Tuesday, April 26, 2011

Busting a Myth: The Age Thing

The age issue with infertility is a tricky one. It's a double-edged sword -- does age matter? Yes. Is age everything? No. 

When I was turning 30 and divorcing, I was panicking and depressed and terrified all at once--here I was, leaving my most fertile decade and starting over in every sense of the word. I had wanted children for years but that hadn't quite meshed with my ex-husband's developing idea of family life (gets in the way of philandering, apparently). So to be hit with single, 30, and fairly wounded from my failed marriage seemed like a huge loss. "You have plenty of time!" exclaimed just about everyone. "Don't worry--I didn't even start my family until 38!" said a woman I worked with. "People have babies into their 40s now, you really don't need to worry!" was the battle cry of just about everyone I knew. I even went to Borders with a dear friend and passed a book on display, "Your Pregnancy After 35," and said, "There it is, my book. Maybe I should just buy it now." She playfully punched me and said "No way! You will have a baby before 35!" Guess not. 

Next week I turn 35. Despite valiant efforts, I am not pregnant. So "Your Pregnancy After 35" is TOTALLY my book. Turning 35 is a little depressing, because it takes a journey that's been difficult for non-age related reasons and makes it start that downhill slide into "old egg" territory. See, this is the funny thing with infertility--it can be totally about your age or it can be absolutely nothing to do with your age. But eventually, the age thing catches up to you if you're not successful. Our actual diagnoses for infertility have zero, zip, zilch to do with my over-30 age range. My husband's male factor issues have been there since at least his mid-to-late 20s and are not at all age-related. I could be 20 and have the best, most plump and sperm-ready eggs ever and not get pregnant without help due to our sperm quantity and quality. And then you have my diagnosis--PCOS. There are women on message boards in their early 20s who are struggling with infertility due to PCOS--it is not only something that visits you when you have left your 20s. My ovaries are and always have been dysfunctional--even when I was a teenager. I used to call my periods my "Immaculate Miscarriages" because they came around every 6-9 months or so and were completely unpredictable. I had a horrible experience when I was 17 and on a cruise to Mexico with my family. My period decided to come in its usual erratic way right as I was to go snorkeling in Xel-Ha, a beautiful nature preserve that I had been really looking forward to. Instead of swimming with technicolor fishies, I ended up pantomiming "tampon" to the Spanish-speaking shopkeepers to no avail and sitting out that part of the trip thanks to my then-undiagnosed PCOS. Even if for some sorely misguided reason I'd tried to get pregnant at 17 it probably wouldn't have worked then without help. Put the two diagnoses together and we are faced with some serious challenges, none of them age-related. 

However, at the same time I can't ignore the age issue. It is a known fact that your fertility takes a dramatic downswing after 35 that continues and gets steeper into your 40s until it dwindles to nothing. Does this mean women don't get pregnant easily and healthfully in their late 30s and early 40s (or even later, completely inexplicably to me)? Nope. There are many of those exceptions that can say "I want a baby!" at 37 or 40 or 42 and POOF! There's their healthy baby despite "old eggs." But, more frequently, you find that fertility starts waning in your 30s and 35 is a definite tipping point. Reasons I know this: 

  • There is a whole  genre of pregnancy and childbirth books for women over 35. There is no such thing as "Your Pregnancy After 25." 
  • Success rates for assisted reproductive techonology start to dip at 35. Typically you will see success rates that say, "Women under 35" and then groupings in 2-3 year intervals after that. They just keep dwindling. But the "Women under 35" group has by far the highest rates--at my clinic an astonishing 51.2% of transfers result in live births. Jump to 35-37 and it goes down to 31.2%.  I am sad to be leaving my current bracket, for sure.
  • Clinics typically begin transferring more embryos to women over 35, because they know that your chances go down as your age advances. 
  • Financial options dwindle as you hit 35. My clinic (like many) has a refund program. It is cheapest up to 34, and then once you hit 35 the amount you pay up front is $2,000 more from 35-37. You aren't eligible after 37. This is because the risk of failure is so much greater as the woman ages, despite the infertility diagnosis. 
  • When you are under 35, you are advised to seek help if you don't conceive naturally after a year of trying. After your 35th birthday, you are put on the fast track--no pregnancy after 6 months of trying? Fertility referral for you! Why is this if 35 is not a tipping point?

It doesn't seem fair, does it? You start out with a non-age-related diagnosis and then BOOM! Your age starts creeping in and making you feel like a ticking time bomb. I used to joke about my kamikaze eggs jumping off into nothingness when I turned 30. Now that I'm turning 35 I am not so amused by that image. 

So, is it true that age can affect fertility? Yes. Is age everything? No. Can women have healthy babies without assisted reproduction into their 40s? Yes. Are they the rule and not the exception? No. Is it because they are models of healthful living and deserve a medal for their fertility? No, they are just really, really lucky. Could you be 24 and have the fertility issues of a 45 year old? Yes. Because you are turning 35 or 40 do you need to throw in the towel? No. But at the same time, once you hit Advanced Maternal Age (which, thankfully at my clinic is 37 and so I haven't quite gotten there yet) your success rates without donor eggs start dropping. Your miscarriage rates start rising. Your possibility for chromosomal abnormalities start rising, too. It is just not fair. 

While our current inability to have a baby is not at all age-related, we are entering territory where my eggs and uterus will start taking the fall for our infertility in addition to the PCOS and male factor. Where I will have to start wondering, are our embryos not super perfect looking and not implanting because we are unlucky, or because my eggs have been sitting inside me since before I was born? Sometimes I curse the lost time of my twenties. But, I have to remember that the pain and heartache of that time spent with the wrong person brought me to the perfect person for me--I can't regret it. Had I met Bryce at another time in our lives it might not have been the right time for us to start our beautiful journey together. And, in a way, since I divorced at 30 it is kind of a miracle that I got to start trying at 33 with an amazing partner in life. I know others who have waited longer for their special someone and are still waiting for their family to expand beyond two loving people. Age is a complication in our fertility journey, not the cause. We have a fabulous medical team at our disposal, but I still can't rest on my laurels and exclaim that "I have plenty of time." I don't. I just have to trust in the process and my firm belief that despite our challenges and the race against time, we WILL be parents. And the experiences age has brought us will help us to be better parents. I can only hope.  

Please visit the following links explaining more about infertility and National Infertility Awareness Week: 

Monday, April 25, 2011

The One Thing I'm Grateful For

Every night at the end of yoga, we come out of our super relaxation pose and slowly emerge to a seated position. We put our hands in front of our heart, and we think of one thing we are grateful for.

That one thing is always, always, every single time, my husband.

I am grateful for the way that he balances me. I am grateful for the way that he understands me, even now in the grip of completely incomprehensible times. I am grateful for how he can make me laugh, hold me and soothe me when I need to cry, and how he surprises me with special treats.  Like an Easter basket filled with goodies edible and otherwise and a quirky Black Knight action figure to guard it all. And a breadcrumb trail of Cadbury Eggs to lead me to my hidden prize. He is the best Easter Bunny.

The view of Cayuga from our balcony.
A goose among the daffodils.

This past week we took a mini-vacation--two nights in a B&B outside of Ithaca on Cayuga Lake. We don't usually do getaways because spending the money on something like that seems luxurious. Too luxurious when we are facing ridiculous expenses to build our family, and don't quite have enough hope in store to believe 100% that this next time will truly do the trick. But this week we decided that we needed a romantic respite, an escape from the everyday of rugs to be vacuumed and dishes to be washed and dogs to be walked and crazy cats to feed and medicate and nurse back to some semblance of health. So we went on our two day escape and it was amazing. Despite the early-spring spiders and the freezing windy weather, we had a truly romantic mini-holiday that fed our relationship in a way that we'd been missing. We hung out in our sitting room with candles and wine and read and talked and made each other laugh. We had a completely decadent 3:00 dinner at a fancy restaurant with 3 courses and a bottle of wine. We walked the Cornell Plantation trails and decided we need an annotated herb garden at home. We slept in a bit and snuggled and loved.

And we hardly ever talked about infertility. It came and went in passing, and that's it. A guest our second night was a single mom with a five year old girl, but they pretty much kept to themselves--we had picked a super romantic bed and breakfast to avoid the family crowd but somehow managed to be small child magnets all the same.  Bryce made one joke, "We came here to get away from children and families because we are infertile people and we get the romantic inn with a child!" I received a sad email from a friend who received confirmation her pregnancy wasn't viable from her last IVF cycle and acknowledged it. And that was it. No planning for the future, no rehashing of our past cycles, just Bryce and Jess on a romantic trip enjoying ourselves and truly escaping the complete infiltration fertility has had on our daily lives.

So what am I grateful for? Hands down, my wonderful husband. I am so lucky to be on this journey with such an amazing man.

Thursday, April 21, 2011

Oh, the Mind Games We Play

It is amazing the capacity the human brain has to inflict mental torture. You can be the most rational person in the world but in the throes of infertility, your thought processes can be your worst enemy. Last night I went to a support group and we touched on this issue--it was so affirming to realize that it is not just my inner voice that is irrational, crazy, and just plain mean.

When you are going into a cycle, there are stages that your mindset goes through. In the time leading up to your cycle beginning, you psych yourself up. "This is the ONE!" you think. The plan is different, you have new tricks up your sleeve (red candles to burn! wheatgrass shots! pomegranate!), and you can let yourself believe that this time is YOUR time. Hope is at a high. It has to be--we couldn't do this to ourselves over and over and over again without truly believing that it could work despite whatever odds are stacked against a positive outcome. When you start your cycle, you have cold, hard data to support your hope or start whittling away at it. You can cling to every appointment, every ultrasound and blood value and think that it is either affirming your hope stores or causing you to have to go into positive thinking overdrive to overcome the new obstacles in your way (not enough follicles, too many small follicles, too little estrogen, too much estrogen, a cyst, a pesky lead follicle that steals energy from all the rest, whatever). When you finally get to the point where you have your retrieval and transfer (or insemination if it's an IUI), what's done is done. You can no longer control (like you could in the first place?!?) how your materials are growing and it is now up to whatever got settled in to nestle to keep it going. You put all your hope into your uterus and flood it with positive thoughts. But you also flood it with questions--what's that feeling? Do I feel different? Is that cramping or implantation? Is that spotting or implantation bleeding? What's going on in there? And then decision day comes. Hopefully all your hard work is rewarded and you get the positive. Or, as in my case every single freaking time, you get a negative and are crushed. But that silent velvety dark place is only a vacuum of numb for a very short time, because then the Voice starts in. What went wrong? What did I do? What didn't I do? How did I sabotage myself? And so the hurtful analysis begins.

That Voice is so destructive, and so illogical--if there really was anything that we could do to make sure a pregnancy could occur and be viable I'm sure we'd be all over that. It is completely and utterly out of our control. We can do all the right things -- not drink, not eat processed food, eat fertility foods and supplements, relax and destress and detox -- and still have a negative outcome. And, oftentimes people we see in the non-fertility microcosm often do all the WRONG things (get drunk and eat McDonald's while sitting in a hot tub and smoking pot after a 10 mile ball-squishing bike ride for him and a 5 mile ovary-bruising run for her) and get pregnant. Obviously there is no such thing as fairness. But obviously there is no such thing as being able to control the outcomes based on thought patterns or actions.

But, that doesn't stop The Voice from flooding your subconscious with thoughts of how you could be doing more, or less, or how if you had only done x, y and z you would pregnant right now. It doesn't stop you from knowing deep in your heart that The Voice is totally full of shit and this is not your fault whatsoever, it is so far out of your control--but The Voice still speaks and really, still has at least some control over you. This last month we did an under-the-radar IUI as something to do in between IVFs (it can be so awful to have 6 months of nothing between treatments and feel like you aren't doing anything to further the baby quest). The Voice was completely batshit crazy. I figured, I wasn't going to care about this. We know that IUI is not our best option (or really even a viable option based on our combined challenges). I was going to go about my business as usual, and do all the wrong things, and that would be that. Except the Voice said, "And because you don't care and you are relaxed and you are aren't thinking about it, this will be The One!" What a crazy thought. Because by thinking that thought, I WAS caring about it and thinking that I really could get pregnant. If I didn't think about it. Which by entertaining The Voice, I most certainly was thinking about it. So even though I didn't go nuts with the foods and the restrictions and everything for this cycle, I was still thinking about it. I still went for acupuncture and Maya. Because I didn't want to not do things that could increase my chances, even though I was telling myself I had no chance so that I would have a chance after all. Makes you dizzy, doesn't it? This is some crazy, crazy mindgame crap. And, incidentally, none of it worked--unsurprisingly we did not get pregnant with an IUI. So none of that internal dialogue made any difference.

The worst time for The Voice is after a failed cycle. This is when you have destructive self-talk, as counselors would call it. A horrid, unproductive and entirely unhealthy inner loop that is no good. But it's there, and all you can do is try to reason with it. Because the bitch won't shut up. The Voice starts going through your cycle with a fine toothed comb to determine what you did, personally, that screwed up your cycle. It can't just be that you fell on the wrong side of the success rates (again). It can't just be that this isn't your time. It has to be that something you did made this unsuccessful, according to The Voice. So you look--did you overextend yourself during the 2 week wait? Did you eat sushi or feta cheese anytime in the past 10 years? Did you have sex when you weren't supposed to? Did you NOT have sex when you were supposed to? Should you have had one glass of wine to relax yourself? Or did that glass of wine poison your innards and tell your embryo not to implant into this wino womb? Was it the walk you took when you were stimming and your ovaries were huge? Or was it that you didn't walk enough and get the blood moving? Is it somehow, horribly some internal thought that you don't WANT this enough and the embryos can sense this and so don't stay? (That one is the worst and a very low blow, but your subconscious really knows how to kick you when you're down.) Does it sound crazy? Yes. Does it sound abusive? Absolutely--if someone else talked to you this way you would NOT be friends with them or married to them, you would ditch them or run to a shelter ASAP. But somehow, The Voice can say these things to you and, unfortunately, you listen at least a little. Even though you KNOW that these things are nutso and there is NOTHING that you did to cause your loss, there is nothing that you DIDN'T do that would have made a difference. All the marathon-running, goat-cheese-eating, espresso-chugging, overextended-at-work women who get pregnant every day can attest to that. So you have to try to find a way to ignore The Voice, or to reason with it if you can't ignore it.

All the meditation and yoga practices tell you to silence that Voice, at least temporarily.  You imagine a blue sky, and your thoughts are clouds blowing through and past you leaving you with nice peaceful blue thoughtless sky devoid of any negative self-talk. Or you imagine a box and you shove those thoughts in there and close it up for meditation, so that you are free of those thoughts for that sacred space but you can open up your box of crazy after the session (with the calming "Your thoughts will be there for you when you return..." offered up to you by the instructor. I wish I could just throw that box off a cliff in the meditation!)  I guess I can silence that voice for a very short time, but it is still there. It won't go away. But somehow it is immensely comforting to know that lots of other people have The Voice too. We just have to find a way to manage it before it makes a difficult process even more painful than it has to be.

Tuesday, April 12, 2011

On Garbage Day and How My Pets Are Not Helping Me Relax

In my neighborhood, garbage day is Sunday. There is really nothing remarkable about it--we take out our trash tote, the recycling bin, and on a fairly regular basis a case of empty wine bottles. There's a creepy car that goes up and down the street looking for redeemables and reusables in the trash, which is a little weird but part of the weekly routine. We like to peek into recycling bins on walks with the dog to see what kind of wine our neighbors like to drink. You can tell a lot about a household by passing by their garbage and recycling.

For instance, this last Sunday I took the dog for a nice walk. It was gorgeous out and I needed the exercise. It became a bit of a torture exercise, though--so much baby refuse. So many houses proudly displaying their empty diaper boxes, new pack 'n play packaging, ridiculous amounts of empty whole milk jugs, baby food jars, and in one case a defunct car seat. It was almost like a neon sign in front of each house--"Look at us! We're a family! Even our GARBAGE reminds you of the simple biological function that you just can't seem to complete! Yay, fertile people!" And then I got back to our house and we had a baby box out on the curb too. It was a brightly colored box from the baby gate that we purchased at Target--it had a picture of a happy mommy holding her happy (but mischievous) baby in her glamorous eat-in kitchen, one hand on the "Munchkin" gate. Thank goodness that gate keeps her baby safe from the Viking stove, espresso machine, and expensive cabinetry holding all sorts of sharp and breakable objects from boutique stores. That is the kitchen of someone who didn't have to spend her earnings on IVF to get that adorable tot. I felt slightly better, seeing our "family" refuse out at the curb. Except we're big fakers.

That gate was for our dog.

See, we don't have children but we have an array of dysfunctional animals. Our wonderful greyhound, Kayak, hated his crate (and we hated how it took up half of our kitchen), so we set up a crate area in the hall with the doors closed and an oldschool wood-and-cable baby gate. It turned out our dog didn't hate the crate, he hates being alone--which is too bad since neither of us are stay-at-home pet parents. Over the weekend Kayak got so worked up when we went out to Maria's on Friday that he pushed the gate just so and topped it over. Then he did it again on Saturday. We can't just leave him out, because he chews on things. Like Stickley furniture and guitar cases. So, we went in search of a better gate, one of those tension-mounted swing-latch thingies. We thought, "We can save this gate and use it when we have an actual tiny human locked away from chewing and eating and climbing on unsafe things!" It made us happy in a weird way. It gave us "family" garbage.
Kayak, skulking behind his handiwork.

However, last night I came home from fertility yoga to find that Kayak had chewed and gnawed right through the latch. Not enough to open it, but enough to make the latch completely and totally defunct. Like, as in I had to use a wrench to unscrew one of the tension rods so that I could get the freaking dog OUT of his "crate." Now it is definitively a dog gate, one that we can't use for a baby. Argh.

...because Rocky is hiding under my desk.
Kitty wonderland. Empty...
Oh, and the other item in our fake "family" garbage was a playgym. Not for a child (and not even really fakeable to look like it was for a baby), but for my crazy cat, Rocky. The cat who was on prozac because he suddenly started acting terrorized--by turns skittish and demonic, hiding in the basement, and yowling for no apparent reason. I know it's not physical because I've taken this cat to two different vets for two full workups and that cat is healthy as a horse. He's mentally ill. The prozac made no difference at all (I actually think it made him worse because of the stress involved with giving him the pill--so much hissing and growling and swaddling and missed swaddling resulting in deep claw marks...) Since the prozac failed miserably, we decided to set up a kitty haven in my back office on Sunday--complete with a giant, fancy cat tree playgym thing that I assembled myself (so proud). He has places to scratch, several places to hide, places to play, places to climb, multiple windows to look out of--Rocky HAS to be happy once he gets used to these new digs. But then I started laughing once everything was set up. I have a freaking cat nursery in my house. Or if not a nursery, then at least a playroom. Because that's not ironic at all.

Abner, having fun with progesterone caps.
And then, we have our wonderful cat Abner, for whom prozac works like a champ (his issues are aggressiveness). Except he steals the progesterone suppository caps from the nightstand and last night stole one with the progesterone bullet still in it and ate it. I have no idea what human female hormones in gross suppository form do to a neutered male cat. I guess I'll find out. I do know that I didn't appreciate having to get up and go downstairs at 5 am to get another one of those damn things because the one I had conveniently set out was sitting in that nasty cat's belly.

So, between garbage day and my insane animals it is a miracle that I can relax at all. Garbage day comes only once a week. I'm stuck with these crazy (yet lovable and occasionally therapeutic) animals 24/7. I love them to death, but I really need them to dial down the crazy before my next round of meds. There's only room for one psycho in this house at a time.

Sunday, April 3, 2011

Miracle Stories

Everyone knows one. People who have been trying for years, who have been told that they will never have children without assistance or never have biological children, period...and then POOF! Pregnant when they least expect it. Usually it's a friend of a friend, or a distant family member, or a friend of a distant family member, or another patient at your clinic that you've never met but is touted as the "hey, you never know!" story by reception. These stories are meant to buoy you up, to give you hope where it seems there is none. They are well-meaning, but sometimes difficult to swallow.

The miracle story lends credence to the "just relax" -- these very, very lucky people all got pregnant when they weren't thinking about it anymore. They got pregnant when they were between cycles, when they were trying naturally (or just not on any kind of birth control). They got pregnant when they had taken a break from treatments to decide what to do next. They got pregnant when they started the adoption process and had made what peace they could with the inability to conceive a biological child without significant cost financially, physically, and emotionally. They got pregnant after adopting a child and building their family a different way. They got pregnant after having children with donor material. Every one of these people finally conceived when they weren't in the middle of the highly invasive, highly stressful infertility treatment process.

So what does that mean to you when someone tells this kind of story? It seems like it's happening all the time, but I think that everyone knows the same core group of miracle people. Bryce made the point recently when we were presented (again) with a "hey, it could happen--nothing is impossible!" story -- these are the stories that people remember and cling on to. You may encounter 100 people who have had some kind of trouble conceiving throughout your travels, but it's that one who made it against all odds who sticks out in your head (1 in a hundred is an incredibly inflated number). It makes for a good story. Your friends who tried and tried and finally succeeded after 4 IVFs or brought beautiful nonbiological children into their lives through adoption or brought beautiful babies from donor sperm or egg contributions are lovely stories, but not as dramatic as the 45 year old woman who decided she and her husband would remain childless and then POOF! got pregnant miraculously. I struggle with the miracle story because in my mind, it is an attempt to make me feel better but it is also an attempt to make you feel better. It can be depressing to sit and talk to someone who puts tons of hope into every cycle and just hasn't been successful yet--so to bring up the miracle people adds a little more happiness and hopefulness into the mix. It can happen! It happened to them, so obviously it could also happen to you! But what if it can't?

I was told by someone after this last IVF that at least we could try naturally between the winter IVF that failed and our new summer IVF that we are planning. Unfortunately, that is just not possible. As much as I would love to have the chance to each month try without needles and medication and procedures for the "what if?" moment, my body is not cooperative. I do not ovulate on my own (or if I do, it is so sporadic that there would be no way to tell when it happened). After the IVF failed in January, I was natural for a period of time until for the sake of timing and an interim procedure I had to come in and get put on Provera (an oral progesterone pill) to induce a period. When they do this, they do a pregnancy test and they check your progesterone levels to see if you ovulated. I was on day 35 of my cycle and I hadn't even ovulated yet (and, obviously, I wasn't pregnant). For those of you not intimately familiar with a typical woman's cycle, ovulation typically happens around day 14 and a typical cycle is between 28-30 days. In some strange way, I was pissed and sad when I got the call with my results. I wanted to be that miracle person. I wanted to have the "You won't believe this--you're pregnant!" call. But instead I got the news that my reproductive system doesn't own or know how to use a calendar. I pretty much have to be on the pill between cycles to ensure that I can get on the schedule for the time I want--and so I'm not unpleasantly surprised with my period since obviously I can't plan for it worth a hoot. Goodbye, dream of being a miracle person.

Now, recently I have actually MET a few miracle people. In person. Not distant mythical creatures, but people I have done yoga with and take classes with. One did 3 IVFs after countless IUIs and had just had it with the process--she started doing the paperwork for adoption, quit a stressful job, ate a lot of pomegranate, and BOOM! Pregnant. She has a toddler now. Another has gotten pregnant multiple times outside of treatment, despite not getting pregnant through infertility treatments spanning 10 times. She has miscarried the first two pregnancies (one a heartwrenching second trimester loss), and on the anniversary of the due date of her most devastating loss found out that she was pregnant--weeks before she was to start an IVF cycle. Hers is a tenuous miracle story and I hope, hope, hope that this is her forever baby--but what crazy timing! Another did countless IUIs and got pregnant with her son on the first IVF cycle she did. She's been trying for a sibling for years, with tons of frozen IVF cycles and fresh--none successful. For kicks she decided to do an injectable IUI and BOOM! She's into her second trimester already. These stories can be encouraging, and I can't ignore them when they come from first-hand accounts. But it is so hard to hang on to hope when I don't know the circumstances -- were they also anovulatory with very low sperm counts? Was it really just the "it only takes one sperm and one egg" scenario at exactly the right time?

I don't know the answer, but I do know this--despite resenting the miracle story, I want to be one. I can't get it out of my head that maybe, just maybe, I will release an egg and one SuperSperm will get to it and we won't have to do IVF in the summer. It's possible--just highly improbable. But not impossible. At the very least, I will take being a miracle person who, despite multiple failures and inexplicable embryo quality issues, is actually SUCCESSFUL on our next venture. That would be a much more likely miracle that I am looking forward to.