It's a rude awakening to realize that you will not be creating your baby the old-fashioned way. When you look at your child, you will not remember the romantic situations that preceded his/her conception -- no candlelit dinner, no exotic vacation setting, not even the mundane sex on a school-night. In your case, you will remember the countless shots you took to your abdomen, the daily visits to the clinic for monitoring, the poking, the prodding by more doctors and nurses you can count on both hands, the cold surgical rooms, the anxiety.
The sterile environment of your clinic will become your second home: you'll sign in, wait in a sad room sitting on neutral furniture from the 90s with many other women -- all more anxious than the next -- and hope they call your name soon so you can get out of there. You'll go into the blood draw room, where you'll be lined up but hidden ever so slightly by hospital curtains. You'll try to be pleasant with everyone, because after all these nurses are often times your lifeline; they will call you, give you directions and sometimes they'll break the bad news. Then you'll be ushered into the ultrasound room, where you'll take off everything from the waist down. You've done this so many times, you've lost all prudishness. Staring at the paint-by-numbers art hanging on the walls, you'll patiently wait for your doctor (or ultrasound technician) to knock on the door. You'll wonder how things look in there and what's next. Finally, she/he will walk in and ask you how you are and get to work before you get a chance to answer. You'll robotically say you're fine, but wish you could answer that question honestly: I'm depressed, lost, isolated. Infertility sucks... You'll get your update on your follicle count and quickly get dressed. But not so fast, because you have to stop by the billing office to make sure to pay your co-pay, because after all, this is the business of making babies.
Oh, and let's not forget the best part: you and your partner won't ever be in the same room when your baby is actually being conceived. You had your eggs retrieved in an operation room while your partner ejaculated to an undesirable porn magazine. Romantic, isn't it? And while you're home, wondering what's going on, an embryologist will make the introductions: "Egg, meet sperm!"
So baby-making didn't quite turn out like you'd imagined, huh? You probably won't be able to share any of this with your future child(ren). But the one thing you will have that others won't is a picture of your baby/babies when they were only embryos and that's priceless. You will get attached to that picture they'll hand you at your embryo transfer. In fact, I remember DH drawing arrows with a name for each embryo. If that cycle works, you'll keep that picture forever. If it doesn't, you'll shove it in a folder, along with the rest of them, where Little Anna, Jack and Laura will be nothing more than another scar on your heart.
I wonder what I will say when my child asks me about where he came from. I don't think I have an answer to that just yet, but I will be able to show him a black and white image of himself, and tell him that he was loved when he was only made-up of 8 cells.
One of the first things your RE will do is to run a few preliminary tests to help determine what may be preventing you from getting pregnant or staying pregnant. I'm hoping that by this point you had your OB/GYN run the baseline hormone tests (FSH, E2, P4, LH), but if not, then your RE will definitely do so.
Next, she/he will do an ultrasound and check if there are any visible cysts, polyps or anything out of the ordinary. If your RE discovers cysts on your ovaries, you are most likely suffering from Polycystic Ovarian Syndrome (PCOS), which can result in anovulation and is a common cause of infertility.
You will be asked to make an appointment for a hysterosalpingogram (HSG) where your RE will inject a contrast dye that will flow through your fallopian tubes to provide a clear picture of your tubes and uterus. An HSG is done 2 to 5 days after your period has ended but prior to ovulation. This is an uncomfortable procedure (you will not be put under) and some might say, a bit painful. Come prepared with a sanitary pad, some Tylenol and ideally take the rest of the afternoon off. Don't skip this test; it allows your RE to see if your tubes are open and to rule out uterine abnormalities like polyps, adhesions or fibroids.
As I'd stated in my last entry, it's important that you write down your conception journey and provide your records from your OB/GYN. Certain causes of infertility are not easily detectable from a simple ultrasound or blood tests; that's where your personal history comes in. Endometriosis (Endo) is one of them. It usually presents itself in the form of very painful periods, frequent miscarriages and heavy periods, and sometimes, nothing at all. Endo cannot be completely diagnosed and/or treated without a laparoscopy, which isn't part of the preliminary tests that your RE will order. But if you have experienced some of its symptoms, your RE may want to do a laparoscopy to confirm Endo and clean it out.
Another test that not all REs will do is an endocrine test to look at your thyroid function. Thyroiditis is a common problem and can lead to several other issues such as excessive weight gain or weight loss, and of course can affect your ovarian function (anovulation being one of its results). So if your RE doesn't run this test, then make an appointment with an endocrinologist ASAP. It's a simple blood test that can be done at any time of your cycle and the results will be available within a couple of days.
Last, but not least, your partner must get a semen analysis. The test can be done on the same day as your first consultation with your RE or he can come back on another day. But my advice would be to have him provide a sample on the same day as your consult -- he's already there, he can't run away. Get him tested. For that, make sure that he hasn't ejaculated in at least 48 hours but no more than 72 hours. If you read my first entry, you know why.
I will discuss many of the above possible outcomes and test in greater detail in my upcoming posts. Until then, remember that these tests (could) hold the key to unlock your infertility. Being able to finally determine the cause(s) of what's been preventing you from having your baby will empower you.
Once you've made the decision that you need to call in the big guns, it's time to pick an IVF clinic and a reproductive endocrinologist (RE). Before getting into the specifics, two key things will play a big role in your selection: (1) which doctors, if any, does your insurance cover and (2) how many IVF clinics are in your area?
Get your researcher cap on and get to work -- you research before you buy a car, right? Well this is a far greater investment, so don't use any shortcuts. If you have the opportunity to chose between a few clinics, it's very important that you look into them and not simply go for the closest one to your house (we eventually flew from NY to Denver). After all, you are going to be spending a lot of time there between appointments, procedures and follow-ups. And you might not know this yet, but you will look up to your RE as though he/she is now your new god. I certainly did -- I looked at my RE for answers, for guidance and to just make this miracle finally happen for us (more on RE/patient relationships soon).
First, look at hard fact, and by facts I mean statistics. Visit the Society of Assisted Reproductive Technology (SART) to find the clinics in your area and compare each clinic's success rates to the national average. Where does the clinic you're considering rank? The results are broken into 3 main categories: Fresh IVF cycles, Frozen cycles (FET) and Donor cycles. Then look under your age group (under 35, 35-37, 38-40, 41-42 years old). At a glance, the three main results you should focus on when making your decision are:
Number of cycles: This will give you an idea for how many patients cycle at that clinic. The number only represents the cycles that took place during that year, so for instance, one patient could have done 2 or 3 fresh cycles in the same year.
Percentage of cycles resulting in live births: This percentage is very important. Unlike "percentage of cycles resulting in pregnancy," live births will tell you more about the final results.
Average number of embryos transfered: This is also very important to take into consideration. With today's technology, doctors are able to reduce the number of embryos transfered and still keep their success rates pretty high. This is partly why the Octomom story was so appalling to those of us in the infertility world; what credible doctor would be willing to transfer 6 embryos?! People like that give infertility patients a bad rep.
A big caveat here is that the numbers don't give you the full picture: some clinics take on more challenging cases and therefore might have slightly lower success rates, some may be more open to doing certain tests that others won't and most importantly, not a single number will tell you where you will be most comfortable and find success.
Once you've compared numbers/statistics and have picked your clinic it's time to research the RE you'd like to have guide you through your cycle(s). While all REs can help any case of infertility, some have areas of specialty -- donor egg, male factor infertility, polycystic ovaries, high FSH, etc. Of course, going into your very first visit appointment you might not yet know what your specific reason is, but sometimes you do (if you had your OB/GYN run the initial tests I mentioned earlier, you may already have some answers).
There is usually a head to the department and while your first instinct might be to go straight to the top, that's not always the best idea -- he/she might be way too busy for you. When cycling, you want your RE to have time to communicate with you, return calls or emails. But sometimes, that RE might be the best suited person for your case and well worth the wait. You need to make that call.
Once you've picked an RE, he/she will be your point person for the whole time you're at that clinic. He/She will determine your protocols. Be warned that it will be very difficult to change doctors. Having said that, you will meet and interact with the rest of the doctors at the clinic for your check-ins, your egg retrieval, embryo transfer and (hopefully) your initial pregnancy monitoring.
Going into your first appointment, write down all the details about your conception journey thus far, obtain copies of all of your records from your OB/GYN and have your questions ready. Most importantly, do not go there without your partner. This is the beginning of what might be a long journey and it's time for you and your partner to become a team. You will not get through it without being each other's rock. It's time to step up and leave the tension from the sex-on-demand days at the door.
This Google News Update appeared in my inbox this week and this is a good time to discuss the financial aspects of infertility treatments and how the new Health Care Bill falls short of alleviating this burden.
An IVF cycle will run you around $15,000 (some clinics are a little more or less expensive). Factor in the cost of medications, you've got yourself a big $20,000 bill at the end of your cycle. So it's no surprise that so many couples crumble under the weight of ART treatments. Some deplete their savings, others mortgage their home and many will accrue additional debt.
While over 7.3 million Americans suffer from infertility, only 15 States have some form of mandate for insurance companies to cover all or part of infertility treatments. Those States are: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, West Virginia. But, I did say "all or part of infertility treatments." So you can be sure that you will have to jump through hoops in order to get the coverage you need. At the end of your obstacle course, you will either be covered for the diagnostic tests, some of the medications and if you're very, very lucky, they will actually pay for your cycles in full. For those of us whose companies did not opt for infertility coverage, you do not have the option of buying individual coverage; you know, you have that "pre-existing condition" and all.
Well, the new Health Care Bill, taking effect in 2014, will make it mandatory for insurers to accept you regardless of your pre-existing condition. But before you jump for joy, nowhere does it say that insurers will be mandated to pay for your IUI or IVF cycles. And I have a sinking feeling that they probably will do anything they can to deny you coverage.
Many don't consider infertility to be a disease. Some even say going through IVF is an elective procedure, like plastic surgery. Comments like "Why don't you just adopt or accept that you're not meant to be a parent" have appeared in numerous discussions on infertility. So it's no surprise that infertility coverage is not any where near the top of legislators' agenda. Clearly those who have children or have made the decision to not have children can't even fathom the severe emotional and physical pain you live with 24/7 in the isolation box that is infertility.
So what can you do? First, we need to start educating people about infertility and not remain silent. Second, you can write your HR department and make your case to include IVF coverage. I guarantee you there are many other couples in the same company who need the coverage as much as you do. Third, you must relentlessly write your local congressmen and senators. It's Infertility Awareness Week and the perfect time to get involved. A great place to start is to get involved with your local chapter of RESOLVE.
As I've said before, do not sit on the sidelines. You MUST take charge of your infertility.
You have now entered the world of infertility. You start noticing all the pregnant women at the supermarkets, the children running around your neighborhood and the baby clothing stores at the mall. And every single one of them is like salt in a deep, deep wound. Your partner may or may not be joining you in your daily pity-party and you turn to a loved one for comfort.
Me: "We've been trying for 6 months. I just want a baby..." Friend: "Just relax. It will happen! Go on vacation or something."
Did you just get punched in the face or did your friend/mother tell you that if you relaxed you'll have a baby in no time?! Now, in all fairness, I know it can be difficult to find the right words to comfort someone you love. You don't want to see them sad or suffering. One of the key things I've learned from my infertility journey and take with me to this day, is: if you'd don't have something truly constructive to say, it's just better not to say anything.
Back to us, infertiles, recovering from the punch in the face, and now fuming. I'm sorry, but the "just relax" argument is wrong on so many levels. Where shall I begin?
1. The first 3 months of having fun-sex didn't get us pregnant. We were relaxed then. Maybe, we even went on vacation. Heck, I even got spa treatments every day.
2. Can you imagine telling someone who has cancer to "Just relax?" You know, "Just relax! The cancer will go away."
3. Countless women get pregnant under very stressful situation. Not to get morbid here, but rape victims get pregnant. Do you think they were relaxed?!
So this is where I go from being the gentle, caring infertility doula, to the exasperated one.
Another gem people love to say is "I understand. I know how hard this is." If you haven't experienced it, you can't possibly know or understand what a person going through infertility is feeling. You can only imagine.
Don't be afraid to politely set the record straight and let the person know that you appreciate their concern. You are living in a world of sadness right now and that you just want them to listen to you. That's all. And if they don't have time to listen to you, an "I'm very sorry" will go a long way.
There is nothing that will kill your sex-life faster than sex-on-demand. Once the fun of the first few months of trying wear-off, you will quickly find yourself in the land of sex-on-demand.
Taking charge of your fertility also means that you are now timing your ovulation and you want to have sex at the right times, on the right days. You are on a mission. You're not messing around anymore. And while your partner may happily oblige initially (what man turns down sex?), he will soon surprise you by saying he has a headache. What?! Yup, the roles are now reversed: you want sex (well, admit it, you really just want to get pregnant) and he is starting to feel used (which, I guess he is. Shhh...) and pressured.
While you might try to let it go once and try to spice things up the next time, it's very likely that you will start to resent your partner for not "contributing." I certainly did and it showed. I slowly became withdrawn and passive-aggressive, which made DH less interested in sex and me even more resentful. And there you have it, the vicious-cycle of sex-on-demand. Faint cracks start to show in your marriage and this is only the beginning... It won't always be that way, but some couples decide to go their separate ways, unable to handle the pressure of infertility. You will read in later posts what we went through and how we came out on the other side of it, stronger.
After a few months go by and still no pregnancy, a certain level of worry starts to creep in. Some of us just bury ourselves into work and hope things will right themselves. Others (like yours truly) want to know why nothing’s happened yet. It’s the beginning of what could be a long, tough road.
The medical journals recommend that women under 35 try up to a year and those over 35 can try up to 6 months before seeking help. I don’t know about you, but I hate wasting time. I say, if nothing’s happened in 3-4 months, go see your OB/GYN. Don’t let them send you home without ordering some basic tests. Have them check your ovarian reserve (FSH), your progesterone (P4), your estrogen (E2) and luteinizing hormone (LH), which you need to ovulate, and get a thorough ultrasound check. If all looks good, then it’s time for your partner so get a semen analysis.
Don’t sit on the sidelines. After all, this is YOUR fertility.
You’re probably thinking, “Come on, are you seriously going to tell me how to have sex?!” Well, not exactly, but before we discuss anything else about infertility, I want to make sure you’re timing things correctly. Many couples think they’re having trouble conceiving when all they really need is to know a little more about the basics of timing sex and ovulation.
Most women’s cycles are 28-30 days. This period is broken up into two phases:
The follicular phase is from Day 1 (Spotting doesn’t count. We’re talking enough fluids to dirty a pad) of your period to ovulation.
The luteal phase is from ovulation to your next period.
Once the egg is released from your fallopian tube, it will only stick around for a maximum of 24 hours. So what we want is to have intercourse a few days prior to ovulation (and on the day of ovulation), since sperm can live up to 5 days (if it’s in the right medium – more on that later).
There are several ways to figure out how long your cycles are in total and how long your follicular and luteal phases last respectively. One way is to chart your waking temperature (you need to do this for 3 months to have a clear grasp of your cycles). The second is check your cervix and the cervical fluids (it’s the “medium” I mentioned above. You’re looking for an raw egg-white like consistency). Lastly, you can purchase an ovulation detector kit from a drugstore (just follow the instructions on the box).
So assuming that your cycles are 28 days, then starting on Day 10 you want to have sex every other day. Unlike what some people think, in this case it’s not quantity (i.e., having intercourse every day) but quality (i.e., healthy sperm) that counts. Having sex everyday will actually diminish the quantity and quality of the sperm. Your egg is not going to stick around for tired sperm, so give your partner a rest.
After ovulation, your luteal phase should be around 14 days. If it seems that your cycles are very short, it may be that your body is not producing enough progesterone (P4). If that’s the case, you’ve got your first red flag. Luckily for you, it can be easily rectified by some progesterone supplements.
You want to take your first pregnancy test (HPT)on the day or one day after your period is due. I know the latest HPTs claim that they can detect a pregnancy up to 5 days before your period, but your body could be producing lower levels of pregnancy hormones (Hcg) that the test might not be able to detect that early on. More on the nightmare of pregnancy tests later.
Infertility sucks. When you're given the diagnosis of infertility, it's an incredibly overwhelming moment. And then you quickly come to the realization that it's going to be a long and treacherous journey to (maybe) have the baby/babies you wanted. Along the way, you will experience the gamut of emotions: sadness, hope, grief, despair, sheer joy, disappointment, anger… you name, you will experience it at some point along the way. As I said, infertility sucks.
Well, I’ve been there and while everyone has a unique story, I wanted to create a place where you can come to for practical and emotional support. I want to impart all of the information I gathered through my years of trying to have a baby so you don’t feel so lost.
Infertility consumed me; it became my life. I researched everything and anything on the how, why, what, who’s of the world of ART (Artificial Reproductive Technology). I know not everyone has the time to devote their every waking moment to this, so think of this blog as the Cliff Notes to infertility. Additionally, I will keep you abreast of all infertility related updates in news and entertainment.
Beyond the practical information, what I longed for the most was to find someone to talk to. Someone who truly understood what I was going through. Someone who wasn’t going to say “Just relax. It will happen.” Well, I’m E. your infertility doula – consider me your virtual shoulder to cry on, your friend who can always find the humor in the darkest of moments (yes, there will be many of both), and the person you can ask anything to (there’s no such thing as TMI here).
Whether you are just getting started, already on the roller coaster or finally on a new chapter, I hope you find the support you’re looking for. Always feel free to ask questions, make suggestions for future blog topics or simply vent.
* Doula means “woman who serves” in Ancient Greek.
This blog is unique in the sense that it is a support and advise blog from someone who's been in your shoes and is now on the other side. I'm here to provide guidance and share news/stories to help you navigate the world of infertility. You can also find me on www.infertilitydoula.com to request one-on-one services in the NY Tri-state area.