Monday, August 23, 2010

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.

Wednesday, August 18, 2010

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).

Tuesday, August 17, 2010

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.

Friday, August 13, 2010

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.

Thursday, August 5, 2010

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.