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Canadian Infertility Awareness Week

Most of my posts in the last few months have been about my pregnancy. I tried not to become pregnancy obsessed on the blog, but it has been hard because I am really, really happy. However, I still want to acknowledge the pain of infertility, not only for myself but for the many, many couples continuing to struggle in their journey toward becoming parents.

As such, I posted more openly than ever before about infertility on facebook. Along with this picture (which I have posted on the blog before):

infertility1

I wrote the following: It’s Canadian Infertility Awareness Week. Infertility is a medical condition that affects 1 in 6 couples for a variety of reasons and it affects people of all ages. As someone who struggled with infertility, I wholeheartedly believe the research that shows that the stress of it is akin to being told you have a terminal illness or the death of a loved one. Even though I’m pregnant, I still have Diminished Ovarian Reserve and may never be able to get pregnant again. I consider myself extremely lucky and want to honor the others who are still trying.

Several people “liked” my post and one wrote a kind message. I decided to divulge more information in response. Here’s what I wrote: Thanks X (and everyone else who liked the status). We got very lucky and got pregnant naturally while on the wait list for IVF. Infertility is often treated like a taboo, hidden topic, but it’s more common than most people realize. For those going through it, it is often emotionally, physically, and financially draining. I know I really benefited from support from friends and strangers alike, so I want to acknowledge our struggle to conceive and the grief we experienced so as to take a step toward making this a more open topic and to support others if I can.

I hope that if anyone on my facebook is dealing with infertility now or in the future, they’ll feel comfortable contacting me to ask questions, share experiences, or just vent. As happy as I am now, I know that my infertility didn’t magically go away and I remember the grief that I experienced. It doesn’t take away from my feelings now and I don’t feel like I was robbed of all the time we spent trying, but it needs to be remembered and acknowledged.

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Insensitivity or Ignorance?

I will admit that I put a lot of people in awkward positions by being very open about infertility, but I was often met with comments that, while probably well-intentioned, were shortsighted and hurtful. I suspect these comments were born out of ignorance to the realities of infertility, rather than insensitivity. All the same, I was ready to shake my friends and family after the words left their mouths. As I know that many people who have experience with infertility have also heard seemingly insensitive comments, I thought I’d share some of my most memorable. Most of these took place over Facebook so I was actually able to get the verbatim transcript.

1) Friend: Maybe some little baby out there needs you ..whatever is meant to be will be. But you will be a mom one way or another! Believe me…I’d skip being pregnant! Not so fun lol

My response: Sometimes I do wonder if maybe we can’t have a biological baby because I have the capacity to love (100% love) a baby who isn’t related to me, or even the same race as me. But we still have to try biologically for our own curiosity if nothing else. I really do want to experience pregnancy. I know you say it’s not fun. But I want to know what it’s like to pee on a stick and actually see a positive, to see an ultrasound, to feel a kick, and to even experience the pains of labor and delivery. If I can’t experience that, I will still love my child, but I will grieve the loss of experience.

2) (immediately after discussing the roller coaster of emotions involved in infertility and waiting for IVF) Oh and (name removed) is pregnant!

3) I can always send you (my daughter), those darn teenage girls.

4) You aren’t getting any younger. (How apt since it turned out that I have DOR.)

What are some of your “favorites”?

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What was the magic trick?

I have seen people ask and post about what was different about the cycle where someone actually manage to conceive. I started reflecting on my cycle and there a few possibilities:

1) the extra CoQ10 my RE had me taking (800mg – 200 4X a day) helped my eggs out

2) the Chinese herbs I was taking finally kicked in

3) chance of pregnancy often rises in the three months after an HSG – we conceived in February, the third month after my HSG

4) I decided eff it – it’s probably not going to happen on its own and we’re on the wait list for IVF. I drank whenever I wanted, not just before ovulation. And we didn’t put much effort into sex (i.e., timing it, making sure we did it tons). My mind was more occupied by other projects, work, and things I enjoy.

I’m hesitant to even post the fourth point because it gives fuel to all those people who say things like: just relax, you just need to get drunk, stop trying. I really don’t think that it’s easy to stop trying or relax and I don’t think alcohol is a magic fertility drug. I think that pouring myself into projects like prepping for my friend’s stagette and getting my mind off TTC and infertility likely helped, but I don’t know that it was the magic trick. I doubt that if I had suddenly been more relaxed say 6 months ago that it would have happened then.

In reality, I don’t think there was a magic trick. I think that it was luck (maybe divine intervention if you swing that way). I think that the perfect circumstances happened to collide this one month. Our RE always said there was a possibility of conceiving on our own, it was just less likely. I don’t know that if we were to try again we’d be able to conceive on our own again. It doesn’t feel like a certainty or suddenly I’m cured. It feels like a very fortunate turn of events.

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We Have A Plan!

We met with the RE again yesterday and now we are officially on the IVF wait list (according to RE the wait is 1-3 months; reception said it’s 2-4 months).

When we met with the RE, he went over everything he said the last time. I have a really good memory so I was kinda like, ok get to the new stuff and let me ask my questions. But it was good that he went over everything in detail. Last time my FSH was 9 and my Antral Follicle Count (AFC) was 5. This time FSH = 9 and AFC = 7. To some, the AFC might seem like an improvement, but really they are the same and still far lower than expected.

My RE ended up saying that our actual diagnosis is Unexplained Infertility because DOR isn’t one of the traditional categories of infertility (e.g., tubal issues, ovulatory problems, male factor) and there is currently no research that says that a woman with DOR inherently has a harder time getting pregnant than someone without it. But, since we have tried for over a year, we are still dealing with infertility and my low reserve is a big red flag that deserves attention.

I asked MANY questions, which even became a joke at one point in our meeting, but Dr. Min was great about it. I must say, I really like our RE. He is candid (he flat out says if he just doesn’t know something because the research isn’t there), upfront, confident (in a way that breeds confidence in me), and really sounds like he knows his stuff.

The RE once again went over our options: we could try naturally for another 6 months (neither J or I wants to wait or has faith in this being the trick), try clomid (unlikely to make a difference – I am already ovulating regularly), try clomid + IUI (small success rate), try injectables + IUI (~22% success rate, but ours would cost about 5K and J thought the odds didn’t sound worth it), or move on to IVF right away.  I asked the doctor which option he preferred and he said he’d go with IVF. That’s what I was thinking and apparently J too.

With IVF, our protocol will be microdose flare and we’d do ICSI (intracytoplasmic sperm injection) since the percent of J’s properly shaped swimmers was on the lower side (4% morphology). Dr. Min said he doesn’t need to experiment with my dosage because he isn’t worried about me overstimulating (and risking OHSS). Instead, he would max me out in an attempt to make as many follicles/eggs as possible. He said he’d be happy  if he could get me to produce a high single digit/low double digit number of eggs. A Google search led me to a graph showing that >10 eggs would give a woman under 35 a 65% chance of live birth, 7-10 eggs = 58%, 3-6 = 38%, and 1-2 = 16%. Depending on the quality of my eggs/embryos/blastocysts, the RE said he’d either implant one or two (and whether it’s a day 3 or day 5 transfer would depend on quality and number of embryos).

If I produced less than 3 eggs, we’d convert to an IUI to give us a better chance and make use of our stimulated cycle. If we started with IUI, the goal would be to make 2-3 follicles. If I produced more, I could convert to an IVF but then I wouldn’t have had the higher dose of meds and I might not be capitalizing on my follicle growing potential.

So here are the things I have going for me: my age (29), my FSH isn’t super high, and my cycles are regular in frequency and length. Having fewer eggs at my age does not place me at higher risk for chromosomal abnormalities and chromosomal testing on the embryo was advised against. My acupuncturist said that ICSI is associated with higher abnormalities, but my RE said the research doesn’t substantiate that. Also, I have read that if there are chromosomal abnormalities, it’s likely due to the issue causing the infertility and not the ICSI procedure itself. However, there is an elevated risk of Klinefelter’s Syndrome (1%). KS is when a boy is born with XXY sex chromosomes. It is associated with reading disabilities and executive functioning (e.g., planning, organization, working memory, processing speed) difficulties – I work with kids with learning disabilities and ADHD (which is really an executive functioning disorder), so I understand that appropriate early intervention could make a world of difference in those respects. More concerning is that KS leads to physical differences which can affect the boy’s self-esteem and cause him to be ridiculed (e.g., smaller testes, more breast tissue). Testosterone and corrective surgery can be used as treatments. Also, individuals with KS are most likely to be infertile themselves. Overall though, the risk is still low.

We talked a bit about egg donation, but right now I feel hopeful about my own eggs. The RE knows though that I am very open to discussing donation if I don’t respond well.

As we were leaving the clinic, we were about to put our names on the IVF waiting list. We were told there’s a non-refundable $300 deposit. J and I hadn’t had a chance to discuss much in private even though we had talked about the likelihood of IVF before this appointment and we both said that was how we wanted to proceed in the office. Standing in front of the receptionist felt like an awkward place for such a conversation and when I asked J if he was sure, he said that I knew more about this stuff and if I thought it sounded best, we should go for it. I didn’t like that response because I worried that I was pressuring him. So we decided to wait and I would call it in later. We talked a bit as J drove me back to work and it became clearer that he did think IVF was best based on what he heard. I still wanted to double check last night and answer any questions he might have, as I have researched all of this so much and it’s all so new to him. He said I wasn’t pressuring him and, honestly, he didn’t understand much other than the percentages and costs (his work revolves around measurement and calculations, so this is not surprising). He said that once I started asking all my questions, he just started wondering if we could pay for it by credit card so that we could get points! I laughed out loud. Leave it to him to be so practical about it all.

So, bottom line, we’re moving forward and I’m hopeful . . .

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TV Infertility

You know how when you buy a new car you start seeing that model everywhere? It was the same when J was diagnosed with diabetes. We see and hear stuff about diabetes (usually type 2 though) all the time. Now it seems like a lot of the movies and TV shows I watch have mentioned infertility (e.g., 90210, New Girl, The Odd Life of Timothy Green, Parenthood, Grey’s Anatomy). I wonder if it’s a coincidence or if it comes up a lot more than I ever realized before. Of course, they usually do a horrible job of capturing what it’s really like, so normally it annoys me more than providing comfort. But, if it can help make infertility more of a “mainstream” topic and less taboo, then I guess that helps. Unfortunately though, the ease with which the characters deal with their infertility issues may add to the notion that “just” doing IVF is as easy as an expensive trip to the grocery store.

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What does 2013 have in store?

I was just reading Waiting to Expand. Cassie has inspired me in the past (100th Post) and she managed it again. I have been so stuck in my fear, anger, and despair, that it is hard to truly look forward to positive things outside of TTC. That is partially due to feelings of guilt whenever I feel momentarily happy or excited. I feel like if I say I’m good, or truly feel good, then it’s a sign that I don’t want a baby badly enough or I’m not committed to infertility treatment enough. I know that’s irrational though because I should try to find ways to stay happy and positive in all of this mess. So in the spirit of Cassie, I am going to list some things I am looking forward to in 2013:

  • My friend’s stagette (and possibly having one of my best friends come stay with us so that she can attend the stagette)
  • My friend’s wedding in Mexico – I love weddings and winter vacations have been a must for J and I since we got married.
  • Two of our friends, and their daughter (whom I’ve met, but J hasn’t), said they’d like to come visit us this spring.
  • J’s annual general meeting in Jasper, AB (it rotates between Jasper, Banff, and Lake Louise). I have never been to Jasper and now that I know some of the other wives and J’s coworkers, I think that the fancy dinner and ball they have each year will be a lot of fun.
  • My 4th wedding anniversary. Even if we only do something simple like dinner or a movie, I like having a night to celebrate our marriage and reflect on our wedding day. I am excited to be reaching our 5th year before too long (seems like a milestone).
  • My 30th birthday. If I could be so lucky to be pregnant when I turn 30, then it’ll be amazing! If I’m not, there will be some sadness over turning 30 before I am a mother. However, a friend and I have been dreaming about just maybe going to Disney World (we both LOVE it!) if I’m not pregnant and we’re between IVF rounds.
  • Halloween – I love it! Maybe we’ll even get dressed up and go to/have a party this year. I miss costumes!
  • Christmas – it’s one of my favorite times of year. I hope we’ll have a baby or one on the way to celebrate, but even if we don’t, I can’t help but get into the holiday spirit.
  • I am also looking forward to starting IVF. I’m not happy that we need to do it or that we’re limited in the number of times we can try, but if it’s our best chance, I want to get it started.
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Babies Everywhere

Seriously it seems like there are babies everywhere. I feel surrounded by pregnancy, talk of babies, and strangers’ babies everywhere I turn when out in public. On one hand I love it, and on the other, I hate it.

Around Christmas I was in the mood to buy a new celebrity gossip magazine but the main story on most of them had to do with a celebrity pregnancy – Princess Kate, Kim Kardashian, Jessica Simpson, etc. I couldn’t bring myself to buy any of those. Celebrities seem to be procreating in droves. Even though I am not a Kardashian fan, I have seen a few episodes of Keeping up with the Kardashians and I’ve read enough gossip mags to know that Khloe Kardashian is dealing with fertility issues (is this confirmed or just rumored?). I couldn’t help but think of her and how she must feel that her sister got pregnant shortly after beginning to date Kanye, whereas Khloe has supposedly been trying with her husband for years. I’m sure she’s happy for her sister (at least to a degree), but also hurting over her own struggle. I also thought of how the magazines speculated that Kate was dealing with infertility when she hadn’t announced a pregnancy within a year of marriage. Who knows when they even started trying. I found myself hating those infertility headlines because a) if she was dealing with infertility, that’s hard to have it splashed on the cover of magazines and b) if she wasn’t, that’s a lot of pressure to put on someone to get on the conception train fast!

Over the holidays, I think I saw 3-4 facebook pregnancy announcements. I find the announcements especially hard when they are from acquaintances. Because I’m not that close to them, my jealousy overwhelms my happiness for them. With friends there’s a better balance and usually the happiness wins out. Here’s what I wanted my facebook status to say one particular night: “I can’t take anymore pregnancy announcements. I am happy for all of you, but each one is another stab to my heart.” Obviously I would never write this because a) it’s completely narcissistic (Did I forget to mention that your pregnancy is all about how it affects me?), b) even though I’m (excessively) open about my fertility problems in conversation with people, I don’t really want to make a blanket statement to all my facebook friends (I don’t want it to seem like an attention-grabbing tactic or to attract the wrong kind of attention), and c) I don’t actually want to rain on the parade of all those happy pregnant people out there. I just want to join in so badly.

I have read this time and again, but it’s true: unless you’ve dealt with infertility, you’ll never really get it. Sure you can empathize and imagine how horrible it must feel, but you don’t understand how it can take over everything else in your life, affect how you interact with your friends and family, and cause you to experience searing jealousy and begrudge others their happiness. Even though I don’t wish infertility on anyone, I wish more people got it. That they understood that pregnancy doesn’t always happen as soon as you want it to (even for perfectly healthy people), that sometimes remaining childless (especially after several years of marriage and a settled lifestyle) is not by choice, that a warning of a pregnancy announcement is appreciated, etc. But again, that’s narcissistic because it means that those other people need to think about my needs (and the needs of others dealing with infertility) while rejoicing in their own good fortune. And that’s not fair to them (although if you know a friend or family member is dealing with infertility, tact and compassion are certainly appreciated).