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As Pamela Tsigdinos cheered for her nephew at a Little League game last week, a parent asked the inevitable question: "Do you have kids?"

For Ms. Tsigdinos, 46, it could have been a painful query. But after years of coping with infertility, Ms. Tsigdinos says, she's at peace as a "non-mom" in a childcentric world.

"I just said, 'No, we are unable to.' "

It wasn't for lack of trying.

Ms. Tsigdinos was 29 when she discovered she might have trouble conceiving. She and her husband Alex embarked on a fertility quest that involved a laparoscopy to treat mild endometriosis, surgery to correct a blockage in his scrotum, acupuncture, several cycles of in-vitro fertilization, and cutting-edge treatments at Stanford University Medical Center.

Finally, at age 40, Ms. Tsigdinos decided with her husband to stop treatments and climb out of the infertility abyss.

"It got to the point where the potential for more heartbreak was actually more overwhelming than the glimmer of very small hope," she explains.

Infertile couples are under the illusion that science will solve the problem, says Ms. Tsigdinos, author of Silent Sorority: A (Barren) Woman Gets Busy, Angry, Lost and Found.

But despite medical advances, some individuals are unable to have biological children, says Judith Daniluk, a professor in counselling psychology at the University of British Columbia.

"People don't understand that," says Dr. Daniluk, who has worked with infertile couples for nearly 20 years.

One in six couples experiences infertility, according to the Canadian Fertility and Andrology Society. Many end up at fertility clinics, but the chances of success plummet with age. For women aged 35 to 39 who undergo one cycle of IVF, the live birth rate is 26 per cent. For women 40 and over, the rate drops to 11 per cent.

In the age of fertility gone amok – from Octomom to Holly Hunter giving birth to twins at age 47, likely using donor eggs – there are no role models for couples who can't have kids, Dr. Daniluk says.

Instead of hearing about infertile couples who create fulfilling lives, she adds, "we hear 'keep going' and '50 isn't too late.' "

Many fertility clinics treat couples long after their financial and emotional bank accounts are overdrawn, says Diane Allen, executive director of the Toronto-based Infertility Network.

"It isn't often that I've heard of clinics trying to help patients gain acceptance that their fertility may be at an end," she says.

Recent books have been published to fill the gap, including Unsung Lullabies: Understanding and Coping with Infertility by Janet Jaffe and Martha and David Diamond and The Empty Picture Frame: An Inconceivable Journey Through Infertilityby Jenna and Mike Nadeau.

In Britain, an organization called More To Life, established in 2006, offers social gatherings for the involuntarily childless and online support at

In Canada, however, support groups tend to focus on coping with treatments, not coming to terms with infertility, Ms. Allen says.

Some couples don't give up until their marriages are on the rocks, Dr. Daniluk says. "The male partner may say, 'We just can't do this any more.' "

Couples who stop fertility treatments often face several years of "grief work" before they can start reframing their lives, she says. The process is usually tougher for women, she adds. They may question their identity, struggle to relate to friends in the throes of baby bliss or search for a sense of meaning outside of motherhood.

Terry Nurmi, an artist in Fort Langley, B.C., says she redirected her energy into making art after a fertility treatment failed. "Every time I do a body of work, it's like giving birth," she says.

In 1996, at age 38, Ms. Nurmi discovered her fallopian tubes were damaged. That year, she did one cycle of IVF but the loss of "three good eggs" was so devastating that she couldn't face another round, she says.

Ms. Nurmi, now 53, says it took almost 15 years before she was ready to explore infertility through art. Using images of sleeping infants, basal temperature charts and petri dishes, her works are part of Inconceivable, a group exhibition (until June 6) at the Fort Gallery in Fort Langley.

Infertility creates a void, Ms. Nurmi says. "You really have to replace it with something."

Some find solace in spirituality, or a marriage made stronger through shared hope and despair, Dr. Daniluk says. Others become advocates for the infertile or start fostering children and parenting in other ways.

Ms. Tsigdinos filled many journals as she dealt with the loss of her unborn children, she says. Eventually, her writings became a book and she started a blog for infertile women at

Infertility still carries stigma, she says. To identify oneself as infertile is to invite judgment or blithe comments such as "Why don't you just adopt?"

But there's no such thing as "just" adopting, she points out. Adoption is an agonizing and expensive process that can take years. And not everyone is equipped to deal with children who may have special needs, she adds. "I truly believe that adoption is a calling."

Although she doesn't have kids, Ms. Tsigdinos says, she feels close to her nieces, nephews and the children of friends. Her marriage to Alex is strong, and she enjoys travel as well as her career as a marketing executive for startups in the Silicon Valley.

"I have had an extremely satisfying life."

What not to say

As if infertility weren't harsh enough, sufferers can become objects of pity, blame and unwelcome advice, says Pamela Tsigdinos, author of Silent Sorority: A (Barren) Woman Gets Busy, Angry, Lost and Found. Here's her list of five things not to say to an infertile couple.

"Your day will come." (It may not.)

"Just relax." (That stresses people out more.)

"I know a couple who gave up trying to have a baby and just after filing for adoption, the woman got pregnant." (Miracle stories may not apply.)

"You can have my kids." (Glib comments dismiss the pain.)

"Maybe it wasn't meant to be." (Ouch.)

The best response, Ms. Tsigdinos says, is "I'm sorry, it must be really difficult."