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.

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.

Versatile Blogger Award

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

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

***********

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

1. I used to be a fashion stylist. I still loooovvveee fashion – I have a stuffed closet and a tower of magazines to prove it.
2. English is my third language, but I guess through the years, it’s become my first.
3. I love good food. I love to prepare it, eat it, watch it on TV. And while I’m on the subject, I have a thing for desserts. Even if I’m full, I claim there’s room in my “second stomach” for some sweet treat.
4. My non-obviously-hot-guy crush is John Krasinksi. A good sense of humor and charm will go a long way with me.
5. I’m strangely incapable of watching any movie that involves an animal getting hurt, but blood and guts with humans, bring-it-on!
6. I never leave the house without some concealer for my perpetual dark circles.
7. I’m hyper critical – mostly of myself. I second-guess every decision I make. In fact, I’m sure I’ll go over this list after posting it, wondering if I should have written it differently.

I would like to bestow the Versatile Blogger Award to the following fab bloggers:

1. Cenk@ Cafe Frenando
2. The Sartorialist
3. Non Chalant Mom
4. Sunshine @ Waiting in Sunshine
5. Keiko @ Hannah Wept, Sarah Laughed
6. Circus Princess @ Circus Children
7. Waiting for a Baby Bump
8. Amber @ Born in a Barn

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?!