My blood silently boiled back towards the end of 2019, when I consulted on a 43-year-old woman with a BMI of 48 who smoked, did drugs, had uncontrolled diabetes… and was 32 weeks gestation. How did she get pregnant and I can’t?!

“I just don’t understand why so many of you young women are having trouble getting pregnant! My friends and I, none of us had difficulty having kids. I just don’t understand it,” is what my mother said as I was talking to her after my third embryo transfer. The first one didn’t take at all, despite the 80% chance of success I was quoted by our previous fertility doctor, a guy who had helped several people I know get pregnant. “It has to work, I thought. I went in for more testing, and my medication regimen was adjusted accordingly. With the second transfer, I got a faint second line on the home pregnancy test, which was encouraging at first, any second line, no matter how faint means that something is trying to grow. The line faded over the next couple days, and by the time I went to have my beta hCG blood work drawn, it came back as zero; I had had a chemical pregnancy. The embryo implants but fails to progress and spontaneously aborts. That one hit me real hard. Seeing those two lines disappear caused a sadness I was not expecting. Mustangman and I cried over that loss. I took a break from all the stress and hormone injections for a couple of months, and in the meantime joined an IVF support group on Facebook for women in Ohio. Boy, did I learn a lot! Besides being introduced to the clinic I just switched to, I found hundreds of women struggling to get pregnant. Like buying a new car, suddenly you start noticing all the other people that drive the same car. I began hearing about fertility struggles from the nurses that take care of my patients. It seemed that the list of couples I knew having difficulty with getting pregnant was growing exponentially. I thought about my own friends, many requiring assistance with medication or procedures in order to conceive. And while infertility is as old as the Bible, my mother’s query rang in my ears: why are so many young women having trouble?

Those of you who know my age might be tempted to place the blame at my advanced age of 36. Pishposh. My mother had me just before she turned 36. Lots of women have children in their mid 30’s- early 40’s. But it’s not just age-related; I see many women in their 20’s having trouble as well. A nurse I work within the OR followed me out from the break room yesterday saying “so I heard you might be pregnant?” This led to a discussion about IVF and fertility in general. I found out she and her husband have been trying for a year with no success. When I asked her age, I found out she’s 28. That is prime baby-making age right there! So what is going on? In addition to PCOS, the most common diagnosis the women on the IVF board give is “unexplained infertility.” And it’s not just the women that are suffering. Men are also taking a hit in their fertility. Scientific America posted an article saying that men’s sperm counts have dropped by 50% over the past 40 years. Another article I read said that men today have 1/3 the sperm count their grandfathers did. Male factor is also a common cause of fertility problems. But that doesn’t explain the whole picture.

So what is it? What has changed since my mother and grandmothers were popping out kids at will it seems? Are our lives so much more stressful that the cortisol is messing with our hormones? Is it because women are working outside the home more? Is it the drugs and alcohol? More sexual partners? Or is it more basic- our food and water? I tend to think it’s the latter. Another article in Scientific America reports studies have shown the amount of estrogen in the water- a result of urine from women on birth control pills- can wreak havoc on the reproductive functions of aquatic and human life. In her book, It Starts With The Egg, Rebecca Fett discusses the various environmental exposures that contribute to poor fertility; the soaps, lotions, cosmetics, and cleaning products we use have been shown to hinder pregnancy. Our soy and carb-heavy diet doesn’t help either. This is why my fertility doctor heavily advocates for keto, and ideally carnivore keto. Carnivore keto is a bridge too far for me, but I have noticed how much better I feel when I don’t eat carbs or sugar.

I’m don’t know what the answer is. But something is happening. While all of my IV drug users with endocarditis cry to me about how much they need to quit drugs so they can be a mom to their X number of children, I cannot stay pregnant for the life of me (PS: they never get sober, and eventually die from their drug use). And I recognize that getting what you want isn’t the result of having a good job or being a good person- God isn’t a rewards vending machine. But it does seem that the people who struggle the most to get pregnant are those that really want children and are willing to sacrifice mightily for it. If one were conspiratorially minded, one might come to the conclusion that that is the point…

With my third embryo transfer, things felt different. I wasn’t blindly hopeful like I was with the first, or as rage-y and negative as I was with the second. I was apathetic, really. But that glimmer of hope that came with that second line on the home pregnancy test and the message from my clinic that yes, my hCG was low but positive, faded when my repeat blood work this morning showed my hCG levels had dropped. I stop all medications and wait. An exploratory laparotomy is the next step. In the meantime, I’ll just keep operating on my patients during the day and playing fetch with my cat in the evening. Come one, how can a fetch playing cat not cheer you up?