Inconceivable: the spiritual test of infertility.

God said, "Be fruitful and multiply." But millions of couples can't do that on their own, and their spiritual struggles are often as daunting as the physical and emotional ones.

New parents often describe childbirth, and their part in procreation in religious, almost mystical, terms. It's a miracle, awesome, glorious. Giving birth to children is why God put them on this earth, a vocation, more important than anything else they will ever do. Some even see it as sharing in God's creative power.

So what if you were told you could never have that?

"You do wonder why God is doing this to you," says Kristin Johnson, whose husband's infertility led a physician to tell the St. Louis couple it would take a "miracle" for them to get pregnant on their own. "You think it's going to be so easy, and then you wonder, 'Why is this happening to me? What did we do wrong? Doesn't God want us to be parents?'"

Infertility is a medical diagnosis (the inability to conceive after one year of trying or to carry a pregnancy to live birth), and one with serious psychological and emotional ramifications. It also can be, especially for Catholics and other people of faith, a spiritual crisis. Although the moral and ethical issues surrounding reproductive technology are part of it, the even larger questions involve one's image of God, vocation, prayer life, and ideas about God's role in a person's life.

The spiritual questions raised by infertility are affecting an increasing number of people, in part because many couples are trying to get pregnant later in life. More than 6 million American women age 15 to 33 suffer from infertility, roughly 10 percent of women of reproductive age. Yet infertility is not only a women's issue: one third of infertility problems are attributed to the male partner, and another third are related to both the man and woman according to the American Society for Reproductive Medicine.

Johnson, who asked that her real name not be used, had drifted from the church but returned to Mass during their infertility problems. "I think I was looking for answers," she says. The couple got a happy one: With the help of reproductive technology, including in vitro fertilization, Kristin became pregnant and is expecting in March. This, too, she sees as God's will, a blessing.

"We definitely think God answered our prayers," she says. And if it hadn't worked? "We were open to adoption, if that was what God wanted for us."

But saying "it was meant to be" when treatment is successful can be hard to hear for those who walk away with empty arms. "That's not particularly helpful to them," says Dianne Clapp, a psychiatric nurse and medical information director for Resolve, a national infertility support organization. "What people really need is support around the loss."

And infertility is a loss--not always of a specific child, although multiple miscarriages are common--but usually the less tangible, more difficult loss of a dream: the dream of an easy, unassisted conception; the dream of children who look like you or your relatives; the dream of having a "normal" family.

Infertility also often involves grief and loss on a spiritual level, as old images of God or ideas about how God works don't seem to fit anymore. "Anger at a supreme being is a normal thing as people wonder 'Why me?'" says Clapp. "But I urge people to reframe it. Rather than searching for answers, I encourage people to pray to God for help in coping and navigating this the best they can."

Fertile faith

Mary and Sam Nelson of Denver married in their late 30s and spent six years trying to have a child. They tried everything: acupuncture, diet, drugs, prayer, and eventually in vitro fertilization. Not only was it ultimately unsuccessful, but it also was a difficult moral decision and cost tens of thousands of dollars.

"Every time we got a phone call from the doctor it was more bad news. It was heartbreaking," remembers Mary (not her real name). "My husband was all set on adoption, but I was having a hard time letting go of the dream."

For Nelson, the deepest grieving involved the genetic connection, as she loved seeing the family resemblance in her nieces and nephews. "It wasn't about the physical, but more about their personalities and how they're wired. I also wondered what a combination of my husband and me would be like," she says.

She eventually found peace by realizing that all children are God's children--a shift necessary for them to adopt their newborn twins. "I got this whole new way of thinking about it, that I'm more connected to humanity as a whole than to just this gene line, so what does it matter?" she says.

Nelson won't deny that she was sad and angry--but it was rarely directed at God. "My image of God isn't of a God doling out rewards and punishments," she says. "Instead, for whatever reason this was happening to us, and I was trying to understand what to learn from it."

One lesson was to let go. "It's hard because the medical side of infertility treatment is so planned and controlled," she says. "You think that if you just eat the right things or do acupuncture, you can control the situation."

She also let go of the need for answers. "There are a lot of things we don't have answers about," she says. "That brings us back to the mystery of our faith."

Accepting and living with mystery is necessary, even when the news eventually is good. Jane and Joe Cavanaugh of Minneapolis were told they had a 2 percent chance of getting pregnant on their own. They struggled with the morality of some infertility treatments and were turned off when their doctor pushed egg donation. Finally, with the help of Eastern medicine--such as acupuncture, yoga, and herbal treatments--they beat the odds.

"I do see our daughter as a gift from God, but I don't know why it happened to us," says Jane, a spiritual director. "I connect it to the power of prayer, because so many people were praying for us. But what about others who have that prayer behind them, too, and don't get pregnant? I was afraid it means that God isn't in charge."

Her husband, Joe, also doesn't see God as waving a magic wand. "That's not a God I believe in," he says. "I do believe this is a miracle in the sense that God's love made it happen. But there's mystery involved. It's about the constant miracle of possibility and trying to be open to the wonderful possibilities God puts in front of you."

Jane calls it being open to the "yes/ and": "One path is not always the right and only way," she says. "But when it's not the particular path we were expecting, it's OK to tell God how you're feeling. You have to keep God in the equation, even if you're sad and angry. God can take it."

Creation spirituality 

"Maybe God doesn't want us to have any more kids." That's what Emily Holtel-Hoag of Cleveland initially thought when she and her husband, Mike, had difficulty conceiving when trying for their second child.

"But the more I thought about it, I realized I didn't really believe God is a micromanager," she says. "I don't think God causes infertility or miscarriages, but I do believe God is present and brings grace to the challenges we have in our lives."

Like most people, Holtel-Hoag used to think of procreation in purely physical terms: she and her husband creating biological children, preferably unassisted by medical intervention. The desire to have children, especially after finding and committing to your partner, is a nearly universal human drive and one that many perceive as God-given.

That's natural, says Jeannie Hannemann, founder of Elizabeth Ministry, which connects women in parishes around issues of childbearing. "Our God is so much a God of creation," she says. "The first command God gives to humans is to 'be fruitful and multiply.' So it's written deep in our hearts that we want to conceive. It's how God made us."

God doesn't desire for any couple to be infertile, she says. "But when we suffer from infertility, God is grieving with us," says Hannemann, who experienced infertility herself. "Yes, God wants us to procreate, but God can also bring good out of every situation. If you are suffering from infertility, God will have a plan for you out of all that pain."

In Holtel-Hoag's case a trusted mentor challenged her to think more expansively about other ways to bring life to the world. "That really clicked for me," she says. "Spiritual generativity is more about how we're going to co-create with God. It helped me see that as human beings we want to be procreators in some sense of the word."

She and her husband considered "creating" in other ways, such as helping a refugee family or becoming more involved in their parish and community. They eventually decided to adopt an infant from Guatemala.

"We realized we have a lot of love in us and a lot to offer," she says. "So if we're not going to have more children we have a responsibility to share that love and these gifts with the world in some way."

While an initial response to infertility might be to be angry at God or to question or reject one's faith, many infertile couples eventually turn to their faith for strength during such a difficult time in their marriage. Prayers range from "Dear God, please give us a baby" to "Not my will but yours be done."

Mary's words from the Annunciation--"Let it be done according to your word"--became Holtel-Hoag's prayer. "I was trying to open myself up to the possibilities and to God," she says. "Now I'd probably say, 'Let it be done, with me, according to your word,' to show that it's a partnership between me and God."

The Prayer of St. Francis is helpful to 27-year-old Katie Malone of Baltimore, who has suffered from early miscarriages in her attempts to get pregnant. "The part about 'seek not so much to be consoled as to console' spoke to me," she says. "I pray to be compassionate toward others and not just focus on this one bad thing that's happening to me."

She also tries to emphasize gratitude in her prayer life, thanking God for five things each night. "I try to focus on the things I have," she says. "It keeps things in perspective."

But that doesn't mean she hasn't struggled with what her inability to carry a pregnancy to term means. "I had a lot of spiritual questions, and I still do, after my two miscarriages. What was it? Was it a baby? Did it have a soul?" she says. "If it has a soul right after conception, then I feel guilty because I couldn't stay pregnant. But it's a hard question. I don't have the answers to that yet."

What she is sure of is that God is calling her to be a mother. "Of course, biological children are what I've always pictured myself having, but I'd be very excited about adoption," she says. "Maybe this is God's way of saying you have a lot to share and there's someone out there who needs a home. I feel we have so much and so much to be thankful for."

Birthing new life

Being able to experience new life--either through a successful pregnancy, adoption, or choosing to remain childless and instead focus on serving the wider community--after the "death" of infertility mirrors the Christian story of Resurrection and redemption. Although the pain is real, ultimately many couples find their faith helps them move through that grief and make life-giving choices for themselves and for others. While they wouldn't wish it on their worst enemy, some couples see their infertility journey as one that helped them grow into more compassionate, open people.

In the end, Holtel-Hoag ended up feeling grateful after her infertility struggle. "It seems to me that when you say 'yes' to God's possibilities, God says 'yes' back to you," she says, just home from her first visit to 3-month-old Isaiah in Guatemala, one of several trips before the adoption is final. "Once we did that, things just seemed to fall in place not just the adoption but life in general."

Mary Nelson's gratitude and compassion are focused on her twins' birthmother, whom they got to know through an open adoption, and on others who suffer from infertility. "You really feel for other people who can't have children," she says. "So many people are going through this, but everyone tells me they feel so alone. I think I really grew in compassion."

The Cavanaughs are grateful for 6-month-old Tess but also for the spiritual insights gained through their experience of infertility. Jane says she not only learned to "trust her gut," but she also expanded her vision of God. "The most interesting thing was the surprise element of God," she says. "You can't figure God out. And I love that."

For more information: www.resolve.org or www.elizabethministry.com.

RELATED ARTICLE: Why the Bible sometimes doesn't help.

Many Catholic couples struggling with infertility naturally turn to the scriptures for solace. Maybe they shouldn't.

Although the Old and New Testaments are full of examples of "barren women"--Sarah, Rebekah, Rachel, and Elizabeth, to name a few--it's unlikely that many contemporary infertile couples will find comfort in their stories.

"First of all, it's always an infertile woman in a patriarchal society like the ancient Near East," says Sister Dianne Bergant, C.S.A., professor of Old Testament at Catholic Theological Union in Chicago. "That's the way they understood infertility. You do not portray your leaders--like Abraham, Isaac, and Jacob--as men who cannot impregnate a woman."

On top of that, infertility was often seen as a punishment from God. And in most of the biblical stories, women who are infertile or way past their childbearing years eventually become pregnant through the grace of God--a miracle that may not happen for the majority of contemporary infertile couples. Rebekah's infertility journey is summed up in one quick sentence--"Isaac prayed to the Lord for his wife, because she was barren; and the Lord granted his prayer, and his wife Rebekah conceived" (Gen. 25:21)--and gave birth to twins, no less!

That's because infertility in the scriptures is used to make a theological point that really has little to do with a woman's ability to conceive. "The infertility is not the point of the story," says Bergant. "It's not about the mother or even the father. It's about the child. If a child is not conceived in a normal manner, that's the traditional way of saying the child is clearly a gift from God. The very fact that these women who could not bear children did means this is an extraordinary child."

And that child is always a son--again because of the patriarchal culture.

In biblical times survival was the primary goal, Bergant explains. "You can't survive if you don't have the next generation. In a society with high infant mortality, few children brought to term, and many women dying in childbirth, all the odds were against a successor. So it was very important that women be fertile and have lots of children. That was a woman's primary responsibility."

That clearly is not the situation of contemporary infertile couples. "So drawing comparisons to biblical characters may not be helpful," says Bergant.

So what can infertile couples glean from scripture? Elizabeth Ministry, named for the infertile woman who eventually gives birth to John the Baptist, models its peer-support and mentoring program on the friendship between Elizabeth and Mary as evidenced in the Visitation.

Elizabeth Ministry founder Jeannie Hannemann points out that Luke 1:6 says both Elizabeth and Zechariah "were righteous before God, living blamelessly according to all the commandments and regulations of the Lord." "So it wasn't their fault," she says. "God didn't curse them with this."

Bergant also points out that in biblical times children were cherished by the entire society. "It really did take a village," she says. "So there's this idea that even though you may not be able to have your own children, the generative impulse and gifts can be shared in different ways."

--Heidi Schlumpf

RELATED ARTICLE: Helping parishioners with the baby blues.

Mother's Day is hard. Baptisms are really hard. Christmas, with all its talk of the birth of baby Jesus, isn't exactly a happy occasion either. Church should be a source of consolation during trying times, but for couples suffering from infertility, it's often an alienating, difficult place. And, although one in six couples now has difficulty conceiving or has experienced miscarriage, few parishes offer any services or even acknowledge the pain of infertility.

"It was very hard to go to church because it was so family-oriented. I'd see the cute babies and start crying," says Mary Nelson (not her real name) of Denver. "And I definitely couldn't go to church on Mother's Day."

Between blessings for morns and dads, preschoolers toddling off to the children's Mass, and Baptisms regularly printed in the bulletin, reminders of infertile couples' inability to procreate seem to lurk everywhere at church. "Sometimes I feel like I don't fit in," says one woman, summing up the attitude of many.

On top of that, more and more Catholic couples are using fertility treatments the church does not condone, such as artificial insemination or in vitro fertilization--both considered immoral because they separate procreation from the sexual act, not to mention the potential for the destruction of embryos with in vitro.

That only adds to the isolation of being childless and unable to conceive. "I was afraid of being judged," says Nelson, explaining why she never approached her parish for help during her six-year infertility struggle.

And although their two cycles of in vitro never resulted in the destruction or freezing of embryos, she still felt guilty. "You feel like you're making decisions that God is supposed to make," she says. "That stuff did get kind of tricky."

Another Catholic woman says infertility was something "you just don't talk about" at a Catholic parish. Celibate priests may be unaware of the prevalence of such problems and uncomfortable trying to explain church teaching, while family life ministers or directors of religious education are too busy focusing on the parish's children to remember the childless.

And then there are unintentional stings, such as homilies that suggest that all women should become mothers or, in one case, a prolife bulletin series in which the prenatal development of a "spiritually adopted," nonexistent baby was printed each week. For the parishioner whose miscarried child had been the same age, the weekly reminder was excruciating.

Resolve, a national infertility support organization, offers couples a form letter to send to parishes or other religious communities, asking for sensitivity around the issue. "Clergy members are usually open and grateful to be reminded," says Dianne Clapp, Resolve's medical information director. "We need to do more of it."

Elizabeth Ministry, which provides Catholics with peer counseling around childbearing issues, has 600 chapters worldwide, though that still represents only a fraction of U.S. parishes. Founder Jeannie Hannemann believes parishes must step up to the task of providing support for these hurting families.

"All these aspects related to childbearing used to get taken care of in the extended family," she says, "but now parishes have to become the extended family."

First and foremost, parishes must offer opportunities for infertile couples to pray and for the faith community to pray for them. "Right now there just isn't an outlet for them to ask for prayers," she says.

Elizabeth Ministry offers a number of aids for parishes wanting to do more. The Rosebud Program is a more sensitive alternative to the popular practice of selling roses for mothers on Mother's Day. It comes with a basket of silk flowers, each a different color representing various pregnancy issues, such as waiting to conceive, infertility, adoption, miscarriage, or other early childhood loss. Parishioners can write their intention on a tag and place a rose in the vase.

Parishes can also ease the pain of difficult days, like Mother's and Father's Day, by acknowledging those who are seeking to conceive, perhaps in the petitions at Mass.

Other tips are available in a new pastoral guide for dealing with infertility, available from Elizabeth Ministries for $24.95. For more information, visit www.elizabethministry.com.--Heidi Schlumpf