Tuesday, December 28, 2010

Good Luck

Most people have something they do for good luck. Knock on wood, rub a lucky coin, wear socks inside out, always listen to the same song before a job interview, etc. These rituals help us feel like we are contributing to the likelihood of something good happening. In my case, lucky charms and rituals help me feel like I have some control over the completely and totally uncontrollable fertility treatment outcome.

Baby Horned Owl
"Other Owl"
I have been really into owls lately. I normally can't stand birds--I find them creepy (especially in swarms). But for some reason, owls have been speaking to me. They are cute. They are wise. They deliver your mail if you go to Hogwarts. I feel like they are a good-luck totem for me. My first owl in the house was a metal sculpture from Edgecomb Pottery near Boothbay Harbor, Maine. He is a cute baby horned owl and sits on my mantel. I got him in April as a "just because" prize from Bryce. My second owl was a cast iron spoon rest from Arena's here in Rochester--this time a birthday prize from Bryce in May. My third and fourth owls came to me in late June--a slightly creepy, Coraline-esque button-eyed stuffed owl from a shop in Bar Harbor, ME and a little plate with an owl on it, also from Bar Harbor (but a different shop). These owls made me feel like I was filling my house with good juju.

My awesome corduroy
owl bag
So, when I was starting my first IVF cycle in August, I felt I needed a special owl prize to reward myself for going through the grueling process. I went to the Park Ave Festival and saw my prize--a beautiful corduroy pocketbook with owls all over it. Cute owls. Owls in many colors that would go with anything--and I could take my good owl juju on the go with me everywhere I went. Unfortunately that bag was sold in the booth, but very, very fortunately I could order one from the seller on etsy.com. I went to pick up my bag at the seller's house, and met a wonderful person who was also going through the infertility journey. My love of owls and need to have a special present for myself during this time led me straight to an awesome friend that I would have never otherwise met. After discovering our unfortunate similarities, I stayed at her house for almost two hours talking about the infertility journey. She invited me to her yoga class and support group for fertility, and I have been going ever since. My search for owl good luck charms brought me a friend, centeredness, and support that I may not have found otherwise.

Sparkly owl pendant
with "moon"
The day of my actual egg retrieval, Bryce had to go back to work for a meeting. I could not be left to my own devices as I was on Percoset and in more than a bit of pain. Enter my friend who came to be my nanny for the day and watch "Love Actually" with me as I drifted in and out of consciousness. This friend brought me another owl--this time an awesome, sparkly pendant. It is not something I would ever have picked out for myself, but I felt it was a very special owl as it was a heartfelt gift and I could wear it on me and REALLY take my good juju everywhere I went. I wore the owl throughout the remainder of the cycle. That cycle didn't work out, and (among other things) I superstitiously think part of it was because my owl pendant was compromised. About a week after transfer, I went for an easy hike in Penfield with Bryce and our new greyhound. There was a bizarre tropical cheeping sound coming from the ground near the trailhead, and hopping around the ground was someone's grey and yellow cockatiel. A profoundly NOT good luck bird, a creepy bird, especially when it flew up on my shoulder and wouldn't leave. The stupid evil bird proceeded to bite at my neck and bit my chain right in two, causing my good luck owl to drop to the sidewalk. I was incredibly upset. This HAD to be a really bad omen. Some freak tropical pet bird flies up on my shoulder and bites my owl charm right off my neck? That is NOT good juju. But, with a new chain the owl has been cleansed of its unfortunate ravaging by the cockatiel and is now, once again, a good luck charm. Maybe wearing it for the entirety of the cycle (and timing the cycle in the winter when birds are less plentiful) will make a difference.
This is the moment--that bird is
biting my chain right off my neck. 

Quilted Owl
This Christmas I was swamped (happily) in owls--I got a set of beautiful quilted owl ornaments from a good friend, an owl ornament from my mother-in-law, a beautiful Hedwig-esque snowy owl print from my mom and stepdad, an owl water bottle from Bryce, and an owl charm on a Troll bracelet. I am swimming in owl goodness.

Which brings me to my next set of good luck rituals, thanks to a friend from the yoga group. She let me know some tips that were given to her by her acupuncturist, and since she got pregnant with her son that cycle I am more than happy to follow them. Ritual #1: Make space in the house for your future baby. Make sure that baby knows you are ready for its arrival so that it can come to you. I have a guest room that I redid in the past couple of years and I have made it my meditation space. It is a soothing space filled with picture books and drawers full of pregnancy books that friends have passed on to me (but I am not ready to read yet). It will be the baby's room one day (soon). Ritual #2: Buy something for your future baby. In the fall I kept passing a onesie in Target that caught my eye. It had a cute frog in a lotus pose on it, and I wanted it but couldn't justify buying a onesie for a nonexistent baby. Finally, Bryce said "Just BUY it!" and so I did. I stored it in my injection closet on top of all the boxes of medication and bags of needles that I would be using for my next cycle. After getting this piece of advice from my friend, I washed the onesie and matching bibs that I bought. The onesie is on the bed in the guest/meditation room so that I can have it near me when I'm relaxing in there. The bibs are stuffed in our pillowcases. Weird? Maybe. I am definitely letting this baby know it can come anytime!!! Ritual #3: Burn red candles. Burn them all the way down until they go out if you have time, and if not snuff them out, don't blow them out. Not sure what's behind this, but I was so excited because I had just filled the house with red candles for the holidays. And we bought a snuffer in the same shop in Bar Harbor as the little owl plate, so I have been snuffing and not blowing out my candles anyway. I bought more red votives and tea lights and have been continuously burning red candles. And snuffing them. (Tea lights are kind of cheating because they burn out in a couple of hours max, but I don't think that hurts the ritual.)

All of these things may seem silly and superstitious. Is a house full of owls, red candles, and empty onesies really going to make or break my chances of getting pregnant? Maybe not. But it can't hurt. I am adding all of these tokens and charms and rituals to my arsenal for IVF #2 -- Future Baby, we're ready for you!

Sunday, December 26, 2010

Ins & Outs of IVF

I have realized that I throw the term "IVF" out there all the time, and haven't really explained exactly what that is. IVF, or in vitro fertilization, is the top of the food chain when it comes to infertility treatments. It is the best shot and the end of the line for those who struggle with infertility but want a biological child. When paired with egg donation, sperm donation, or embryo donation, IVF can even give you a partially biological child that you nurture internally and give birth to. It is an amazing process and the technology really blows my mind. What blows my mind even more is that it is largely not covered by insurance -- some states mandate coverage but NY is not one of them. Yet, with IVF you have the least chance of multiples since the process is so controlled, and it has tremendous diagnostic value. You can actually see the egg and the sperm interacting, and see what happens when they meet and multiply and turn into embryos (hopefully). Your second IVF has a greater statistical chance of working than your first, in part because of everything your medical team can learn about how your reproductive functions are or aren't functioning by monitoring everything happening the first time. This is why I am not totally depressed that IVF #1 didn't work out, because it gives us a much better chance of succeeding with IVF #2. (Hopefully we end there!) So, here are the ins and outs of each stage of IVF, for your educational reading.

Phase 1: Suppression
Suppression looks differently for different protocols--some people need more and some people need less. For me, suppression is the birth control pill and then Lupron injections with the pill for a week, then just Lupron alone for a week, then a low dose of Lupron until egg retrieval. The Lupron basically shuts down your system so that it starts from scratch with the medications that encourage follicle development. It puts you into a menopausalish state so that the medical team can really finagle everything going on without your own hormonal surges (which in my case are faulty) interfering. The low dose of Lupron throughout the cycle is to keep you from ovulating on your own, which is a very bad thing with IVF. About a week and a few days into Lupron injections you have your baseline ultrasound, to make sure that your ovaries are nice and quiet (no cysts). If it's your first cycle, they do a trial transfer to get measurements on your uterus and practice threading the catheter through your cervix to deposit embryos without disrupting the uterine lining. Lots of fun. If all is clear, then you move on to Phase 2.

Phase 2: Follicular Development
In a typical woman, each month one follicle develops on an ovary, grows to maturity, and then ruptures, releasing a mature egg on its journey to be fertilized (or not). When you do an injectible IUI (intrauterine insemination), you are doped up on Follicle Stimulating Hormone (FSH) so that you produce multiple follicles and give a better chance for sperm to hit their mark. Typically you don't want more than 4 or 5 mature follicles because you don't want to risk having a litter. With IVF, you are pumped up with as much FSH as is appropriate for your given diagnosis or issue, because you want as many eggs to reach maturity at the same time as possible since they will not be fertilized by chance by roaming sperm inside your body. They will be fertilized in a very controlled environment and then a limited number of embryos are returned to their cozy home. Therefore, the follicular development phase in IVF is INTENSE. In my first cycle, by the end I had 18-22 or so follicles that looked like they could be in the mature range by egg retrieval. Sounds like a lot but not all of them will survive to embryo stage. Because so few of mine did the last time, I am being pumped way up to produce lots more. To put this in perspective in terms of bodily comfort: a normal ovary is about the size of an almond. Mature follicles are around 18-24 mm in diameter, and if you have 18-30 or so of them (say, 10-15 on each side), your ovaries blow up to the size of large navel oranges. If you experience mittelschmerz, or the sensation of pain at ovulation, you have an idea of what ONE follicle can give you in terms of pain. It is not comfy! I find that wearing elastic or stretchy waisted pants a few days into injections is absolutely necessary. I am puffy and visibly bloated. Plus, in order to get your follicles to do their thing, you need to take FSH via injections. I take two medications: Follistim and Menopur. Follistim is probably my favorite because it comes in a pen. You don't even feel the needle stick because it's so thin and the pen is so much easier to handle than a syringe--no awkward grip, no flicking the bubbles out that never totally disappear--it's awesome. Menopur is a different story. I hate injecting this drug because it requires a syringe AND it requires mixing powder and liquid. I am not a medical professional, so why must I turn my kitchen counter into a pharmacology lab? And, because you are drawing up liquid and then injecting it into the vial of powder and swirling it around to draw back up into the syringe so that you can inject it into your unsuspecting belly, there are particles in the liquid that don't totally dissolve. These particles equate to a very, very unpleasant injecting experience. The shot burns like a motherflipping wasp sting. You can't get the medication on your skin because it's an irritant (awesome) and if you manage to get it into your belly fat without getting a drop on you, you just get to go straight to the awful awful burn. I did discover after speaking with a nurse about how heinous the shot was that icing the injection site before swabbing and sticking makes a HUGE difference. I will tell you I am not excited about injecting the new dose of this drug, because it involves drawing up the liquid, injecting it into the powder, swirling, drawing up the mix, injecting it into another vial of powder, swirling, and THEN drawing up so you can inject twice the particles into  your scared little belly. Should be fun. BUT, as unpleasant as that drug is, the combo of it and the Follistim make for some beautiful follicle growth. Which leads to Phase 3.

Phase 3: Trigger/Retrieval/Fertilization
Throughout the follicular development phase, you are monitored with ultrasounds and bloodwork to make sure that your follicles are developing nicely and your estrogen levels are rising appropriately. Once everything looks awesome (and you are supremely bloated, stabby, and uncomfortable) you are cleared for trigger. You take your Ovidrel shot, which maybe you've taken with IUIs before. Before, the trigger shot served to release your eggs from the follicles so that after the insemination the sperm would have something to meet. Now, the trigger shot serves to ripen the eggs in the follicles so that they are mature and ready for harvest. The terms are more than a little surreal--I feel kind of like an egg farm at this point. The follicles really swell up after trigger and the day after is incredibly tender. However, the day after trigger is the first day that you have NO SHOTS! Not one. No Lupron, no Follistim, no Menopur, nada. Which is nice because after retrieval you trade 3 comparatively dinky 1/2 inch needles for the mother of all needles. The day after trigger you go in for your egg retrieval, which is a surgical procedure under anesthesia where an ultrasound-guided needle is used to pierce the vaginal wall and go into each follicle to flush and retrieve those precious eggs. Sound uncomfortable? It is. You come out of the surgical room and your ovaries are incredibly sore. Apparently, after they're flushed, they seal back up and fill with fluid and can actually be bigger than they were before. Percoset is a lovely prize after that procedure. You can ask about your egg haul (but you won't necessarily remember it through the haze of anesthesia), and they will be able to tell you how many were harvested. You have to wait to see how many were capable of attempting fertilization and how many actually fertilized. While you were out, your husband produced his contribution and then his washed and hand-picked swimmers are prepared to be injected into your mature eggs in a dish. Amazingly, injecting sperm into an egg does not guarantee fertilization. Your eggs are fertilized and then you wait for your call from the embryologist the next day to see how things are going. From the moment those eggs leave your body, you are totally and completely obsessed with how they are doing. In the days leading up to my retrieval, I was consumed with the idea that I had ovulated through the Lupron. If this happens, there are no eggs to retrieve and the shots are for nothing. I was terrified of this. Once I was assured that my eggs stayed out, my new obsession was how many? What quality? How are they doing? You trade one stress for another.

Phase 4: Transfer and Wait Wait Wait
The day after retrieval, you get your call from the embryologist with news on the progress your little pre-babies are making. They tell you how many embryos you have and whether you will have a Day-3 or Day-5 transfer. I had a Day-3 transfer, which means that our embryos were better off back in my uterus than continuing to develop (or not) in the petri dish. Embryos should have 8 cells by Day 3. A Day-5 transfer means you have super hearty embryos--they have to be blastocysts (many many cells already divided into the part that will be the baby and the part that will be the placenta). This kind of transfer has a higher success rate, but it is a gamble to see if your embryos will make it that far. If you have extra embryos, they have to survive to Day 6 in order to be frozen for future cycles. Those are SUPER hearty embryos because they must survive the freezing and the thawing process. I didn't have any of those last time but sincerely hope to this time. A frozen cycle is much more economical than starting all over fresh. I got my call last time that I had 5 embryos, and by the time my transfer came I was left with two viable embryos: one was 8-celled and the other was only 6, but they transferred both in case the other was just playing catch-up. You go to the same room where you had retrieval, but this time you are awake and there are no needles jabbing your privates. You get a picture of your embryos and they inject them through a catheter into your uterus. You can see the whole thing on the ultrasound screen--the embryos are too small to be seen with the naked eye but you can see the swish of fluid containing the embryos go out into your uterine cavity. It is really, really cool. Now all that is left to do is wait. Well, wait and get a giant shot of progesterone in your behind every morning. It's really kind of mean--you have to start the progesterone-in-oil (PIO) shots right after egg retrieval, and then you continue them until either you get the news that you aren't pregnant, or if you ARE, you get to take them for up to 10 weeks or so! Yikes. This is a 1.5 inch thick needle in a syringe that has to be injected into your butt muscle on your outer hip area. I CANNOT do these myself, Bryce has to do them. But, they are vital, because they keep your lining nice and plush and keep it possible for an embryo to implant and grow in your uterine environment. But they suck. Icing is mandatory, as is heating your ass where the shot was because otherwise you end up with big lumps of oil and bruising. It really is nasty. But, it is all worth it when you get your "Congratulations!" call after the wait is over! (I'm only entertaining the "Congratulations" call at the moment, not thinking about the "I'm so sorry" call I got in September that was nothing less than devastating.) Just a note, though--the progesterone is mean. It mimics early pregnancy signs, so you have tender boobs and super tiredness but it's likely the progesterone, not actual signs of pregnancy. It fools you and plays cruel mind games with you. Only the call will tell you you're pregnant!

So there it is, IVF in all its intense, magical glory. I am SO grateful to have this technology available. I am SO lucky to have a husband who is a willing partner in undergoing all of this craziness so we can get pregnant and have a baby. I am SO appreciative of all the many people who are very familiar with my reproductive system and will make this dream a reality.

Thursday, December 16, 2010

The Positive Power of Meditation

It's a great and terrible irony -- stress can keep you from getting pregnant, but infertility treatment is incredibly stressful. You are encouraged every which way to relax and live in the present and let things roll off your back so that your body can accept a new life. However, I would like to see the average person relax when they have to get up earlier than the usual early time to prepare injections and then actually stick that needle in their own stomach, endure icky transvaginal ultrasounds on a regular basis, get stuck for blood draws to the point where you look like a smack hound and you're told next time just might be in your hand if your veins don't start cooperating, experience incredible fluctuations in hormones that make you absolutely bonkers (as in unpleasant, unlivable, with the frustration tolerance of a flea)... the list goes on and on. It can be incredibly frustrating to be told over and over again by medical professionals, yoga instructors, books and magazines, internet sites, well-meaning people you know, etc. that you really ought to find a way to relax during this process.

BUT, unfortunately, there is weight to that argument. Despite the hectic lifestyle of a person with a consuming full-time job going through infertility treatments, I have had to just make way and carve out a space for relaxation. And the way that I have found most helpful is through meditation. Not just meditation where I sit in a room carpeted in river stones and filled with potted bamboo plants (although that would be super cool, and I once knew a family who were practicing Zen Buddhists and had that setup in the living room of their apartment). Because "quieting your mind" on your own is incredibly difficult when your mind is racing with all the what ifs and guilty feelings and medicated insanity that I've mentioned in previous blogs. I'm talking guided meditation and visualization aids. I discovered it with my first injectible cycles and it is phenomenal. It forces you to relax. Eventually, even if your mind is racing at the beginning, you can focus on the images and breathing exercises being given to you through your headphones and surrender to the deep relaxation that is offered.

Here are two of my favorite meditation sets and why:

Healthy Journeys with Belleruth Naparstek: Help with Infertility
I bought this as a set of MP3s (since I was just going to download it to my iPod anyway) for maybe $13. It is awesome! There are four exercises: Conception, Affirmation, Relaxation, and Meditation. The Conception one is my favorite because it helps you to visualize what you hope is happening inside (or in my case at this point, outside) your body--the meeting of egg and sperm, the multiplying, the implanting. It is very soothing and visualizes you with the child you were meant to be with, and guardian beings (ancestors, spirits, angels, whatever you choose to envision) surrounding you and rooting for you. It is incredibly powerful and made me cry the first few times I listened to it. Affirmation is also great--it is a series of statements that you repeat to yourself in your head that validate the many feelings that go with infertility and help you realize your strength and courage and the faith you must have in your body. Relaxation actually has no fertility-related words in it at all and is great to fall asleep to. I have used some of the visualizations in this meditation for the final relaxation pose in yoga and it has been very helpful for quieting that busy mind of mine. Meditation is meant for after a failed cycle or disappointing news, or if you are taking a break or are ending treatment. It is very calming and reassuring but I can't bring myself to listen to it after a disappointment because it makes me cry. So I focus on the positive ones!

Circle + Bloom Mind/Body Program with Joanne Verkuilen
I just recently bought the IUI/IVF specific program for Circle + Bloom, and I LOVE it. A friend recommended it, and as I will try anything at this point, I bought the set of CDs (not cheap, retail $69.95 but thanks to a holiday 50% off sale I got it for way less!). This set of mind-body visualizations is specific to your cycle, with a different exercise to listen to every two days. There are even exercises specific to trigger, egg retrieval, and transfer. There are also precycle meditations to prepare you during the wait period before your follicular phase begins and you really feel like you are rolling towards your big day. I previously experienced horrible insomnia with Lupron, but since I've been listening to Circle + Bloom before bed I am not experiencing that at all. These put me into a very deep relaxation state. They calm you and quiet you, and then help you to visualize what your body ought to be doing at that moment in your cycle. Then they give you visualizations to help you feel more in control. Which is important. So far, I am a huge fan of this set of guided visualizations.

It is hard to find the time to do these, but I do it because they are so helpful to me. I can only hope that the increased sense of control by being able to use my mind to help my body, the deep relaxation, and the improved sense of well-being that these meditations give me will help us to achieve the goal we are working so hard towards!

Sunday, December 12, 2010

Happy Holidays?

The holidays are really, really hard when you are dealing with infertility. I feel a little more prepared this year than last, but it is amazing what will bring me to tears. In hopes that maybe it will help people understand the minefield that is the holiday season for the fertilely-challenged, here are situations that can be particularly difficult.

  • Holiday Cards. I love getting holiday cards from friends and family: seeing what people are up to, filling up my sliding-glass door windowpanes with festive images. But at the same time, holiday cards can be a very painful reminder that everyone seems to be celebrating the holidays with their beautiful babies and small children and you aren't. Last year I opened all the cards, ooohed and ahhhed over all the babies and toddlers, and then promptly displayed the small children at the bottom of the door/red velvet ribbon so that everyone else's fecundity wasn't staring me in the face over dinner. I love seeing cute pictures of adorable children. It just makes a person cry when you realize how many people have the family you dream of and how far behind the eight ball you are even though you are trying so, so hard. I decided last year to do photo cards from now on even though we don't have children to showcase. Last year our card was wedding photos--this year, I chose pictures from our Maine vacation for our card. I put all the animals' names on the card even though we don't have any pictures of the animals on the card at all, because at the time "The _______ Family: Bryce and Jess" sounded small, even though we most certainly are a family of two. Holiday cards can be hard to receive and hard to put together when you were hoping to have a family portrait with a new addition (or at least the announcement of a new addition) and it just hasn't come together yet. 
  • Christmas Carols. I know, this one is weird. But think about it--all religious Christmas carols center on the arrival of a very special baby. The entire Christmas holiday is about the birth of a miracle child. Secular Christmas carols often center on the joy that Christmas brings to little children (minus songs like "Baby It's Cold Outside," a song I always thought was a date-rape anthem and falls into the "It's Christmastime, let's get it on" carol category). When you yourself are sans miracle baby and sans small children to bring Christmas joy to, hearing the carols all the time can trigger waterworks. I love Christmas music and listen to it all the time, but have to prepare myself that sometimes the songs will make me teary. Or, like this morning when I was listening to Annie Lennox's verson of "Universal Child," dissolve into a full-on sobfest while driving home from Dunkin Donuts. It's a catch-22. Christmas carols make me very happy, but at the same time can catch me at a moment where all the joyous baby tidings just make me incredibly sad. 
  • Family Parties/Work Parties/Friend Parties Involving Lots of Small Children. I don't personally have this issue as most of my extended family with small babies/toddlers live far away and we don't get invited to kids' parties from friends. So, I don't have to go to parties like this for the most part. But for people who do, being the reproductive-age-married-no-children people at the party can be awkward and uncomfortable and cause sadness--because you want to be making holiday crafts with your little kid and probably someone is going to ask "So when are you going to have kids?" Luckily, since I have been very open about our situation and have very supportive family and friends, the only people who would ask such a thing are friends-of-friends or distant relatives who don't know what we're going through. (And I have decided that my strategy for this year is to point-blank tell people nosy enough to ask exactly why we don't have kids yet.)
  • Holiday Parties in General. This is mostly because the holidays are full of fun drinking cheer -- wine! eggnog! cocktails! -- and if you are in a treatment cycle you can't have any of it. Which makes people do stupid things like wink at you exaggeratedly ("Not drinking tonight? Hmmmmmmm? Anything you want to tell us?") or flat out ask if you are pregnant. Offering the excuse that you are on antibiotics or got really drunk last night so you couldn't THINK of drinking tonight only work for so long before people either think you have tuberculosis or are a raging alcoholic. And, if you are in a treatment cycle you do not feel well and even can be bloated enough to look a little pregnant--which only fuels rumors and winking. These parties also tend to be filled with people you don't really know--friends of friends. People who will ask you if you have kids or assume that you have kids and say something like, "Great to get away from the kids for a night, huh?" All of which can make a person struggling with infertility suddenly feel a whole lot less festive. 
  • Shopping. I did the majority of my Christmas shopping online this year. Partly because I am pressed for time, partly because I hate crowds, but also partly because Christmas shopping can be incredibly difficult, especially at the mall. The mall is filled with children, and strollers, and giant pregnant bellies. I used to think if I went to the mall all the time I would surely get pregnant because it is such a fertility hotspot--look around next time! There are babies and bellies EVERYWHERE! Of course, that could just be because my mind zooms to that immediately. I am  super sensitive to the presence of babies and pregnant women. I have mommy-dar. There are cute onesies everywhere. Onesies tend to make me cry too. Case in point: In Maine we walked into a store that had a onesie that said "Stud Puffin." I left the store sobbing. For some bizarre reason I wanted a reason to put my nonexistent baby in a "Stud Puffin" outfit. Another example--a catalog had a onesie that said "I was worth the wait." I almost bought the damn thing because it will be so appropriate, but teared up and decided I didn't need to spend $30.00 on a onesie for a baby who won't be here for quite some time. So, I can still get ambushed by catalogs and websites, but it is a lot harder since I can ignore baby-centric stores. Unlike the mall which is teeming with stores and actual babies. 
  • Facebook. Oh Facebook, I have such a love/hate relationship with you. Over the next few weeks I will not be trolling through my Home page so much. That's because over the next few weeks Facebook becomes photo after photo of babies and children and happy families frolicking in the snow, picking out Christmas trees, opening presents, eating Christmas cookies, etc. Seeing them in isolation is fine but when it is 90% of the content it is a bit much to take. Also, people tend to start posting things like "Christmas is so much more meaningful when you have children" and "Ah, Christmas is really for the children" and "I love Christmas so much more now that we celebrate it is as family." Maybe not exactly those posts, but close enough. I get it, and I appreciate the sentiment, but for someone who really wants to share a holiday with the joy of a child and can't, it makes me feel like my Christmas is worth crap because I don't have kids. Which is totally not true, Bryce and I do a really good job of celebrating just the two of us and having fun traditions. But seeing all those posts can have the knee jerk reaction of "My Christmas is so empty."
The holidays are a wonderful time and Christmas is one of my favorite holidays. I still feel a lot of love and joy and spirit of giving. We have decorations and traditions of our own that we will one day share with our children. But it is still a mixed bag for people going through infertility. I experience the sadness but try to have more joyful moments with the wonderful life we have now. 

Thursday, December 9, 2010

Sticky Situations

Infertility is not easy on so many levels. Physically it is challenging and demanding. Financially it is draining. Emotionally it is exhausting and difficult. But it is also rife with ethical issues. A lot of really, really hard questions, choices, and decisions are considered and made during the process--especially at the IVF level. Because this adds another layer of complexity to this experience, I thought I'd share some of the ethical concerns I've personally grappled with on the journey.

ProChoice and IVF'er?
I have always been Pro Choice. I believe that a woman's body is her business, and that the choice to have an abortion is not by any means an easy one but that it can be lifesaving in many ways. I have spent a lot of time carefully using words like "fetus" and "embryo" and have tried hard NOT to personalize a cluster of cells as a baby. A potential baby, yes, but actual baby? No. So now I wrestle with that, since the cells clustering (or not clustering) are our potential babies, I can't help but personalize. I get excited to see how many embryos I might have, because those embryos would be my baby/babies. And if I was successful at an IVF attempt but lost the pregnancy at a very early stage, I would most definitely see that as a baby loss, not a cluster-of-cells loss. I can reconcile this newer outlook with my Pro Choice belief because this is my experience, my body, and my choice. Just because I am struggling to get pregnant myself does not mean that I begrudge other women in difficult circumstances their right to terminate their unwanted or dangerous pregnancies. (I also don't begrudge myself the right to wonder how it is that people who don't want babies can get pregnant and I can't when I desperately want one, but that's besides the point.)

Selective Reduction
Moving on to a somewhat related note, "selective reduction" is a term that haunts infertility and adds fodder to people who think that infertility treatments take the sanctity of life lightly. If you become pregnant with high-order multiples, it can be dangerous to carry them all to term--dangerous to the mother, dangerous to the fetuses. Or, you can be pregnant with triplets and have an "incompetent cervix" and risk losing all of the babies. You are urged to consider selective reduction, where the doctors determine which fetus(es) are least likely to survive and "reduce" them (abort them) in the best interest of the strongest fetus(es). Sound harsh and Darwin-esque to the extreme? Let me assure you, NO ONE wants to be put in the position of having to undergo selective reduction. It is traumatic. You risk losing all of your potential babies. It is horrific emotionally and physically. The good thing is that most clinics have guidelines in place for treatment to prevent the need for selective reduction in the first place. Most of the time this happens in IUI and not IVF, since with IUI (intrauterine insemination) your ovaries are stimulated to make multiple eggs but how many fertilize is not controlled beyond how many follicles you are permitted to have at the time you undergo insemination. The result is totally dependent on how many sperm reach how many eggs in the body. With IVF, many eggs are fertilized outside the body but usually only 1-3 embryos are put back in depending on age. It is possible for embryos to split once implanted and for you to end up pregnant with triplets or more with IVF, but it is very rare (at most conservative clinics). Jon & Kate Plus Eight and the Octomom are not the norm. (In fact, the Octomom's doctor lost his license because it is totally irresponsible and dangerous to implant that many embryos on purpose!) So, selective reduction is unlikely to be a choice that I have to make at this point. But I have thought about it and the repercussions of being in that situation.

What Happens to Those Embryos?
Before you can even start an IVF cycle, you need to sign all sorts of paperwork. Paperwork that necessitates having a conversation with your husband that you never in a million years imagined earlier. What happens to your embryos in the event of a divorce, the death of one parent, or the death of both of you? Even though these embryos are a cluster of cells, they are still worthy of a pre-nup of sorts. You need to think about what happens to them. If you divorce, who gets them? Or do they get destroyed so no one gets them? Same thing if one or both of you die. Do you say "Ok, you can have the embryos if I die so that you can implant them in your new wife and have a piece of me live on in a somewhat creepy way?" Or do you say "If I can't be there, they go bye-bye!" It's a very serious conversation. You also have to think about what you will do if you have surplus embryos and you are done building your family. Do you save them just in case? (Storage is not free.) Do you destroy them? My clinic does not have the option to donate them, which is unfortunate. They used to up until 2005, but I'm not sure why that option went away. I am personally hoping that once you store them on your own (in another storage facility, not amongst the ice cream) you can find a way to do that if you would like. Although it's really odd to think of a child with both my and Bryce's genetic makeup walking around in someone else's house somewhere else in the world, I can't imagine what a gift it would be to give that option to another couple not as lucky. Of course, this is all hypothetical--you sign away your embryos before you've even taken a single shot of follicle-stimulating hormones. It turned out on IVF #1 that we didn't even have any embryos that met the quality specifications for freezing, so at this point we do not have to worry about that. I will tell you that not having embryos to freeze was a devastating part of my last cycle. I didn't want a zillion, I just wanted enough so that I could do a (much, much cheaper) frozen cycle if it didn't work out, or if it did work out and we wanted to try again for a sibling later on the cheap. We may have to worry more about these decisions with this next cycle, as they want to increase the number of follicles I produce dramatically in hopes that I will produce more better-quality embryos. In a way, we will be lucky to have to seriously consider what to do with physical, existing embryos.

When Is Enough...Enough?
Hopefully we don't have to come to this point, but we have to discuss it at length anyway to make sure we are on the same page with when to stop treatment. Financial considerations definitely play a part, but a bigger concern is... what am I really doing to my body with all of this? I am pumping my body full of drugs that stretch my reproductive organs to their limits. It takes weeks to have your ovaries recover back to their normal size and stop being tender after egg retrieval. All of the literature explaining the risks points to the fact that pushing so many hormones through your body does carry a higher-than-average risk of ovarian cancer. Taking the follicle stimulating hormones increases your estrogen levels to astronomical heights--you are monitored throughout the process to prevent hyperstimulation, but it does happen. OHSS, Ovarian HyperStimulation Syndrome occurs when your estrogen levels spike and the fluid that fills the follicles starts filling your abdominal cavity as well. In extreme (and very very rare) cases, you can end up in the hospital to drain the fluid because it can surround your lungs and your heart and other organs and be fatal. It is scary shit. IVF puts you at the highest risk of OHSS, because they can pump you up to produce as many follicles as possible since fertilization occurs outside the body. My estrogen on my last cycle hit 2425 at last monitoring. (To put it in perspective, on my last medicated IUI cycle it was 490 at the highest, and on my last non-responsive clomid ridiculousness cycle it was 49.) Close to 5,000 and you are entering serious OHSS danger zone material. If you go too high, the clinic will cancel you in the interest of your well-being. But again, you have decisions to make--how high are you, personally, willing to risk? What is the price to your body for the baby you want so badly? When do you cry Uncle and decide that a biological child is no longer a safe option for your health? (I'll tell you--I am DEFINITELY not there yet.)

So there you go--IVF is a very serious and complicated procedure on a physical level, but it is absolutely just as complicated on an ethical level. We have made our choices and we stand by them, because we believe that we have the right to try for a child that is ours biologically. A child that has my vocabulary and spelling acuity and Bryce's scientific mathematician mind; our musical sensibilities and creative bent; Bryce's green eyes and my curly dark hair. Or maybe a total anomaly child who is super sporty and looks like neither of us, but we will love to the point of embarrassment. We are not yet ready to wade through the ethical dilemmas and sticky situations inherent in adoption (and there are a LOT of considerations on that avenue to parenthood as well). We'll explore those when and if we decide to go that route. But, for the time being, we will continue to wrassle with the viscous mass of IVF issues we're mired in and make the best choices we can for our family-to-be.

Sunday, December 5, 2010

What if...

It is no secret that I hate infertility. Am I growing as a person because of my experiences, am I learning things about my capacity to deal with a crap hand, am I meeting a new community of women I wouldn't have otherwise? Yes. But it doesn't change the fact that I HATE INFERTILITY. One major reason why I hate it (other than not being able to perform a basic human function, having it take over my life, the sheer expense of it...) is because of the guilt factor. I'm sure that the "reproductively-typical" people out there have their share of guilt throughout a pregnancy and into rearing kids. However, when you are among the infertile, the guilt starts way, way earlier. And lasts into the pregnancy and beyond. You are lost in a sea of What-Ifs.

  • What if all the joking I did in my first marriage about how "I can't have kids, I'm barren" when faced with the inevitable "When are you having kids? You should really have kids" questions was a self-fulfilling prophecy? 
  • What if I hadn't been on the Pill for so long and could have figured out the PCOS piece earlier? 
  • What if I hadn't gone to pick up our new greyhound on the same day as transfer instead of chaining myself to the bed? Would I be pregnant now? 
  • What if I hadn't accidentally gotten into wheat a few days after transfer? 
  • What if I hadn't moved tables around in my classroom before the first day of school, even though I wasn't supposed to lift things over 15 pounds for a week or two after transfer? Did I dislodge implanting embryos? 
  • What if it wasn't a true negative in September, but that I had started implanting and something I did interrupted the process? 
  • What if I haven't been eating enough leafy greens, buckwheat, superfruits, and organic whole milk to get ready for the next go-round? 
  • What if in wishing for twins I doom our children to complications that will affect them their whole lives? 
  • What if putting all of these hormones in my body at high levels makes it more likely that I will die in my 40s of ovarian cancer, leaving my husband and precious children behind? 
  • What if we experience a loss after everything we're doing to just get pregnant? Will I be able to forgive myself for not being able to hang on to that little whisp of life?
  • What if I do everything right this time: I eat all the right things, I lay in bed for days after transfer, I have my superpositive outlook...and it still doesn't work? 

The list goes on and on. Do I know that rationally, it's unlikely that everything about my infertility is my fault? Yes. Does it stop me from thinking about every possible cause for something that doesn't necessarily have a clear cut-and-dry answer? No. I envy people who go away for a weekend and get drunk and go dancing and get pregnant and stay that way. I envy people who go to the gym every day or lift heavy things or have a glass of wine and don't realize they're pregnant and it has absolutely no impact on whether an embryo implants and grows.

I try to let go of the guilt and worry that surrounds infertility, but sometimes it is just not possible. I just have to let these nasty little thoughts come into my consciousness and then try to stomp them flat or put them away in little jars or light them on fire so that they transform into ash. But I don't think I can ever truly stop those thoughts from coming back. It's all part of the process.

Monday, November 29, 2010

Introducing.... Lupron

Seeing as how at some (undisclosed) point I will be going through the IVF wringer again, I thought I would spend a little time on Lupron. It's the first non-familiar drug most people take when doing IVF (the first drug is the Pill in some but not all cases, but most people are familiar with that one!). It starts Phase One of IVF--Suppression.

In my case, in part because I have PCOS and have wacky hormones but respond really well to the ovulation stimulation drugs, I am suppressed by both the Pill and Lupron. Once the Lupron starts it's very exciting--the countdown is on for stimming medication (and Follicle Watch begins!). The point of the suppression phase is to shut your system down temporarily so that your amazing medical team can take over artificially via the FSH/LH stimulating drugs you start later. In order to get prepped for possible pregnancy, your own dysfunctional body has to be told to shut the hell up, basically. It's disturbing because essentially you are throwing your body into menopause for a short while before you are kickstarted into SuperFertility. I sincerely hope it is not a totally accurate preview of what's to come.

Lupron itself is one of the cheaper IVF drugs, and it is not scary looking. It's clear, it's stored in the refrigerator in a little vial that does not have to be mixed mad-scientist fashion on your counter, and it requires a teensy needle. Lupron is injected subcutaneously (into the fat under your skin) with an insulin needle--it's a skinny syringe with a superthin 1/2 inch needle. It is a breeze to pull up, a breeze to inject, and it doesn't burn or sting going in. What's not to love?

In my opinion, a lot. Once the drug is in your system and starts doing its quick-and-dirty menopausal magic, it can wreak havoc on your body. I had read a lot about Lupron before starting it over the summer, and was terrified of "Lupron Rage," "Lupwon Bwain," hot flashes, night sweats, and the very scary sounding "Lupron Bleed" that one book says can require lining your car with garbage bags so you don't ruin the upholstery. Ew. My actual experience was pretty nasty, but not the laundry list I read about. I definitely had increased irritability, more so than with Clomid (or at least I thought so, not sure if Bryce agrees with me there). I had the brain farts--it is so frustrating to know what you want to say but to lose the words to get it out there. Or to start a sentence and halfway through completely and totally space on what you were talking about. I definitely had hot flashes, which in the summer is just cruel. I was working mornings at the Red Cross Baking Work-Study with my student and had to wear a lab coat--despite the A/C I ripped it off and ran into the walk-in freezer more than once. Night sweats were not an issue, although apparently I radiated heat like a brick oven. I did not experience a horrible hemorrhage as I was warned I might. BUT, I did suffer hideous, awful insomnia. The kind I have never been unlucky enough to experience. I would fall asleep ok at about 11, but then wake up at 2 or 3 in the morning and...stay awake.  I would listen for the birds to start bringing on the dawn. I would watch the sky get light. I would read by the early morning light until it was an acceptable time to get up and go to work, on 3-4 hours of sleep. Which once is manageable, but every night for a week is just horrific. It magnified the irritability. I had nowhere else to go because we were sleeping on the futon at the time while our bedroom was being renovated. The guest room upstairs was floor to ceiling full of our bedroom furniture. I was trapped. Luckily I talked to a nurse when I went in for a monitoring appointment, and she let me know it was ok to take Benadryl, and if that didn't work that there might be something that could be prescribed. At this point they were about to halve my dosage, so the Benadryl was enough. That was a small miracle, and such a relief! And, after the dosage was halved and the estrogen-increasing drugs were started, the insomnia and hot flashes went away entirely. Which is good, because I was on Lupron from two weeks or so before I started the stimulation meds all the way until just before egg retrieval. (After you get your ovaries to make a bunch of follicles, the Lupron helps you to NOT ovulate on your own so that the precious little eggs can be scooped up at retrieval and set up to dirty dance with the hand-picked sperm in the petri dish.)

I guess it's good to know what to expect this time, although everyone reacts a little differently. I hope you react differently each time and I can skip the insomnia, although now that I know Benadryl should help it will be better!

Monday, November 22, 2010

Prenatal Anxiety

Every month, or every other month if I've thought ahead, I have to go into a store and do one of my least favorite chores. The store is GNC, and the chore is buying prenatal vitamins.  GNC carries prenatal vitamins without iron, which is great for sensitive stomach types. I figure if I need the ones with iron they can tell me that when I'm actually pregnant and nauseous anyway.

So why is buying vitamins at a supplement store so stressful? Because I have been buying prenatal vitamins for nearly a year and a half. And I have nothing--not a baby, not a bump, nothing but the satisfaction of due diligence--to show for it. Just anxiety and a couple of self-pitying experiences.

The first was just a few months in, and was more of a shot to my vanity than anything else. The guy behind the counter rang me up and then said "Congratulations, are you having a boy or a girl?" Granted, he looked like all he knew about from women he learned from his mom, so he probably didn't know that you have to be about 16 weeks to find out the sex. This was when I was skinnier, and I certainly didn't look 4 months pregnant! I mumbled, "Oh, I'm not actually pregnant, see they're PREnatal vitamins so you're supposed to start taking them before, when you're trying to get pregnant..." I ran out of the store and felt both chubby and a little sad.

The second was more recent--I went in and they'd rearranged the store, so I couldn't just grab them and be standoffish so the staff wouldn't feel like they had to ask me about my blessed un-event. Apparently there was a new wonder product available. A superbaby trifecta of sorts, with the regular prenatal vitamins, a calcium supplement, and a DHEA supplement. Supposedly it would optimize brain, eye, and bone development in the fetus. The salesman went on and on and made it seem like any good mom would want to ensure that amazing developmental boost for their growing fetus. I had to politely interrupt him and say, "Well, I'll think about that one when I actually have something developing in there. I'm not actually pregnant yet. It's an ongoing quest that's taking a while." He was actually really nice, and dropped the sales pitch to ring me out. As he handed me the receipt, he said kindly, "Good luck with that." I barely made it out of the store without bursting into tears. First because I had no reason to buy the superbaby supplement set, and second because this cashier was actually heartfelt and kind. I was touched.

Every time I go, I worry that there will be the same people in the store time after time and they will realize that I am still not pregnant and still buying and taking the prenatal vitamins (although so far turnover seems high). I worry that they feel sorry for me, or think I'm some nut who will come in one day with a creepy vacant-eyed baby doll tucked into my Baby Bjorn. More frequently I just worry that I am going to be on prenatal vitamins for years without actually growing a baby in my lonely uterus. I know that's probably not true, and especially given my uber-positive take on this next cycle I know that I will get to go buy those vitamins wearing actual maternity clothes sometime relatively soon. But it haunts me just a little bit every time a realize I've only got a day or two of vitamins left and have to make my pilgrimage to the GNC down the hill.

But, tonight I went in, bought my vitamins (two months worth so I don't have to go in when I'm full of holiday no-baby blues), and didn't cry in my car after. Hooray for progress...

Wednesday, November 17, 2010

Battle Plans

I am getting ready for my second IVF sometime in the near future. I have decided to approach this one with a full arsenal of supports. Not that I half-assed our last attempt at pregnancy, but there are things that I can do now that I didn't do, or didn't do as well, then. Here is my battle plan...

1. I can vow to really relax and lower my stress levels during this attempt. My stims phase was during summer school last time and our house was under construction for the bed/bath renovation we did upstairs, so up until a few days into stimming we were sleeping on a futon (or in my case, not sleeping). It was not comfortable. I was not well rested. Once we were into the stims phase I was back in my (new) bedroom, but there were still workers in the house and outside it working on stuff involving pressure spray and chipping out fieldstones in the patio. Again, not restful. This time hopefully those kinds of things won't be going on and I can truly relax. (Side note: This is not to vindicate those who would say "Just relax! Then you'll get pregnant!" This is more of a "I need to relax in spite of all the insane things I'm doing to my body just for a chance to get pregnant, so that my body is not teeming with cortisol on top of all the other hormones that are artificially introduced" kind of thing. Super relaxation on its own merits will still fail to get me pregnant...)

2. I can really and truly vegetate after transfer. Last time our wonderful greyhound, Kayak, arrived on the same day as transfer. I went anyway to pick him up and while I spent most of the time there on a bench or sitting in the car, I still feel like I didn't do as good a job as I could have resting and staying put so those embryos could settle in. My rational self knows that going to pick up the dog isn't what caused my IVF to NOT result in a pregnancy, but my more front-of-mind irrational self thinks somehow that may have contributed to our failure. Therefore, after transfer I am going home and I am going to spend the rest of the day in bed with trashy reads and movies. And the next two days will be either in bed or on couch. No chances this time! I foresee takeout in our future...

3. I can better prepare my body. I have acupuncture appointments already lined up. I have been doing Yoga for Fertility for months and hopefully that is having a cumulative effect on my body and soul. I am not as fit as I could probably be (thank you, IVF #1) but I feel good. I know what to expect this time, so I know what to do to make myself more comfortable. I am also doing Maya Massage, more on that in #5. It's important for my body to be primed because this time they are increasing my meds quite a bit--they want me to have many more follicles in hopes that this will produce more mature eggs and more viable embryos. So my stimming experience will be different but hopefully the acupuncture, specialized yoga, Maya Massage, and the special tea in #5 will prepare my body for the stimming onslaught!

4. I can better prepare my mental well-being. This helps not only me but Bryce, too. If I can stay a little more calm and centered maybe things will work out better this time. Not that I was basketcase previously, but there was a lot of nervousness and anxiety and depression and crying and feeling sorry for myself and Bryce. I'm trying very hard to approach this time with a more meditative mind. I am opening up my mental state for possibilities and trying not to even entertain the thought that it won't work. (I'm not stupid, I know it's still at best 50% likely to work, but I am going to focus on the GOOD 50%.) I am going to attempt to not drive myself crazy with every little thought of what could go wrong. I am going to invite good things to happen to me and Bryce. I am going to meditate more frequently and set intentions for my day, every day. You never know, it might work! :) In the meantime, it will at least make me slightly more stable during this process and therefore less unpleasant to live with. 

Look! Magical fertility vapors!
5. I can do some really freaky holistic stuff. Since my mind is open to possibility, I am willing to try anything within reason. Like for instance, going for a massage specifically for your abdomen to externally stimulate, increase blood flow, and realign internal reproductive parts (sounds fairly creepy, but it was felt amazingly relaxing and healing). And then purchasing a beautiful packet of whole leaf herbs that looks like a really awesome fertility tea. Smells like a delicious Tazo tea you might get at Starbucks. But this tea is not meant for consumption. Oh, no... this tea is meant for steaming your uterus and her friends. I have a picture of the crazy witches' brew looking stuff boiling on my stove. Basically, I soft-boiled it, steeped it, placed it on a trivet on the floor, and then positioned my birthday-suited self directly over it while wrapped in a blanket so no cold air could interfere with the hoo-hoo steaming. Or, as it's more endearingly called by the folks at the holistic healing center/fertility clinic where I got it, a "Vag Bath." Clearly, I am very serious about wanting to get pregnant. These activities are very relaxing, albeit a little weird, and if they help me get pregnant I am 100% behind them. Although not behind them enough openly to steam in front of Bryce (who just about fell over laughing when I explained why the house smelled overwhelmingly like a soothing herbal tea when he got home yesterday). 

I am giving it all I've got this second time around the IVF merry-go-round. I think our chances are good. Oh wait, I forgot, I'm changing my mindset. I KNOW our chances are good. 

Tuesday, November 9, 2010

To The Pregnant People

Ok, so I am going to be brutally honest here, and hope that you respect my honesty and don't think that I'm a bitter jerk. I fully admit that I have a double standard when it comes to pregnant people.

When someone tells me (or posts) that they are pregnant, my first genuine thought is "I am so happy for you!" I am actually happy for people who can have babies when they want to. However, my thoughts then tend to shift to  feelings of sadness, jealousy, hope, or even anger. It all depends on who you are. If you are someone who I am very close to, I will feel mostly happy for you and a little sad for me, regardless of the circumstances. If you are someone who I am not as close to, it really depends on the circumstance. Let me elaborate. (Note: please do not try to figure out if you are one of the hypothetical people below. I mushed a whole bunch of different scenarios together for most.)

Pregnant Person A: Best friend, pregnant with another child. First thoughts: Wow, I am so happy for you, that is awesome! Second thoughts: Wow, it must be nice to be so fertile. Third thoughts: Crap. So much for being pregnant at the same time in our lifetimes. Fourth thoughts: More cute children to adore! Fifth thoughts: I am never going to be able to have a cohesive phone conversation with you again now that there are so many miniature people to get into the car, keep occupied, keep fed and dry and burped, keep from killing each other in the playroom. Overall thought: I am really happy for this person, even though they were able to get pregnant multiple times easily. But I am stuck with a tiny, petulant "Why not me?" voice in the back of my head that I can beat into submission most of the time.

Pregnant Person B: Facebook friend, haven't seen in person in a long time. Announces pregnancy via early ultrasound (so early it's just a gestational sac, no fetus to behold). Fleeting feelings of "I'm so happy for you!" that morph into incredible sadness and resentfulness that for some people, announcing a pregnancy so early is not a harbinger of doom and gloom--they can announce that way (some even by posting a pee stick picture, talk about early!) and have a healthy baby 9 months later. Must be nice to live in a fertile bubble where once you're pregnant, easily and quickly, you stay that way with little to no incident.

Pregnant Person C: Acquaintance, find out on Facebook (everyone's doing it apparently). Feel the "I'm so happy!" vibe and then actually talk to person or partner. Person/partner is totally unenthusiastic about having another baby (or a surprise baby, or another surprise baby). Sudden feelings of wanting to shoot pee sticks through this person's skull, because they could at least pretend to be happy that the miracle of life has visited them and not you, who would be totally grateful even if it meant living on the street. (I realize that different situations are difficult for different people, but that knee jerk feeling of "can't you just PRETEND to be happy???" supercedes any compassion for the added expense of a not totally planned baby).

Pregnant Person D: Person you overhear talking at work and then realize they're pregnant when they do nothing but complain about being pregnant or that instead of having a desperately wanted girl, ugh, they are having a boy.  Or vice versa. I feel "wow, that's great she's pregnant" and then immediately want to inject progesterone in oil shots into this person's nether regions. The complaining about the downsides of pregnancy I can get behind--for some people it is not a glowy joyous time but a time filled with edema, painful varicose veins, hemorrhoids, and/or constant vomiting. I get that that sucks. But you get to have a baby at the end of it, so I can't help but not be too sympathetic. Especially if you know what I am going through and complain ad nauseum to me. The people who are not happy with the sex of the baby? I feel nothing but anger. It's not the baby store, people. You get to have a baby, and while you may be bummed that you didn't get your preference, you are pregnant with a beautiful child. The happiness feeling is short-lived in this case because the sense of injustice is just too overwhelming.

Pregnant Person E: Friend of any sort who had announced they were going to try to get pregnant soon, and then announce that they are pregnant fairly immediately after starting to try. I'm happy, really I am. But I am also very, very, very jealous. I do not wish my experience on anyone, but feel particularly gypped when someone is able to say "gee I'd like to have a baby right about now" and BAM! They are pregnant. I am happy for your incredible good luck. I am happy that your wish for family transformed itself instantly into expectant motherhood. I am just feeling like perhaps I built my house on an ancient burial ground or wronged some sorceress or some other scenario where I have really crap luck while you are probably not entirely aware of just how incredibly, beautifully fortunate you are.

Pregnant Person F: Person you know from treatment, clinic, fertility yoga class, or who you just know went through some fertility issues tells you they are pregnant. Instantaneous "I am SO HAPPY for you!" that stays and is followed by a surge of hope. Because if it happened for them, it can happen for you. Especially if the person had a particularly long and arduous journey. For me, and forgive me for this but I'm being honest here, this person EARNED it. They struggled for their baby and it finally happened. There may be a fleeting "When will it be my turn" that is simply human, but in general, this pregnant announcement gets hugs, jumping up and down, and tears of joy not tears of unfairness, jealousy, and bitter sadness.

I could keep going (there are SO many different scenarios!), but I won't. A couple things to add though--if you are lucky enough to be a pregnant person coming to tell me in whatever way that you are knocked up, PLEASE do not tell me in an apology. Do not tell me as you would tell an ex-lover that you probably gave them an STD. You are pregnant, and that is awesome. If you tell me like an apology I will feel worse. It is possible to desperately want what you've got and be happy for you. This is happy news, exciting news! I will feel like a killjoy of the worst sort if you tell me like it's bad news. I may be sad later, but my first thought is always well wishing. Because I am genuinely happy that this miracle happened to you (even if later I want to harm you with infertility paraphernalia due to witting or unwitting insensitivity). And someday I want to be announcing my pregnancy too. Just not with an ultrasound on Facebook, or a picture of my pee-soaked stick (let's face it, I won't have one to share anyway), or a transcript of the IVF nurse's message on my cell phone. And I won't be announcing early, because I don't live in a fertile bubble and am too afraid of tempting fate.

If, in the euphoria of my pregnant bliss I forget all this and turn into one of the more distressing pregnant people listed above, please feel free to whack me over the head with my sharps container.

Friday, November 5, 2010

Laying Down Bets

Beginning infertility treatment is exciting in a way. You are upset that you have to go through this process, but once you have made at least a little peace with that you just want to get going. You might have a highly hypothetical "hmmm, how far are we willing to go?" conversation with your partner, but it's in passing and deep in your heart you know, just know, that you will get pregnant before you seriously have to consider that question.

But then things might not quite work out the way you hoped, and you might not experience a miracle and get pregnant sooner than later. You, like me, might have one IVF under your belt and be looking seriously at the question "When is enough enough?" Because IVF is expensive. It eats away your savings, your future earnings, your financial freedom. For us, a fresh cycle is estimated at about $13,000. Several thousand dollars of that cost is the medication, which is ridiculously expensive. A friend just told me that one medication she needs to go on next cycle will cost her $1,800 out of pocket. Eighteen hundred dollars for maybe a week's worth of meds! If we are were to pay out of pocket with no financial assistance, three fresh cycles of IVF would cost us $39,000. "Fresh" meaning that an egg retrieval is performed and new embryos are created. "Frozen" cycles are where surplus embryos from a fresh cycle have been frozen and can be thawed and transferred with minimal medication and monitoring--those are wicked cheap in comparison. I was not lucky enough to have any surplus embryos to freeze last time, so I am working with "Fresh" numbers.

$39,000 is a crazy amount of money. And if you don't get pregnant after that, adoption is not free. That can also cost tens of thousands of dollars. It is very overwhelming. It begs the question, "How the hell can we afford this???"

It ends up feeling like you are at the high-stakes poker table at a casino. How many cycles can we feasibly afford? Which financing options are the best short-term and long-term? At what point do we say Uncle and throw our energies into the adoption process? (Which, by the way, is not a shortcut to getting pregnant. Lots of people apply for adoption and do NOT then miraculously get pregnant on their own, despite the anecdotes that creep out of the woodwork when you even mention in passing that you are open to adoption at some point.) This is supposed to be a time of great hope for us--we are trying to build our family one cell at a time and have a lot to look forward to. Our doctors are very enthusiastic and positive about our chances this second time. We have a new, juiced-up protocol that will likely make me very uncomfortable but produce more, and higher quality, embryos. But it stinks because before we can move forward we have to seriously entertain "The End" conversation. Which is what we recently did for hours, with T-charts and tears and long silences, as we tried to figure out which financing option that is offered by our clinic is best for us in the long term and will give us the best chance with the least financial strain.

Your first IVF is largely diagnostic, so you can't really go into it 100% thinking that you will get pregnant that first time and just do it once. Some people manage this, and I envy them. Many people need to do 2 or 3 so that the protocol can be tweaked and everyone can see exactly what happens when your genetic material meets so that they can figure out how to get the best numbers. We have been very lucky and so far have not paid full price, and for that we are tremendously grateful to our clinic. We qualified for a grant the first time so it was about half the sticker price, and we qualified for the same grant this next cycle. We were in the running for the refund program as well, but with the grant available and questions over whether we would actually be approved, we decided to go with the grant. This is largely because the cost for the grant for one cycle was less expensive by almost $10,000 if we manage to get pregnant. And if we don't, and we have to pay out of pocket for a second fresh cycle, the cost of the grant versus the refund program is within $600 of each other. So it's not unless we fail after three total cycles that the refund program really kicks in and becomes financially a better choice. It was a really hard choice to make. Mostly because with the refund program I would have the option for 3 more fresh cycles (a total of 4 tries), and with the grant we will have to stop and reevaluate after 2 more. I am not ready to really think about that. I want to believe that the doctors' enthusiasm and belief that this next cycle is IT and we are totally getting pregnant with the second IVF. But it is hard to do that when you have had the same level of enthusiasm for your first IVF only to have it end a failure. And, what if the IVF that will work for us is the fourth one? What if we quit right when we would have gotten pregnant?

This process brings up a lot of difficult questions, difficult circumstances, and no good answers. Did we decide on a definitive stopping point? No. Did we decide on a "reevaluation" point? Yes. Did we choose the option that is best for the short term with the hopes that we'll get pregnant as quickly as we're projected to, instead of the one that offered the better long-term protection if we have multiple failures? Yes. Maybe that's a sign that we are thinking positively about our chances as well. Or maybe it was partially because if we didn't take the grant, there was a chance we could also lose the refund program and end up empty-handed (and really in a pickle to even get two more cycles in). Honestly, I am starting to feel like a racehorse. Everyone--ourselves, the team of doctors--are projecting potential wins and losses and hoping we made the right call. I really, really hope we made the right call.

Tuesday, November 2, 2010


Infertility is all about waiting. Waiting, waiting, waiting. Most of the time by a phone.

First you wait for results to your workup. What's wrong? What else is wrong? Why is nothing showing up wrong? Then that wait gets replaced with the wait to get started on your treatment. When can you get on the schedule? When will you actually get the chance to put your plan into action? Then you wait for medication to kick in. This is a twofold wait. When will your ovaries start bubbling up with new follicles, and when will your body start displaying any number of side effects? This part of the process can take what seems like forever. For a Clomid cycle, you take the pill days 5-9 and have your first monitoring appointment around day 14 or so. Then, depending on what they see, you come in again after another couple days. And then another day or two, and then possibly daily depending on how slow or quick you respond. With injectibles, it can go really long. I had a cycle where I was on injectibles for 17 days. They monitor you much more closely on those medications because of the risk of hyperstimulation and too many follicles to proceed with IUI (depending on the clinic you go to, you can be cancelled or switched to IVF if you make more than 5, because the chances of having high-order multiples is so high). I was in the office every 3 days, and then every 2, and then every day.

And, every day you go in they take blood. Every time they take blood you receive a phone call sometime in the afternoon letting you know what your estrogen levels are and whether or not you have to come back or if you can stick a fork in it 'cause you're done. You become a slave to your phone. Missing the call is not a disaster, because they will leave a message, but taking the call could be your only shot at talking to a live person that same day, depending on the timing. My clinic is AWESOME about getting back to you if you leave a message on the nurse line, but then you are just a slave to your phone a second time. I carry my phone with me in my pocket, even at school, when I am expecting these calls. I quell any dirty looks with "I am expecting a very important call from my doctor regarding some test results." That usually stops people from thinking I'm some slacker with my phone out while I'm teaching! Hopefully you get the call that tells you you can take your trigger shot, which will release your eggs from the follicles so you can have the IUI two days later. After you take the shot (at home, given yourself, not by any licensed medical practitioner unless you happen to be one), you wait for your procedure. After the procedure, you wait for two weeks. The longest two weeks of your life. The dreaded Two Week Wait. Then, if you didn't get your period at the end of the two weeks, you are REALLY pasted to your phone. Because then you go for bloodwork in the morning and expect your most important call. The call that either starts with "Congratulations!" or "I'm so sorry."

If you're doing IVF, the waiting (like everything else) is more intense. You have the same wait to get started--ironically, the thing you desperately want NOT to see at the end of a cycle is the very thing you need to get in order to start the cycle. Your period, Aunt Flo, monthly visitor, Martha, red flag of freedom or despair--whatever you want to call it. It calls the shots. You have all the waiting for stims (injectible medications) to start and for stims to take effect, but this time when you take the trigger shot it is to ripen your eggs, not to release them. Then you have your egg retrieval procedure and wait to see how many eggs were in your haul. For me, the time between the trigger shot and retrieval was really stressful--I was terrified that my eggs wouldn't cooperate and that they would release on their own (which would cancel the cycle). I couldn't wait for the doctor to tell me how many eggs they retrieved. They tell you a rough number when you are loopy from the anesthesia, but then you have to wait for the call from the embryologist to tell you how many were truly mature enough to attempt fertilization. This wait was the third hardest wait because you can have eggs retrieved, but then not have them be mature enough or good quality enough to try fertilization. Then, the second hardest wait: waiting for the call from the embryologist to see how many embryos you have and their quality. Having eggs fertilize does not guarantee that you will have good embryos to transfer, which makes the call scary until you get your stats. Then you have the embryo transfer and the two week wait begins (thankfully shortened in a way since it is 2 weeks from fertilization, not transfer). You get two weeks when you don't have to have your phone in your pocket on vibrate so you don't miss an important call. (Those two weeks are difficult for other reasons, but that's for another time). Then the day of your blood test comes and you are a wreck, just a wreck, waiting for that phone call. This is the call that will tell you if all of your money, time, discomfort, and emotional distress resulted in a pregnancy, or if you are once again waiting for your period to arrive so that you can give it another go. I got my call at 1:27 in the afternoon and had to wait until after 5 when Bryce got home to listen to it because I did not want to get the news by myself. The little green voicemail light flashed at me all afternoon long. Now that was a long wait.

The waiting doesn't get any easier the further down the infertility road you go--I had to wait for a call just yesterday regarding my test results for the refund program. I sat through a haircut with my phone in my lap and then put it on vibrate so that I could at least feel it go off since the blow dryer was so loud. I took a phone call mid-blowout because I was waiting for those results, so that I could find out how much longer I have to wait before I can get started on my next IVF cycle. It doesn't get any easier, but I am sort of getting used to it. I just want to trade in all of these stressful waits and phone calls for a nice, long, 40 week wait for my healthy, happy baby to arrive. At least I will have plenty of practice with waiting!

Sunday, October 31, 2010

A Love Letter

Today is Halloween--a cold, sleety/snowy Halloween. But it is also my one year wedding anniversary. Here's to you, Bryce...

Even though we have been married only a year, it already feels like a lifetime (in a good way). We have endured so much over the past year. We have managed to make it through tests and treatments and hopes and disappointments no worse for the wear--if anything we are stronger for having the difficulties that we face together. You have been an amazing support through all of the painful moments, especially since those moments are just as painful for you, too. You make me laugh and distract me when I'm feeling down. You put me in check when even Clomid or 18 ginormous follicles are not a good excuse for my poor behavior. You are patient, and giving, and so, so loving. I am so grateful that if I have to be going through this sad, maddening, and painful experience, that I am going through it with you--a partner who is supportive, loving, and has a great sense of humor. Someone who can stick a big, scary 1 1/2 inch needle in my ass while telling me he loves me...and I can believe it 100%. Someone who knows me so well that he can deflect conversations or comments made by others that may be too much for me to take before I even realize that my feelings may have been in jeopardy. Someone who doesn't mind that fertility treatments have taken their toll on my body and appreciates my curvier curves.

I really thought that we might celebrate our first anniversary with our baby already here, or at least on his/her way here. It makes me a little sad that at this point it may not even be possible to celebrate our second anniversary with our future child... but I am comforted because you love me so deeply and so completely that even if we celebrate our 5th anniversary with no baby, we will be happy together. I know because you told me so! So thank you--thank you for being my friend, my lover, my nurse, my pillow, my support, my comedian, my litterbox-cleaner. Thank you for loving me so beautifully, for much longer than the one year we have been married. Thank you for being the father of our future children, no matter when or from where they come. How can we not be fabulous parents when we have such a solid foundation of love between us and such a desperate longing?

Happy anniversary, Bryce. I love you so, so, so, so much.

Thursday, October 28, 2010

Testing, Testing...

With infertility comes a lot of tests. What's wrong? Which part is wrong? How many parts are wrong? In the beginning, the tests can help you figure out if you are dealing with male factor or female factor, or both. They can help you figure out which course of treatment is best for you. Or, they can invade your body and NOT tell you anything about why you can't get pregnant. I am lucky to have a definitive diagnosis (PCOS and male factor infertility). Even though it sucks to be in a position to have a diagnosis, there is a clear reason for why I can't get pregnant. I can't imagine how frustrating it must be to be labeled with "unexplained infertility."

Testing is on my mind because I am checking two more tests, hopefully my last, off my list this month. Today I had a Saline Sonohistogram, and I've been in the midst of a Clomid Challenge Test for a week now. But, up until this point I have also had oodles of blood tests to gauge hormone levels, Bryce has had oodles of semen analyses, and I have had two HSGs. Some of these tests occur during your initial workup. Some of these tests will come up after you've started treatment and there's an idea that there may be further sleuthing to do. And some of these tests you may want to ask for.

Semen Analysis: Ok, so I didn't go through this one, but it's one of the first tests a clinic (or your OB/GYN) will do to rule out male factor. This is most commonly the only test that the men going through fertility treatment have to do. Basically, they provide their contribution in a cup--this is called "collecting." They can collect at home or at the clinic, in a lovely room with dorm-style furniture (that is hopefully easily sanitized) and a host of supposedly exciting magazines and/or videotapes. There are also explicit instructions on how to make sure that your sample stays sterile (and by sterile I mean uncontaminated. Bad choice of words). Your partner can go in the room with you and there are specific instructions for what you can and can't do to "help." It is a very bizarre setup. If you collect at home, you have to live 45 minutes or less from the clinic and you have to keep the sample warm en route. Which means it gets tucked into your pants or in your bra if you (the lucky lady) are delivering the goods alone. It seems like boys get off easy (haha) here--their test is somewhat familiar territory to them and supposedly "fun." But, speaking for the boys, there is a tremendous amount of pressure to perform in this situation. It is not fun. There are people walking by the collection room at the clinic and people are waiting (in the case of IVF, really clear that they are WAITING for you so that they can get mixing). Or your wife or partner is sitting in the car, not so patiently waiting for you to come out with your cup so that you won't be late for your appointment at the clinic. There is a lot of stress and uncertainty and feelings of having your manliness judged by the meager contents of a sterile cup. It is definitely not a sexy moment. I think the best thing you can do is have an honest conversation about what works for your guy. Some guys welcome help, and others want to just be left to do their thing. You can talk to your clinic and see if collecting there is less stressful than collecting at home--everyone wants you to have the best possible sample. Once the sample is in the andrologist's lab, it is analyzed. You get a report that explains the quality of the sperm. It will tell you the total number of sperm in the sample. Then it will tell you the total motile sperm per sample. "Motile" is the same as "good swimmer." It will also tell you the morphology, or the shape of the sperm. Odd-shaped sperm don't swim as well and can't fertilize, so those count against you. The average man has 40 million sperm. When you have male factor, it's way less. Or it can be not so much less, but those that are there are not good swimmers, funny-looking, or both. If you have 20 million sperm but only 2 million are motile, that's not so great. In order for IUI to be a truly viable option with a good prognosis you need to have 10 million or more, or so we have been told. BUT, male factor infertility can be pretty treatable, at least in the IVF stage. You only need 100,000 motile sperm to qualify for a financing program for IVF at my clinic--that's pretty amazing. And, as people say over, and over, and OVER, "It only takes one." 

Blood Tests: The lucky lady gets these. All the time. They start in testing and then just keep on coming. You will have blood tests to check your thyroid (sometimes that's the culprit). To check your prolactin levels (too much of the hormone prolactin can cause irregular ovulation). To check your estrogen, progesterone, and FSH (follicle stimulating hormone) levels. Your FSH levels will tell you what your ovarian reserve is--how many quality eggs you have to play with and the likelihood that you will be able to get and stay pregnant. Levels that are too high early in a cycle indicate a low ovarian reserve and possible premature ovarian failure. You actually want low levels of FSH. High estrogen at the start of your cycle can also indicate poor ovarian reserve. Estrogen levels should steadily increase when you are responding to treatment (or normal and producing a healthy mature follicle). Then there's progesterone. That comes from the empty follicle sac (called the corpus luteum) and tells your body to keep that uterine lining nice and plush so that an embryo can implant itself and stay there. If you have low progesterone levels, or they drop too soon, then you might be able to have a fertilized egg become an embryo but your uterus can't sustain it through implantation. If this is the only issue it's great--they can give you progesterone support in the form of suppositories, gel, or shots. Or in my case you can add this to a host of issues, but at least there's a fix for this one. The Clomid Challenge Test is also a blood test, but you have to take Clomid cycle days 5-9. They look at your FSH levels on day 2 or 3 and then they look again around day 10 to make sure you have a good ovarian reserve. I am actually not sure why you take Clomid for this other than maybe it causes your body to start the process if it wouldn't otherwise, but it seems just mean to have such a nasty little drug be a part of a test. 

HSG: This is the Hysterosalpingogram (go ahead, try to say it!). It looks at your uterine cavity and the tubes to make sure they are clear. It is usually done at the hospital. They do an x-ray of your uterus and fallopian tubes while they are pushing dye through your uterus and out your tubes. Sound uncomfortable? It is. Some people have no problem with the HSG--a little pinching, a little cramping, that's it. That was not my experience. I actually had the HSG twice in a 2-month period because there was an error in the first one. An error where the radiologist did not do the test correctly. There is a balloon on the catheter that is supposed to inflate and then sit like a stopper in your cervix to keep the dye in your uterus and the pressure such that the dye can be easily pushed through the tubes if they're clear. In my case, the balloon was in the middle of my uterus and so there wasn't enough pressure. So the doctor told me that both my tubes were blocked, which would have made all my IUIs up until that point a total and complete waste of time, and would mean IVF was my only chance barring surgical correction, since you don't need tubes to do IVF. Understandably I was very, very upset. Especially since I had already done 5 IUIs and was in the middle of a 6th, and had requested the HSG since it was not a part of my initial workup. Luckily for me, upon reviewing the films and seeing the error, my doctor at the clinic called for a re-do, that he personally would administer, and which turned out normal. My tubes were not blocked at all. Whew! It just stunk that I had to do a painful test twice to figure that out. My thoughts on the HSG: Definitely take ibuprofen before to help take the edge off. I honestly don't know why they don't offer light sedation for this test! Know that your husband or partner can't come into the room with you, since it's an x-ray. He will be able to come in with you to review the results later, after you've really needed a hand to hold and squeeze.  Request that a reproductive endocrinologist (RE) from your clinic perform the test, not a radiologist. I love radiologists and they are very nice and talented people. But radiologists perform a lot of different tests throughout the days and weeks, and they do NOT do a lot of HSGs. REs do these ALL THE TIME and so it will most likely be faster, more comfortable, and more accurate if you have an RE do it. And, lastly, I would ask for this test if it is not part of your early work-up. If your tubes are clear, you are all set and have one less thing to worry about. If not, you will find out before spend time and money and mental energy on IUI cycles that will not work because of tubal blockage. 

Saline Sonohistogram: This test looks solely at your uterus. You can do it in the doctor's office, no need to go to the hospital. It is also not as uncomfortable as the HSG, although I had one today and while it was less uncomfortable during the procedure, I feel much more tender afterwards. I did take Advil before just like the HSG, but it didn't seem to be too effective. The HSG looks at the periphery of the uterus, while the saline sonohistogram looks at your entire uterine cavity. It can unearth fibroids and polyps that may have been missed on an HSG that could compromise your ability to carry. I asked for this test because I wanted to make absolutely sure before we paid a lot of money to put my body through IVF again that NOTHING was physically wrong with my uterus. The actual test is kind of cool--a catheter with a balloon (again with the balloon!) is passed through the cervix and a saline solution is injected into your uterus to highlight what's inside. At the same time, the lovely internal ultrasound is making a nice movie of your innards on the screen. It's a little crowded down there. But, luckily for me, this test was also normal--there is no physical reason why a little nugget couldn't nestle into my womb for nice long while. That peace of mind is definitely worth the discomfort. 

So there you have it--some tests that we have gone through in the course of our infertility journey. There are others, of course, for both men and women, but hopefully I won't have to experience those too!