Looking Back and Forward

What a year this has been. On a personal level, there were many highs and many lows. In fact, I'd say the emotional roller coaster continues.

Looking back, a huge source of happiness and pride for me has been this blog. While coping with my own pain of infertility, I always hoped that in the end (other than a prized baby), my experiences would serve some purpose. Something positive had to come of this. I got so much out of this community -- support, laughter, a virtual shoulder to cry on -- and hoped to find a way to give back.

So here we are. It's not yet the anniversary of this blog, but in the spirit of the impending New Year and resolution lists, I feel the need to look back... and forward. I was reading old comments today -- always thoughtful and inquiring --  and it brought tears to my eyes. You, readers, keep me going.

I hope I have been able to cover a lot of topics that were pertinent to your situations. I try to take a broad strokes approach, as I realize that each story and each struggle is uniquely painful. Nevertheless, we are bound together in this shared experience of infertility, and that's exactly what I attempt to convey with every entry.

What inspires me most are each of your personal stories. I read many of your blogs -- I follow some very closely and love discovering new ones. In many ways, these blogs are pages of our life journals, ironically shared with complete strangers and yet so very very private (so much so that we live in anonymity out of fear that someone we know might find us out). We write because we need an outlet to express our deepest disappointments, frustrations and hopes. Some have hundreds or followers and other have a handful of devoted readers. Comments and thoughtful messages remind us that we are not alone.

In order to bring everyone closer together and inspired by Mel's ICLW, starting in the New Year, once a week I'm going to feature a blogger. A blogger who might not have hundreds of readers but would get so much out of a few supportive comments. A blogger who you might have never heard of but has a very similar story to yours. A blogger who takes a fresh look at the infertility struggle. A blogger who when all said and done, left me thinking and inspired me to write about.

Another item on my "Infertility Doula's Blog New Year Resolution" list is that I'd like to feature more information. I get a lot of infertility related alerts/news but cannot find the time to write about each thoroughly at the expense of not writing about them at all. Up until now, I didn't want to simply put the info out there without commentary. But who says I have to write a whole entry about a single scientific discovery? They each leave me with thoughts and questions, so why not share those with you? Maybe it will lead to an interesting discussion.

Lastly, I had mentioned that I wanted to start leading a RESOLVE support group. I have worked out the logistics, but wanted the holiday season to pass before getting it up and running. I will provide the details of the support group in the New Year.

My hope and wish for the New Year is that each and everyone of you finds happiness. For the great majority of you, this happiness lies in a child/children, but for others it lies in finding closure. Neither is a simple feat and both require incredible strength. Where ever you may find that strength, I hope to remain (or become) your little oasis.

With love,

The Infertility Doula.

The Silence Can be Deafening

I recently enjoyed a lunch with a childhood friend of mine. She and her husband have been trying on and off for a year. Like 99% of us, when they first began to TTC they had no problems disclosing this information to close friends. We've all been there; you talk about how great it would be to be pregnant at the same time, how your kids will grow up together... But when months turned into a year (or more) and that "close friend" is now 3 months pregnant and you're clearly not, everyone involved finds themselves walking on eggshells.

There seems to be three basic paths that people choose to take when dealing with their infertile friends/relatives: One is to morph into detectives, picking up on every little clue possible, but never openly addressing the issue. Another is to completely ignore that the infertility even exists and just further drive the "you must get pregnant soon" message. And lastly, the "I know you can't handle this, so I'll spare you" approach, making decisions on behalf of the infertiles. All of these, in their own way, are robbing the person/couple dealing with the infertility from finding their voice and their place as they steadfastly continue to hope that they will be parents someday.

Beyond the heartache, living with infertility means living with contradictory emotions. One part of us wants to keep all of this pain private while the other part just wants to let it all out. We remain silent through the most inane comments -- "Just relax!" "Go on vacation!" -- when all we want to do is snap back to tell those people that it's rather impossible to "relax" when countless strangers whose names you don't even know have seen the inside of your uterus. But no, we bear down and weather the insolence.

When we choose to remain silent, we find ourselves subjected to conspicuous analysis of our every move, looking for the tell-tale signs of pregnancy or lack-thereof. Those looks are not the most subtle (Hmmm, I wonder if she's going to order the sushi), or is it perhaps that we're also hyper-sensitive to the meaning behind our most mundane decisions -- to order a glass of wine or not. All a reminder that yes, indeed, you are still barren.

My friend was telling me that she wishes her pregnant friend would just check in with her and ask what's happening rather than trying to pick up on meaningless signs. That rather than assuming one thing or another about their pregnancy status, that she would just get the facts and let her be.

Putting myself in pregnant-friend's shoes, I can see how awkward this situation might be for her as well. If she asks about what the hold-up has been, then it might be an invasion of privacy. But not asking, as it turns out, can be even more disconcerting.

Then there are those who pretend like the infertility issue doesn't even exist and proceed to talk at length about so-and-so's pregnancy with their third child (for some strange reason, mothers tend to champion that approach). The assumption that of course you will also get pregnant in no time, so why beat around the bush. I remember while we had been trying for a year, someone decided to gift me hand-me-down baby stuff (crib, clothes, etc.), because after all, I will get pregnant tomorrow (or once I relax!). I felt like this move was a rude reminder of my infertility and not a generous donation to my future life with baby -- both parties, completely unable to relate to each other's messages. (I eventually donated all the stuff to goodwill. Couldn't stand having it in my house.)

On the other end of the spectrum, a fellow blogger recently tweeted about how upset she is over not being told about her SIL's upcoming baby shower. In this situation, the family clearly knows that this couple is dealing with infertility (openly discussed or not) and their solution to "deal with it" is to spare the infertile couple the agony of sitting through a baby shower.

I was viscerally brought back to how I felt during my years of infertility. While I had pulled away from life, friends and family, I also couldn't accept that I was viewed as weak and fragile. Other people's deafening silence and/or avoidance of our infertility made me feel even more pathetic. What?! They don't think I can handle a baby shower?! Oh, they have NO idea how tough I am! In truth, of course I couldn't. But when your life has spun out of control, you want to know that you are still capable of making your own decisions. That to go or not to go to a baby shower should be a decision you make for yourself and not one that's thrusted on you as though you're some kind of incompetent child.

To those friends and family who are unsure how to handle other's infertility, I would give the following advice: If you are close to the person, then when appropriate, sensitively broach the subject. If the infertile person wishes to talk about it, your role is to simply listen. Don't pretend to understand or say "I know how you feel" (unless you've been there). Simply offer your presence if and when needed. Sometimes, all we need is to have a shoulder to cry on. However, if you're not that close or should the infertile person choose not to discuss things, then don't try to read into their future actions. Let them live and cope the best way they know how.

Most importantly, don't make decisions on behalf of the infertile individual/couple. Deep down, you probably think that you're doing the most thoughtful thing possible, but it's only exacerbating the utter loneliness and chaos of the journey.

Infertility is a personal roller-coaster that one must feel allowed to ride. You don't know when the ups and downs are coming, but you anticipate. You didn't choose to get on that ride, but you need to be able to brace for impact and raise your arms in the air when you feel full of hope again. For those people in your lives who remain as spectators, watching you from the sidelines, it is your responsibility to give them a role or at the very least delineate the boundaries. The pendulum swings both ways. You bear a responsibility for how you wish to be treated. Speak up.

Jan 7, 2011 -- ETA: I came upon this wonderful entry by Jess over at "A little blog about the big infertility." She wrote an eloquent letter to her friends and family about the new path of embryo adoption she and her husband will be pursuing in 2011. She beautifully describes their wishes that they not tip-toe around them and let them make their own decisions about what they can or cannot handle. Her letter is a prime example of speaking out. I sincerely hope that her/their wishes will be answered in every way.

Dollars and Cents: Affording Infertility Treatments

I was contacted by a reader desperate for some information on affording infertility treatments. Considering the cost of treatments and everything that precedes and follows an actual IUI or IVF, I hope this entry will be helpful to many of you (who reside in the US).

Insurance Coverage/Plans:

First I want you to read your insurance plan very carefully. Unlike the owner's manual to your television, when it comes to your insurance plan, the fine print could give you the most important information regarding infertility coverage.

Find out if you live in an infertility treatment mandated state. For instance, New York provides mandated coverage for IUIs and medications. While Massachusetts residents will be also covered for IVF. Don't limit yourself to your state of residence -- if your employer is in a mandated state, they must offer infertility coverage (let's say you live in NY but work in Connecticut). Some insurers will cover at various percentages while others will give you a "lifetime" maximum amount of dollars to go towards your infertility treatments.

If you are lucky enough to have coverage, make sure there aren't any provisions and pre-requesits to the coverage. In some fashion, they will ask that you prove your infertility. (No, they do not read your blog, but they should.) Also, when you're gearing up for a cycle, make sure you check with your insurer to obtain a cycle number and that you have a letter confirming your coverage for that pending cycle.

Even if infertility treatments aren't covered, some tests (blood or surgical) are often times part of your basic coverage. So for instance, if your RE recommend a hysteroscopy but your insurer won't pay for it if it's done by a specialist, don't be afraid to seek the help of your gynecologist to perform the recommended procedures or tests.

If you're required to pay out-of-pocket to then get reimbursed by your insurer, you have to stay on top of it like your life depends on it (in this case, your wallet). Many insurers will deny claims, to eventually approve them after you've spent hours fighting about it. If you know your coverage inside out, you will be surprised at how much more you know than the representative on the phone. I've said this on countless occasions: you must be your strongest advocate.

With the upcoming changes in the Health Care Bill taking effect in 2014, you will no longer be denied insurance for preexisting conditions. But keep in mind that if  infertility coverage is part of your current plan, it will most likely be dropped by 2014. Universal health care may be coming at the cost of your infertility coverage.

Lastly, if your employer has not signed up to cover infertility, then pick up the phone and call HR. Make your case. Sixty five percent of employers who cover IF said they do so because their employees asked for it. So, petition your employer for IF coverage. Here's a sample letter.

Grants:

Some pro-bono agencies provide infertility coverage grants offered by Fertile Dreams, INCIID and the Cade Foundation. They come with strings attached and are incredibly selective (at times discriminating). But it's certainly worth the shot. Before you commit to any program, be mindful of the restrictions that are involved with pro-bono grants. Here's a link to important questions to ask when reviewing your grant options.

Shared-Risk Programs:

When you take into account the exorbitant cost of multiple rounds of IVF, some clinics and third-party companies are offering what they call "shared-risk programs" or package-deals. These programs cover multiple cycles with a money-back-guarantee if none of the cycles end in a live-birth. Expect to pay a larger sum upfront but you will have peace of mind knowing that you have 4-6 cycles before it all runs out. Depending on the plan offered, after 2 cycles, the consecutive cycles come to a fraction of the cost of just one cycle. Keep in mind though that these programs, similarly to grants, are very selective (FSH, age, past history and reasons for the infertility will be closely scrutinized). Also, they will not cover preliminary tests, medications and certain aspects of the cycle (like the anesthesia).

On a personal note, after paying for 4 IUI and 4 IVF cycles mostly out-of-pocket, we opted for a shared-risk program. The program initially rejected us but we pleaded our case via our new RE. They accepted us, we payed $30K. The first cycle with the program worked.

Other Options:

Medications -- All clinics have donated or left-over medications (injectables or otherwise). This is the time to work your people skills with your nurses. Also, when your RE calls in for your drugs, they often don't qualify whether they approve generic or brand name. Generic drugs are just as effective as brand names and cheaper.

Flexible-Spending Accounts -- Employers offer flexible spending accounts. Use them! If you know you're going to do a cycle (or more), a flexible spending account will allow you to put some of your hard earned pre-taxed money towards your treatments.

401(k) -- Some 401(k) plans allow you to dip into your savings for medical purposes without any tax penalties. This should be a last resort option as you are taking a great risk by dipping into your future for treatments that cannot guarantee success.

Clinical Trials -- Fertility clinics have on going clinical trials. Ask your RE if they are working on any trials that you may qualify for. Make sure you understand what's involved, what's covered and how beneficial it will be to you.

Create an Infertility Fund -- How many of us have received useless gifts for holidays and birthdays. If you have come out to your loved ones about your struggles, I would encourage you to open up an infertility fund. This is also the time to reach out to your community. You may be surprised by the outpouring of support. In the same spirit, contribute to your own fund by doing some spring cleaning. You must have countless things that are buried in the depths of your closet (or house) that you have not touched in ages. Put them up on eBay or do a yard sale.


Lastly, keep records of all of your infertility related expenses and all other medical expenses. If they add up to more than 7.5% of your adjusted gross income, you will receive tax benefits.

Holidays Are Not Easy, Even When You Have Candy

This morning, I kissed my husband goodbye and sent him on his way to work with a giant bowl of candy. I think he's going to be very popular today. But last night, we were not the popular ones. We didn't have any trick-or-treaters. Sifting through the mound of candy, picking out my favorites, it didn't take long to realize why not a single monster, princess or superhero stopped by.

When we moved to this charming town we had dreams of what life would be like. In part, we imagined little trick-or-treaters knocking on our door or us going around in our safe neighborhood with our kid(s) in tow. By the time summer turned into autumn and the leaves reached peak foliage, we'd already been through months of trying and three failed IUIs. I certainly was in no mood for Halloween and be reminded of what was already feeling out of reach. So, we kept our lights off and hid in another part of the house where we wouldn't be seen. They still came, still rang the doorbell...

Months turned into years and it wasn't until this year (now 5 years since we'd moved out of the city) that I finally felt like I could be part of the community. I made a trip to Target, got a few decorations to put on our door, a super-sized bag of candy and at last a bowl befitting of the celebration. I pictured opening the door. Handing out candy and my son getting to see all these kids dressed up, making him excited to become one of them next year. But instead, it was me and the candy (let's say the candy won and I'm not feeling so good today).

Even though I am finally on the other side, I was reminded of the scars of infertility. Some are buried deep within, some are visible ones from surgeries, but this one -- not having kids knock on our door on Halloween -- was a haunting reminder of how detached I had become from everything and everyone.

Along with the cold weather, the beautiful leaves and the seasonal festivities come the obvious presence of neighborhood kids and family gatherings. Halloween, Thanksgiving and the holidays make up probably one of the toughest few months for the infertile community. There really isn't a magic way to avoid being perpetually reminded of your crushed dreams.

I'm sure there will be lots of advice passed around on how to best handle these awkward and often times hurtful situations. I'm not sure I have the best advice considering. But what I can give you is a promise that I and the rest of the community will be at your finger tips (blog or twitter) for comfort.

Facebook and Why It's an Infertile's Worst Nightmare

I know I'm not alone when I thank the great minds that have allowed us to virtually connect with one another. I know many talk about "the good old days" but I can't imagine having to cope with infertility, which already drowns us in public silence, and not be able to share our fears and joys with a community of women/men who truly understand what we're going through.

Some of us connect in anonymity, via blogs, Twitter and even take that leap to become friends in real life. But the one virtual connector that seems to always come up in conversation is Facebook -- and not in a good way. Most of us are on it, willingly or by peer-pressure. The idea of reconnecting with long lost friends was certainly the appeal for me. But once infertility barged into my seemingly pleasant life, I started avoiding FB like the plague (although the sadistic side of me managed to drag me back to it too many times). Filled with pregnancy announcements, ultrasound pictures, and the latest "Oh Jr. just said the cutest thing today!" I cursed its dubious inventor.

What enraged me most was being surrounded by people who were over-sharing the lamest details of their lives, while I, who was actually experiencing something real, could not complete the "What's on your mind?" box honestly. I knew that if I did, it would either lead my so-called friends to stage an intervention or wonder if I had Tourettes. During those day, you had the option to "Dislike" something (Why did that ever go away?) and my little arrow had brushed over it many times. I knew I would probably get chastised for "disliking" an ultrasound picture, so instead, I would get online and within minutes have the support of countless people about the evils of Facebook.

Facebook seems to know so much about us and the various life stages we're experiencing -- "Boost your fertility in 60 seconds," "Go back to school mommies," "The best new sex-toys" (Not that I ever saw that one!) -- and yet, it's incapable of shielding us from the types of updates that would make us want to throw something at our beloved computers.

For all the filtering and customizing available, why can't we have a "Hide" button for that kind of news? And I don't know about you, but it seemed that other peoples' "baby news" always came at the worst possible time -- a "Sorry, not pregnant again. You looser" day, a "This cycle isn't going to work" mood day or a "My husband hates my guts for forcing him to have sex with me today" day.

I don't have hundreds of friends -- I never understand people who "friend" someone they've just met -- so during my pregnancy and my son's first year, I tried to stay away from anything that might hurt those I knew were coping with IF. Today, they are all either pregnant, expecting or parents. But every time I do post something, I take a second to remember how lucky I am that I can go on Facebook and not completely regret it.

UPDATE: Is the Washington Post reading my blog? I think so. I'm flattered, really.

Infertility on Reality Television: Giuliana & Bill

I never quite understood the whole reality TV craze. To me, it's like a watching a giant train wreck: it's horrible to see and yet you can't look away. Of course, being the jaded consumers that we are, we know that so-called reality shows are not truly real (unnecessary drama will be added to the mix to keep it all interesting). Especially those that involve pseudo celebrities making fools of themselves. Whether they "invite" us into their homes or show off a few dance moves, we enjoy watching them unravel. Behind the bleached-teeth smiles and meticulously managed personas, they are like just like us: flawed in every way.

So when the Giuliana and Bill show started (now in its third season), I seriously had not interested in watching yet another celebrity couple vanish into the failed-Hollywood-marriages-heaven (or hell). Giuliana DePandi, host of E! and "Apprentice" winner Bill Rancic brought in cameras to follow them as they learn the juggle their public careers, a young marriage, all while flying back and forth between LA and Chicago. Well, I wished them good luck and moved on. 

Then I started hearing about their struggles to conceive and finally saw them speak out about it on "The View" during a show dedicated to infertility. So much about that episode bothered me but I'm not going to go into details here. What stayed with me was Giuliana and Bill's appearance and their openness about their difficulty to conceive. I was pleasantly surprised to see them be so open about it and glad that they didn't shy away from pointing the finger at their fellow Hollywood crowd for creating the perception that one can conceive whenever, with whom ever -- Giuliana talked about feeling duped by it all. 

Again through the rumor-mill teasing this season of the show, I came to find out that they had made their first attempt at IVF and that they had experienced a miscarriage. That's when I finally set my DVR to record the show and observe how the process of IVF, early pregnancy and miscarriage would be handled on national television.

The first episode of this season was their first foray into the world of IVF. There were genuine moments of fear, love and pain. What hit home (as I'm sure it will for you as well) was the part when Giuliana and Bill were trying to figure out their schedule to start IVF, and Bill pointed out all the conflicts he had with his speaking engagements/appearances. Giuliana then confronted him and reminded him that they need to be in this together and that the success of cycle must come first. I saw that this couple was for real -- Bill explained himself (wanting to provide for his family) and cleared his schedule. You get a gold star, Bill.

As they started their cycle, there was the shock of the amount of medications (read, injections) involved with an IVF cycle. Unfortunately, you never saw them taking the shots, nor could you even fathom how many are involved to make a cycle move along. Then there was the egg retrieval and embryo transfers. Perhaps because of their celeb status or maybe they have an ultra-friendly RE, but all the kisses on the cheeks and the warm smiles and the extensive personal attention took away from the clinical and austereness of the IVF experience. Maybe I'm just jealous that the most I go from my REs were sympathetic smiles from across the desk during my WTF meetings. 

Watching the show kind of reminded me of TV shows that misrepresent the way some careers work in real life; like how advertising agencies or hospitals function. You get a taste for the drama of it all but if you're in that field, you shake your head and say, "That would never happen!" So I go back to my initial point, reality-TV is not real. It's dramatized, edited and simplified for the masses. While Giuliana and Bill Rancic teased the show by openly admitting their infertility, the show in the way it depicted an IVF cycle wasn't nearly as real as it should have been. Certainly this is not an IVF documentary but an entertainment show (it's on The Style Network!), but here's a chance to televise a young couples journey through infertility and the physical (and financial, for many of us) toll of IVF was treated like an underpaid extra. 

What was genuine and felt un-dramatized were the emotional reactions of the Rancics, especially Giuliana's. Her fears were very clear. After all it is her body that will experience the hormonal upheavals. She unabashedly craved the attention she deserved during her recovery period. As a couple, they had to come clean to their families (or at least to Giuliana's mom) about the cycle. And after the transfer, there was that naive hope that we all have experienced after our first foray into the world of A.R.T. -- what should we name the baby/babies? OMG, what if we have twins! Let's get a baby name book! Let's buy a house in the 'burbs.

What made the announcement of a positive pregnancy test most heart breaking is to know how this all ends for this young couple. Like a train wreck, it's awful and yet I can't look away.  

RESOLVE Peer-led Support Group - NY Area

As what feels like a natural progression of what this blog is intended to do, I have decided to volunteer my time to lead a RESOLVE support group. We will discuss general infertility issues, along with any specific topics that may be affecting you at the time.

The objective of the group is to get together with fellow women and men who are coping with infertility in complete anonymity. 

I want to encourage you to come to find strength and comfort in a safe environment where you will be free to talk about anything that's on your mind. 

This group will be in New York. Before I nail down specifics (meeting place and time), I would like to know how many of you would interested to join. 

I can lead the group in NYC (UWS) or in Westchester, depending on the need. So please, either comment here or feel free to shoot me an email (ebh824@gmail.com) and let me know your preferences. 

And please, help spread the word. 

Always Hope but Never Forget

In our shared journeys through infertility, most of us will experience loss. Loss comes in so many forms: loss of hope, loss of belief, loss of embryos, loss of a pregnancy, and worst of all, loss of a child. So today, on Pregnancy and Infant Loss Remembrance Day, I took a few moments to think of the three babies-to-be that I lost along the way. I thought of the months of treatment leading to each pregnancy, the ambivalent joy I felt at the news, and the ineffable sadness that stayed in my heart as I slowly picked up and dusted off "hope" from the rubble of my life.

When you're dealing with infertility, it feels like everyday is a loss remembrance day. But as we try to keep our chin up and fight through the pain, it's important to have a day when we can allow ourselves to feel again; to think of the what-ifs of pregnancies lost (and even cycles waisted).

Like the differences of our infertility paths, we have differences in our losses. We isolate ourselves and forget that there are countless others who are or have experienced a similar loss. The I Am The Face campaign is a visual reminder that we are one of thousands of individuals who share a pain that only those who have lost can really understand.

While the loss of my early pregnancies crushed me, I cannot even begin to imagine the loss of a late-term pregnancy and/or the loss of an infant. Once you feel that baby moving around and then actually hold him/her, a piece of you and of your heart must die with them. To look at my son today and imagine losing him at any point makes my heart ache. So when I look through the wall pictures on I Am The Face, I wonder what kind of pain is behind most of those smiling faces. I wonder how they experienced the loss. Where they are in their journeys. How they are remembering those little embryos/babies/infants.

If you're stopping by, I'd like to hear your stories of loss so I can think of you individually today.

A Nobel for IVF, But Not Much Has Changed

Apologies for the long silence. It's very unlike me... A few of you have written me asking if everything's ok. I can't tell you how touched I was to hear that I was missed. Virtual hugs to all.

So, the other day, when the big news broke that Dr. Edwards was receiving a Nobel Prize in Physiology and Medicine for developing IVF, I thought it will be the perfect topic to discuss. Surely many of you had heard the news and were probably jumping for joy over this long overdue acknowledgment -- or like Julia at A Little Pregnant, you created a unique artwork to express your excitement; really, how can you top that?

But then, I decided to wait things out and see what the comments were going to be on the news sites. It seems that most Nobel prizes never go without some controversy. Someone somewhere just isn't going to be happy about it. So I sat there by my computer watching the comments pouring in. It was no surprise of course that right out the gate, the comments were negative and critical. Some blamed IVF for over-populating of our already over-populated planet (What about the countless unwanted pregnancies/babies?); others suggested that it went against "God's design" (Then when you get cancer please don't seek out medical treatments -- like stem cells, because it seems to me that "God" wanted you to die, plus we're over-populated anyway); while many went straight for the "why don't you just adopt" route (Really? I'd never considered that option. Thank you for enlightening me). The Vatican of course was apparently "perplexed" by the award, not that I expected any other reaction from them.

Eventually, voices of reason and sanity trickled in from people who were in one way or another affected by IVF. Considering there are about 4 millions babies out there as a direct result of A.R.T., I'd say the comments boxes should have been flooded with congratulations and thanks.

While I pondered how to tackle this news and the reactions that ensued, I started reading opinion pieces from respected writers and bloggers. I think this Op-Ed piece by Robin Marantz Henig (author of "Pandora's Baby: How the First Test Tube Babies Sparked the Reproductive Revolution") exemplifies the overall perception of where our society stands 32 years after the first IVF baby, Louise Brown, was conceived. The piece declares (and it's not the only one) that we have come a long way and that "our attitude toward Dr. Edwards's research has completely changed: I.V.F. is now used so often it is practically routine." (She does point out that some skeptics are still out there, but that the numbers are marginal.)

Unfortunately, I'm not sure that we've come along far enough. While I can't imagine anyone still believes that IVF babies will come out with genetic defects (or some kind of monsters), as long as people and even the press continue to callously use "test-tube babies" to describe the progenies created via ART, I think it's pretty clear that the stigma persists. (Plus not a single test-tube was ever used. Petri dishes sure, but no test tubes like in your high school chemistry class.) That terminology is incredibly dated and yet thrown around today to categorize our kids -- "Oh, yes, so-and-so also has a test-tube baby. You should meet her" -- as though our kids are somehow abnormal; part of some grand experiment.

Even if I manage to move beyond this hair-raising terminology, I cannot get past the comments suggesting that we don't deserve to have the family we want. Whether it's the "playing God" comments, the "just adopt" comments or "we're already over-populated" comments, they all point to one thing: If you're infertile, you should not have kids. And if you want kids, then adopt. But only if you're of a certain age, married and not gay. Our society, as progressive as we believe it is, still establishes the boundaries of what it deems to be right and wrong according to some archaic set of believes that predate our abilities of rational thought and tangible scientific progress.

Awarding a Nobel Prize is a wonderful step in the right direction, but the fact that it took them more than three decades to grant this acknowledgement (and thus, robbing Dr. Steptoe who passed in 1988 from being celebrated) is nothing to boast about. The Nobel committee claims that they need proof of the legitimacy of the scientific discovery before awarding a prize. Establishing certain benchmarks is certainly necessary before honoring someone with a coveted prize. But 30 years is not an acceptable measure in this case since the committee in no time honored scientists like Fritz Haber, Antonion Moniz, Johannes Fibiger*all of whom were proven wrong shortly after their prizes were handed out.

Winning a Nobel Prize for pioneering modern day ART has allowed for the science that is for many of us our only hope to receive front-page placement in the news, but it isn't doing much to shed light on the personal heart breaking journeys that too many of us have taken/are taking.

Where do you stand on this matter?

* Thank you Mel at Stirrup Queens for pointing those out to us.

The Birds and the Bees: An Infertility Story

If good comedy is rooted in pain, well I guess EMD Serono (division of Merck), makers of Gonal-F and Ovidrel, have nailed it. As part of a guerilla marketing campaign, EMD Serono has launched these five web-videos available on the dedicated website, IncreaseYourChances.org. The site then links to a more educational site, Fertility Lifelines.

We follow along the story of Neil and Karen, a bee and a bird, who are desperately trying to conceive. With a dash of poignant humor, the web-videos touch upon the many emotional issues that infertility stirs in us. From attending baby showers to sex-on-demand to the toll that it takes on a marriage.

Browsing through the various sites to glean some of the reactions, I was happily surprised to find that most people appreciated the positive step that this campaign was taking -- making the IF struggle public, opening the door for dialogue and highlighting the everyday anguish. But, some found the spots offensive and belittling the terrible heartache that is infertility. Some suggested that advertisers would never make fun of ED, for instance.

If I were to put my former-TTC cap on, I am quickly reminded of my hyper-sensitivity and my inability to deal with anything that reminded me of our "failures." Yes, pharmaceutical ads don't usually parody illnesses, so why should infertility turn into a joke? But, if I were to put my former-ad-girl and now hindsight-20/20-girl hats on (Ok, I realize that's two hats, but work with me here), I would say the web-videos are rooted in true insight, and the use of humor makes the stories more accessible -- they stay with you; the little details, the nervous laughs. Furthermore, this campaign has tremendous legs (ad speak for opportunities to do more in other media). Perhaps we will continue to follow Neil and Karen on their journey as they do see an fertility specialist, hence further expanding on the countless ways in which infertility affects a couple's lives. And I actually applaud EMD Serono for allowing themselves to be taken outside the box of traditional pharma advertising (good creatives and account people at that ad agency!).

I want to hear from you. What did you think about the campaign?




P.S. Thank you to my fellow blogger, This is More Personal, for sharing these videos.

The Invisible Line of Infertility

For better or for worse, infertility does not discriminate. It knows no creed, gender, age, race, socio-economic status or political affiliation. As I look down the list of this month's (and every month's) ICLW participating bloggers, all I see is a sea of women (I would also include men, but I haven't see any yet) who are suffering quietly in real-life and hoping to find a voice in the virtual one. We support one another, commiserate, laugh, bitch, sometimes shed a few tears and even express genuine joy for much deserved pregnancies. And yet, I occasionally, notice an invisible line that forms, creating almost individual infertile groups in a subconscious race for who will have suffered most and deserved that child most when all is said and done.

You know the lines I'm talking about -- young vs. old(er); first vs. secondary-infertility; those who can conceive but can't maintain pregnancies vs. those who can't conceive without ART; those who are TTC naturally vs. the ones who have done countless ART cycles; those who are doing IUIs vs. those who are doing IVF; even the amount of years it has taken to conceive. Some of these "us vs. them" stances are overt, others are subtle, while many are hidden somewhere in the mess that infertility has left behind when it ravaged our lives.

But like family, as disfunctional as it always is, we are the first ones to come to each other's rescue regardless of our differences and the details of our journeys. I am honored to be sitting at the same table as all of you. Here, on this blog, I welcome each and everyone of you -- happy to help, discuss and listen. I'm sure it goes without saying that at the end of this ordeal, what we really want is to belong to the motherhood club and see each other's familiar faces at that same table, and toast as we acknowledge that we wouldn't have gotten there without this strong community.

Happy ICLW!

Living in Uncertainty: A Deja-Vu

I've been reminded again at how terrible I am with uncertainty. For the last 6 months, we've been on edge, wondering if we are staying in NY or moving to another state. This not only involves moving our whole lives to a new place, but also losing our support system, friends, family, for what may be an amazing opportunity for DH's career and for our finances. Looking back on this period, has made me realize that I have a coping system that I had used while TTC and that even in this completely unrelated scenario, I find myself doing again. It's almost like my 12-steps, although no sponsor is there to get me back on track when I lose my way.

When faced with a big news, I initially experience a moment of shock, which involves a lot of "I can't do this!", followed by some tears of panic. Then, I start absorbing the news and start thinking of how I can pro-actively overcome the situation. Like during my time of TTC, I research. Yes, research is my salvation. It's the only way I know how to cope with things that are out of my control. I feel empowered by knowledge and somehow, this knowledge brings me to a more accepting state -- "Ok, maybe I can do this!" 

During this research process, I feel compelled to share everything with DH. Poor guy, he comes home at the end of a long day and has to listen to me go on and on about this one topic. I guess by sharing all this new info with him, I'm looking for validation that I'm on the right track and even finding out about a new angle that I may not have covered.  

Once I feel that I have scoured the internet and available literature, I sit there and put things on a balance. Pros and cons. I make lists (mostly mental ones) of various scenarios; plan Bs, Cs and Ds. And I draft action-steps that will get me to the finish line... that I can just as quickly shred to pieces to reenter the world of panic. 

Vacillating back and forth, I eventually reach a point of exhaustion, where I become incapable of thinking straight; where I need someone else to make decision for me. And then, I wake up one day, unable to do anything useful -- even writing this blog that I enjoy so much seems like a challenge. Like a prisoner of my own thoughts, I wait for sentencing day (you can equate this part of the last days of the 2 week wait). During that time, I feel like my life is on pause. I imagine myself in the middle of a busy highway, while people/cars are just whizzing by. During my days of TTC, it was people going about their lives, having kids (that I couldn't have) and careers (that I could no longer handle), while I, stuck in one position by some invisible chains, stand there, completely incredulous that despite my best efforts (remember all that amazing research?!) have no control over the situation. 

I thought I had learned my lesson after coping with the uncertainties of infertility for all those years, but turns out I have still much to learn. Life is filled with obstacles that are meant to make you think, act, and reinvent yourself even. 

I realize that the uncertainty I'm living with now is nothing compared to the uncertainties of infertility. In fact, I am sometimes ashamed that I would even make a big deal out of this impending move, but in the spirit of self-acceptance, I have to let myself go through my own coping process, even if I know deep down that in the end, I will get to the other side of this journey, just as you, dear bloggers/readers will get to the other side of yours. 

News: CDC Videos on A.R.T.

Brief news update: The CDC, along with contributions from Aetna, have launched three videos on their site addressing different aspects of A.R.T.

The first video primarily focuses on the importance of being healthy prior to TTC and during pregnancy. Ways to increasing your odds to conceive and sustain a healthy pregnancy. The second video deals with the resources available to patients through the CDC. As I'd explained in an earlier entry, you can obtain SART reports for the IVF clinics in your local area. What this video provides is further understanding on how to read and interpret the data available to you. Lastly, the third video makes the case for single embryo transfers -- dealing with the complications of multiple gestation and the improvement in the technology to be more confident in single embryo transfers.

Despite the relatively poor quality production (Ok, so I'm a bit of a production snob after working in advertising and fashion) and dry delivery, I found the information to be relevant and accessible to those of us who are just getting started on the IF roller coaster. And the fact that the CDC and an insurance company (Aetna) have joined efforts to shed more light on IF treatments gives me hope that we can begin to discuss these issues more openly. Who knows, perhaps our law makers will also be more sympathetic to our struggles and make IF coverage a mandate in all states. One can always hope, right?

Cleaning Out My Infertile Past

In the spirit of cleaning out the clutter that has taken over my house since we started our IF journey and now further solidified by the presence of a toddler, I decided to venture into that corner of my house that is filled with stacks of papers and files that would put any hoarder to shame.

Sifting through the towers upon towers of papers, I found myself surrounded by my past. In one corner I had all the brochures and pamphlets handed out during the "Welcome!" meetings at the countless IF clinics we'd visited. Whether it was to find a clinic to start a cycle or a clinic to get a second opinion, they seem to contain the same information immortalized by the cliché family and baby pictures. I used to work in advertising, so I can appreciate the importance aspirational imagery, but I personally always found those pictures tough to look at (Will that ever be us?). And somehow, even today, as the picture perfect families were staring back at me, they brought back all of the sadness that they used to stir up in me.

Then in another corner were my medical records, dating back to my first visit to a new OB/Gyn. We had moved out of the city and purchased a house to fill with children (Ha!). The basic medical information quickly turned into extensive test results, ultrasounds, semen analyses, surgeries, IUI and IVF cycles. I had made meticulous notes of each cycle -- I guess treating that chapter of my life as the biggest PhD thesis helped me stay as sane as possible. Amongst the pages after pages of notes, time tables and consent forms were the pictures of the embryos that were at once my only tangible hope, only to always become the sources of my greatest despair.  There they were, our first two embryos; DH even has arrows pointing at them with each of their names. Eventually we got wiser and never named them again, but after every transfer, I would keep that black and white print out of our embryos by my bedside and wonder what kind of kids they'll become.

In the final pile were the receipts from the clinics, the labs, the anesthesia, the freezing of embryos, and of course the medications. As if it weren't bad enough that IF rips a hole through your heart, it also rips a hole in your pocket. When we bought our house, we knew it would need all sorts of repairs, but once the cost of IF treatments became an undeniable reality, we put everything on hold. Being the optimist that he is, DH would want to keep things moving along with our house (It's going to happen! Let's just fix these windows), but I would sternly stop him; reminding him that we don't know when our treatments will end and that we need to hold on to this money for our baby. Well, today we do have our miracle boy, and yes, our bathrooms are still outdated, but it was the best money we'd ever spent (and unlike the housing market, things around here only trend upwards).

So now, almost 3 years since my BFP, I only have two piles: one for recycling and the other for shredding. Somehow I think I'm going to have a hard time letting the pictures of the children (embryos) that never were slip through the sharp blades of my shredder. I think in the end, I'll have to stash them somewhere deep in my desk drawer to be rediscovered many years from now.

That corner of my home office looks tidy and clean now; yet empty somehow.

A Case Against Infertility Treatments

One of the things I love most about this brave new world of blogging is that I get to read some truly diverse points of view on everything from what makes the perfect chocolate souffle to what the future holds in the land of international politics. So, when I came across this blog entry I felt compelled to share it with all of you. Now, I must warn you that it may stir some violent reactions when you read it (Keep that mug away from your computer. I wouldn't want you to throw it into your screen and then you can't read my blog anymore. Sniff!) but keep reading -- and of course, share your thoughts with me, I know you'll have many.

Writer and comedian Jessi Klein just turned 35. And in the land of (in)fertility we know what that means. During her most recent visit to her gynecologist, she was confronted with the idea of freezing her eggs. You see, Jessi isn't in a committed relationship, and a baby isn't in her plans at this time. In her latest blog entry on The Daily Beast, Jessi makes her case against seeking infertility treatments. For one, making her body do something it doesn't want to do seems wrong to her, plus she hates needles. Second, the cost of treatments could be better used for other things. Third, as she enters this new milestone of 35, Jessi has decided that she will never be "desperate" enough for anything. That she will take life as it comes, with or without a baby. And should she want a baby some day, then she'll pursue adoption.

Jessi concludes, "If I have one wish for this birthday, is that 35 is the end of desperation and the beginning of acceptance." Well that's very nicely said. But if with age comes wisdom, I'm not sure that Jessi has truly attained that level of maturity and wisdom just yet. You see, she claims that she knows "plenty of women in their late thirties and early forties who are having happy, healthy, gnocchi-tushed babies." I'm afraid Jessi's friendships must not be deep and meaningful ones, because I have a sneaking suspicion that most or at least some of her older-mommy friends must have struggled with IF, but probably never told her. I guess I can't blame Jessi for not being educated since many women fall for the illusion that we can have babies easily at any age (Are you up to date with your People Mag subscription?!). In fact, recently, Giuliana Rancic -- TV host on E! who interviews celebs -- appeared on "The View" and talked about how "duped" she felt by the celebrities she's interviewed, who were having babies at a later age and making it seem as easy as apple pie. Of course, us infertiles know better. We've learned our lesson (so has Giuliana, by the way). It's not that easy; not even close.

In her same theme of acceptance, Jessi doesn't want to force her body to do something it doesn't want to do. If only infertility were that simple. Should Jessi ever change her mind and actually want a biological offspring, I sure hope she has her next boyfriend's sperm tested or doesn't get too upset over recurring miscarriages. Or maybe she'll just chalk it up to, "it just wasn't meant to be." You know, since she's not the desperate kind and all.

Jessi does leave a window open for motherhood someday (although, I think it's a bad idea in her case): "And if I still want a baby, I'll try to adopt. Which doesn't seem like a very bad way to go at all." Ahhh, the old, "why don't you just adopt?!" I love that one, don't you? I don't think we're all vain-crazies who only want a child that is biologically ours because we think we're just that special. We simply want to be parents and some of us have actually explored adoption (I did). If and when Jessi does someday decide to pursue adoption, she's in for a big surprise: the waiting, the disappointment, and then more waiting, oh and of course the thousands of dollars spent (which apparently could be spent on better things).

In truth, Jessi probably isn't meant to be a mother. And if she can be honest with herself, I'll applaud her for that. I see way too many women who think they want children only to appoint a full-time nanny to rear their kids while they get their nails done. Jessi -- and apparently, Oprah -- not only doesn't understand why we would subject ourselves to the physical and mental beating of infertility treatments, but finds it rather "annoying." I wish her new found self-aceptance would develop into an acceptance of others. Maybe next year.

So, happy birthday Jessi... You still have much to learn. I look forward to the day when you realize that maybe you should have listened to your gyno or at least taken the time to know us, "desperate" women (and men).

Stress And Infertility

How many times have we heard "Just relax, it will happen" and have felt the urge to smack that person? Well, for me, there were too many instances than I could count. When you're struggling to conceive, naturally or via the help of an infertility clinic, stress just becomes a big part of the whole equation. I don't see how you can possibly avoid it when each month hinges on that evil HPT to tell us whether we've finally done it.

A new study shows that apparently there is a direct correlation between stress and one's chances of conception. Women who had high levels of the enzyme alpha-amylase (a biological indicator for stress) were 12 % less likely to conceive each month than those who had low levels of the enzyme. In fact, even low levels of the enzyme were indicative of hampering one's chances to get a BFP. I'm not sure how statistically significant the result of this study is, but it's certainly worth taking notice.

Statistics are all well and good, but when practically all women who suffer from IF seem to be Type-A, managing and accepting stress becomes a great challenge. We just seem to be surrounded by things and people that remind us of our struggles and our pain. Stress, at that point, almost becomes a nefarious coping mechanism. It's difficult to even make time to find outlets to relieve our stress, but if we can finally look at stress relief as yet another tool to help us conceive, perhaps we won't see it as such a futile exercise. I don't think that being stress-free will be the magical bullet that will finally allow you to conceive, but in the spirit of coping with IF in the most ideal way possible, finding ways to reduce your stress is worthwhile.

Some fertility clinics are better than others at providing stress reduction guidance. Whether you are able to tap into the resources offered by your clinic, or you're just going to research it on your own, there are numerous ways that you can relieve some of the tension and anxiety that's eating at you (and at your fertility). For one, yoga and meditation. The ability to breath and reconnect with your body will have a long term benefit (even when you finally do have kids) when coping with stress. As I've suggested before, seeking therapy is essential when you're unable to get out of your own head. A third party perspective and guidance may give you a renewed sense of acceptance of yourself. Lastly, this might actually be the perfect time to explore a hobby or interest you've had -- take a cooking class or an art class. Anything that allows you, even if for a couple of hours, to get back in touch with your old self; you remember her don't you? She's still in there, I promise.

How do you cope with the stress of infertility? Please share, as this may help others who are struggling.

Adapting to Unexpected Changes During Your Cycles

I started this blog because I wanted to help fellow infertiles. I wanted to create a blog that I wished was out there when I was still trying to conceive. You know, some 20/20 hindsight from someone who's been down this road before. I wish I could write every day, but because this blog is more topical, I sometimes struggle to find a subject that would speak to all of you. Perhaps I'm just having a guilt trip for not writing daily. Anyhow... So when my fellow blogger Fox in a Hen House suggested that I talk about dealing with the unexpected, I thought, "Brilliant!" Today, I'm going to make some suggestions about finding ways to deal with the unexpected changes during a cycle. Let me emphasize that I am not talking about situations that finalize a cycle, like a BFN or no embryos can be transferred. I'm solely going to focus on unforeseen changes that can be rectified.

Fox's current situation is a great place to start: she was diagnosed with Premature Ovarian Failure at age 35. After a few Clomid cycles, she started an injectables IUI cycle. Turns out her body is responding amazingly well to the meds and at her first visit, she had 13 follicles! Exploring her options, she has agreed to convert her IUI cycle into an IVF cycle. Now that's pretty unexpected. Usually you hear of IVF cycles being converted into IUIs, but hardly ever the other way around. Fox took things in stride. She adapted. Was she prepared for an IVF cycle? No. But is she going to make the most of it now? For sure.

We probably adapt to a lot of unexpected changes in our daily lives without ever realizing it. But when it comes to IF cycles, it seems we lose all ability to take a step back and accept the new direction our cycle is taking. We have too much vested in the cycle and are too emotionally committed to just go-with-the-flow. I've said this many times before, no cycle is ever text book. Not a single one of mine ever went according to plan. You have to find a way to realize that it's out of your hands. I know that this is incredibly difficult to accept, especially when it seems that most IF patients are Type-A personalities (why is that?!). You must remember that you have put your trust in the hands of a reputable clinic (tell me you did your research!) and that your body is in many ways independent from you. Some days it will surprise you with a wonderful gift and other days, it will disappoint you, like a disobedient child.

So when you have a curve ball thrown at you during your cycle, you need to find a way to adapt. How you ask? Well for one make sure you get a hold of your RE (do not accept playing telephone and having the nurses be your point person). If your RE is any good, he/she will make the time to review your options with you directly. Ask all your questions -- What's happening? What does it mean for the cycle? What are my options? What is your recommendation? You're not the first patient whose cycle hasn't gone according to plan and you're certainly not the last. If, like in the case of Fox, it's actually good news, you need to embrace it. Cycles are lived in short windows of time (even if the 2 week wait feels like an eternity). If you miss out on an opportunity, you will always look back and wonder "what if...." But sometimes, the news isn't good, and in those situations, you must remind yourself that you have come this far and that it's too soon to throw in the towel. A skillful RE/clinic will make lemonade out the lemons you've been handed. They will find a way to optimize the situation; that's their job.

So, let's review a few unexpected issues that may arise and ways to (possibly) resolve them:

• Making too few or too many follicles --> Adjust the dosage of your meds. If no change occurs by the next visit, consider converting your cycle.
• You're experiencing OHSS --> The excess fluid may be removed prior to your ET or you may need to complete your cycle with a FET.
• Lining not thickening fast enough --> Try high doses of vaginal viagra to increase blood flow and go to daily acupuncture.
• Lining is too thick --> If you've confirmed there's no polyp prior to your cycle, a thicker lining shouldn't be an issue.
• Premature LH surge (i.e., pending premature ovulation) --> Administer Ganilerix to curb the LH surge until all follicles are ready.
• DH was unable to provide semen sample --> Either go in there to "help out" or consider freezing the eggs and do a frozen cycle. 
• DH's sample is less than usual --> If it's an IUI, ask to do another insemination the next morning. For an IVF cycle, you only need a few healthy ones.
• Your embryos aren't dividing well --> You can opt to transfer them on Day 2 or 3. Your body will give those embryos a better fighting chance than a petri dish.
• You were expecting a Day 3 ET, now it's a Day5-6 --> This is actually great news and it means that your embryos are doing very well. 

The silver lining here is that most issues that may arise during the cycle have solutions that you can explore. At that moment you may not be able to see those solutions, but your RE is there to guide you in the right direction. You can be proactive and do a little of your own research to ask the right questions; it's the not-kowing that frazzles us. Plus, don't forget that I'm your disposal. I'm happy to answer any questions and even look things up for you to help you make the best decision.

Once Upon a Time: My IVF Story

Last time I talked about the various benchmarks that we are expected to meet in order to qualify the month and a half of injections and emotional distress as a "successful" cycle. In truth, many of these gradings, ratings and labelings are nothing but assumptions. I think there's no better way than to share with you my final roller-coaster/less-than-perfect IVF cycle to show you how really, you never know when it's finally your time.

After 4 IUIs and 3 IVFs, we packed our bags and headed to Denver. We figured we couldn't do this much long and we put all of our eggs (and remaining funds) in one basket and hoped for the best. As I was cycling out of town, I went in for an initial monitoring at my local NY clinic after 4 days of stims. Bad news: I only have 3-4 follicles. To put my disappointment into perspective, I used to produce about 20-30 eggs each cycle. Obviously, I almost decided not to bother flying out (with my dog, nonetheless!) to Denver, but after much convincing from the Denver nurses, I reluctantly found myself on a date with Wandy. Ok, so a little improvement, now I had 8. Not worth a happy-dance, but I'll take it.

I finally unpack and settle into what became my home for 2 weeks. I go in for a couple more monitorings  only to find out that my lining isn't cooperating, as usual. It's been an issue for me through all of my cycles, but I thought I'd have better results this time since I was popping blue-pills where no pill should go. But, to no avail, my lining was around 5mm. The nurse informs me they might have to freeze my embryos and do a follow-up frozen cycle to complete this one. Cut to me in tears; scratch that, sobbing as I pick up DH from the airport.

Well, maybe DH was my lucky charm, but at my next monitoring, my lining had grown a little more (6.5mm). When I think about it today, I wonder if the nurse was just trying to make me feel better. Who knows. Anyways, so we're moving right along and now, surprise, it looks like I'm about to prematurely ovulate. Awesome! Rush to the drug store, get yet another over-priced shot to stop the ovulation. Three days later, it's retrieval day. I feel like I'm finally being treated humanely -- private nurse, private room, hot towels for my little veins... 10, 9, 8... Zzzzz.

Waiting for the egg and embryo counts: 8 eggs, 5 mature, 3 embryos. So, it's a Day3 transfer. I'd never done a Day3 transfer before, because with 30 eggs, the doctors usually had plenty to work with. I sadly assume that this cycle is never going to work, especially when I find out at my transfer that one embryo looks good, another is ok and a third is probably useless. I can tell that the RE is not thrilled with what DH and I have produced (remember, embryo quality validates us), but he tries to remain cheerful nonetheless. I'm sent on my way to bedrest for 2 days with the information that if an embryo hasn't implanted by 7dpo, it probably won't anyway. I'm pampered by my DH and my wonderful mother (who flew all the way from Europe!) but my disappointment is not easy to hide.

Back in NY, I end up having to give my own PIO shots (ouch!), which hurt even more when I'm convinced this cycle is a bust. I keep busy and hopeful by delving into the world of adoption; going about my life, much to my mother's dismay. DH checks in with me from his shoot out in LA to remind me not to give up. Here we are at 12dpo and I start spotting. I call DH, tell him it's over and not to bother  flying across the country to be at my side when I POAS.

It's POAS day and I do what's expected of me (after all, DH flew 6 hours just to be here and will fly back to LA the next day -- I told you guys how amazing he is!). I almost don't even bother looking at the result on the HPT (it has to be BFN, right?) and do a double take when I discover a second line. I was so convinced that the cycle didn't work that I was almost disappointed that it did. I tell DH that it's a faint positive, which probably means the beta is low and therefore, we're done. DH scrambles to find pictures of others' HPTs to prove to me that it's not faint ("Look, this woman had the same faintness and she had twins!"). Sure enough, my beta comes back a 29. Oh, I've been down this road before (chemical pregnancies and an ectopic), this is one of those again.

"This is the first day that you have a chance to start believing in our baby! Are you really going to care he/she started at a 29 when he/she is finally in your arms?" Those were the powerful words from my DH that kept me believing. And today, our son probably has in many ways his father to thank for being alive, because after so many years of failures, I couldn't accept success -- which ever grade, number or label it came in -- when it stared me in the face.

I'm E., your infertility doula, and my story is not an urban legend.

The Infertility Competition

We spend so much time scoring and labeling things and people, it's like we're in a perpetual competition. Most of the time, I wonder who or what we're competing against. But when you're going through IVF you are up against, what often seems like, insurmountable odds. Your FSH has to be acceptable; you have to produce the best quality eggs (and not just 1 or 2 of them!); then your embryos will be graded like the dozen eggs at your grocery store; and at last, should you be so lucky to get a BFP, even that might not be good enough.


As you begin your cycle, it all starts with your FSH levels. Most clinics will have a cut off -- usually they'll want you to have an FSH lower than 12, but every clinic is different. This is one way your clinic weeds out the "bad eggs" (pun definitely intended!). They want competitive success rates, so if your FSH is too high, you're going to be a big challenge to them. So before you can even put your legs up on the stirrups, you're sent to the back of the line  to either do a few months of acupuncture with the hopes of lower your FSH or perhaps to revisit your option of egg donation. Either way, when you've psyched yourself up to start a cycle, there's nothing that will deflate your spirits faster than not even being allowed to enter the race.

Then you're on to follicle counts. What's an ideal number? Who really knows. But most IF literature will tell you that 10-12 mature follicles will yield the best success rates. It's really your RE's objective to try and control the quantity of follicles you produce. If you have PCOS, like I do, you're likely to produce more follicles, but your RE should aim to taper the development of too many follicles, as this will most likely lead to weaker quality eggs (and hence, embryos). However, if you have POF, then you'll be thrilled if you have 5 mature follicles. Either way, remember, it's about quality and not quantity. As cliche as that might sound to you, I speak from personal experience, which I will discuss next time.

Now, you've finally made it to the other side of your egg retrieval and looking at the second chapter of this arduous process: the embryo transfer. As your joint contributions (egg + sperm) develop into embryos, the embryology lab will grade each embryo to eventually select the best two (or three) to transfer back into you. The grading of embryos* will vary based on the age of the embryos to be transferred (Day 3 vs. Blastocysts are the most common stages of transfer) and the quality. Sitting in a backless gown across from your RE, only to be handed something that looks like a report card always left me in a cold sweat. Deep down, you feel like those grades are a reflection of you and your husband (Who are we kidding?! Of course, it's all about you) -- of how well you performed through this obstacle course. Of course it's not about how well you did, but they are your embryos and you want them to have a head start in life (even before the crazy pre-K interviews that lay ahead). At the end of the day, regardless of their grades, you will welcome back any and all embryos your RE has selected for you. All you can hope for is that they stick and don't leave your roof for the next 18 years.

At last, the much anticipated POAS day is here and you are (hopefully) doing a happy dance in your bathroom, holding your positive HPT in one hand to prove to yourself and the world that you did it! You'll go in for your Hcg/beta test to confirm the happy news. And even here, you will have to meet a certain score to validate your pregnancy, because we wouldn't want you to get too happy, right? Ideally your Hcg should be 50 or better at 14 days post ER (for more detailed chart go here). Lower levels of Hcg are usually not good news (there are exceptions) and indicative of either an impending chemical pregnancy or an ectopic. And very high initial Hcg levels will have your nurse proclaim, "Ohh, ohhh... someone's having twins!" Most clinics will have you go in every 48 hours to see your Hcg levels double (or better). The tension will continue to build until your first ultrasound (oh, magic wand, how I've missed you) to check that there is indeed a little bean in there.

In the land of infertility, we strive to be overachievers. We define our worth by the number of eggs produced and the quality of our embryos. But I promise you that when your day comes (and I really hope it does for all of you), you won't care how many embryos you created and what grade they were. There is no telling which embryos will turn into mini versions of yourself (even the REs will admit it), so I say this with caution: this cycle could be your cycle. Here's to hoping. Cheers!


*Day 3 embryos will be checked for number of cells (8-10 cells @ 72 hours); the evenness of the cells (they should be all about the same size); and the degree of fragmentation (you want as little fragmentation as possible).Your embryo will be graded on a scale of 1 to 4, and the ones with the most even cells and least amount of fragmentation will be transferred back into your uterus. However, if you are looking at blastocysts (Day5 or 6), then the key factors are: the expansion of the blast (graded on 1 to 6); the quality of the inner cell mass, i.e. the baby-to-be (graded A, B, or C); and the quality of the torphectoderm, i.e. the placenta-to-be (graded A, B, or C). Every lab has a different scale, so a 5 could mean a good or bad thing depending on your lab. Make sure your RE explains exactly what the letter and numbers mean as it pertains to your precious embryos.

Other People's (IVF) Babies

Today, I went to visit my friend EAM at the hospital. She delivered two beautiful baby boys on Friday. EAM and I have known each other for nearly two decades, but I think it was over the last couple of years that we have grown even closer. As I've said before, for better or for worse, infertility changed me forever, so when she told me three years ago over lunch, "We've been trying for a while, but nothing yet..." I immediately shared all of my IF-wisdom and told her to get checked. I basically walked her through a lot of the same things I talk about here. It's become instinctive now. I know that something is going on even if a friend tries to hide behind her silence. In those situations, I will in no uncertain terms announce that we had trouble conceiving, and then I'll keep the door open for them to open up if they want. And without fail, they always do. And the first question always is, "How did you know that we are going through this?" Like I said, it's bigger than me now. Some have gay-dar, I have IF-dar. I just can't help myself.

Well, it took her a few tries, but EAM is now a proud mama: the joy, pride and raging hormones included. Seeing her babies reminded me of how strange it was (and still is) that I never felt jealous or resentful when my fellow IVF friends (real or virtual) crossed the threshold and became pregnant (and eventually mothers). Somehow, knowing that they had a tough time getting there made it ok to finally bask in the glow of motherhood. In fact, walking the streets of NY and seeing the double strollers, I would immediately proclaim "Ah, IVF-babies!"as though it made it ok that these moms were parading their kids around me, reminding me why I was sticking myself my countless needles ever day. Even today, mothers of multiples have a special place for me. Last week, I met a mom at the toddler gym. She walked in with her twins and somehow, I instantly felt connected to her. So strange. I mean, we probably have nothing in common, truly. And yet, the pervasive bond of IF is immediate. This mom, of course, has no clue of our "bond." And who knows, maybe we'll never discuss it, but I silently will nod with approval, "Yeah, you're one of us!"

Now I wonder, during my years of coping with IF, was I unfair to mothers who had singletons? With singletons, it's not as obvious to tell whether the parents struggles to conceive or if they were a result of a fun night of good old fashioned sex. Maybe some had also struggled and were also deserving of compassion. And today, perhaps, perfect strangers around me are shooting darts behind my back when they see me with my son -- completely oblivious that if they simply said "We've been trying for a while, but nothing yet..." I would drop everything, listen to them, share what ever information I have (heck, I'd even take them to the RE myself) and most importantly tell them that I know how they are feeling.

How do you feel when you see IVF babies around you?




P.S. As more IF-friends around me become new parents, I think I'm inspired to start writing a second blog about parenting after infertility. I'll keep you all posted.

Versatile Blogger Award

I started this blog just a short few months ago with the hopes of helping others navigate the rough seas of infertility. So it was an incredible honor when I found out that Jay Bronte at The Two Week Wait bestowed upon me the Versatile Blogger Award.

As I gather it, I first have to thank the person who nominated me (of course! I have manners). Then share seven things readers might not know about me. And lastly, I have to pay it forward my selecting eight other bloggers I’ve recently discovered (but who haven't been nominated yet).

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Thank you Jay for recognizing my blog! Coming from a talented and smart cookie like yourself, it’s an even greater honor. You inspire me to be a better blogger and to continue on my humble path to help women like yourself.

1. I used to be a fashion stylist. I still loooovvveee fashion – I have a stuffed closet and a tower of magazines to prove it.
2. English is my third language, but I guess through the years, it’s become my first.
3. I love good food. I love to prepare it, eat it, watch it on TV. And while I’m on the subject, I have a thing for desserts. Even if I’m full, I claim there’s room in my “second stomach” for some sweet treat.
4. My non-obviously-hot-guy crush is John Krasinksi. A good sense of humor and charm will go a long way with me.
5. I’m strangely incapable of watching any movie that involves an animal getting hurt, but blood and guts with humans, bring-it-on!
6. I never leave the house without some concealer for my perpetual dark circles.
7. I’m hyper critical – mostly of myself. I second-guess every decision I make. In fact, I’m sure I’ll go over this list after posting it, wondering if I should have written it differently.

I would like to bestow the Versatile Blogger Award to the following fab bloggers:

1. Cenk@ Cafe Frenando
2. The Sartorialist
3. Non Chalant Mom
4. Sunshine @ Waiting in Sunshine
5. Keiko @ Hannah Wept, Sarah Laughed
6. Circus Princess @ Circus Children
7. Waiting for a Baby Bump
8. Amber @ Born in a Barn

Letting It Out: Expressing Your Frustrations with Infertility

Loud screams are echoing through my house these days. My 18- month-old son seems to have reached his terrible-twos ahead of schedule (no surprise of course!). He will throw himself on the floor, kick and scream if he doesn't get his way... While I watch him in disbelief (is taking away the now almost empty tube of toothpaste worthy of a rage so great?) I do envy his pure freedom of expression. There’s no second guessing yourself, no second thoughts about societal norms – what you feel is what you show. Frustrated that things didn’t go your way? Let out a loud “Noooo!!!” and throw yourself on the floor. Someone take your toy away? Hit them and snatch it back. Can you imagine if we as adults could be so unfettered with our emotions? 

 

I can’t tell you how many times I have sat across from a friend who complained about pregnancy being so hard while I silently grinned and beard it. What I really wanted to do was to give them a piece of my mind; tell them how good they have it; that a little morning sickness is nothing next to the heartache of infertility.

I have always found it baffling that us infertiles will bottle up our sadness in order to make “happy fertile people” feel more at ease, rather than them trying to comfort us. Babyshower to be organized for the office secretary? Sure, I’ll get the “It’s a boy!” balloons. Ultrasound pictures shared with the world on Facebook? Well, what good is a friend unless she gives the picture a big “thumbs up”? 

Why do we fear expressing our true emotions to the world, when we have every right to be angry, sad and frustrated? The only place we seem to be allowed to truly FEEL is behind closed doors. I can vividly recall the many times I have ran to the bathroom after a public “we’re pregnant!” announcement or burst into tears the moment I got into the safety of my car after a visit to the OBGYN's office. At the very least, maybe there should be areas in public where you can go into a sound proof room, let out a big scream and go back to your table as though nothing had happened.

All I know is that for now, I’m really starting to think I could learn something from my toddler. So if you’ll excuse me, I have to run around naked because who wants to wear clothes in this heat anyway?!

Getting a Second Opinion: It's Not Cheating

So, you've been on your infertility journey for a while under the care of an RE; you've tried a little of this and a little of that, and even received some "baby dust" virtually sprinkled by your friends... and still nothing to show for all this time you've spent agonizing over whether this month is finally your month. Well, it might be time to get a second opinion. A fresh pair of eyes on your case may just be what you've needed all along.

My fellow blogger The 2 Week Wait decided to "grab June by the balls" (her words!) and seek out a second opinion (she was supposed to be "on a break" from trying to conceive, but of course, there's never such a thing when you're dealing with IF). She expressed to me how she was a little hesitant about getting this second opinion as she had a nice rapport with her current doctor and felt that consulting with another RE would feel like cheating on her first. I could certainly relate to that feeling. After almost 2 years and more cycles than I could count on both hands, I had finally decided that it was time to get a second opinion at another highly respected clinic. (For ease of understanding, I'll call the first clinic/RE "A," and the second clinic/RE "B.") It took me a while to muster the courage to call, make an appointment and ask for a copy of my records. After timidly phoning my RE's assistant (praying that I won't have to confession the reason behind my request) and signing a waver for the release of my records, I was finally ready to make the jump.

It's always difficult to get an appointment, but if you can manage to coordinate the dates, try to get in before your next period starts, so that should RE "B" decide to run some Day3 blood work or do a minor surgery (Hystero or HSG) to cover all the bases, you won't have missed the window and waisted yet another month.

Armed with pages and pages of my long history of fruitless cycles, DH and I waited amongst the sea of other childless couples at Clinic B. After so many cycles at Clinic A, I knew the drill, but here, I was back to being a newbie -- suddenly unable to anticipate my next move or take comfort in the faces of the nurses whom I had gotten to know on a first name basis. Finally, we were ushered into the office of RE "B," which made the cheating-on-RE-A feeling that much more tangible. After some initial small talk, we got down to business: RE "B" reviewed my records, made some notes, followed by a few indiscernible sounds (Was he approving or disapproving of my prior protocols), he finally shared his thoughts...

REs, like all doctors, have very big egos. They take pride in their expertise and knowledge (as they should), so more than likely, RE "B" will have a few criticisms of your past protocols (you were triggered too late," "too much stims," etc.) But in the end, you will either leave this new place with a new and improved conception action plan or simply find yourselves back in the arms of your first RE (A one time use of the magic wand shouldn't count as cheating. After all, there were no feelings involved) . In the interest of keeping hope alive, I think it's somehow more desirable to hear RE "B" tell you how RE "A" messed up (either missed something or didn't follow the right protocol) than to hear that you're on the right track and "it's only a matter of time."

To the detriment of your emotional and physical state, having gone through a few cycles in another clinic could actually be a good thing when you're trying to move forward with a new RE -- your response to earlier protocols allows RE "B" to have a better picture of your medical history and possibly devise a more successful protocol. And perhaps, even if RE "B" doesn't have a revolutionary approach, sometimes you just need a change of scenery. Month after month of disappointments at Clinic A has probably left you with some PTSD. You may need a clean slate, a new start, heck, maybe you're just tired of getting calls from the same apologetic nurses ("I'm sorry, your Beta Hcg was negative.").

On your quest to finding your new RE, the same rules apply as your initial search. Find someone who is highly reputable and don't be shy to ask all of your questions. But having cycled a few times somewhere else, you now have the advantage of being more knowledgable about your situation, so with a little research you might find a clinic that has a strong success rate for your specific issue (i.e., high FSH, MFI, PCOS, etc.).

Most importantly, when it's time to finally break up with RE "A" don't feel guilty. Sure, you've gotten to know each other and you've probably looked up to him/her as your personal fertility-god. When we finally had our "What-The-Fuck?!" meeting with RE "A" before we decided to move on, I was heartbroken to discover that our special relationship wasn't that special at all. That I really was just "another patient." I walked in there expecting to softly break up with RE "A" only to leave his office feeling like I had been the one to get dumped. Should you not feel the need to face RE "A" then don't feel guilty to quietly walk away -- just slip out of the surgical chair, close the door behind you and no need to leave a Post-it note saying "Goodbye." This is the business of making babies. No one is doing this out of the kindness of their heart. You and your dreams come first so give yourself the freedom to play the field until you find doctor-right and not doctor-right-now.