The Infertility Doula

Limitless Possibilities: Twin Selective Reduction

2011-08-15T15:09:00.000-04:00

Being an infertility vet, you get to hear a lot of harrowing stories and meet some incredible women who have had to make difficult choices along the way in their quest to build their family. One that has come up a few times is selective reduction -- a process that reduces the number of fetuses in a high-order gestation, usually triplet and up. It is rare, however, to pursue selective reduction when carrying twins, as twin gestations have become much more common these days. While there are still risks involved with twins, doctors are far more knowledgeable about the necessary precautions to be taken in order to facilitate a healthy pregnancy and delivery.

The process of selective reduction involves injecting potassium chloride into the heart of the fetus(es), leading it to stop. It is probably one of the hardest decisions one can make: how do you choose which one of your babies should die? In some instances, the results from a prenatal screening makes the choice more obvious (albeit, still as painful), while others leave that decision to the random selection by one's doctor (position and access to the babies).

I have had friends who were faced with this heart breaking decision; all of whom opted to reduce from triplets to twins. So when I came across this article in the New York Times Magazine by Ruth Padawer -- "The Two-Minus-One Pregnancy" -- I was amazed to read that twin reductions are also common. Similarly to the silence we experience when going through infertility, there seems to be an even greater taboo when it comes to opting to reduce a twin pregnancy to a singleton.

I leave it to you, dear followers, to draw your own conclusions, judgements and questions when it comes to this specific type of selective reduction, but here were some of my thoughts that I'd like to put out there:

Not everyone who chooses to reduce a twin pregnancy to a singleton pursued infertility treatments, but for those who did, is the stigma attached to the twin to single fetus reduction not a reminder for the REs to transfer fewer embryos -- ideally a single embryo -- rather than transferring 2,3,4 or more in order to ensure implantation?
While the final decision of how many embryos to transfer is left to the patient and her doctor, many infertility patients who are receiving either limited or no insurance coverage (i.e., paying out-of-pocket for each treatment) request that at least two or more embryos be transferred to increase the odds of success and not having to undergo any further treatments. If insurance companies covered IF treatments, would fewer women find themselves in this difficult position of having to terminate one or more of her fetuses?
As infertility patients, do we take the risks of high-order multiples too lightly seeing so many twins and triplets strolling down our neighborhoods or on TV? While each failed cycle leads to the next, are we too quick to want to "complete" our family in one shot and not taking the time to evaluate our physical, financial and emotional limitations? (I am not referring here to women who transfer a single embryo that then splits up.)
A lot of the language used by the women interviewed for this story refers to their desire to be the "the best mom possible" for their children. Some of these women already had children while others were simply overwhelmed with the idea of parenting twins. Either way, they deemed that having a singleton would allow them to "perform" at the highest standards. I wonder how much of our societal pressures to be "super moms" affected the decisions to pursue selective reduction? Is being an "imperfect" parent truly that horrible? Aren't' all generations brought up by so-called imperfect parents and somehow turn out okay?

I leave you with a quote about the duality of choices by bioethicist Josephine Johnston from this riveting article that continues to stir in my mind as I put it in various contexts:

“In an environment where you can have so many choices, you own the outcome in a way that you wouldn’t have, had the choices not existed. If reduction didn’t exist, women wouldn’t worry that by not reducing, they’re at fault for making life more difficult for their existing kids. In an odd way, having more choices actually places a much greater burden on women, because we become the creators of our circumstance, whereas, before, we were the recipients of them. I’m not saying we should have less choices; I’m saying choices are not always as liberating and empowering as we hope they will be.”

I look forward to reading your comments.

Feminist Views on ART, Surrogacy, Egg Donation and Adoption

2011-06-06T15:55:00.000-04:00

C. over at The Infertility Revolutionary brought this fascinating issue of The Scholar & Feminist online, a webjournal published by the Barnard Center for Research on Women, titled "Critical Conceptions: Technology, Justice and the Global Reproductive Market."

The webjournal is comprised of lectures, documentary excerpts and papers presented during a series of conferences dedicated to discussing the new world of reproductive technology from a feminist point of view.

I have had the opportunity to read through most of the material and have found them all fascinating. There are important questions that are being discussed here, some of which I found potentially controversial and others central to our personal debates on these relevant issues.

The topics covered are the "baby making business," the legal aspects of infertility coverage, egg donation and surrogacy in India, the identity implications of donations for the offsprings, our societal portrayal of surrogates and the global "trade" of today's adoption process.

I encourage you to read some it when you find a little time. I'd be happy to discuss any specific articles that you would like.

Fertility Wellness Workshop

2011-05-31T18:17:00.000-04:00

Fertile Bliss, Inc.
Presents
a

Red Tent FertilityWellness Workshop

For Women who are looking for a sense of community and tools
to empower them through their journey towards motherhood.

Have you been trying to get pregnant?

Have you considered alternative methods to enhance your pregnancy possibilities?

Are you interested in learning different ways to support and help you as you go through this process?

If so, come to the Red Tent Fertility Wellness Workshop.

You will learn helpful fertility-enhancing tips, receive a robust gift bag, nutritious snacks, the opportunity to connect with like-minded women and a chance to win free services, jewelry from Schwa Designs and
Circle + Bloom CDs.

Presenters:

Erin Hessel of Esema Healing Arts (http://www.erinhessel.com/) an acupuncturist and doula will provide insight into fertility acupuncture techniques and strategy, as well as reproductive wellness tips such as fertility cycle charting.

Tracy Toon-Spencer of Fertile Life, Inc. (http://www.fertilelifenyc.com/) a yoga instructor and mind/body coach, will lead a gentle, restorative, fertility yoga class and offer mind/body techniques to aid in relieving stress.

Pardis Partow of Hummingbird Healings (http://hummingbirdhealings.com/) an intuitive healer/coach, Reiki Master Teacher and medium, will teach self-care methods to help maintain a healthy, spiritually balanced life, as well as information on Reiki and other healing modalities.

Hannah Springer of Earth Body Balance (http://www.earthbodybalance.com/) a renowned traditional foods nutritionist, will provide comprehensive pre-pregnancy nutrition education, as well as a packet of fertility recipes and resources.

June 18th, 2011

9:45am-3:00pm

Om Factory Yoga Studio

265 West 37th Street at 8th Avenue, 17th floor

$75.00 in advance (until June 15th ) via PayPal

$100.00 – after June 15th

~Space is limited so book early~

Questions and/or RSVP: Fertileblissnyc@gmail.com
Payments via Paypal.com: Fertileblissnyc@gmail.com

**For more info, you may contact Jes at Baby Step to Motherhood**

"Time to Chill" by Nancy Hass - Vogue Article

2011-04-15T15:52:00.001-04:00

Past the glossy pages of this month's issue of Vogue Magazine (May 2011), there's a thoughtful article about egg freezing and what it could represent for women's reproductive future.

Egg freezing in an attempt to stop the proverbial "biological clock" from going off is becoming more and more mainstream thanks in part to a greater awareness of infertility issues and recent scientific breakthroughs.

Some important thoughts and questions are discussed here, some of which have been brought up in earlier articles and blog entries. One that really struck with me was whether egg freezing was giving women a false sense of security of their future ability to have a family when the perfect career and partner have been crossed-off the To-Do-List. Furthermore, while a woman may undergo several cycles in order to accumulate enough oocytes to freeze, how many cycles will it take to guarantee that one will be able to develop into a healthy baby?

I for one have produced well over 80 oocytes (through monitored cycles) and (thankfully) have now only one child to show for my many cycles. If one's odds of conceiving is about 50/50 (at a good clinic), I'm not sure where that leaves us. I know some women conceived on their first cycle, while others have done close to ten and are still trying. Or during one cycle I produced 28 eggs (thanks to PCOS) but none took.

Another important question is how late can you wait until you are ready to have those eggs turn into embryos and be transferred back to you? One of the pieces that I wrote that seems to get the most hits is my "That's not my grandchild" entry, where I discussed older women giving birth/becoming mothers in their 60's and even 70's. I know many were outraged that it was even legal for women who were well into their menopausal years to be given access to donor eggs.

Honestly, I still haven't made up my mind on this one. If you have the foresight of freezing your eggs at 30, have a great career and/or not finding the right partner for you, or simply that you just weren't mentally or financially there yet, then shouldn't you technically be allowed to claim your eggs at 50 to finally take the plunge? Unlike traditional egg donations, these frozen eggs are yours. I'm sure this must be hotly debated amongst bio-ethisits.

I know I'm raising more questions than I'm answering (not the typical format of this blog), but those are all valid questions to ponder and I'm sure you'll have many of your own. Please share them with me.

Stuck Between Two Worlds: Pregnancy After Infertility

2011-03-23T15:04:00.000-04:00

Countless blog entires and chat room conversations deal with the deep isolation that comes with infertility. The inability to share one's fears and struggles can be debilitating on numerous aspects of one's life. Many of us take solace in our fellow infertile friends we've made through social networking and blogging. It's a tight knit community that allows for meaningful bonds to be formed, where one's sadness is met with endless words of support and virtual hugs.

And then one day, someone finally gets the much desired BFP. It is a day of celebration, shared on some level by everyone. Words of congratulations and excitement are passed around. One of us has finally made it to the other side of the dark tunnel, opening the door for more hope to be experienced by others, and that someday, we will all meet on the other side. Unfortunately, the good news doesn't happen to all at the same time. Some, most, are left behind.

As the initial beta numbers turn into updates of heart beats and ultrasounds, you may find yourself in a different type of isolation: after countless months/years of TTC, you know better than to announce to the world you're pregnant at 7 weeks. And yet, you're also no longer experiencing the grueling day to day of infertility treatments. This infertility to pregnancy purgatory can feel endless and lonely.

There is no right way to move on to this next chapter. There is no magical moment when suddenly you can proudly announce to the world that you too are with child. That time of accepting your undeniable luck can take weeks and even months (it took me over 5 months to finally admit that I was really going to have a baby). Meanwhile, you tread lightly. Trying to take everyday as it comes. Finding friends who can support you during this time can be even harder than finding friends who are coping with infertility. (Early) pregnancy after infertility can ironically turn into a time of longing for the camaraderie you'd shared for so long with other infertiles. Meanwhile, those who are still in the trenches assume that you must be in complete bliss, but in truth you're living in great fear; fear of having to start all over again, fear of finding out that you never "graduated."

My advice would be to find a couple of people (close friends or family) who have been there for you in real life through the tough times (doesn't have to be limited to IF struggles). Sharing the news with someone will encourage you to begin to embrace this new chapter. Don't deny yourself the right to be happy. And remember those who are still struggling and don't forget what it felt like to be in their shoes -- all of those dreadful pregnancy announcements on Facebook are still just as unacceptable now as they were then. Stay in touch with your IF friends and continue to offer as much support as is asked of you. Yes, you will indeed lose touch with many of them (either be it their choice or just the evolution of life), but some will remain your friends forever.

Being pregnant after infertility doesn't mean you no longer belong to the infertility community, it simply means you are a symbol of hope to many and an advocate for infertility to a new community -- the pregnant/parenting community. You still carry a responsibility to raise awareness for the 7.3 million who are still fighting to have a family of their own.

Complimentary Treatments: Infertility Yoga

2011-02-07T16:43:00.001-05:00

In case you missed it, The New York Times had an article about the benefits of yoga for those undergoing infertility treatments.

While complimentary Eastern practices were for many years discredited by Western medical establishments, it seems that these days they have become an integral part of infertility treatments.

Acupuncture for one has been scientifically proven to help increase success rates for IVF patients. For others, acupuncture has improved FSH levels, blood flow and overall health.

Herbal supplements, on the other hand, may or may not help with infertility treatments. Some attest that it may actually counteract the intended results of fertility drugs.

As for yoga, besides its clichés of making you more Zen, at least for that hour, it helps keep your mind and body active. The physical aspect of the practice is not to be underestimated, especially when you are restricted from doing any vigorous exercises while undergoing IF treatments. Your body is no longer your own when you're doing IVF, but with yoga, you have the opportunity to do something that has a physical component to it and hence, hopefully give you more control over how you feel about yourself.

I think it's a wonderful thing that clinics are combining Eastern practices with their Western methodologies, but at times it seems disingenuous. Many of these clinics offering complimentary treatments fail to incorporate them in an organic way. The offices and general attitudes of the staff are still very rigid and clinical; devoid of anything that makes you feel at ease or whole. Maybe the future of IF centers will take on a more integrated approach expressed both in the available treatments and attitudes.

While relieving stress and having a positive attitude is essential when coping with infertility, I know it can be very difficult to take the time for yourself. Additionally, you can quickly find yourself caught up in trends that make you feel as though you are not doing enough to increase your chances for success. I fear that this article may insight such feelings. Certainly attending an infertility yoga class can be beneficial, but it is not the only thing that's going to give you access to a more peaceful place. You could attend regular yoga classes (with more modified poses) or just take a class that will tap into your pre-IF self (it's in there somewhere, I promise). Attend a cooking class, a book club, a writing class, or simply close the door for 30 minutes everyday and meditate. The point is, try to get out of your own head for a little bit everyday and surround yourself with supportive people.

Catching up with my Rambling Thoughts: The Urge to Have a Baby

2011-01-27T22:46:00.000-05:00

I must apologize for my absence. The last few months have been a whirlwind and despite my best intentions, I seem to have neglected one of my favorite things: this little blog of mine. Infertility related topics are on my mind daily, but I just haven't been able to sit down and write something compelling.

Not writing has now filled me with a million thoughts and for better or for worse, here's the latest installment from my disjunctive mind:

While enjoying a pile of magazines at Gate 32 on my way to LA, I read a really interesting piece in ELLE written by Corrie Pikul, titled "The Clock-Watcher." (February 2011) In it, Pikul talks about how confused she feels about not feeling a natural pull/desire to have kids and whether that's indicative of a woman who doesn't really want any kids.

'For huge cataclysmic life decisions, like getting married or having a baby, I think people do want to be taken over by a feeling. Otherwise, how do you ever figure it out? If you don't have that part of yourself that irrationally wants to go ahead with this, how do you make decisions?'

asks psychologist Daphne de Marneffe, PhD.

It got me thinking, did I ever truly feel that urge or did it turn into an obsession only once I found out I couldn't have a baby the old fashioned way?

I must admit I was never one of those kids who dreamt of her wedding day, of the white picket fence, the dog and the two gorgeous kids bounding across freshly cut grass. Having found the love of my life, getting married felt like a natural progression. Today, I couldn't imagine my life without him, but marriage itself is still not what validates our bond.

So when we decided to try to conceive, I don't recall any urges per se. Similarly to getting married, it was a natural progression of our relationship. We had moved out of the city because the underlying expectation was to start a family. That's what people do, right?

Don't get me wrong, being a mother is truly the most rewarding experience -- the clichés about parenthood are unfortunately truly, so I'll spare you. But this article has lingered with me for the last week. How much of our lives do we actually owe to undeniable desires and how much of it is just us letting the river carry us to the next big ocean?

There's nothing like coming face to face (or should I say ass-cheek?) with a 1 1/2" needle filled with a thick oil to make you think whether having a child is truly something you want to do. (Infertility treatments take commitment and test every aspect of your identity and relationships.) And yet, every time I said, "That's it! I'm done with this shit!" I found myself begging for more. Could we save some more money for the next attempt? Could I find some strength buried deep down inside of me to do this all over again? What if the next cycle is the one we've been waiting for?

What is it that drives us to take on such torture month after month if not for a genuine urge to have a child?

Many times my husband offered that we stop trying; that we had each other and perhaps that should just be enough. I know it hurt his feelings when I told him that was not an option. Having a child would be the only way to complete the circle and that I needed to experience motherhood in what ever form it came in.

A cost-benefit approach was never discussed, because, I believed at the time, that becoming a mother was the ultimate way to define myself as a woman and a wife.

It's probably a good thing that we don't make pros and cons lists for all the big decisions of our lives, otherwise, we'd probably be left devoid of what makes life meaningful.

An Article, a Friend: Two Stories of Hope via Third-party Reproduction

2011-01-11T11:54:00.000-05:00

I've often talked about the close bond that form despite the great challenges that we face in the infertile community. Some of those bonds break past the anonymity of chat rooms/blogs and flourish into real life friendships. Well, such a friendship was formed between my friend Sunshine and me.

Whether it's the years of trying, the losses or the countless invasive procedures, each of our journeys are painful and emotionally debilitating ones. Well, of everyone I know, my friend Sunshine has been through hell. Pure, unforgiving hell. You only have to glance at her infertility journey recap page to get the picture.

Beyond the numbers and figures, I see the true image of a determined soul who never completely gave into despair and always fought through the blizzard (both figuratively and literally) to finally hold two babies in her arms.

This last chapter of her IF journey introduced us to one other pivotal character -- a gestational carrier named Kelly. She has proven to be the most benevolent and dedicated carrier one could hope for. I read each of Sunshine's entries with great interest and admiration. The decision and experience of going through a gestational carrier was a very rewarding one, and one that has resulted in the births of twins.

I feel the need to point out that not all experiences with carriers are as affable and yield such exceptional outcomes. Stories of carriers who take the money and vanish; carriers who sue the parents to get the child back; carriers who smoke and drink during the pregnancy. Like all diverged paths to parenthood, the one of third-party reproduction can be fraught with challenges.

There must have been something in the infertile air, because on the same weekend that Sunshine announced that her little miracles were finally here, I came across this article in The New York Times Magazine: "Meet the Twiblings" by Melanie Therstrom.

After undergoing infertility treatments, Therstrom and her husband decided to turn to third-party reproduction options. They opted for an egg donor and for the embryos (donor egg + Therstrom's husband's sperm) to be transferred to two gestational carriers. The babies were born just days apart. It is a fascinating and thought provoking journey. And like all infertility stories, there were many expressions of the loss of hope, the coping mechanisms and the retrospective look on the journey that resonated with me and I believe will resonate with you as well -- the common threads that connect us all.

Here, a few highlights from the article:

"For many couples, the most crushing aspect of fertility treatment is not all the early morning blood-draws but the haunting feeling that the universe is telling them that their union is not — in a spiritual, as well as a biological, sense — fruitful."

"We were careful to refer to the fetuses as the “drafts” rather than our chosen names to remind ourselves that they were notes toward the children we wanted, but if they died, they were just beginnings like all the embryos had been, and we would start again."

"Plan A — making babies with the tools you have around the house, as they say, the fun, free tools — faded into the background, and Plan B became foreground. I can count the ways Plan B is a less-desirable way to have children — the route seems to take you off the edge of the world and into the land of scrolly dragons. But when you actually go there, the map shifts. The brain’s ability to rewrite — to destinize, as it were — the birth story and turn a barn into a manger is so powerful that Plan B, all its unsexiness notwithstanding, became the best plan, because Plan B created the children that we have and are convinced we had to have."

Follow Friday

2011-01-07T16:42:00.000-05:00

I knew when I made the decision to start a weekly "Follow Friday" entry -- featuring fellow blogger entries that resonated with me -- that I would find myself in a bind. Too many of you are fantastic writers and so eloquently describe the various emotional stages you're experiencing.

So, I'm not going to limit myself (or you, dear readers) to just one entry. I'm going to feature as many as I'd like. I will attempt to summarize the entries and share some of my favorite quotes/passages.

After that, my hope is that you link back, read the full entries and comment.

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

Jess at "A little blog about the big Infertility"-- "Sharing":

After TTC for the last 5 years, Jess and her husband have decided to pursue embryo adoption. With this decision, she has written a beautiful letter to her loved about about the decision, in which she highlights her hopes, the complexities of their decision, and addresses head the pain of infertility, but that in the end they are resolute and hopeful.

"Be sad with us and be happy with us, but don't pity us. [...] We do get sad sometimes, but there is always joy in our lives. [...] The road to our inner peace will be paved with or without children, but I do believe they are on their way -- eventually."

Jessica at "Waiting for a baby bump" -- "Separated from the wolf pack":

In this entry, she talks about feeling left behind, specifically by her friends who have moved on to motherhood, and how those friends are still supporting one another through teething and breastfeeding issues, while not taking the time to acknowledge Jessica's pain. I think this post, poignantly written, will hit home with so many of you.

"They've had their babies, they are mommies and I am not part of the mommy club. I feel like I am in Jr. High all over again and it makes me want to puke. I am wiser (a little wiser), older (much older) and less likely to get my feathers ruffled by stupid comments about IF, but the ignoring, I can't take it anymore. I know, I know, they probably don't know what to say, or don't want to bring it up or talk about their kids for fear upsetting me... nice and thoughtful they all must be, but I don't think so. I really think that I have been forgotten. In fact I know that I have been forgotten. I am the odd-woman out and the fact that most of them, whom I have known for over 20 years, have no idea how to relate to the woman who can't get her ass over the infertility fence before their kids go off to college."

Sloper at "Park Slope Purgatory" -- "Unblocked; or things I didn't accomplish before I turned 30":

Sloper, like many of us, made of list of things she wanted to accomplish by the time she turned 30. Some milestones seem so far away until you turn the corner and realize you've only checked off a few (at best) of those items from your list. Sloper's list included having a baby, which she's undergoing treatment for, and getting published. She has found a new drive to pursue this dream. Like so many of us, along with the death of hope, infertility robs us of our aspirations. I applaud Sloper for focusing back on herself and her dreams, and not letting IF take everything away from her.

"And yesterday, for the first time in ever, I thought to myself that maybe it would be okay if I couldn't have a baby soon. Maybe I still have other dreams I can pursue. Maybe I'm still young enough not to throw in the towel on everything. [...] I want to fight for it. I have the will to win at something again and the need that's maybe strong enough to overcome the fear."

Looking Back and Forward

2010-12-20T21:27:00.000-05:00

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

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

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

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

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

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

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

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

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

With love,

The Infertility Doula.

The Silence Can be Deafening

2010-11-21T08:57:00.001-05:00

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

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

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

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

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

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

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

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

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

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

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

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

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

Dollars and Cents: Affording Infertility Treatments

2010-11-11T15:31:00.000-05:00

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

Insurance Coverage/Plans:

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

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

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

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

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

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

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

Grants:

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

Shared-Risk Programs:

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

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

Other Options:

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

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

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

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

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

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

Holidays Are Not Easy, Even When You Have Candy

2010-11-01T10:01:00.000-04:00

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

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

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

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

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

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

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

2010-10-22T16:05:00.003-04:00

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

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

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

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

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

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

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

Infertility on Reality Television: Giuliana & Bill

2010-10-21T08:35:00.000-04:00

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

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

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

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

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

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

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

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

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

RESOLVE Peer-led Support Group - NY Area

2010-10-18T15:33:00.001-04:00

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

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

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

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

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

And please, help spread the word.

Always Hope but Never Forget

2010-10-15T13:56:00.001-04:00

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

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

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

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

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

A Nobel for IVF, But Not Much Has Changed

2010-10-11T10:44:00.001-04:00

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

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

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

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

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

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

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

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

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

Where do you stand on this matter?

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

The Birds and the Bees: An Infertility Story

2010-09-27T16:10:00.001-04:00

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

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

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

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

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

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

The Invisible Line of Infertility

2010-09-20T20:56:00.002-04:00

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

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

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

Happy ICLW!

Living in Uncertainty: A Deja-Vu

2010-09-09T14:21:00.000-04:00

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

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

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

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

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

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

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

News: CDC Videos on A.R.T.

2010-09-02T13:52:00.000-04:00

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

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

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

Cleaning Out My Infertile Past

2010-08-23T16:18:00.000-04:00

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

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

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

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

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

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

A Case Against Infertility Treatments

2010-08-18T13:58:00.003-04:00

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

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

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

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

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

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

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

Stress And Infertility

2010-08-17T07:47:00.001-04:00

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

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

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

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

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

Adapting to Unexpected Changes During Your Cycles

2010-08-13T12:39:00.001-04:00

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

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

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

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

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

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

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

Once Upon a Time: My IVF Story

2010-08-05T13:36:00.001-04:00

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

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

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

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

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

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

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

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

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

The Infertility Competition

2010-07-29T14:18:00.002-04:00

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

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

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

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

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

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

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

Other People's (IVF) Babies

2010-07-26T17:00:00.003-04:00

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

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

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

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

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

Versatile Blogger Award

2010-07-25T08:21:00.000-04:00

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

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

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

I used to be a fashion stylist. I still loooovvveee fashion – I have a stuffed closet and a tower of magazines to prove it.
English is my third language, but I guess through the years, it’s become my first.
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.
My non-obviously-hot-guy crush is John Krasinksi. A good sense of humor and charm will go a long way with me.
I’m strangely incapable of watching any movie that involves an animal getting hurt, but blood and guts with humans, bring-it-on!
I never leave the house without some concealer for my perpetual dark circles.
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:

Letting It Out: Expressing Your Frustrations with Infertility

2010-07-07T07:25:00.001-04:00

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

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

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

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

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

Getting a Second Opinion: It's Not Cheating

2010-06-22T11:47:00.001-04:00

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

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

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

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

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

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

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

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

It's Not You, It's...

2010-06-11T13:20:00.000-04:00

Last time I talked about how your weight can affect your fertility. Today I'd like to talk about how infertility (IF) affects your weight. In truth, your weight is partly a physical manifestation of the psychological toll IF takes on you. Three studies have shown that a person who is going through IF experiences the same psychological distress as someone going through cancer. Yes, cancer! I just don't understand how our law makers can know this and still not make IF coverage a mandate in all states. But I digress...

As much as the psychological effects of IF is the elephant in the room, it is often overlooked by REs/IF clinics. Unless you are going through a donor or gestational program, no one in the medical field hands you a list of therapists to visit along with your the stack of brochures. Many women feel deep anxiety, depression and a great sense of loss. After all, we played with our dolls when we were little girls and eventually got married with dreams of filling our home with kids, but now we're stuck with this ordeal. These feelings of sadness are further exacerbated by the hormones that are associated with the medications that we take during the course of IF treatments. Several studies have confirmed that the use of medications like gonadotroprins (GnRH) increases the patients' feelings of depression. So the equation goes something like this:

Stress of IF + Meds + Pregnant Women Around You = Depression

We each have our own way of coping with depression and some of us translate this pain into an unhealthy relationship with food. This relationship can turn unhealthy and lead to eating disorders, which perpetuate the IF issues: anorexia in one's desire to control the only thing you can (i.e., your weight) or compulsive eating in one's finding comfort in food. Our loss of self and self-esteem cannot be taken lightly. I always encourage you to seek some counseling.

Unfortunately, in additional to the extreme mood swings that comes along with IF medications, there are also physical ramifications that are involved with GnRH drugs (ovulation stimulating drugs) -- primarily bloating and weight gain. So you're not imagining things, you really are a few pounds heavier. You might find it petty to bring up your weight concerns to your RE in light of the complexities of your IVF cycle, but I do think it's reassuring when you get validation from your RE of the physical transformations you are reluctantly experiencing. Most of the weight is likely to go away after you've ended your IVF treatments. Although, I know for many of us who have done back to back cycles through the years, the weight gain just keeps adding up, making it more difficult to get out of the vicious cycle. Staying away from strenuous exercise, you should take part in light activities like walking or swimming. It will help release some of the tension and make you feel more connected with yourself.

Which ever aspect of weight/IF scale you fall in, be good to yourself. While your weight is not just a number, don't let it define you either. You are strong and determined to have this baby. Be kind, be accepting and do not be too proud to seek help.

There is a song by Alanis Morrisette that I love and that I would like to end this entry with: "That I would be good." I hope the lyrics give you the same comfort it gave me.

What the Scale Isn't Telling You About Your Fertility

2010-06-08T21:54:00.003-04:00

Someone recently asked about the correlation between weight and infertility. I thought that was a really good question and one that is not discussed nearly enough. When going through infertility (IF) we are so focused on what's going on in that mysterious region south of our belly button that we neglect to see what's going on right before our eyes. In thinking about my friend's question, I saw two possible ways to tackle this topic: on the one hand, the effect of weight on one's fertility; on the other is how infertility affects our weight. Today I'm going to focus on the former and provide you with some topline information for your to discuss with your doctor.

Being too thin or too fat can affect your fertility. In fact, an estimated 1 in 5 is coping with IF has an underlying issue with an eating disorder. You do not have to be dealing with a clinical eating disorder to be struggling with weight and IF. People with an eating disorder just happen to be at each extreme of the spectrum, but there are many gray areas before you can achieve a healthy middle.

In a culture where you can't bee too thin, it's very difficult to feel sorry for women who are barely filling a size 0. But in truth, an unhealthy thinness can have a huge effect on your fertility. When you are just 10-15% below your healthy weight (for your height), that corresponds to a third of body fat loss, which consequently leads of menstrual dysfunction (this is called the "Critical Weight Hypothesis"), a common cause of IF. So imagine what someone dealing with anorexia is doing to her body. Living with a very distorted sense of body imagine, people with this eating disorder starve themselves to a point where their organs and reproductive systems are affected. Sadly, in some cases, even after recovery, women who have dealt with anorexia for years may have caused permanent damage to their body. Another group that I would include under "too thin to ovulate" are over exercisers -- those women who spend hours at the gym, running miles and miles on the treadmill and then jumping into a aerobics class, to eventually treat themselves to a mini-smoothie. While the scale might indicate a "healthy weight," the lack of body fat affects them in similar ways as a someone who is overly thin. Behind those perfectly defined abs are women who have very little body fat and therefore have trouble ovulating and hence, conceiving. Whether you are dealing with anorexia, over exercising or are simply too thin, you are very likely to suffer from amenorrhea (no ovulation or menstrual cycles), irregular menstrual cycles, PCOS and reduced egg quality. While it is important to feel good about yourself, especially during a time when everything has come into question as a result of your IF, I urge you to focus on increasing your food intake. Include more good fats (avocados, nuts), lots of protein (chicken, milk) and Omega-3 rich foods (wild salmon). Avoid artificial sugars, especially if you're struggling with PCOS. And don't over exercise. Trust me, your baby isn't going to care if you have a six-pack.

On the other end of the spectrum are women who are overweight. Some women are genetically predisposed to being overweight, others have grown from being an overweight child to an overweight or obese woman, and lastly you have your compulsive eaters -- this overlooked eating disorder involves bingeing on food without purging. To be considered overweight you need to be in the 25-30 BMI, and anything over 30 is considered obese. Above I talked about the importance of some body fat, excessive body fat can have similar effects to your reproductive system as someone who is too thin. Some overweight and obese women suffer from amenorrhea, PCOS with insulin resistance (an inability to process sugars), which ironically can be both the cause for the extra pounds and the result of them. Studies have shown that overweight women aren't as much affected by IF as overly thin women, but the pregnancy risks associated with the excessive weight increases your chances of gestational diabetes and pre-eclampsia. Following a lean diet high in protein, whole grains, fruits and veggies, combined with regular exercise still remains the best way to manage your weight. Recently, women who are overweight and PCOS have found some success when taking Metformin, which has helped with more regular and higher quality ovulation, and yes, weight loss.

If you have been experiencing unexplained weight gain or weight loss, your first step should be to check your thyroid function. Hyper and hypothyroidism can affect your weight and as a result your reproductive system.

Discuss any concerns you have about your weight with your doctor and don't be afraid to meet with a nutritionist who can guide you in the right direction.

Stay tuned for my next entry where I will discuss how IF affects your relationship with food, your body and your mind.

What to Expect When You're ... IVFing

2010-06-04T16:18:00.000-04:00

In my last entry, I talked about the emotional transition of letting go of IUIs and gearing up to IVF. So today I'd like to give you a little "What to Expect" -- the IVF version.

There are countless sites that will give you specifics about the technicalities of IVFs and the various protocols that your RE will consider before you start a cycle. What I'd like to do is to give you the broad strokes of things that will take place and the things you need to prepare yourself for as you embark on the IVF marathon -- so pardon the cut-and-dry tone of this entry.

When you decide to go through with an IVF, first call the IVF coordinator at your clinic and reserve your spot for the upcoming cycle. It would suck to get yourself emotionally ready for a cycle, only to find out that they can't squeeze you in for another 2 months. Clinics like to cycle people in groups and every few months (usually 3), they close down their embryology lab for clean ups. So you need to make sure that your period falls during the weeks/months when the lab is open.

Next, if this is your first IVF, you'll to sign up for injections class. The classes are usually held by one of the nurses and will walk you through the various protocols and the respective injections. Some will be pre-filled syringes (e.g. Lupron), while other will have to mixed (e.g. Menopur). You should attend this class with your partner. Some women prefer to have their partner do the shots for them. I did the large portion of the sub-Q shots myself, but DH would do the progesterone shots (it's hard to aim for your own butt, but I have done it myself on more occasions than I care to remember). Should you need a refresher on how to mix and/or inject yourself with a specific stim, check out this site. It contains a video for every stim medication you will be using; from how to prep the injection site, to mixing, to injecting.

On Day 3 of your period, you will go in for blood work to check your hormone levels and make sure that your RE doesn't need to do any last minute tweaks -- most importantly, your E2 should be less than 20. An ultrasound will be performed to make sure that your ovaries are quiet and that there are no cysts. Suppressing your reproductive system allows for your RE to control the stimulation of your ovaries in order to obtain as many eggs as possible. From this day forward, you will be going in for monitoring at least every other day (as you get closer to trigger, it will be every day).

If all looks good, you will begin taking your gonadotropins, which are your ovary stimulating drugs. The duration that it will take for your follicles to be fully mature will vary on your protocol and how your body responds. My stim period was usually around 10 days. During this time, your RE will monitor your progress via blood work (general rule is for your E2 to reach 150-300 IUs for every mature follicle) and ultrasounds. It's a very fine balance that your RE is trying to achieve before deciding when you're ready for trigger -- a large portion of your follicles have to be mature (18-23mm), but not so much so that you might prematurely ovulate. Also, if the blood work detect a slight LH surge (signal that you're starting to ovulate), your RE will should be able to suppress it. This is why it's so important to attend daily monitoring. There is very little room for error. Sometimes your RE will let go of one or two mature follicles in order to give a larger group of them to catch up. One last component to determining your trigger date is the state of your uterine lining. By the time of trigger and/or transfer, your lining should be triple striped and around 8mm (think fluffy cushion = good place to grow for the next 9 months). I will talk more about uterine linings another time (mine never cooperated).

The stimulation period can be physically uncomfortable. As your follicles mature you will feel bloated and have some tenderness in your lower abdomen. That's because you are growing so many follicles. Everyone responds differently, but rule of thumb is to have around 10-12 mature eggs. But more or less is fine too. At the end of the day, it's about the quality of your eggs and not the quantity of them. For instance, women with PCOS tend to produce more eggs, but they also tend to be lower quality. It is essential that your RE monitor you in order to avoid ovarian hyperstimulation (OHSS), which, if left untreated can cause fluid collection in the abdomen, kidney failure and twisting of an ovary. So keep a close watch on your discomfort level and bring it up to your doctor. During the stim period, avoid working out and doing any strenuous activities. Also, avoid eating soy based products (milk, ice cream, etc.) -- soy mimics estrogen, hence may lead to inaccurate readings of your blood work. Reduce your caffeine intake -- it's hard letting go of that 4th cup of coffee, but you can do. Try to keep the stress levels in your life to a minimum and focus on your health and your growing follicles. You're getting so close!

Approximately 34-36 hours before your egg retrieval (ER), you will be asked to take your Hcg shot in order to release your eggs from the follicles. You MUST take the shot at the exact time you're given by your clinic (not an hour before or after). As I've said before, there's no room for error and timing is everything. If you've been doing most of your stims yourself, well tonight's the night for your DH to show that he was paying attention in class. The Hcg shot is a larger needle that has to be given on our tush.

The morning of your ER will be like any surgery day -- no eating or drinking prior to surgery. Your partner will have to come with you. He will provide a semen sample (remember no ejaculation for at least 48hrs but no more than 4 days). You will meet with your doctor and the anesthesiologist. You'll be placed on a surgical bed: 10, 9, 8 ... Before you know, you'll wake up in the recovery room with your partner waiting for you. A nurse will check on you regularly and when you're ready you'll have to make a trip to the bathroom. There will be some blood in your urine (don't panic!), but if you can urinate, then you're ready to go home and wait for the emrbyology repot. Plan to take a couple of days off work. This is the time to be pampered by your partner -- eat light foods, drink lots of electrolites (Gatorade), and rest.

As you prepare your body for your embryos to come home and hopefully implant, you will start taking progesterone shots. Most are sesame or peanut oil based. These were the most painful part of the cycle for me as the oil is thicker and the needle quite large. Simultaneously, some REs will also have you take estrogen patches. These are pretty easy to apply. Both of these hormones are meant to prep and sustain the (hopeful) pregnancy.

On the 3rd day after your ER, you'll get a call that will let you know how your embryos are doing -- how many there are, how they look (embryologists grade each embryo and ultimately select the ones to be transferred), and most importantly, whether you'll be doing the embryo transfer that day or on Day5 (blastocyst stage). Again, your partner should come with you. When it's time to go in for ET, drink lots of fluid (no peeing right before the transfer!) and ask for some valium. It's important to remain relaxed during the transfer. Some studies have shown that a difficult transfer can hamper success. Your RE will discuss how many embryos he/she recommends be transferred. A good clinic doesn't need to transfer more than 3. In fact, these days, IF clinics aim to transfer 1 or 2. I know you have a lot riding on this cycle, but resist the urge to transfer more than that -- unless you've been living under a rock, you must have heard of Octomom. After the transfer, you can continue to lay down at the clinic for another 30 minutes. You'll probably receive a picture of the embryos that were transferred. Then, take the rest of the day off to soak in the bliss with having your embryos home.

Twelve to 10 days after ET, you'll go in for your beta results (pregnancy results). A nurse will call you with the outcome (unless you already cheated and took an HPT). I hope that it will be fantastic news for all of you. For the next few weeks, they will keep a close eye on your Hcg levels and your progesterone. You'll have your first ultrasound around 6.5 weeks and you'll officially "graduate" onto the the real world around 8 weeks.

My most important advice is to expect the unexpected. Not a single one of my cycles was text book. There was always something that led me to question if the cycle could possibly work under the circumstances. And my worst cycle on paper (fewer embryos, thin lining, etc.) was the one that gave me my beautiful son. So it's not an urban legend, it really does take 1 embryo (perfect or not) to make it happen. Now tie up those running shoes and remember, slow and steady wins the race. I'll be there along the way cheering for you.

Bye Bye IUI: Preparing Yourself for IVF

2010-05-31T19:01:00.000-04:00

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

2010-05-23T12:16:00.001-04:00

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

2010-05-21T09:28:00.001-04:00

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"

2010-05-17T15:54:00.000-04:00

"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

2010-05-14T14:22:00.008-04:00

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

2010-05-12T15:03:00.004-04:00

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

2010-05-10T12:13:00.004-04:00

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)

2010-05-10T11:39:00.002-04:00

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:

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.
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.
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

2010-05-08T08:54:00.008-04:00

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

2010-05-04T19:47:00.006-04:00

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)

2010-05-02T11:42:00.003-04:00

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.)

It Takes a Village to Make a Baby

2010-04-29T13:18:00.013-04:00

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.

P.S. I heard about this children's book called "I can't wait to meet you" by Claudia Bates. Finally a book to help us tell our story. I'll review it on a separate entry.

Testing, 1, 2, 3: Preliminary Tests Before IVF

2010-04-28T08:15:00.003-04:00

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.

Finding Doctor Right: The Art of Picking Your IVF Doctor

2010-04-27T13:35:00.007-04:00

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.

Money Talks: Insurance, Health Care and Your Infertility

2010-04-26T12:37:00.006-04:00

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.

When "just relax" doesn't cut it anymore

2010-04-24T18:12:00.004-04:00

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.

Sex-On-Demand

2010-04-24T12:38:00.003-04:00

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.

Try, try again...

2010-04-24T11:57:00.004-04:00

I remember when DH and I decided that it was time for us to have a baby: we had sex all the time. I think we were filled with the excitement of starting a new life together (in our new home, that we bought to have a family in). It was fun and easy. When nothing happened on that first try, we said, “It’s ok. We have time. More sex, please!” Then the second month came and went, as did the third. By that point, I was starting to get concerned. That’s when I decided to read up on things and purchased Taking Charge of Your Fertility, 10th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health. Knowledge is power and now I was on a mission.

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.

Are you doing it right? Conception 101

2010-04-24T11:33:00.010-04:00

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.

So there you have it: Conception 101. If you want me to elaborate on any specifics above, just let me know. If you have time, I would highly recommend that you get this book:Taking Charge of Your Fertility, 10th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health

Welcome

2010-04-23T18:01:00.004-04:00

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.