Thursday, July 29, 2010

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.

Monday, July 26, 2010

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.

Sunday, July 25, 2010

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).


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:

Wednesday, July 7, 2010

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?!