To Have or Have Not: Fertility, Chronic Illness, and the Big Question.

Pregnancy in all its beauty by @ainsleydsphotography

How do we tackle the decision to have children, especially when we have a chronic illness that can affect fertility?

TW: Fertility, childbirth

I don’t know if I can have kids. 

And I don’t know if I want to. 

Part of me feels like there would be nothing more natural in the world than holding a newborn created out of love in my arms. I’m great with babies- I’ve always found looking after them came naturally to me. Even as a kid I was deemed the ‘baby whisperer”. 

I sometimes wonder if it would be the missing piece that made my life ‘complete’. 

And then I wonder… Do I actually have any missing pieces? 

I know for a fact that many people find fulfilling and happy lives without children, and I can certainly see myself as one of them. Zero guilt trips overseas, more disposable income, more time to focus on your health, social life, career and volunteer work, the ability to look after your friends or siblings' children (and then give them back when you are tired), no stressing about organising and paying for childcare, sleep ins, cocktail nights, the list goes on.

Solo travel in Cuba with no responsibilities.

I see so many childfree women thriving, with rich, purposeful lives that likely wouldn’t be possible if they’d had kids. I know that parenthood is not a prerequisite for fulfillment. And I’m genuinely grateful that we’re starting to celebrate the lives and achievements of women that aren’t centered around marriage or motherhood. Childfree influencers like @danni___duncan are shifting the narrative, showing the world that a life without children is just as worthy and wonderful.

But then I hear from friends and family members who describe the kind of love that they have for their children. The kind of love that can’t be put into words, the immense sense of purpose that they feel, the way that it changed them for the better, and I wonder if I too might feel that way too. I wonder how incredible that might feel. 

Then I circle back…. because I am also aware that this is absolutely NOT everyone’s experience, and although it is not talked about enough, there are definitely people who come out and bravely admit that they regret having children, no matter how much they love them. 

So how do we make such a huge, life changing decision? 

I recently shared these thoughts on threads- and the response was overwhelming. Hundreds of people shared their experiences of their tough decision to either have kids, or not have kids, and many talked about having that choice taken away from them due to infertility. There is comfort in knowing that I am certainly not alone in this vortex swirl of ‘to have or have not’. 

The possibility that the choice might be taken away from me adds extra weight. Endometriosis means my chances of conceiving are already lower— around 30%- 50% of people with endo face fertility challenges. But beyond whether it’s possible, I also worry about how pregnancy, childbirth, and parenting might affect my health. Some mornings I can barely get out of bed. What happens if I throw a screaming toddler into that mix? How could I consider having a baby when there are days I feel guilty about not doing enough for my dog? 

In my early 20s I had deep fear of getting pregnant. I knew it was not for me at that time, I knew I wasn’t ready, and when my current boyfriend started talking about it I wanted to run for the hills (and thank god I did). I couldn’t imagine anything worse than having kids with him, being stuck in a small town, with no career and no freedom. I was 100% sure that that was not the life for me. So I went traveling, I lived a life of total freedom, I enjoyed my time galavanting around the world as a childfree woman while my friends from high school were popping out kids left right and centre, and I had zero regrets. 

Then I met my most recent ex, and something in me changed, some kind of weird biological desire took over and all of a sudden I could imagine it. I wanted it, even though I knew I wasn’t quite ready for it. But it was not meant to be, and when that relationship ended (somewhat traumatically) I swung back into my childfree life—determined to be the cool aunt with a stacked bank account, great sex, great shoes, and a fabulous lifestyle.

I was in this place when I met my current partner, and then became very sick shortly after we got together. He has been the most incredibly supportive and caring person and he is the most amazing dad to his son from a previous marriage. We have talked about the idea of having kids many times. Neither set on a hard ‘yes’ or ‘no’ answer. I know he would be a good dad because he already is a good dad. I know he would be an incredibly supportive and hard working partner because he already is that.

But I’m also realistic. He’s not superhuman. Parenting—especially with a partner who’s chronically ill—is going to be hard. And we need to be sure we’re ready for that.

There are many fears, considerations and concerns I think about when it comes to this decision. Of course there is the universal consideration to our environment and the way the world is right now (what kind of future would we be leaving for our next generation?), but most of my concerns are driven by my own personal fear and uncertainty. 

Period Problem.

Firstly is the fear of having to deal with my periods again. This might sound silly to many, and I think few people without endo will understand this, but allowing my body to be in such immense and debilitating amounts of pain month after month is not something I’m ready to face. Knowingly putting my body through that pain is a huge decision to make and it’s something that I have no choice but to deal with if I want to try and conceive. It’s not something I have the energy for yet. And I’m not sure when I will. 

Pain and Medical Trauma.

Then there is the fear of the physical and mental pain of miscarriages, medical appointments and of course the birth itself (valid). Having been through so much medical trauma already, the idea of dealing with painful and potentially traumatizing medical emergencies is a serious concern that I need to have the strength to face. I’ve been around women enough to know that although we are talking about it more often, miscarriages are still far more common than most people realize. It’s a reality of the attempt to conceive that many people have to deal with and they can be incredibly painful and dangerous for the pregnant person. Birth is also another potentially dangerous and certainly extremely painful medical procedure that you need to be mentally and physically strong enough to handle. Although living with endo has given me some insights into this level of pain, and I know I could get through it if I needed to, I’m not sure I really want to be putting myself through that again. Even if you do get a joyous fleshy bundle at the end of it. 

The incredibly powerful Ashley during the brith of her son.

What if it doesn’t work?

Then there is the fear of failure- what if I decide I want this and then it doesn’t work? Will I be heartbroken if we can’t? How much of a toll will that take on my mental health? My relationship with my partner? What if I come off the medication I am on that’s currently helping me to live with a lower level of pain and suffer month after month of pain only to discover that it was for nothing? 

The Practicalities.

Then there are fears around finances, energy levels, not having enough support or resources etc etc etc. Also very valid. Although I often hear comments like ‘you just make it work’ and ‘you're never truly ready’, and ‘there’s never really a good time to have a baby’, others will tell you the immense physical and mental toll these levels of stress have on your health, your relationships, your sanity etc. I don’t think it’s wise or responsible to brush these concerns under the table. 

Am I healthy enough?

I’m scared that I won’t have the energy or health to be a good mum. Being a parent is hard work both physically and mentally, and with my health the way I am at the moment I can barely look after myself, I can’t manage a full time job, so how am I supposed to take care, nurture and entertain a tiny human with all the things they need for healthy development? Of course, this may change, and my health might improve, many women with endo have gone on to be incredible mothers, but I am not at the stage yet where this feels like it would be possible, unless I could nap A LOT, which is not very realistic. What if I can’t give the child everything it needs?

Details with little moments of love and connection.

Unfortunately, biologically female bodies don’t have the same freedom with time as cis-men. The pressure to decide “before it’s too late” looms large—whether it’s from society, family, or your own internal clock.

For a long time, I told myself and my partner: “If it happens, it happens.” And I meant it. But with endo, I don’t have the luxury of seeing what happens naturally. I can’t just stop using my medication and let fate do its thing. Coming off my medication would cause life-altering pain. So if I do decide to try, it’s an active decision—with serious consequences.

This is an incredibly complex topic that can not be properly covered when someone casually asks you “so do you think you might have kids?”. There is so much to consider and I feel like I’m only just now at an age where I can start to think about it all responsibly with careful consideration to both myself, my partner and a future child (if there were to be one). 

Chapelle Roan was right, I see what mothers go through and it is hard as hell. It’s an incredibly difficult (unpaid) job and mums most often do not get the support they need. And while I do see friends who are incredibly happy with their children, it would be naive to not recognise that they are often also struggling. I take my hats off to them with full respect. 

I’m just not sure I have that fight in me. But I’m also worried that by the time I’m ready for the fight the chance to step into the ring might already be over.

Beautiful Aimee and her bub during a family photoshoot.

So how do we decide? 

In many ways, I don’t think this decision is ever fully rational. It’s not just about logic, practicalities or timelines—it’s emotional, biological, deeply personal, and constantly evolving.

Maybe, at the end of the day, it comes down to this:

Which is scarier—regretting having them, or regretting not having them?
And then:
Should I make this decision from a place of fear… or from a place of love?

And if it’s love, what would I choose?

No doubt, this is something I need to talk over with my therapist, but in the meantime, I would love to hear your thoughts on this if you have been or are currently in a similar situation.

Have you felt the same and decided to stay child free? 

Or have you previously felt like this and decided to give parenting a go? 

How did you decide what to do and what was your driving factor? 

A deep and waffly one from me today that I felt like I had to share because I know I am not alone in this place of wavering uncertainty…

XX Ainsley