In the News...

I wanted to bring to your attention a couple articles that caught my eye recently. I found them pertinent to our discussions here and I hope you take the time to read them.

The first one is "How Older Parenthood Will Upend American Society" by Judith Shulevitz, which appeared in The New Republic:

It's a sobering read about how the graying of American parents is affecting the makeup of many generations to come. This article covers many aspects on this topic. The main one that jumped at me was the paradigm shift that has come as a result of the correlation between significant rise of children born with mental and physical disabilities (genetic mutations, autism, schizophrenia, etc.) and the increased age of the respective fathers. It appears that the proverbial ticking clock may no longer be limited to women, but now men need to become much more aware of when they choose the finally have children.

The other highlight for me was the obvious, nonetheless painful reality of the brevity of human life -- "A woman who is 35 when her child is born is more likely than not to have died by the time that child is 46." Many couples that I know undergoing IF treatments are in their mid-thrities. Somehow it feels completely normal -- after all, many are educated, professional men/women, who wanted to accomplish certain things before being surrounded by diapers. I wonder how it will affect the sociological conversations for the next generation in terms of caring for older parents at a younger age and future healthcare entitlements for the rest of us "older parents" (with dwindling numbers of babies, who will care for us and how will our care be payed for?).

The article does raise the question of IF treatments and its effects on the wellbeing of the next generation and the lack of regulation of this industry.

Which leads me to this next article: "Are Infertility Doctors Turning into Predatory Bankers?" by Peter Ubel, which appeared in Forbes:

This brief article covers the murky waters of the for-profit IF treatments (the more patients an RE has the more money he/she makes, thus possibly offer more treatments than necessary) and the kickbacks REs receive from referring patients to loan companies that are supposed to help pay for the exorbitant IF treatments.

This reminded me of two important topics that I always bring up: 1) Sadly while we look to our REs as these heavenly beings who are going to make our dreams come true, in the end, it is a business transaction. So if you are not getting 100% of your RE/clinic, you can always take your hard earned money elsewhere. And 2) we MUST continue to advocate for our cause and press our lawmakers to get insurance companies to provide greater/full coverage.

Affording Infertility Treatments (Revisited)

I had previously covered various options you could explore in order to afford infertility treatments. I wanted to repost my entry and also direct you to this article from US News, which in part highlights similar options, along with a couple of additional ones.

What else would you add to the list?

"Dollars and Cents: Affording Infertility Treatments"


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.

Unbaby.me

Well friends, someone has made your dreams come true. Someone just sent this to me and I knew I had to share it.

We've talked about how we dislike Facebook for all of its ridiculous comments and baby pictures (unless they're ours). This app. will refresh your feed to replace all baby pictures with cats and dogs.

Haven't tried it myself, but sounds promising.

Male Factor Infertility (MFI) Follow-up

I've already shared with you the basics of male factor infertility (MFI) in an earlier entry (benchmarks, tests, general options), but a recent discovery is worth revising this topic.

According to this article in Scientific America, researches have managed to decode the human genome of a single sex cell. Unlike other cells, sperm and egg cells contain only a single set of chromosomes. This discovery will enable scientists to decode the genetic makeup of your partner's sperm. The hope is that it may finally give some answers to those suffering from "unexplained infertility" and will hopefully become part of the standard testing done during RE visits.

This sequencing of a full genome from a single sex cell, like the sperm (and maybe some day the egg), is expected to become available for infertility lab uses within the next five years. In the meantime, there a few options that are worth mentioning:

• PICSI: While ICSI is commonly used in fertility clinics, surprisingly PICSI is not as prevalent. In essence, PICSI is a sperm selection method that allows embryologists to select sperm beyond just their appearance (remember morphology and motility of the sperm?) and then be ICSIed (yes, I used it as a verb!). This method entails placing the sperm in a dish that contains Hyaluronan. This is a substance found in the cells around human eggs -- and in other tissues. The theory is that mature and most importantly sperm with good DNA will bind to the Hyaluronan, hence be selected for ICSI. For what it's worth, we used this method at our last IVF cycle at CCRM. 

• SCSA: This is another test available, perhaps closest to this new discovery, that allows us to find out more about the DNA of the sperm. SCSA (Sperm Chromatic Structure Assay) is a sperm DNA fragmentation test. In other words, it looks to find any "breaks" in the DNA of the sperm, which can be one of the reasons behind recurrent miscarriages -- sperm and egg meet, embryo is formed but quickly dies because of fragmented DNA. Now the question is, is it worth doing this test if ultimately even if the results came back positive for high fragmentation you (a) would continue to try using your partner's sperm, or (b) you would not consider using donor sperm? Those were the questions posed to us when we inquired about it with our RE. There may be value in testing if you are near the end of your rope and need to find closure.

With every discovery we seem to be coming closer to finding some answers for the millions of couples struggling with unexplained infertility and MFI. 

But like technological advances, scientific advances are very quickly replaced with other more promising discoveries. 

Would any of the above sperm selection options give you the closure you would need to stop pursuing infertility treatments if you found out that your partner's sperm just doesn't seem to make the cut?

Limitless Possibilities: Twin Selective Reduction

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. 

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

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.

Looking Back and Forward

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.

Holidays Are Not Easy, Even When You Have Candy

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

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

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.  

The Birds and the Bees: An Infertility Story

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.

News: CDC Videos on A.R.T.

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

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.

Stress And Infertility

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

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

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

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

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

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.

Letting It Out: Expressing Your Frustrations with Infertility

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

 

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

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

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

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

What the Scale Isn't Telling You About Your Fertility

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.

Bye Bye IUI: Preparing Yourself for IVF

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

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

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

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

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

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

An Ode to Virtual Friends

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

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

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

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

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

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

Happy IcomLeavWe!