'When are you going to have a baby?' can be a loaded, painful question

Stefanie Howell and her husband, Chris, live in the small town of Baie Verte on Newfoundland's north coast, on a street surrounded by young families.

While they love hearing the sound of children playing outside, it is a constant reminder of the painful journey they were keeping from friends and neighbours.

"I had one person tell me that I needed to have a baby so I could fit in on our street. Like you don't realize the kind of damage that's doing to somebody when you make those comments," said Howell.

The couple has been quietly struggling with infertility for the past three years, going about their business day to day, "hiding and and pretending that everything was OK."

"We didn't want to burden other people with what we were going through, and most of our friends do have children and we didn't want them to feel uncomfortable being around us, and bringing their children around us because we were going through this, so we kind of kept it all bottled up,' Howell said.

Learning to rest

All that changed in January, when Howell decided to open up about the stress and strain caused by trying and failing to have a baby in a blog she called Learning To Rest.

"I just got tired of pretending, of hiding, you know, everyone asking questions, 'How come there's no babies yet?'
and I just got to a breaking point, I think I kind of needed everybody to know exactly what we were going through."

The extra emotional strain that that adds to a marriage is huge, it's massive.- Stefanie Howell

The journey since learning in 2016 she may have a bicornuate uterus, which is heart-shaped instead of pear-shaped and is associated with reproductive issues, has been long and painful.

Exploratory surgery also confirmed Howell was suffering from endometriosis — a disorder in which uterine tissue spreads and can cause scarring and blockages. She hoped correcting that would be the answer to her fertility problems. But six months later, she still wasn't pregnant.

The Newfoundland and Labrador Fertility Clinic in St. John's gave the couple two options in June 2017, intrauterine insemination or in-vitro fertilization — the costly procedure, which involves fertilizing an egg with a sperm outside of the body, is not offered in Newfoundland and Labrador.

Four rounds of IUI over four months in the last half of 2017 put a big strain on the couple's marriage.

"I blame myself, my husband blames himself … you get so stressed out you're blaming each other when really it's nobody's fault," she told CBC Radio's St. John's Morning Show.

"The travelling back and forth, wondering what we're going to do next, and if it comes to that we have to do IVF, the travel, the cost of extra medications, being away from our family, the extra emotional strain that that adds to a marriage is huge, it's massive."

According to Dr. Sean Murphy, a reproductive endocrinology and infertility specialist in St. John's, one in six couples of reproductive age has fertility issues.

"It is incredibly common, so whether you know it or you don't, you definitely know somebody who has had or is going through reproductive concerns," he said.

Most of the cost of IUI is covered by the provincial medical plan, but IVF is not.

"The gold standard for many reproductive concerns and diagnoses is in-vitro fertilization, but unfortunately it's not available in Newfoundland. So the costs become significantly increased once you start looking at that."

Murphy said the province has the medical expertise to offer IVF, but he assumes the cost is a barrier. Eastern Health doesn't have the specialized labs and other equipment necessary to offer the procedure here.

Similar to cancer diagnosis

The couple is in a holding pattern right now. Blood work for the last attempt at IUI indicated Stefanie may have an ovarian cyst, so the procedure was postponed. And Howell said she isn't emotionally ready to consider taking on the mental, physical and financial strain of IVF.

I've learned that I just need to be honest, and to say were having issues.- Stefanie Howell

"Studies show the stress a couple goes through in dealing with a fertility diagnosis and treatment … is at least equivalent to dealing with a new cancer diagnosis, so you can certainly appreciate what couples often go through," said Murphy.

One thing that has helped them deal with the strain is opening up to friends and strangers about the situation on their blog.

"Deep down I know there are a lot of other people out there that are going through these things, and I got to the point I just didn't want to feel alone anymore, and I don't want those people to feel alone anymore," said Howell.

The couple hoped writing about their feelings would be an outlet to help them cope, while letting other people going through the same thing know they had someone they could talk to. 

"And that's exactly what happened. I had people messaging me from right across the country," said Howell.

"It has taught me that I am a lot stronger than I thought, my marriage is a lot stronger than what I thought it was, and I do have a lot of support."

Opening up has also changed how Howell responds when people don't realize they're bring up a painful and sensitive topic when they ask, "When are you going to have a baby?"

"I've learned that I just need to be honest, and to say we're having issues, it's not coming naturally to us like it [does] for some people, and we are working really hard at it."