On a Tuesday afternoon in late April I was absent-mindedly sponging down my daughter Ellena’s highchair, and obsessively checking the clock. It was the day my OB-GYN would be calling with the results of a key hormone test. Ellena was just over a year old, and my husband and I had only been trying to conceive for a few months, but at 42, I knew it was best to make sure my numbers were favorably lined up.

I can still easily recall the rush of fear, after the phone finally rang and I stood in the dim light of our narrow Upper West Side kitchen listening to my doctor’s voice: “The follicle-stimulating hormone helps us assess a woman’s ovarian reserve. I’m afraid your levels are much too high, Julia. At 42, with an FSH of 42, there is nothing I can do for you. You should see a fertility specialist. The sooner the better. I’ll send you a list.”

This can’t be true, I thought, taking a slow, deep Lamaze breath and trying to reason my way out of panic: We conceived Ellena on the first try. How could things fall apart so quickly?

The next morning, armed with a list of referrals, I set out in search of a more hopeful prognosis. But things were not off to a great start. “I’m sorry,” said the receptionist at the first doctor’s office. “He will not accept you as a patient. Your FSH is too high; he doesn’t think he could help you.” The five reproductive endocrinologists who did agree to see me displayed graphs of plummeting success rates for women over 40, with high FSH.

“No,” said one, “in-vitro is no longer an option.”

“No,” said another, “we have no documented case of anyone conceiving a biological child with these numbers. You could move on to egg donation, and of course adoption is always an option.”

“By the way,” added one of the well-meaning experts, “you’re not alone in this. Secondary infertility is more common than most people realize.”

In the days that followed it felt like the entire Upper West Side suddenly swelled into a giant mocking belly. Not a week went by without one of Ellena’s playmates becoming a big brother or sister. Feeling shamed, and excluded—besieged by a sense that my diagnosis was a penalty for my many character flaws—I rummaged through the old grab bag of self-flagellation. I was fluent in the language of self-blame and my rising hormones offered a compelling opportunity to use it. What was my problem, getting in line for seconds before everyone had a first turn. After years of floundering, didn’t I finally have it all? Unlike the many involuntarily childless couples, I had a healthy, blue-eyed little girl lighting up my days beyond anything I could have imagined; I was married to a man well worth the wait, and I loved my job teaching English as a second language at Hunter College.

If you had asked me what it was about the diagnosis that pained and shamed me, I might’ve said: I failed. I failed my daughter by being unable to give her a sibling, my husband who wanted a larger family; I failed myself by ignoring the glaring reality of my biological clock. Or, had I paused my frantic race for that last viable egg and allowed a deeper truth to rise up, I might’ve said: I don’t really know why this feels like such a colossal defeat; I don’t know why adoption is untenable right now; I don’t know why I can’t even glance at the unopened package of syringes attached to a pamphlet on egg donation.

*

With every “No, there is nothing you can do,” I found myself sinking into a familiar swamp of despair. The crippling self-doubt that rose after I emigrated from Czechoslovakia at 19 threatened once again to pull me under. Back then, leaving behind everything dear to me—my parents, my friends, my “promising young actress” status, a language I loved—I was scrambling to figure out who I was. Now, unable to fulfill what was presumably one of my most elemental tasks, the scaffolding I rigged up to construct a new identity was suddenly collapsing under me. Still, a part of me was hanging on, unable to let go of the search for more answers.

And there was no shortage of recommended remedies from healers of all ilks. I replaced one set of experts on Park Avenue with the experts in Chinatown and its environs.

Their solutions included jumping rope to “shake up my organs,” as suggested by the first acupuncturist, or making love on bright red sheets, prescribed by the fourth. I tried homeopathy, placing tiny white sugary pellets under my tongue. One unconventional psychiatrist proposed visualizing plump follicles uniting with eager sperm.

None of this worked.

A year later, running out of money and steam and still not the slightest bit pregnant, I walked into a health-food store, glanced toward the topmost shelf lined with books, and Fit for Life caught my eye. I reached for the small paperback, opened it at random and read: “… if there’s no energy in your body, it means you’re not alive.” That string of words landed like a revelation. Of course. Energy. Aliveness. That was language my body could work with. What I needed to do was translate those ungraspable lab reports into a relatable vocabulary.

Fit for Life was best known as a diet book. I’d heard about it years earlier at a party, where a friend of the host’s had described how the Fit for Life diet was finally helping her shed pounds. Weight was not my problem, but I was intrigued with authors Harvey and Marilyn Diamond’s energy-generating tips, such as choosing combinations of foods that were easier to digest, and eating less at night. That meant no more rice and beans, plantains, and roast chicken piled on one plate. Certainly no more wolfing it all down an hour before toppling into bed. It made supreme sense. If I ate a lighter evening meal early enough, I’d give my body a full night’s rest from the labor of turning it into fuel. It could then channel the surplus toward balancing hormones and perking up my drooping ovaries. I also loved the notion of natural hygiene: cleansing and emptying before presenting my stomach with the next day’s workload. Soon a brand new cream-colored juicer graced the kitchen counter and my morning croissant gave way to a tall glass of freshly squeezed green lemonade.

I wasn’t on a Fit for Life or any other specific diet, but the book got me to pay a lot more attention to what I was putting in my mouth and why. Cruising through the aisles of our neighborhood health-food store, I inspected labels with an eye out for potentially depleting ingredients: added sugar, unrecognizable lists of preservatives, salad dressings with highly processed oils. I started noticing how often my hand would distractedly reach for anything that might’ve filled me up, but didn’t do me much good. It wasn’t hard to figure out that stale Cheerios and greasy fries did not make for fertility-boosting edibles.

And the book affected more than just my meals. Taking action on my own behalf, action that made sense to me, began to alter my mood. Within weeks I was inching from a place of dejection to one of hope.

A voice of knowing, a voice I didn’t even know had been silenced in me began speaking once again, leading the way, clearing the path, dispatching guiding dreams. In one such dream I discovered a malignant growth in my uterus, a tumor that the doctors in the nightmare promised would vanish the minute I stopped clamoring for more than I already had. I didn’t need to call my ex-therapists to tell me I was trudging through the treacherous Child-of-Survivors-Guilt terrain, where self-sacrifice was traded for the privilege of being alive. Having traversed this stretch of land before, I knew enough to switch on the high beams when things got eerie, anticipate the twists and hairpin turns, hang on to the wheel and keep my eye on the road.

Eight months after that Fit for Life epiphany, I conceived my younger daughter, Adira, without medical intervention. Forty elated weeks later, we became a family of four.

The presence of both of my daughters—now in their 20s—is for me a source of unending wonder. And the pilgrimage that led me to complete our family brought other astonishing gifts. Though I had no intention of pursuing a vocation in the baby-making world, after Adira’s birth everywhere I went I met women battling the supremacy of statistics and labels that left out essential parts of their stories. One day, galvanized by yet another harrowing testimony, I resolved to host a Sunday afternoon gathering of women and couples who heard about my pregnancy and reached out for advice. Most of them had either been pronounced untreatable, had gone through years of invasive procedures, or were pursuing an array of perplexing natural remedies. And yet, in this group of rejects we began to celebrate the birth of babies who didn’t seem to care about the latest study on ovarian decline. Gradually fertility advocacy and education became my life’s work.

*

When Ellena and Adira studied for their bat mitzvahs, I watched them bending over the Torah scroll with their tutors and wondered if I, too, could someday learn to chant like that. A few years later I joined a trope class with a patient woman rabbi and I’ve been leining ever since. It turned out that my birth Torah portion was Chayei Sarah, the story with two of the matriarchs who struggled to conceive. Each year when my birthday rolls around, I get to ponder what it is that Sarah and Rebecca are attempting to transmit to me. What idols need smashing? Which oppressive, burdensome beliefs must I question?

The theme of fertility is one of the leitmotifs of the biblical narrative. Over and over we read about infertile—in Hebrew, ‘aḳarah—women unable to fulfill the commandment to be fruitful and multiply, as if being fertile and fruitful hinged on the woman’s ability to give birth to a child. In the last two decades of researching, writing, and teaching, I got to meet women from all corners of the world. In pretty much every case, their sorrow, not unlike Sarah’s and Rebecca’s anguish, was compounded by a sense of shame and brokenness. Centuries later, stigma and a sense of inadequacy are pervasive in the world of human procreation.

As for those two numbers: the FSH of 42 at the age of 42? I guess they were favorably aligned after all. It wasn’t until years later that I learned what any self-respecting mystic would’ve caught at first glance: When a number appears twice in a sacred text, it’s time to sit up, pay attention, and look for the hidden meaning in the story. In mystical Judaism, Shekinah is the resplendent earth-dwelling feminine aspect of the divine. I like to envision her standing tall, rooted in the earth, an infinite number of slender strands streaming from her fingertips, carrying sustenance to all of creation. Every now and then She tugs at one of the strands to pull us out of harm’s way. Rereading my story through the lens of my spiritual inheritance, today I hear in those two numbers a tug of the Shekinah; an invitation to set out on a pilgrimage toward a place where the wisdom that orchestrated my own coming into the world is a palpable presence.

I confess that in the range of human experiences, motherhood, for me, is very near the top of the list. But a biological pregnancy is not what makes us fertile. To let all that comes—the difficult and the easy—move through us, and to respond to it as truthfully as we can, to keep turning pain into labor pain as we birth our kindest, most useful Self, is about as fertile as any of us could ever hope to become.

***

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