Baking Life’s Sweetest Miracle: A Cake Analogy for Understanding Infertility

By: Erica Ferraro

When I received my initial diagnosis of DOR and realized that I would need to undergo multiple rounds of IVF to have a chance at starting a family, I encountered considerable difficulty in explaining the situation to my friends and family. Not only was I struggling to comprehend my diagnosis, but also the terminology and intricacies surrounding infertility treatments seemed unfamiliar and complex to those who hadn’t personally experienced the battle. This lack of understanding often stems from the fact that many women (and men) lack a fundamental comprehension of how menstrual cycles function. Without this basic knowledge, information about infertility treatments can seem overwhelming.

Even within the infertility community itself, there exists a great deal of confusion, heightened emotions, and, unfortunately some fertility clinics that fail to be transparent about success rates and statistics. Why does this occur? Well, just like any other field, infertility is a healthcare business. This is the harsh reality, which emphasizes the importance of advocating for oneself, gaining a thorough understanding of one’s infertility diagnosis, and being aware of the odds of success. With this knowledge, we can make more informed decisions alongside our doctors.

Trying to have a baby is like baking a cake. You need two things: the ingredients and the kitchen. Oh, and you need the baker. Let’s start with them first.

The Baker

When baking a cake, envision the baker as the ultimate “process” leader. Even bakers can have their off days though. They might be worn out, lacking motivation, or unwilling to whip up that cake. Picture this: they’ve got all the ingredients lined up, and their shiny new kitchen is ready to go, but they can’t bring themselves to “bake.” And let’s face it, without the baker’s enthusiasm to mix those ingredients and pop the cake in the oven, it won’t bake itself.

Now, let’s apply this analogy to why some couples opt for IUI or IVF. It is not that they’re missing any vital ingredients to create mini versions of themselves, nor are they incapable of carrying a baby to term. It is just that their bodies seem to have a bit of trouble with the whole process. Take folks with PCOS, for example. They may have top-notch eggs and maybe even high-quality sperm, but their ovaries aren’t cooperating in the regular ovulation department. Or how about a woman with blocked tubes or a guy with a pesky varicocele that’s messing with his sperm flow? In these cases, our baker just needs a little helping hand to achieve their goal of baking that fantastic cake.

The Ingredients

Our cake-baking adventure requires two key ingredients—flour and sugar. But here’s the catch: some bakers only discover missing one or both crucial elements when they’re all set up and ready to bake. Talk about pressure! They’re likely racing against the clock for a special occasion, and panic starts to creep in. These resourceful bakers need to get creative to bring their cake to life. Sure, they still love baking, and missing one deadline won’t stop them from whipping up treats in the future. So, they embark on a mission to find alternative ways to make their cake. They might dash to the store for different brands of flour or sugar or even ask their neighbor to lend a hand with supplies. But here’s the thing: purchasing or borrowing ingredients can be pricey, time-consuming, and might result in a cake that differs from the original vision. And that’s okay! However, bidding farewell to the original cake idea takes time and is no piece of cake (pun intended) for these bakers. You see, they grew up watching their parents create beautiful cakes for various special occasions, not realizing that cake baking is a true gift not everyone possesses in the same way or timeframe.

Now, let’s dig into the costs. It turns out that flour (eggs) is way more expensive than sugar (sperm). Getting different flour might require taking out a loan or finding other means to obtain it, while sugar is somewhat more readily available but still requires extra funds. It is a time-consuming and planning-intensive process. And for bakers who can’t produce their flour and sugar, complete substitutions might be necessary. Phew! That’s a lot for our dedicated bakers to handle. All they wanted was to bake a cake that everyone would enjoy. Why is it so darn challenging to create something universally loved?

Once the bakers secure their ingredients, they mix everything and bake that cake in their fabulous kitchen, equipped with a high-speed mixing stand and top-of-the-line stove. After a suspenseful 9 minutes (months), voila! The cake is done. It may differ from their initial vision, but some of the best recipes are where we get a little creative.

In the world of infertility, this scenario aligns with couples opting for IVF where they may be missing viable eggs, sperm, or both, and a donor for one or the other is required.  In cases where both eggs and sperm face challenges, embryo adoption becomes an option, too. With these choices, the woman can still carry her baby to term, but a vital ingredient is missing or compromised. This can be due to factors like diminished ovarian reserve, poor egg quality, advanced age, sperm morphology issues, lack of sperm, low sperm quality, sperm fragmentation, karyotype issues, genetic concerns, and more. Some families may possess “quality” eggs and sperm but carry significant genetic conditions they wish to avoid passing on to their children. Genetic screening typically occurs right off the bat when consulting a fertility specialist. It is just a shame that OB/GYNs don’t proactively encourage this with families trying to conceive naturally. I wish all couples who want to have children proactively sought out genetic testing to rule out future issues. I could probably write another book on all the things I wish healthcare providers proactively informed their patients of, but, let’s stick to one emotionally intense topic at a time.

The Kitchen

And let’s not forget about our dear baker’s kitchen! It is equally crucial for our baker to have the functioning tools in their kitchen to bake that cake. Whether they naturally possess all the necessary equipment or have to purchase substitutions, they still need to mix those ingredients in their trusty stand mixer and bake them in their reliable oven. But here’s the twist: imagine our poor baker facing a broken stand mixer or an oven that won’t heat up. Talk about a kitchen nightmare! Now, they have to get resourceful and think outside the box to find a way to bake their cake. This unexpected hurdle popped up when they thought they were all set with their ingredients. Frustration levels skyrocket, especially when there’s pressure to deliver that highly anticipated cake within a specific timeframe. Fixing kitchen supplies can be a real headache—costly, time-consuming, and downright elusive. Sometimes, the exact reason why the oven isn’t working is as mysterious as the Bermuda Triangle, and getting those diagnostic tests done on the appliances is both a pain in the wallet and physically exhausting. Our baker cherishes their kitchen, and it can be challenging to witness their beloved appliances undergoing procedures or accept that their culinary sanctuary isn’t functioning correctly. Sometimes, the baker may have to hire another skilled baker to take on the task. But oh boy, that can be a rollercoaster ride of emotions because other bakers are humans, too, and humans can be unpredictable. Perhaps our baker eventually finds a way to bake their cake in their kitchen, but it might require additional tools that take a toll on their physical well-being.

Now, let’s dive into sustaining a pregnancy. Imagine someone who, despite having no issues conceiving naturally or creating embryos with their eggs and sperm during IVF, is physically unable to carry a pregnancy to term. It is like our baker having all the ingredients ready but facing an insurmountable challenge when it is time to bake. This can be due to various factors such as anatomical abnormalities, blood disorders, thyroid issues, and more. Some women are told that, anatomically, they cannot carry children, while others experience the heartache of RPL, defined as two or more consecutive miscarriages. Often, the reasons behind these recurrent miscarriages are only discovered through intensive testing and blood panels conducted at a fertility clinic during IVF. In such cases, a gestational surrogate or carrier becomes an option, but boy, is it an expensive and emotionally daunting process. For women who do end up carrying the pregnancy themselves, they may require additional medication, therapies, or additional surgeries before, during, and after pregnancy. It is a journey that demands a lot from the baker’s body and soul and requires them to be resilient at every step.

To all the bakers out there with dreams of baking their perfect cake, I want you to know that I am cheering you on with all my heart! Trust me, it will be delicious no matter what kind of cake it is, how it is made, and where it is baked. You see, the most essential ingredient in any baking endeavor is love. With love as your secret ingredient, there’s no doubt that your cake will be filled with warmth, sweetness, and pure magic. So, keep that oven preheated, and let your passion guide you to create something extraordinary. You’ve got this!