A lot say their sex life never came back," she adds. In fairness, this may have to do with the screaming insomniacs who emerge from successful treatments nine months later.
J. and I survived. We got through nights of chastely curling up together, through the first negative pregnancy test, then the second. By that third test, all those bedtime injection sessions had brought us closer than ever. And, after learning that our third attempt had worked, J. made me feel sexy as my breasts swelled, my belly slowly ballooned, and we indulged in the joy of no-strings-attached romps. Last December, I delivered my own screaming insomniac, which meant, if we were lucky enough to steal a few moments alone in the bedroom, we couldn't imagine anything more alluring than sleep. Until we could, when the stars aligned one night: Our baby daughter closed her eyes before 10 p.m., and we did it for the first time as parents. Then we conked out.
Cara Birnbaum is a freelance writer and coauthor of The Youth Equation: Take 10 Years Off Your Face. She lives in New Jersey.
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