Esther Santer, 32, gave birth to her first child in 2021 after undergoing fertility treatments to address male factor infertility impacting her husband, Avi Rosenberg. Santer, a New York City-based lifestyle and parenting influencer, has been outspoken about fertility and male factor infertility with Fertility Out Loud, an online community to support people who struggle with infertility. She shares with TODAY.com her experiences of undergoing fertility treatments and her hope to reduce the stigma associated with male infertility.
After getting married in 2017, following three years of dating, Avi and I waited to start our family. I took birth control for a year until we felt ready. I thought it would be easy and we’d get pregnant quickly. I felt so nervous that I would get pregnant too quickly that I never considered that I might not get pregnant at all. After about seven months of trying without success, we realized there might be something wrong. But I’m terrified of needles, and I wasn’t ready to visit a fertility clinic to meet with a reproductive endocrinologist. For two more years, we tried to conceive, with no luck. All this time, the pressure to get pregnant increased. There's a strong emphasis on having a family in the Jewish community, and that intensified as time passed and there was still no baby announcement. People expected that we would have children and I wanted them, too! But it wasn't happening. When we started trying to conceive, I was 26, which seemed so young. I couldn't figure out why it was so difficult for us. I began feeling all the feels from the pressure, which came from every direction.
At this point, I realized we needed to get tested to see why I wasn’t getting pregnant. Soon we learned that our infertility was considered male factor — Avi has a low sperm count. We were surprised to hear this because I hadn't heard of male factor infertility before. But after learning more about it — even from people I know — I realized we weren’t alone. In a way, I felt hopeful and relieved because I thought it if was not my problem, I could avoid undergoing all the fertility treatments and shots. I soon learned that was not the case.
After speaking with our doctors, it became clear that going through fertility treatments would be the only way we could successfully get pregnant. Alone, we had only a 4% chance of conceiving. (Through our experience we learned that some men have no sperm and the only way they can start their families is with help from a sperm donor.)
Avi began taking supplements that could increase his sperm count — they worked, which gave him slightly boosted numbers. That change encouraged the doctors to allow us to try intrauterine insemination (IUI), which we weren’t really a good fit for — Avi's sperm count was still too low — but our doctors let us try it because of my needle phobia. Emotionally, I needed to know we tried everything before I committed to in vitro fertilization. IUI did not work, so then I started the testing to begin IVF, including bloodwork, monitoring of my thyroid levels, ultrasounds and ultimately daily injections, which Avi gave me.
I went through IVF during the early days of the COVID-19 pandemic and I attended appointments alone. That felt incredibly difficult even though Avi always waited outside for me. Luckily, our first transfer worked — we joke that Avi wasn’t even in the building when we conceived. On November 26, 2021, after a traumatic experience leading to an emergency cesarean section, I gave birth to my son, Nathaniel. While I was exhausted by the three-day labor, I felt so much gratitude that I had a baby. Feeling grateful helped me grapple with the medical difficulties I encountered. And, by this point, Avi could be by my side throughout the delivery.
People often asked what was taking so long, or if I was pregnant yet. They frequently assumed that it was my fault that we couldn’t get pregnant.
As we struggled to conceive, people asked us intrusive and insensitive questions and gave less-than-helpful advice. People often asked what was taking so long, or if I was pregnant yet. They frequently assumed that it was my fault that we couldn’t get pregnant. Avi had initially wanted to keep our infertility private but decided to speak up after receiving too many comments about us not having children. Often people would tell Avi things I could do to help me get pregnant and these suggestions weren’t helpful.
The fertility treatments caused bloating and sometimes people saw me and assumed this puffiness meant that I was pregnant and asked when I was due. While many of the people meant well with their questions or suggestions, the comments felt triggering to us as we were struggling so much to have a family. And, the assumption that I was to blame showed a lack of understanding about fertility.
Another misunderstanding we now face is that people believe that because we had one child, we no longer experience infertility. There is no cure for infertility and getting pregnant a second time, which we hope to do, will likely mean more fertility treatments.
We both thought sharing our story could be a good way to educate people about infertility and male factor infertility. I’m grateful that Avi feels comfortable with being open. Now I welcome questions because I see it as a chance to educate others. After I first shared our journey on Instagram, so many women reached out about their experiences with male factor infertility. For some of them, their husbands feel too embarrassed to share, and they suffer in silence. There is so much unnecessary shame around male infertility, and I hope that changes. Infertility is not just a women’s issue and by keeping male factor infertility a secret, people feel isolated and alone as they face challenges starting their family. I hope people experiencing infertility know they are not alone and you do not have to live in silence. There's power in sharing.