New expert guide lays out what to expect when you’re trying hard to be expecting
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Author interviewThere is no one-size-fits-all approach to conception

New expert guide lays out what to expect when you’re trying hard to be expecting

In new book, New York Times columnist Amy Klein guides readers through the confusing and fast-changing fertility treatment landscape with empathy and humor

Renee Ghert-Zand is a reporter and feature writer for The Times of Israel.

Amy Klein, New York, March 8, 2020 (Mira Zaki)
Amy Klein, New York, March 8, 2020 (Mira Zaki)

Writer and journalist Amy Klein had no idea what to expect when she wasn’t expecting. Having never thought much about fertility — let alone infertility — she found herself ill-equipped to handle her and her husband’s failure to conceive quickly and naturally.

This was almost a decade ago when there was little clear, concise and practical information available for people coping with infertility.

“At that point, people had the impression that fertility treatment was a guarantee that you’d end up with a child in the end,” Klein told The Times of Israel.

Although Klein, 48, eventually gave birth to a daughter five years ago, she became acutely aware during three years of intensive treatment that not all initially infertile individuals or couples end up so lucky. She also learned through trial and error that there is no one-size-fits-all approach for those struggling to become parents.

‘The Trying Game: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind’ by Amy Klein (Ballantine Books)

Klein’s new book, “The Trying Game: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind,” is a comprehensive guide to navigating the complex and confusing realm of medical intervention for conceiving a child.

As is evident from its title, the book is full of humor, through which Klein diffuses the pain and frustration of fertility treatment so that readers can focus on absorbing the incredibly useful and well organized information she shares.

The book’s 24 chapters are presented in four sections, covering topics such as how the reproductive hormonal system works, how to find the right doctor and clinic, how to plan financially, how to handle (or not) the inevitable emotional rollercoaster, and how to deal with family and religious pressure (Klein was raised in a Modern Orthodox family in Brooklyn). The author gets into the nitty gritty of various treatments, including intrauterine insemination (IUI), in vitro fertilization (IVF), preimplantation genetic testing (PGT), and sperm, egg and embryo donation.

A veteran contributor to Jewish and Israeli publications, Klein initially shared her experiences of trying to get pregnant in the “Fertility Diary” column for The New York Times’ Motherlode parenting blog.

“The idea would be for me to write about it for about three to four months and then it would shift to a pregnancy column,” Klein said.

Klein’s failure to get pregnant as quickly as she predicted resulted in her writing some 30 essays on infertility over three years. She said she did not consider adoption in her quest to become a parent.

Amy Klein and her husband Solomon and daughter Lily. (Courtesy)

By the time Klein eventually gave birth and found her footing as a mother, the landscape was different in terms of public sharing about fertility treatment. Also, science and trends in the field were changing at a breakneck speed. Rather than a paucity of information, there was now too much of it out there, leaving people overwhelmed.

As a result, Klein decided to write “The Trying Game” not as a straight memoir, but rather as more of a guide and resource. She included her own experiences, those of others with infertility, and up-to-date medical information from physicians and studies.

I want the mistakes I made and what I suffered to have meaning

“I want to help people through the journey. I want the mistakes I made and what I suffered to have meaning,” Klein said. “So I made the book part personal, part prescriptive.”

“The Trying Game” is aimed at a wider audience than just heterosexual couples. In one chapter titled, “I Did It My Way,” Klein covers infertility issues faced by single mothers, gay and transgender parents, and the topic of egg freezing.

Illustrative: Eran Pnini Koren and Avi Koren, a gay Israeli couple, with their child conceived through a surrogacy procedure in Thailand. (Facebook)

“For me, it was always a thought to include everyone trying to have children. A lot of the struggles are the same,” she said.

Klein considers herself fortunate to have Israeli citizenship (she lived in the country in the 1990s), and to be married to an Israeli-born man. This made her eligible to come to Israel for treatments that were either unavailable or prohibitively expensive in the US.

After four failed rounds of IVF in the US, Klein and her husband moved from New York to Jerusalem for eight months in 2013-2014. At Shaare Zedek Medical Center, they had free access to preimplantation genetic testing and other treatments.

“We’d be sorry if the PGT didn’t help, but it would be less awful than seeing $50,000 go down the drain as we could have in the US,” Klein said.

While in Israel, Klein became pregnant with the use of a donor egg, but she unfortunately miscarried a month later.

Illustrative. In vitro fertilization (IVF) of an egg cell. (iStock by Getty Images/ man_at_mouse)

“Miscarriage with IVF is little understood,” said Klein, who eventually discovered thanks to the expertise of a New York reproductive immunologist that there was actually nothing wrong with her eggs, as she had been told. Rather, her body was rejecting the embryos that had been transferred into uterus.

With this newfound knowledge, Klein — now undergoing immunological treatment — returned briefly to Israel for a final round of IVF with a second donor egg. The embryo transferred worked, and Klein finally had a successful pregnancy.

“I’m super-grateful to Shaare Zedek and Israel, but going abroad for fertility treatment is hard,” Klein shared. “It isn’t easy being away from your regular friends and support system.”

The biggest benefit of undergoing fertility treatment in Israel is that repeated IVF treatment is free for a woman of Israeli citizenship up to age 45, to a limit of two children. Israel has the highest fertility rate in the OECD, and is the world’s per capita leader in use of IVF.

Also, it was comforting to Klein that in Israel so many people are either going through fertility treatment or know others who are. She found people in the US to be less knowledgeable and more judgmental (especially of the fact that she started trying to have children only after marrying at age 41).

Amy Klein and her daughter Lily wearing masks during the COVID-19 pandemic, New York, 2020. (Courtesy)

“In Israel, people are more aware and opt for fertility treatment earlier. It’s just considered another medical treatment there,” she said.

“The Trying Game” came out in April, just as COVID-19 hit New York hard and began spreading across the US. As a result, some fertility clinics closed all together, or stopped doing embryo transfers. It’s been a difficult time for people who were in the midst of treatment, which must be  carefully timed and monitored. (IVF treatment was interrupted or postponed for many Israelis due to the pandemic, and was partially reinstated in late May.)

“It’s been so hard for people to be stuck at home and on social media seeing parents complaining about their kids being at home while your dreams are put on hold,” said Klein, who is now the ambassador for reConceiving Infertility, Hadassah’s new initiative to de-stigmatize infertility and advocate for change.

Klein went through 10 doctors, nine rounds of IVF, four IUIs and four miscarriages before having her daughter Lily. Even after enduring all that, Klein said she would not have given up had she not gotten pregnant that final time. Although she was physically and mentally exhausted, she would have looked into other options, including embryo donation.

“It’s one thing to stop fertility treatment, and it’s another to give up on wanting to be a parent,” she said.

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