Nothing gets to Beverly Goyer quite like the word "infertile."
Even now, with her 2-year-old twins cavorting around her, the word slices through conversation.Audrey wants a pretzel. Zachary wants a cookie. One wants to climb on top of the sofa; the other wants to squeeze on Mommy's lap. Their mouths are moving almost as fast as their limber arms and legs.
In the midst of the morning romp, Mrs. Goyer stops to explain:
"Infertility is always a part of you," she says. "You parent differently because of it, I think. Not better. Just differently ... . You always have a fear with you."
Other women who have encountered impediments to childbearing attest to lingering anxiety and a sense of failure.
"Yes, they're very happy and grateful," said Dr. Marcelle Ceders, director of the center for reproductive health at the University of Cincinnati Medical Center. "But it's like having a disease that hasn't gone away. Something still isn't right."
In the last decade, infertility has moved out of secrecy and silence into news headlines, office talk and the plotlines of soap operas. But the emotions that accompany it often remain a mystery to those who have not experienced reproductive difficulties.
In 1990, when the National Center for Health Statistics conducted its most recent survey of birth trends, the "overall" infertility rate in the United States had not changed in 30 years. However, the number of women who had never had a child was increasing. So, too was the percentage of childless couples who were infertile.
This translates into more than 5 million American women (and a lesser number of men) who try to achieve pregnancy but are thwarted by biological circumstances.
Yet a growing number do become parents - through either adoption or high-tech medical procedures - in-vitro fertilization (IVF); gamete intra-fallopian transfer (GIFT); microsurgery; donor sperm; or donor eggs, the technique that gave Beverly Goyer her twins.
For those who have waited for years and spent thousands - which often isn't covered by insurance unless the state government has interceded in behalf of policyholders - the creation of a family seems nothing short of miraculous.
But what happens when their kids are just kids? Noisy. Impetuous. Self-centered. Angry.
"When I'm frustrated or impatient, I feel really, really guilty," says Mrs. Goyer. "I think that's because I went to such extremes to bring them into my life."
Audrey and Zachary arrived by Caesarean section after three days of induced labor. That came after a nightmare pregnancy, after three IVF attempts and numerous surgeries. As grueling as her pregnancy was, Mrs. Goyer is still glad she experienced it.
"Oh, absolutely. I wouldn't trade it for anything."
Women who became mothers with ease may not relate to such experiences. But women who endure years of infertility treatments do, often banding together into support units. A number of Cincinnati women, for example, maintain a support group called Miracle Moms.
For Mrs. Goyer, a teacher for 20 years and now a full-time mom, joining the organization was a way "to turn a negative into a positive." It's not just the challenging moments these moms understand, but also the strangely sweet ones.
"Eddie's been waking every morning at 5:30, teething," says Gayna Bassin of her 1-year-old adopted son. "But I don't mind. I just think of all the times I cried myself to sleep wishing for a baby who would wake me in the middle of the night."
Mrs. Bassin, a violinist with the Cincinnati Symphony Orchestra, had her first child, Michael, biologically 10 years ago. But when she and her husband, Jeff, tried for a second they ran into a slew of difficulties - five years' worth.
"It takes over your life - the shots, the blood tests, the hormones, the ultrasounds," she said. "And the outside world isn't supportive."
When one mother describes infertility as "a living hell," others nod in agreement. Some have undergone a dozen miscarriages. Some have lost full-term babies conceived through IVF. Some have had adoptions fall through at the last minute.
"There was a terrible emptiness that nothing could fill," says Mrs. Goyer. I'd never wanted anything more."
Almost every couple can describe remarks uttered by friends or relatives that burned into memory. Dr. Joyce Sutkamp Friedeman, author of the 1995 book "How to Become Your Own Best Infertility Counselor," has heard so many insensitive comments that she's composed a list of snappy comebacks.
Or, as she says, "I coach people so they're armed when they go into the battlegrounds of cocktail parties."
Dr. Friedeman, a Northern Kentucky counselor who endured 15 years of infertility treatments, now has three children. She doesn't agree that feelings of inadequacy persist forever. But she does believe that anxiety makes a lasting impression. Infertile couples, she says, tend to turn into overprotective parents.
"They've experienced so much loss they expect more," she says. "You always worry."
Perhaps so. But Gail Huff, who became a mother nearly three years ago when she and her husband adopted Alex, points to other common denominators among miracle moms. One of them is grit.
"We all did the ultimate family planning," says the suburban Cincinnati resident. "We could have given up. But we went over obstacles and achieved our goals. We're all very strong."
Lisa Hingsbergen, a co-president of Miracle Moms, agrees: "Infertility changes your life, forever, every aspect of it. It also changes your whole take on parenting. I've never seen such devoted parents. They want so much to be the best they can be."