WILLIAMSTOWN -- Three foster children came in and out of the lives of Heidi Sue and Annie Angueira before the couple could even begin the journey that finally brought them the infant they knew they'd be able to keep.
The arrival of baby Julia, whom Heidi Sue An gueira delivered in December 2009, ended years of struggle for the couple, who had muddled through foster-care programs in the South before turning to intrauterine insemination (IUI), using Heidi Sue's egg and a sperm donor with her wife's traits.
The couple, who met in 2003 and got married in 2011, always knew they wanted to be mothers. As foster parents in Kentucky and Tennessee, they cared first for a newborn and then 1- and 2-year-old siblings. All three eventually were brought back to their biological relatives.
When Heidi Sue and Annie finally decided, in 2009, to use reproductive services to conceive a child at a fertility clinic in Alabama, they got pregnant with Julia on the second try. But when Heidi Sue started spotting, the fear of possibly losing the baby she'd been waiting years for underscored the high-wire stakes of being a longtime parent-in-waiting.
"It's a very emotional process," said Heidi Sue, 37. "You really want this baby, and it's not happening. And even though I knew that it wasn't happening because I had some known problem, I wanted to be pregnant; I wanted to have a baby.
"All these logistics come into play that you take for granted, I think, when you just have kids easily.
On Mother's Day, especially, it is universally acknowledged that motherhood isn't easy. But for a growing number of people in the United States, it's the road to there that poses the most significant challenge.
What most couples can accomplish swiftly, more than 7.3 million women and their partners struggle to achieve.
For gay couples such as the Angueiras, as well as for heterosexual pairs who face issues such as infertility, the act of conceiving a child can be wrenching. Moreover, the avenues available to the couples are expensive, sometimes grueling and, for those in the Berk shires, potentially far away.
After moving to Williams town last fall for Annie, 50, to take a job as director of planning and construction for Williams College, the couple is preparing to begin another IUI next month to add a fourth member to their family.
Two-year-old Julia is hoping for a sister, but in either case her future sibling likely will be conceived at Baystate Repro ductive Medicine in Springfield.
Almost two hours from the family's Williamstown home, the clinic is the closest place that Heidi Sue can receive a full complement of fertility testing.
"I feel pretty positive that it's going to work, and we're excited about it," Heidi Sue said. "But on the other hand, I'm preparing myself for this marathon process."
Baystate Reproductive Medicine is the only "full-service" infertility clinic in Western Massachusetts, meaning it's the go-to site for everything from semen analysis to specialized procedures such as in-vitro fertilization.
Clinics in Albany, N.Y., and in the Hartford, Conn., area also are within a comfortable driving distance of the Berkshires, although procedures at those sites are less likely to be covered by Massachusetts insurance.
Dr. Cynthia Sites, chief of the Baystate clinic, said about 7 per cent of her clients come from the Berkshires, or about 135 new patients since last May.
What often is already a tough task becomes an even greater emotional toll when significant travel distances for multiple appointments a month are factored in, she said.
"I think the testing in and of itself is somewhat stressful -- coming to the realization that the woman or man or both are quote-unquote ‘responsible' [for the fertility problem]. There can be some blame placed, so I think that can create stress," Sites said. "And having to drive from the Berkshires and be here so often, especially in the wintertime, is very stressful."
Fertility treatments can be costly -- among the most complex, in vitro fertilization can be upward of $12,000 for a single attempt. Prospective parents also must find out if their insurance policy will cover the procedure, as well as how many attempts it will pay for.
Still, not every fertility procedure requires major costs or a specialized center. Local obstetrician-gynecologist offices can offer counseling and initial services such as semen analysis or ovary stimulation.
At Northern Berkshire Obstetrics & Gynecology in North Adams, about half of the couples who come in for fertility treatment, including IUI, are able to conceive without turning to a specialized, or "tertiary," center, according to Dr. Charles O'Neill, an OB/GYN at the practice.
"It's a huge investment in time, energy, emotion and sometimes money to take that next step," O'Neill said. "So we try to do as much as is feasible and safe at the local level."
At Baystate Reproductive Medicine, the staff has had informal conversations about the possibility of holding a monthly clinic in the Berkshires to help make the connection less difficult for potential patients, Sites said.
Nonetheless, as many acknowledge, the specialized technology and services simply can't be available in every corner of the country.
"I think that for people in the Berkshires it would seem it's just one of those frustrations of practicing in the rural part of the country: You can't have a major scientific facility on every block," O'Neill said.
Julie Pedroni, a philosophy professor at Williams College who teaches a course on the ethics of reproductive technology, explained that because infertility is still considered something of a taboo, the logistical steps an infertile couple has to go through to conceive make it difficult to maintain privacy.
Regardless of the infertility's cause, she said, the onus falls on the woman to make appointments and undergo tests -- and if she lives in the Berkshires, she may be juggling this burden far away from her home and her job.
"It interferes with normal life -- not that it shouldn't, not that it's not a harbinger of things to come when you have kids," Pedroni said. "But it's harder to keep it private when there are so many ways in which it affects daily life."
For the Angueiras, the option is open to try to conceive their next son or daughter at a nearby doctor's office that offers IUI. But the expense of donor sperm -- $500 a try, plus additional fees -- means they're that much more invested in increasing their chances that the insemination will work on the first try.
"You're not just thinking, ‘I'll try next month.' You have to figure out, ‘Can we afford to do this again next month?' " Heidi Sue said. "It's taxing in so many ways. ... It's obviously totally worth it, but the process really is kind of grueling."
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OB/GYN offices might offer initial counseling and services, but below are some specialized centers within driving distance of the Berkshires that offer more extensive infertility services.
n Albany IVF
399 Albany Shaker Road
n Baystate Reproductive
then search for "fertility"
3300 Main St., Suite 4D
n Center for Advanced
100 Retreat Ave., Suite 900
and 263 Farmington Ave.
n CNY Fertility Center
38A Old Sparrowbush Road