A Nobel for IVF, But Not Much Has Changed

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.

Adapting to Unexpected Changes During Your Cycles

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

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

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

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

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

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

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

Once Upon a Time: My IVF Story

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

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

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

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

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

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

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

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

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

The Infertility Competition

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


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

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

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

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

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


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

Other People's (IVF) Babies

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

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

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

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




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

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

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.

Bye Bye IUI: Preparing Yourself for IVF

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

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

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

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

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

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

The Little Pill That Could

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

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

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

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

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

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

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

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

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

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

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

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

The Sting of Mother's Day When Coping With Infertility

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

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

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

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

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

Worst Case Scenario: True Story of a Wrong Embryo Transfer

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

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

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

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

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

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

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



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

It Takes a Village to Make a Baby

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.

Money Talks: Insurance, Health Care and Your Infertility

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.