Bye Bye IUI: Preparing Yourself for IVF

So, it's been 4 rounds of disappointing IUIs and you have now reached a crossroads. Coming to terms with what lies ahead is very daunting. You thought you had already mustered up all the courage in the world to make an appointment at an RE's office, show up with your partner, get tested and begrudgingly wear your badge of honor in the IF club.

After your first IUI, you had reached a level of comfort and ease -- knowing your way around the clinic, the nurses, the protocol -- and you were still able to take a big gulp of Hope every day along with your Clomid. Before you knew it, one cycle after another had eaten away at your spirit (or worse, you had a BFP but went through a miscarriage) and now, you are staring at yourself in the mirror wondering if you can truly accept becoming an IVFer. Sure, the title is not stamped on your forehead, but it's like that unrelenting zit that you think everyone notices but no one talks about -- you know it's there and that's all that matters.

Going through IVF is demanding on all aspects of your life -- your body, your emotions, your wallet -- so it takes a certain kind of spirit and strength to get through it. You cannot underestimate the importance of the support system you are going to need in order to cope. This is where you and your partner have to be on the same page. And while you will physically be carrying the heavier load of this burden (your stomach will turn into a pincushion, your arms will put any heroin addict to shame, oh and the raging hormones will have you seeing red all day!), he has just as much vested in each cycle as you do, so don't undermine his feelings. You need his love, strength and care. Especially if at the end of the month you are back to square one, you're going to want your rock to prop you up.

Next comes your friends (and/or family); whether they are real life friends or the virtual ones (you'll need some of both), you will want someone to speak to in your moments of fear and anxiety. Trust me, there will be many instances when you will need to be listened to and comforted. There are countless blogs and chat rooms, filled with women who are in your shoes (or even better, veterans who have invaluable advice). So reach out to them.

Like a black hole, IVF will suck anything and everything out of you. It is very easy to lose yourself in it and let it control your life. It certainly swallowed me whole, but I did eventually get to a turning point where I physically forced myself to come out of my cave of misery and live again. A big part of it was to see a therapist (mine was the wonderful Jen, my only real life IF sounding board). I encourage you to make time to speak to someone once a week. Having that time allotted to finally get out of my own head was always an unexpected relief. I would also urge you to do something that is non-IVF related during your cycle (working like mad does not count!). Being able to focus, if only for an hour, on something that makes you happy, takes your mind off, and reminds you of who you were before IF crashed into your life. Cook, bake, paint, garden, read... Whatever it takes to hold on to who you were and still are under the dark cloud of IF.

While going through the motions of your first (hopefully, only) IVF cycle, try to remember that IVF is not a last resort; it is a means to an end -- just a long and traitorous journey before you reach the finish line.

An Ode to Virtual Friends

They are everywhere. At the local Starbucks, at the park, the mall, the restaurant... No, I'm not talking about pregnant women (although they did unwittingly get some jealous looks from me over the years). No, I'm talking about people with computers and internet access. As my computer is undergoing a slew of diagnostic tests as a result of a liquid spill (computer turning into its infertile owner, perhaps?), I'm sitting around glaring at all the people around me who are able to get in touch with their virtual friends.

Sure, I could be making use of this computerless time to go out, smell the roses, interact with the real world but instead I long to talk to my virtual friends that I have come to love and depend on over the years. In a time when we are constantly reprimanded for being too "plugged in" I am here to make the case for the importance of virtual friends.

The infertile community is unfortunately (or perhaps, fortunately) very large. And thanks to chat rooms and blogs, we don't have to feel so alone. Talking about your infertility to your real life friends/family can be torturous; from the friends who scurry away at the news of your struggles, to those whom you chose to avoid out of fear that they're going to make the big "we're pregnant!" announcement, to the ones full of assvice ("just relax," "go on vacation"), coming home to the comfort of an anonymous chat room/blog where your girlfriends really get you, is like a big cup of hot coco on a frigid night.

While you might identify yourselves by code names, leaving you wondering what the digits, letters, and screen names represent, over time you become so attached to one another. You happily answer questions; share stories;  commiserated over failed cycles; shed tears over losses and hopefully one day join in on the good news of a pregnancy (somehow, I was always genuinely happy for my fellow IF-friends who had success -- after all, they deserved it).

It is amazing how an experience so heart breaking can bring together women (and men) who might never have met before; overlooking our socio-economic, political, religious and cultural differences, we find strength in each other. We speak our own language (DH, PCO, IF, RE, CD3, ICSI, etc.) and have the same gallows humor. Free of all judgment, you can be truly be honest about not wanting to go to yet another baby shower, for not gushing over ultrasound pictures on Facebook, avoiding "baby" movies, and not once having to explain yourself.

Misery loves company and this my ode to my comrades (virtual and real life) who have fought in the trenches of IF with me -- those that have made it to the other side and those who are still fighting a good fight.

Happy IcomLeavWe!

IComLeavWe

Welcome to my blog. This is my first time participating in IComLeaveWe and as luck would have it, I spilled milk all over my laptop. So while I'm trying to survive for the next week without my computer, I'm borrowing DH's computer (when he brings it home from work) to write this quick entry and send my support to all of you fellow infertile bloggers (I love discovering all of your blogs and hearing your stories).

I created this blog as a place for those of us suffering with infertility (IF) can come to for advice, IF news and support. We went through several years of IF; dealing with PCOS, MFI and an uncooperative thin lining. Along the way, we experienced 3 miscarriages and an ectopic that ruptured my right tube, not to mention countless BFNs. We eventually had success, but our journey of IF has never left me. The pain, the sorrow, the worry, the occasional joy... they're all still with me.

So now, here I am. I want to impart all the information I gathered through my years of IF, when it all consumed me and when I spent my days reading and researching. I want to help you navigate this world that is so complex. I hope you'll take the time to look back on my earlier posts to find something that speaks to you. And if you have any questions or topics that you'd like me to research for you, never hesitate to write me.

I look forward to getting to know all of your through your eloquent words.

Lots of love,
The Infertility Doula.

That's Not My Grandchild: "Pregnant at 70"

"Is that your grandchild? How cute!" asks a woman to another at the playground as they watch the toddlers running around. "No, that's my child," answers the 63 year old woman. Yes! You read it correctly. I am talking about women becoming mothers at an age when most women become grandparents.

"Pregnant at 70" aired on TLC last night and I've been racking my brain trying to answer two basic questions: 1) What is the lasting impression I got from the show? and 2) How am I going to write about it? And frankly, I don't think I have a good answer to either... Sure, I am writing about it, but this entry is going to be a free-flowing one, so bare with me.

Before watching the show, I had a pretty good idea about what I might want to say, but now, I'm really torn. Before I go on any further I should probably give you a synopsis of the show (unfortunately I am not able to find a link to the show, but it will air again tonight at midnight, so set your DVRs!): We follow 4 women, who through IVF and egg donation, became mothers at a very late age. Lauren has a 30 year-old daughter and 3 young children. Her 5-year-old was born when Lauren was 58. Two years later, she delivered her twins. Sue, an English woman, gave birth to her daughter at 57 and now at almost 60 is considering having a second one. Rajo, from a remote village in India, is the oldest woman to ever give birth to her first child at the age of 70. Janise from California was pregnant at 59 and again at 62, and already had 10 kids from two previous marriages. Is your head spinning yet?

The love that all four women have for their children is undeniable. These women, like most women who conceive with the help of ART, were unwavering in their desire to become mothers. They struggled with disappointments and loss, but persevered. They are all devoted mothers and all determined to remain (relatively) healthy in order to be truly present for their children. My broad stroke observation ends here; that was the easy part. Now the questions bubble up and I can't even keep them straight.

How old is too old be become a mother? In the US, where ART treatments are not regulated by a governmental body, there is no age limit to treating a patient. In England, where certain laws are in place, 50 is the cut-off. What would happen if in America we decided to begin legislating and regulating ART treatments? How will we decide when you're just too old to be a mother? Already, most clinics are likely to turn away patients over 42 -- after all, older women are more challenging cases and that's not good for the clinic's success rates and bottom line. But who and how will they pick that finally number? Sure, logic might dictate that if you're post-menopausal, you probably should no longer have a baby. But wait a minute, what about all the younger women who have premature ovarian failure? I guess technically speaking, they aren't really producing any or very few eggs, so should they be lumped in there with the older women? Of course not, because after all one has to assess your ability to carry the baby to term without jeopardizing your and your baby's life. But wait a minute, then what about younger mothers who have diabetes or other health problem? Their risks of complications are higher and children born to mothers with diabetes are twice as likely to be born with a birth defect. Hmmm... so back to the drawing board.

My instinct when I first heard of the show was to categorize these women as selfish. To quote Janise, the mother of 12 children: "When Adam is 8, I'll be 70. When I'm 80 he'll be 18 ... and when I'm 100, I probably won't know how old he is!" For the sake of their children, I do wish all of these older moms a long, healthy life. But realistically, most of them won't probably see their children graduate college or get married. As much as they seem quite determined to stick around for a while ( Lauren takes upwards of 35 vitamins daily!), they are all suffering from the natural ailments that come with old age. Lauren has arthritis and has her 41-year-old husband diapering and bathing the kids. Sue suffers from multiple health problems that have had her in and out the hospital. Sure, those of us who conceived or are trying conceive before our boobs hit our knees don't have a guarantee that we won't get hit by a bus tomorrow or get terminal cancer, but to knowingly bring a life into this world when you have already lived over 3/4 of your life, I'm not sure what that says about the kind of future you are setting up for your children. Will your 10-year-old come home to a frail mother and be forced to take care of you as you physically and mentally deteriorate before her/his eyes? Will he/she feel abandoned because you passed away before he/she got her learner's permit?

The Indian doctor, who treated 70-year-old Rajo, made a thought provoking comment, "older parents make better parents." The Indian doctor's argument is that older parents have the time and desire to dedicate every moment to their children. To a certain extent, that's probably true, although being absent because you're trying to make ends meet shouldn't disqualify you from being recognized as a good parent. I wonder if these older mothers' devotion to their children is more a result of their life long desire to have children rather than their age. In other words, are all women who suffered through infertility or loss are destined to be more devoted mothers?

As you can see, unlike my usual entries, I don't have any answers, advice or even a clear opinion for that matter. Just questions leading to more questions. I'm just as perplexed by it all as you probably are right now. I'd love to hear from you.

The Little Pill That Could

The Pill (I probably don't need to tell you which one) turned 50 last week. It's been blamed by conservatives for the sexual revolution and celebrated by feminists for giving women choices outside of their traditional roles. But as I read this enlightening TIME article, I couldn't help but notice how much irony is packed inside that little thing that over 100 million women systematically take everyday.

Let's start from the beginning. Its inventors Gregory Pincus and John Rock were both devout Catholics and both fascinated with creating life. Rock had 5 children and 19 grandchildren and was the pre-eminent infertility researcher; while Pincus successfully created a rabbit embryo, which became the precursor to IVF. In the mid 1950s, Rock and Pincus experimented with synthesized progesterone (derived from wild yams) to block ovulation. At the time, they were hoping that a few months on the Pill would help jump start a women's fertility (which it did for some women), but as we know today, most women use the Pill as birth control. So it's pretty ironic that  two men whose mission was to help barren women conceive, invented a pill that would actually help prevent conception. Want another twist to the story? Well, the Pill was finally approved by the FDA on May 11, 1960 -- yes, that's Mother's Day! Hmmm... interesting, no?

By all accounts, the Pill can be credited for helping women carve out a significant presence in the work force. In fact, by the 1970s, women were getting married later and wanted fewer children; with that, employers no longer had an excuse to turn women away or relegate them to secretarial jobs. Today, many women devote themselves to their education and careers, and some consciously choose to delay family building. I think most of us look up to successful women, I certainly do, but while I was going through IF, I started looking at those women differently. Don't get me wrong, I still admired them for their drive and intelligence, but I did wonder where they stood in terms of having children. Did they not want kids ever or just now? Had they been fooled into thinking that they could still easily conceive at 40? After all, so many celebrities of a certain age pose on the cover of magazines with their bundles of joy, never disclosing that they either did IVF and/or used donor eggs. Or maybe, these women were also silently dealing with IF and hiding their pain behind the doors of their corner offices.

Being on the Pill has given us so much freedom to define ourselves as sexual beings. We can "test drive" more than a single partner, we no longer have to worry about the condom breaking, we know when Aunt Flow's going to show up and heck, we can even go for 4 months without a visit from Her. But perhaps we got caught up in the excitement of it all and postponed facing our impending infertility. Female fertility begins to decline around 27 and hits a significant drop after 35, but surprisingly, 40% of women think that fertility only begins to decline after 35. That's a lot of women who are postponing the possibility of having children and most importantly, are delaying the realization that they might need ART to conceive.

The causes of IF are countless, but reproductive age plays a significant role in the dramatic rise of couples seeking ART treatments. From the quantity to the quality of eggs retrieved and subsequently the viability of the embryos being transfered, age isn't just a number when it comes to making babies. Now, I know better than to blame the Pill for the millions of people coping with IF or even age for that matter (I was one of countless "younger" IVF patients), but I do wonder if in our pursuit of having it all (and with the aid of the Pill), we are missing out on our primal need to bare children. What do you think?

I Think I'm Feeling Something: The Two-Week-Wait

Are you checking your boobs every hour to see if they're sore? Think you're feeling queazy?  Counting the frequency of your visits to the bathroom? Buying up all the pregnancy tests (HPT) at your drug store? Googling "signs of pregnancy"? Then you must be in the dreaded two-week-wait (2WW). Yup, that world of limbo, filled with hope, anxiety and fear -- what if this cycle didn't work, again! I hated that period of my IVF cycles. Sure I could have chosen to be hopeful and excited for the big HPT day, but truthfully, my pessimism always reared its ugly head.

I was always the most hopeful at the beginning of my cycles. Lining up all the drugs I would be injecting myself with  and creating a spread sheets of it all made me feel empowered. (Have I mentioned I'm Type-A?!). Then there were the daily visits to the clinic; I walked in there like I owned the place. I checked in, chatted with the nurses, prepared my disturbingly bruised arms for blood draw, patiently waited for the RE to use the magic-wand and tell me how many follicles were forming in there. While technically I didn't have any control over the outcome of these visits, I felt like an active and informed participant of my cycles. I would even psych myself up that this cycle was finally going to give us the baby we always wanted.

The egg retrieval day was a pivotal day; my mood and outlook slowly changed, I became on edge and ready to dump the cycle in the growing pile of failures. But before I could reach the point of complete jadedness, transfer day would come and DH would bring me back to a better place. After all, we were possibly one step closer to our baby/babies, right? I would lay there while he'd sit next to me and lovingly look at the black & white image of our embryos. Sure the embryologist might not have rated them a perfect A5 but everything we'd read (DH tirelessly reminded me) indicated that the grading didn't mean anything. So, I would follow DH's lead and for the next couple of days I'd manage to maintain a sliver of hope. I would listen to my meditation tapes and visualize my little embryos floating around, looking for a place to call home.

But before I knew it, I would wake up irritated, as if my mind had been taken over by the witch of doom and gloom. I would tell DH that this cycle didn't work and that we're never going to have a baby. I would shift between pure anger at our infertile selves and tears of desperation. DH's ability to handle my pessimism always went in stages: Stage 1, show understanding and compassion; Stage 2, remind me that it is all an unknown and that we can't give up yet; Stage 3, complete exasperation and a stern request that I no longer poison him with my negativity. Things were tense around the house. I would try to keep quiet (for his sake) but the torture of the unknown never ceased to keep me underwater. My mind would play tricks on me and rob me of any willpower to be optimistic. Oh and then there were the progesterone shots. That 1 1/2" thick needle shoved hesitantly by DH on the upper quadrant of my butt never got easier. Why am I putting up with this shit? Am I crazy?

And the final day would come. I had made the mistake before of taking an HPT too early, but I learned my lesson pretty quickly. The night before the test, I would toss and turn; I'd vacillate between the anticipation and dread of the early morning hours. I would wake up, slowly make my way over to the bathroom, unwrap the HPT like a delicate gift and pee on it. I would pretend to be patient but finally, I would face my future. Squinting to make sure I was seeing correctly the outcome of a month long cycle -- is that two lines or one? HPTs are evil I tell you. Finally I would resign myself to my apparent fate and make my way to the clinic to get the final beta numbers. That clinic that gave me hope at the beginning of my cycles would morph into a temple of doom where I, along with my hopes, would perish in the flames of infertility. Dramatic, I know, and yet even to this day, those are vivid memories of my countless two-week-waits.

Clearly I handled the two-week-wait as poorly as one can. Tell me about how you cope with it?

Taking It Like a Man: Coping With MFI

MFI was one of the many issues that was preventing us from having children. Unlike what I expected, DH handled it rather well. Sure his ego was bruised and he experienced lots of conflicting emotions (especially when I brought up using donor sperm), but he made it clear that we were partners on this journey and that he will do what ever he can to make it happen for us. He made some dietary and lifestyle changes (no laptops on the lap, lots of multi-vitamins designed to help sperm production and quality). Most importantly, he showed-up; he was always by my side, he changed his meetings around in order to take care of me post egg retrieval, heck, he even came out to Denver with me so that I wasn't alone during that cycle. I asked him to briefly share what the experience was like through his eyes and what advice he had for other men. You can read his thoughts below. 

I realize that not all partners are going to be as resilient in the face of this news, so here are a few suggestions on how to help him cope (and keep your sanity): First, give him some space and don't nag. Men, as we well know, are not the most communicative creatures. They need to internalize things first, and that process takes a while. His silence should not prevent you from doing your own research and feeling pro-active. I certainly was the researcher in our case and when DH was ready, I would share with him everything I found out that day. I promise you that he will eventually be more apt to talk about it, but I guarantee you that he will shut down even more if you nag him. When he is finally ready to talk, share with him some of the options that are out there, along with blogs written by other men who are also experiencing MFI. He might say he doesn't have time, but I promise you that he will check them out when he's ready.

Secondly, when he is finally ready to talk, remember what you want to hear from people when you share with them your journey through infertility; you want to be heard, you want to feel comforted and the slightest callous comment is like a dagger through your heart. Well, behind that tough exterior, your partner feels exactly the same way, so while you might have to initiate the conversation, let him take it from there and air-out his frustration and insecurities. Also, consider seeing a therapist together. Sometimes, it helps to have a third-party facilitate -- a therapist's office is neutral ground and a place where you can truly listen to each other. RESOLVE offers a list of mental health professionals, which I encourage you to check out, even if you end up going by yourself to better communicate with your partner about his infertility issues. 

Lastly and perhaps most importantly, remember why you wanted this baby in the first place: you are happily married or in a loving relationship with your partner and you want to create a family TOGETHER. Sure you could get knocked up faster alone, using the sperm of a medical student who likes rock climbing and plays the piano, but this 23 year old is not going to be there for you when you're overwhelmed by parenthood. Again, it's about togetherness. So make a conscious effort to make time to stay connected. Go out to a romantic dinner (and don't talk about infertility!), meet for drinks after work, and make sure you remain physically connected. Having gone through the period of sex-on-demand, it's hard to reconnect sexually and leave the heavy baggage of infertility at the door. Especially if you're dealing with MFI, your partner may be feeling inadequate or "less of a man," if you will. It is partly your responsibility to show him that you still desire him and that you love him just as much as you did before you found out about his infertility. So, time to buy some lingerie and make reservations somewhere nice!

MFI is hard on everyone, but especially on your partner, so become his rock and let him lean on you. 

********************************

Typically infertility is seen as a woman’s burden to bear, but if your experience is/was anything like mine, it’s plenty hard on men too. Sure, we’re not the ones with the burning maternal instincts. Nor are we the ones having needles shoved into every square inch of our bodies and begin to look like a bruised pincushion. We are, however, often times the ones who have to shove those needles in there. A task I personally found horrific, shoving a metal spike into my soul mate’s flesh EVERY day and watching her wince in pain, all because she wanted that baby so badly -- not fun.

But that’s almost the easy part compared to the coping and humiliation. Coping with the fact that the one thing your wife wants more than anything else in the world (including you) is a baby and you can’t seem to give that to her. The guilt and the pressure that swells inside of you borders on hate. You hate your wife for adding pressure (as if you needed any more), you hate the situation and most of all you hate yourself. This penis of yours that used to give you so much pleasure is now the bane of your existence.

Soon you’ll start jacking off into cups for analysis and popping pills to improve your “quality." Whatever the case, you will do what is necessary because all you want is for this to go away so you can get back to that life you both had intended on living.

Then, somewhere along the way, you lose yourself, forgetting that you are going through something too, and that your wife isn’t the only one who is suffering. But we are men, right? We’re supposed to be strong and fix everything and make this all better. But when you are this lost, how do you find your way back? Sad to say, but you have to put all of that on the backburner and go after this baby like it is the single most important thing in your life (because it should be). Literally everything hangs in the balance: your self-esteem, your focus, your marriage and your future. And I promise that if you do this, resolution will come. For some it may come as a successful IVF cycle or an adoption. While others may turn to donor sperm or living life as a couple, but as long as you have given all of yourself, leaving no stone unturned, you can look back and say, “I made this happen” and not “This happened to me.”

That’s what I did. At one point I literally took a month off of work and moved to Denver with my wife and dog so that we could go to the best IVF clinic on the planet. It even cost us tens of thousands of dollars of our own money, but one look at my son and it was worth everything. I never look back. And the best part is, I also feel like my marriage is infinitely stronger, because I showed her what I was willing to do for “us.”

Signed, Mr. Infertility Doula a.k.a. DH.

It Takes Two to Tango: Male Factor Infertility (MFI)

Infertility is a harrowing experience for a couple, but while as women we are able to talk about it (albeit within the comfort of anonymous chat rooms), men are often times much more isolated. Historically, being able to procreate often and with various partners is a big part of the male gender identity, so when the semen analysis numbers come back sub par, it's a very tough pill to swallow. And considering that 40 to 50 percent of cases of infertility are due to male factor, that's a lot of men who are silently suffering (2.5 million men every year!).

While some cases of MFI can be treated with lifestyle and dietary changes (you'll have to be patient with those as they take 3 months to see results), most cases are a result of the genetic malformation of the sperm. A basic semen analysis will give you a clear picture of where you stand. Most clinics and/or urologists go by the standards established by the World Health Organization -- below are the parameters:

• Normal seminal fluid volume (the amount of sperm in the sample) and concentration: 2-6 milliliters  in volume with a minimum of 20 million sperm per milliliter.  
• Sperm count should be greater than 40 million per sample.
• Motility (the number of alive and moving sperm) of at least 50 percent.
• Morphology (correct shaped sperm) of at least 30 percent. Most clinics go by a stricter Kruger test that requires that 12 percent of the sample must have perfect morphology.

In addition to the hard facts of a semen analysis, your partner should see a urologist who will check for physical (e.g. varicoceles) and hormonal abnormalities. He/She will suggest the necessary treatments to help alleviate the issues. Should the examination indicate Azoospermia (no measurable sperm in the semen), micro-surgery can retrieve sperm from the testes and the epididymis (technology is a beautiful thing).

There are a few paths that can present themselves as a result of these tests:

1. If your partner's semen analysis comes back within the ranges listed above or slightly below, you will most likely get the green light to attempt IUIs. 
2. But, if you are dealing with a more severe case of MFI, you will probably go down the IVF with ICSI road, where by the semen is cleaned and the best looking sperms are directly placed inside the oocytes. The 2008 SART member clinics results indicate that 64 percent of IVF cases involved the use of ICSI with 44.4 percent of those resulting in live births. Those are the kinds of numbers that give hope. A piece of practical information I'd like to impart is that if you are going to use your partner's already "fragile" sperm, use a fresh sample rather than a frozen one. Your success rate should be higher as a result of it (it's a different story if you're using donor sperm) -- this is purely anecdotal, but I have personally spoken to women who finally achieved success ones they started using fresh samples. 
3. A last option, and a difficult one to accept, is to use donor sperm (DS). This a low-tech and low-cost approach, but riddled with many emotional challenges for your partner (and for you) to come to terms with. I'll discuss it soon. Your clinic should be able to direct you to a sperm bank or have donor sperm profiles available to you. 

In upcoming entries I will discuss the emotional aspects of MFI; donor sperm; ICSI vs. PICSI and the bio-ethical conversations surrounding the use of ICSI.

The Sting of Mother's Day When Coping With Infertility

Holidays are tough when you're going through infertility. Whether it's your relatives asking why you don't have kids yet, or your sister-in-law complaining about her 3 kids that she popped out one after the other and callously tells you you can have hers, or your cousin making her pregnancy announcement, or children showing up at your door to spread the cheer. But no holiday stings more than Mother's Day.

Sure, you're thankful for your mother (unless she's adding insult to injury by telling you about so-and-so's new baby), but truthfully, Mother's Day is just a horrible reminder of what you're not, what you want so desperately to become and even, perhaps, what you might never become. Strangers will wish you a happy Mother's Day, oblivious to your heartache hidden behind your silence. But, for someone coping with infertility, every day feels like Mother's Day, so by the time that one Sunday in May rolls around, it's like another gallon of salt poured on the wound.

If only Mother's Day was contained into a single day (you could just sleep through it), but no, instead TV shows, magazines, advertisers spend at least two weeks gearing up for the big day. Segments like "What to get for Mother's Day," or "The special mom of the year" seem to make up a large portion of programming. And just when you think you're coming up for air with a commercial break, advertisers have to scream about their Mother's Day sales or promotions with images of unattainable motherhood/parenthood. You might try to hide in the darkness and anonymity of a movie theater only to be bombarded by the "Babies" trailer (and no, I'm not creating a link to it). Seriously?! It's like a conspiracy.

I don't think there's a good way to deal with Mother's Day, but if you are lucky enough to have a loving partner, then make it a date-day and do things that don't involve families: take a romantic bath together, eat at a fancy restaurant, go see an R rated movie. Also, there isn't enough that could be said about taking solace in your fellow infertile friends. They understand your isolation and the tragic pain of Mother's Day, so get together with them -- there's (emotional) strength in numbers.

No matter which way you go on Mother's Day, I want you to make the day about you and the fragile feelings that need to be sheltered from this Hallmark holiday. After all, Mother's Day is about showing appreciation for a mother's hard work, well I say, no one is more committed and hard working than a woman trying to have a baby. So here's to you my fellow infertiles!

Worst Case Scenario: True Story of a Wrong Embryo Transfer

Imagine if you will that you are giving IVF one last try. After a grueling month you finally get that dreaded call: Congratulations, you're pregnant! Just as your heart soars, they follow the news with a "but." Oh, and is this a big "but" -- turns out they transferred* the wrong embryos and that this baby to be is not genetically yours (can you hear your heart sinking so fast it hits the floor?). Well that's what happened to the Savages.

After years of trying for another baby and countless miscarriages, Carolyn Savage became pregnant and delivered a healthy baby girl. From that cycle they had some frozen embryos that they saved for a future attempt. After a year, they decided to give it one last try to have another child. And when they thought their dreams had come true, they quickly discovered the unconscionable error their clinic had made.

On the same day, another call had to be made; that one to the Morells, who were happily raising their twin daughters (yes, IVF miracles) and were oblivious that their frozen embryos had been used without their consent.

This story is an amazing one and it re-establishes my belief that there are some exceptional individuals out there, like the Savages. They were faced with the toughest decisions one could possibly face -- deciding to terminate the pregnancy or keep the baby with the understanding that they would have to give the baby back to his/her biological parents. This case covers so many aspects of the world of infertility. By deciding to keep the baby, Carolyn effectively became the gestational carrier for the Morells. But unlike a gestational carrier case (where a woman agrees to carry the baby to term for you because the genetic mother is unable) Carolyn actually wanted a baby. She wasn't getting paid for this, she wasn't doing it as a business arrangement. Out of pure selflessness, Carolyn Savage cared for this baby for 9 months like it was her own and agreed to say goodbye to him on his first day of life.

Let's not forget what the Morells must have been experiencing -- what if Carolyn Savage had decided to terminate the pregnancy? She certainly would have been in the right to do so in light of the heartache she was facing. But what about the Morells' embryo? It's a life after all and what could be their future child. I'm very pro-choice, but after going through IVF and experiencing the attachment you feel to a microscopic embryo, I look at the beginning of life very differently these days. Within those few cells are someone's hopes and dreams of a family.

Logan is now 7 months and loved by both families. And while Shannon Morell was robed of her pregnancy, my heart truly goes out to Carolyn Savage. As the Savages stated during their interview on the "Today Show" back in September (Carolyn was 35 weeks along at the time), the hardest part was still to come: saying goodbye to Logan and coping with the unimaginable loss.

This case also reminded me of a fascinating book I'd read a few years ago -- Everything Conceivable: How the Science of Assisted Reproduction Is Changing Our World -- and more specifically a section that dealt with genetics vs. biology. Recent epigenetics studies suggest that genes are not immutable, that the biological environment of gestation does affect our genetic make-up. So for instance, while an egg-donor mother might not be genetically linked to her baby, she does affect the genetic development of her child. So with that, I hope Carolyn Savage did pass on some of herself to Logan; her strength and generosity can never be understated.



*Please, please, please, do not confuse an embryo transfer with implantation. The former is the procedure during which embryos are put back into your uterus. Implantation is the physical burrowing of embryos/embryo into your lining, where they/it will spend the next 9 months. The media keeps saying "the embryos were implanted by the doctor." I wish doctors knew how to guarantee implantation, but they have no control over that. So, please use the correct terminology: it's embryo TRANSFER.

Intrauterine Insemination (IUI)

Assuming that all looks pretty good for you and your partner, one of the first steps on the path to conceiving your baby through Artificial Reproductive Technology (ART) will be to try a few IUIs. Either because your RE thinks you need just a little extra help or because you need some time to ease into IVF, an IUI is a low-tech procedure that has brought success to many. Also, of all infertility treatment options, IUIs are more likely to be covered by your insurance, so if your RE thinks you might have a shot, why not give it a try?

There are two types of IUIs: a natural IUI cycle -- where you won't take any medications and your RE will monitor your natural ovulation to perform the insemination -- or a medicated IUI (most common). A medicated IUI entails taking either oral meds (usually, Clomid) or injectables to stimulate your ovaries. If you're using injectables, I would keep an eye out that your are not over-responding to the drugs and making too many follicles -- that's how you can end up on the Today Show with sextuplets. You should be monitored carefully.

Timing is everything, so once your RE determines that your follicles are mature and your LH is about to surge, you will be asked to take an Hcg shot to help release the egg(s) within 36 hours of the shot*. When given the green light, make sure that your partner doesn't ejaculate until the day he's due to provide his semen sample. On the morning of your insemination, your partner will make a deposit. His sperm will will be washed and prepped for your visit. The procedure is quite simple and painless: the washed sperm (don't be scared, it's going to look bright pink!) is placed in your uterus via a small catheter (think pap smear test). You can lie there for 15-20mins (take your iPod) to make sure all the sperm are swimming to the top and not leaking out. Fourteen days after your insemination, you will stop by the clinic to take a pregnancy test.

The most important thing to remember when going down the IUI road is to set a limit to them. Statistically, if you haven't gotten pregnant within 4 IUIs, your odds of getting pregnant from that point on are quite small. It's simply not worth wasting your time with them if you are paying out-of-pocket or are working against the clock; IVFs are far more effective. So if you're RE is encouraging you to try IUIs with no end in sight, I say get out of there fast.

*Some studies have shown that the success rates of IUIs can increase up to 6 percent when you do a double IUI, meaning you are inseminated two days in a row. In that case you will go in 24 and again 48 hours after your Hcg shot. I guess you could try a double IUI if your RE is open to it (although if your insurance company is paying for the IUI cycle, they will probably reject payment for the second insemination.)