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.