Our Infertility Journey (1.16): When Hope Outweighs Despair

I was starting to despair, but I had not yet lost hope. Despair is a terrible thing. It’s that sick feeling in your stomach that slowly creeps in. It makes you want to curl up in a ball and ignore the outside world. It makes you feel that your problem is the only and most important in the world. It definitely causes you to become self-focused. Holding onto hope was my only hope. I couldn’t despair. I had to trust that this would work. If I was negative about it what good would it do? Somehow the power of positive thinking was going to make a difference. I begged God. I cried. I pleaded. I told him that I was angry that he would do this to me. I had followed what I felt was a calling to go into medicine. I had dedicated my life to helping other people. Why wasn’t he helping me now? My anger turned into remorse. I apologized for anything and everything that I had ever done wrong. Was he holding out on me because of some unconfessed sin? I didn’t know, but I wanted to clear up anything that could possibly influence his response to my desperate cries for help.Anxious woman thinking in her bed next to her sleeping partner

I had to wait several weeks before starting the frozen cycle. All during this time I had been trying to act normal at work. Only a few people there knew what was going on. I didn’t want to make my private business public to the whole office (ironic since I’m now sharing it with the world). I didn’t want them to ask me how things went or to look at me with pity. I wanted to see my patients and then go home.

In primary care you get to know your patients fairly well. I sat down and started to ask my patient how she was feeling? I knew that she was pregnant. It hadn’t been planned, and she wasn’t all that happy about it. I had actually been the one to diagnose her pregnancy several months before. I then asked her how the baby was doing. She gave me a strange look, then glanced toward her young daughter who was playing in the room. She then whispered to me that she wasn’t pregnant anymore. Oh, I said, “I’m so sorry. What happened?” I assumed that she had a miscarriage. It didn’t even occur to me that she would have ended the pregnancy. All I wanted was to be pregnant, so the thought of giving that up was far from my considerations.Baby Holding Mans Finger

She responded in a whisper that she had an abortion. Now was not good timing to have a baby. Regardless of my position on pro-choice vs. pro-life (I’m not here to get into a debate. I am just sharing from my infertile perspective), in that moment, I felt like someone had punched me in the stomach. The only thought that kept going through my head was that, “I would have taken your baby. I would have loved your infant. If only you knew what a precious gift you had. I would give anything for that.” I swallowed my stomach, forcing it to go back to its normal position, and I responded without missing a beat. My face did not show my sorrow or my surprise, instead, just as medicine teaches us, it showed no signs of judgement. I simply said, “Oh, are you happy about that decision, and how are you feeling since the abortion?” I became objective because medicine mandates objectivity. As a physician I was forced to be objective and non-judgemental, but as a desperate woman wanting to become a mother…I grieved.

The beautiful thing about the frozen cycles was that I didn’t have to do a stimulation cycle. This meant that I only had to do a portion of the shots, and I had to take steroids. Unfortunately, the protocol for frozen cycles was that the progesterone had to be given as shots…Not the small needles, but the intramuscular shots in the butt twice daily. Usually, the spouse was the one to give these shots because it was a little hard to reach the correct spot on yourself. Besides, the needles were like torture devices. No one in their right mind would want to see that going into themselves. I surely didn’t. They had to be spaced out by 12 hours, one in the morning and one in the evening. The problem was Dave’s schedule. As a surgery resident, he was getting up at 4:30 in the morning in order to leave by 5 on certain days. I am not a morning person to begin with. Just imagine being awakened just so that you can bend over and have someone drive a needle (two by four) into your butt cheek.

.Money in syringe

The first time I was incredibly nervous. It was about as bad as I thought that it would be. Having your husband inflict pain on you makes you somewhat more of a wimp as well. You have to put on a brave show for someone you don’t know, like a nurse, but you can whine and complain and say what you really feel when it is your husband. I am not one to get light-headed and woozy at the sight of needles, but after the first shot, I had to lay down…immediately (I’ve since gotten a lot tougher:) I thought that I was going to pass out. That sensation did not diminish over time. With each shot I felt more than a little flushed and light-headed. Then my butt began to get pretty sore. I started to have a pretty red spot on each cheek and decided that someone should take a look to make sure nothing was wrong. It turns out, that my husband has a very precise aim. He was giving me the shots in exactly the same spots every single time. You don’t really want this much precision! He was instructed to widen his aim to prevent a site reaction from getting worse.

It hurt to sit, and it hurt to stand. I started to long for the Crinone progesterone gel that turned into a cottage cheese curd-like discharge. It may have been gross and messy, but it certainly didn’t hurt like this. I decided that I could do anything at this point though. I could even give myself the shots; And, well, I had to. Dave was running late one evening (as in I don’t think he left the hospital until the next day.) I was on a strict schedule with my shots, and I wasn’t about to mess things up. I didn’t really have anyone else to ask, and I didn’t want any of my neighbors seeing my assets. My coworker had mentioned that because of her husband’s schedule she also had to give herself the IM shots at times. If she could do this so could I! I loaded the syringe, attached the mile long needle and prepared to self-inflict torture. I had to contort my upper body while looking in the mirror in order to make sure that I was in the right spot and wasn’t going to hit a nerve. After several start and stop attempts, I just decided to get it over with. The funny thing was, it was so much better when I gave it to myself than when Dave did it. It’s like getting your own splinter out. Somehow it just hurts less.

Transfer number three was scheduled. Again my primary infertility specialist was not going to be present for it. Instead it would be the head of the department. I was informed that his technical skills were very good, and we shouldn’t have a problem this time. Well, that was not entirely true (I’m sure his technical skills are fine…but we still had a problem). All three of the embryos survived the thawing process. The plan was to transfer all three because frozen cycles are known to have lower success rates than fresh.The Equipement Of Gynecologist Room

Striped down, knees in the stirrups, ultrasound smashing my belly once again, the transfer started, only to be started and stopped several times. The physician confirmed that my cervical pathway was more than a little tricky. It was winding and somewhat challenging to feed the catheter through. I lay there with my legs in the air panicking. Not again! They had to get the embryos in. The concern was that embryos are very temperamental to their environment. They should either be in the incubator, or they should be in the uterus. Any time out of these environments could compromise their quality and ability to survive. Eventually, the infertility specialist was able to get the catheter in place. The embryos were transferred, and we had three embryos floating around in my uterus. The idea that we could get pregnant with triplets and even as many as six babies put me into a little bit of a whirlwind; But, who were we kidding, we hadn’t been able to get pregnant once yet, so what where the odds that we would get pregnant with three?

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Our Infertility Journey (1.15): Fresh Embryo Transfer…second time’s the charm?

Several days after my egg retrieval, my uterus was ready for my second ever embryo transfer. When we heard that we had 6 embryos we were ecstatic. That sounded like so many compared to the last time. However, on arrival we were down to 5. They had decided to transfer only 2 embryos to minimize our risk of twins, but the two were perfect quality! Finally, we were going to be parents! My infertility specialist was in another procedure that day and was unavailable to perform the transfer. Instead, one of her partners was present for the procedure.

I was back in my striped from the waist down position with my legs in the air; I was ready to have this work. My legs started to cramp and get numb after a while, and the ultrasound probe was more uncomfortable than I had remembered. There was so much pressure pushing down over and over again against my sore ovaries that had just been poked with needles numerous times. Time after time, the physician attempted to pass the catheter tube into my uterus. The embryos were handed to her and then passed back to the incubator. She just couldn’t make the tubing work. Several times she unconvincingly thought that she was in the right spot, only to then conclude that she was not. Back and forth the embryos went.Sperm injection

I was starting to get nervous. This was supposed to be the easy part of the procedure. Tiny capillary tube in, baby in, presto…pregnant. Eventually, the nurse, who by now I considered a friend and who was holding my hand on the opposite side from Dave, suggested that we call my primary infertility specialist to let her try. Thankfully, she was able to come down from the operating room. A wave of relief swept over me when she entered the room. Not, that the other physician wasn’t good, but there’s a trust that develops between a doctor and a patient over time. I trusted my primary infertility specialist. I had researched her and chosen her as my doctor. Her knowledge level was great, but her surgical and procedural skills were also top-notch (which is why I had chosen her in the first place). She quickly moved into position and got to work. Unfortunately, my cervix decided that it wanted to be tricky for her as well. After at least another 15 minutes and several different types of tubing, she was in! In went the embryos. We waited for the confirmation from the embryologist that none were left in the tube. Yes, we were once again with child!

I got up from the table, desperately, needing to pee. Their protocol said that I didn’t need to lay flat, or put my legs in the air, or anything special. I could get up and go about my day as usual, but I still wasn’t allowed to exercise due to my ovary size. I was thrilled. This was going to work. Two great looking embryos were now inside of me. They were my little munchkins. I texted my friends letting them know how things had gone. We were only a week away from Thanksgiving, and we were going to Charlotte to see my parents for the holiday. I couldn’t wait to hear the words, “You’re pregnant.” We just had to make it through Thanksgiving and then we would know.

Our trip in Charlotte was fun. Everyone was excited for us. It was going to work this time because the medications had been so much better, the embryos looked much better; and well, it was just going to work. We decided to take a day trip to the Biltmore house. On the way home, Dave took a curb while pulling into a gas station. He didn’t just bump it a little, no, I felt myself lurch in the seat, with my seatbelt tightening. I freaked out! How could he be so careless? I couldn’t be jostled! What if he had just ruined everything that I had worked for? I went a little insane on him and then just stopped speaking the remainder of the way home. I don’t like getting angry, but I had so much riding on this cycle. It wasn’t like it was easy for us to get embryos. Every step had been challenging. He reassured me that everything was fine, and that it would take more than a speed bump to disrupt things. I didn’t want to hear a word of it. Although I eventually forgave him, I was a little nervous that it may have messed up our chances. I was probably blowing things completely out of proportion, but when you are on a gazzoodle of hormones and you have as many emotional and physical ups and downs as I had, you would probably have freaked out as well.

I was at work when the call came. It was my infertility nurse. She had been assigned to me from the beginning, and it was a good thing. I called her quite often when I had a concern, and she was the one who called me with my blood work results and my pregnancy test results. She was the one to hold my hand during the procedures, and she was the one saying “Hi,” to me each morning before my countless ultrasounds. She had called me with the news on my first cycle informing me that I wasn’t pregnant. She had a way of delivering the news that was very predictable. She always started with my name. She would say, “Emma, this is Libby (changing her name for privacy sake).”  And, then she would repeat my name and my results. “Emma, you are not pregnant.”  Followed by a sincere, “I’m so sorry.”

I had gone in that morning for a pregnancy test. Libby was calling with the results. Unfortunately, once again, I already knew what they would be. I had been feeling crampy for several days, and I was having a little bit of spotting. My munchkins had decided not to stay. I felt like they had betrayed me. Libby’s voice confirmed my concerns. “Emma, you’re not pregnant. I’m so sorry.” I was heart-broken. How could this be? This time had been better. This time had been as good as it would get. I called Dave to let him know, but I couldn’t reach him. Typical. He was working. I simply left him a message saying, “It didn’t work. We aren’t pregnant.”a woman blowing on a dandelion muted colors vintage toned

My infertility doctor called me as well to check on how I was doing with the news. We discussed options once more. At least this time we had frozen embryos so I wouldn’t have to go through a stimulation cycle again. And, of course, the price was much less for doing frozens. My gunner attitude pushed me to ask when we could get started again. I would have to wait a little while, but they could start me on birth control and once I had a period we could proceed with a frozen cycle. I was game. I do have to say that the periods after a failed IVF cycle are MONSTROUS. The medicines make the lining of the uterus thicker to support the embryos, but that means that you have more lining to shed. Fun, Fun! Not only are you not pregnant, but you get the worst period of your life. Oh, wait did I already mention that above? It’s worth mentioning again.

From,

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Our Infertility Journey (1.11): The Neighborly Infertility Waiting Room

As soon as my ovaries shrank back to their normal size (after a failed IVF cycle, sabotaged by ovarian hyperstimulation); my hormone levels normalized; and I had my period, I was immediately ready to start another cycle of IVF. I was going to make this work. I was not going to be discouraged. I was going to get pregnant.Pregnant Woman holding her hands in a heart shape on her baby bu

I was fertile…incredibly fertile…confirmed by a tiny drop of medication overstimulating my ovaries.  I didn’t need a break. I needed a baby. And, so, we started over again. This time I was required to have more frequent ultrasounds and more frequent blood draws (oh, so convenient for my work schedule). The medication doses were titrated to push the ovaries to make follicles but not to hyperstimulate. We were on the right track. But…

Once, again, I hyperstimulated. It was not as intense this time. I was able to continue the cycle, but unfortunately because we were using such small doses of medication I ended up with a lot of very small follicles that didn’t have eggs at the right stage of maturity. I only had a few follicles that looked promising. Would these few follicles be enough? I held onto hope.

During this cycle, a somewhat random and awkward series of events transpired. As I made my way into the clinic one morning, I noticed a familiar face. Not just a vaguely familiar face, but the face of my next door neighbor. She sat alone, looking down at either her phone or a book, or anything just to avoid eye contact. I knew that she had seen me. How could she not, with only a glass wall to separate us on entry, and one other person sitting in the waiting room?Three patients sitting in doctor's waiting room

For several months now I had observed that everyone always looked up when someone entered the waiting room. Maybe they look out of curiosity. Maybe it was an instinctive reaction to the sound of the door opening. Maybe they thought the nurse was about to call their name, or maybe it was a glance longing for connection-the connection of seeing someone else struggling with the same grief that infertility brings. In this silent community of women, all were pained by similar emotions yet distanced from one another by shame or a desire for privacy. But, behind each heart filled with pain was also a yearning for understanding and support.

As I sat down, I tried to make eye contact. Instead of feeling like my privacy was being invaded, I was excited to find comradery. I wanted to know my neighbor’s story. I wanted to tell her mine. I eased myself into the seat, sore from my distended pelvis. I wondered if she was in the middle of a cycle. As my mind was racing through possible scenarios, she briefly glanced my direction. I tried to catch her eye and smile. This time she did see me, but instead of saying hello and exchanging pleasantries, she simply gave me a hasty, half-hearted smile and quickly looked back down. Each morning after was the same.Outdoor profile portrait of a beautiful thoughtful Chinese Asian

I didn’t judge her. How could I? Just months before I had been shrinking behind the vending machine hoping that no one that I knew would see me. How could I expect her to behave differently. She hadn’t invited me into this private part of her life. She didn’t want me to know her struggle. She deserved the right to her privacy, to her reaction, to her annoyance at my presence. I understood. She was dealing with her infertility struggle in the way that worked for her. Who was I to pressure her to talk or to share?

Over the next several months we saw each other frequently. Our exchanges were limited to a quick glance and a brief smile. By now our husbands were accompanying us to our appointments whenever they could. My neighbor’s husband would smile and greet me comfortably, as though we were both in our front yards watering flowers. Our husbands worked out in the same gym and would run into each other on occasion. Somehow they were easily and openly able to talk about our simultaneous infertility journeys and failed IVF cycles.

Young woman doctor in cap and face mask in surgery room interiorAs coincidence would have it, we both ended up having our egg retrivals on the same Saturday morning. So, just the four of us sitting in the fish bowl waiting room at 6 am, eager, worried, and more than a little tired. Would we both come out of this round pregnant? Would only one of us have success? How many eggs would each of us get today? How many embryos? So many questions…so many what if’s. I wasn’t sure what to say. Besides, my mind was more than a little hazy from the sedating medication I had taken before arriving to the hospital. This clinic expected you to be tough. A benzo by mouth and some IV narcotics were all they gave for egg retrievals. Looking back, I’m a little jealous of my friends who had full anesthesia at other clinics! I’m pretty sure I’d be okay with never knowing what an egg retrieval feels like!

From The Mom in Me, MD

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It’s a Hush, Hush Word…Infertility

SHHHHHHHH…..I’ve got INFERTILITY ISSUES! People put autism puzzle stickers and breast cancer survivor stickers on their cars, but I have yet to see an “Infertile Couple” awareness sticker. Is the diagnosis of infertility any less of a diagnosis? Insurance companies lead us to believe this by their lack of coverage for medically necessary infertility services (a blog for another day).  Although infertility may not be life threatening like breast cancer, it is a painful and limiting condition that profoundly impacts many lives.NEW YORK - MAY 24: Actress Sarah Jessica Parker attends the prem

I assume that the stigma of infertility in part stems from the fact that SEX is broken. Who wants to admit that their sex doesn’t “work”? And, although Sarah Jessica Parker may have normalized talking about explicit sex over the dinner table, many of us don’t want to share the intimacies of our relationship with friends, let alone strangers. In my mind, one of the beauties of intimacy is that it is something shared just between my husband and me. And, although I don’t shy away from joking about sex with friends now and then, I don’t make it a habit to share what I do in private. Talking with girl friends about periods, child-birth, and boobs is no big deal. But, infertility doesn’t naturally or comfortably fall into that “normal” girl talk.

Our culture is inundated with sexuality, but the idealized kind filled with Victoria’s Secret Angels, Tatum Channing physiques, and Ryan Gosling charm (okay, and physique!) Infertility is poor performing sexuality. Who wants to talk about that? Not men, and not most women. No, men hate bringing up (sorry for my choice of words here) their struggles with erectile dysfunction. Most aren’t even able to verbalize their complaint. Instead, they just point at their crotch and stutter, “I can’t, umm,” followed by a fill in the blank. And, in the past 15 years I have only had one woman come to me concerned over her lack of orgasmic ability.Lovers

Thus, infertility falls into the hush, hush sensitive topic category. It is sensitive, but the shame and stigma associated with it prevent women and men struggling with infertility from getting the resources and support that they need. Breast cancer used to have a similar stigma associated with it. Women should not openly talk about their breasts! How improper! Yes, it was cancer, but the “unmentionable” kind. Thankfully, the shame that used to accompany the diagnosis of breast cancer has been diminished due to proactive campaigns encouraging and empowering us to embrace our womanhood, “feel our boobies,” and kick cancer in the butt. This change in culture has led to life saving advancements in breast cancer research and treatments.

Can a similar cultural revolution transform how infertility is viewed? Yes, but only if people are willing to step outside of their comfort zones. If thirty year olds still refer to their genitalia as their “junk,” how are we going to have a real conversation about infertility. Using real words and talking about real life problems is a good starting place. Acknowledging that the human body often fails us, and that infertility is one of these physical and biologic failures that is out of our control, lessens the stigma, even if slightly. Normalizing the idea that infertility is incredibly common may also empower men and women to open up more readily about their struggle toward parenthood. The more that people talk about this culturally uncomfortable issue, the less uncomfortable it will become.Group of multiethnic babies crawling isolated on white backgroun

Reducing the stigma of infertility will positively and powerfully impact the infertility world. Infertile couples will have a larger support system if more people are willing to share their stories. This in turn will lead to increased social networks and social capital. With increased unity focused on the cause of infertility, more money will be raised for research, leading to improved infertility treatment options. Awareness campaigns may lead to political activism, forcing insurance companies to take infertility seriously and cover necessary treatments. Imagine a world where people have increased fertility because of improved infertility treatments and insurance coverage! If population control is your thing, then this may not excite you. But, for those of us hoping to add to the human race, this thought is utopia!

From The Mom in Me, MD

 

Our Infertility Journey (1.10): The “Gunner” in Me…and My Ovaries

I expected things to feel differently. I knew that my ovaries would be working overtime with all of the hormones, so I brushed off the full feeling in my pelvis as “normal.” But as soon as my feet hit the floor on the second week of my IVF cycle I knew something wasn’t quite right. I jumped up and down a little bit beside the bed just to confirm my discomfort. Taking my dog, Bentley, for a short walk around the block confirmed my fears. Every step felt like a jab into my lower abdomen. I could feel each footstep as though it was kicking me in the belly. I had peritoneal signs.Young woman stroking her belly becouse of bellyache

Most people wouldn’t be familiar with this term, but I had routinely ruled this symptom in and out in belly pain patients presenting to my office and the emergency room. Peritoneal signs meant that I now had free-floating fluid sloshing around in my abdomen and pelvis. In my case, this fluid was coming from my ovaries. I was hyperstimualting! This may not sound like a big deal…but it can be. Not only does ovarian hyperstimulation cause discomfort, it can be very dangerous. Ovaries can get so large that they twist on themselves, cutting off their blood supply and ultimately dying if not surgically corrected quickly enough. Body fluids can spill into the abdominal cavity and fluid can pour into the lungs compromising breathing and even leading to electrolyte disturbances (potassium and salt imbalances). If severe enough, ovarian hyperstimulation syndrome can lead to kidney failure, blood clots, and even death.

My risks were low. I wasn’t too old. I wasn’t too young. I wasn’t too skinny, and I wasn’t to heavy. I didn’t have polycystic ovary syndrome. I was a model patient for IVF. This couldn’t be happening! But, it was. My estrodiol levels were off the charts and climbing! Just stopping the medications wouldn’t necessarily stop the hyperstimulation right away. These medications would continue to work for hours and even days before they would no longer have an effect on my ovaries. Moving forward with the IVF cycle would only make things worse and compromise my health and safety. It was over. The only option now was to cancel the cycle and wait for my ovaries to calm down. Wait…Wait…Wait…Woman Suffering From Stomachache On Sofa

What now? That was my big question. Over a week of shots, thousands of dollars spent, and nothing to show for it except for a medical complication….what now? I needed a plan. I needed an answer. I needed to know that we could move forward. If IVF wasn’t an option, then what was?

Although my infertility specialist had used tiny doses of the stimulating medication on me since I was considered fertile (funny for someone undergoing infertility treatments!), my body’s response to the small doses was like a rocket launching for the moon. The next time around I was told that we would simply use even smaller doses of the medications. I was ready. “Sign me up. When can we get started?” Those were my most pressing questions. In medicine, this mentality is referred to as a “gunner”-someone who is dug into the trenches ready to give it their all no matter the cost. I was an infertility gunner.Close Up Of Woman Inject Drugs To Prepare For Treatment

I had been gunning for things for years-medical school, residency, Hopkins admission-this wasn’t any different…other than that it matter so much more. Motherhood mattered more to me than any degree or job ever could. I longed for a baby more than I had longed for anything. As soon as my ovaries calmed down, I gladly grabbed my injections ready to get started again. IVF was my ticket to motherhood, and I was going to make it work. I had to…what other option did I have? Guns blazing was going to be my style. I warned Angelina Jolie to watch out; I was about to steal her role for Mr. and Mrs. Smith II. The baby making scenes weren’t going to be quite as sexy…but we WERE going to make a baby!

From The Mom in Me, MDShot of a sexy military woman posing with guns.

 

 

When breastfeeding doesn’t go your way…

Seeing other moms discretely breastfeed their babies while sipping lattes, answering text messages, and having in-depth conversations with their friends left me wondering what I was doing wrong. Why couldn’t I make breast-feeding look this easy? I wanted to sit at Starbucks perfectly covered by a pretty, Petunia Pickle Bottom nursing cover! Instead, I was still working on getting my baby to latch correctly without biting off my boob in the process. Would it ever get easier?SCARSDALE, NY - SEPTEMBER 15, 2013: A tall Starbucks coffee in f

I know that you are all expecting me to say, “Yes, my daughter became a model breastfeeder! I was sipping my own lattes at Starbucks in no time.” But, the reality of the situation was that breastfeeding was always a challenge for me. My daughter eventually figured out how to latch correctly, but then she decided to start biting me! YES, BITING! After we had a pretty heated chat about how naughty it was to bite mommy, she then decided that home was the only place she liked to nurse. Each month it seemed like a new breastfeeding challenge arose. Each month, we muddled our way through.Mother breast feeding her baby with closed eyes

I was determined to breastfeed for at least a year. And, although I loved the bonding that breastfeeding brought, I couldn’t help counting down the days until her first birthday. Because she was a preemie, I still had to pump in order to give her fortified bottles with breast milk. The extra step of pumping several times a day in addition to nursing left me feeling akin to a dairy cow. I was exhausted, moody, and sometimes downright irritable.Cute Baby At Hands Of The Mother In An Embrace, Monochrome

Would I do it all over again? Absolutely! Reminiscing about my love-hate relationship with breastfeeding reminds me that most things worth doing are challenging. Although breastfeeding doesn’t always get easier for some of us, neither does motherhood! Poopy diapers, skinned knees, toddler melt-downs, teenage rebellion…as moms, we are in it for the tough stuff. Although I love the beautiful moments that motherhood brings such as cuddle time, kisses on my nose, and a little hand to hold; I’m also grateful for the challenges. These remind me of what I’m made of…or at least what I’m becoming…someone a little less selfish, a little more genuine, and a lot more determined to be the best at my biggest title…MOMMY!

From The Mom in Me, MD

 

 

Our Infertility Journey (1.7): Signing on the Dotted IVF Line

The day had come. I walked into the hospital alone, irritated that my husband wasn’t going to make it on time for one of the most important meetings of our life. As the elevator dinged and the doors parted, I took a deep breath, squared my shoulders, and stepped off what seemed like a 1000 foot drop with no end in sight. Instead, I found myself standing at the infertility check in window. The desk was situated in a general medical hallway outside of the actual waiting room, which was enclosed by a wall of glass. It felt more like I was standing in line for a movie ticket than for a doctor’s appointment. Actually, it felt more like I was standing in line for an X-rated movie ticket. I felt the eyes of each person that passed. They knew why I was there, why I was in that line. They knew my dirty secret! They didn’t even need a billboard that said, “INFERTILE…STAND HERE!” No, it was written all over my face.

I had hoped to hide in the waiting room, out of sight from the familiar faces of coworkers. But, the location of the check in desk…in the hallway…was far from an ideal hiding spot. I assume that HIPAA requirements were being met, but standing in an open hallway right next to the elevators and the surgery and obstetrics residency work rooms felt like an invasion of my privacy. My shoulders (which I had just squared) were now hunched, and my chin was tucked to my chest. Maybe no one would notice me? I willed myself to disappear, to become invisible for just a few moments. If only I could make it into the waiting room without being seen. There I could at least vanish into the crowd of other women.Young sad woman alone in a black stone beach.

As I stepped into the waiting room, I was met by a startling number of pregnant bellies. Was I in the right place? To my dismay I discovered that this waiting room serviced both the prenatal clinic as well as the infertility clinic. So, those of us in the unfortunate infertile group now had the privilege of surrounding ourselves with very pregnant women. Was their fertility supposed to rub off on us somehow? Were we supposed to be encouraged by their success? Or, was this some kind of cruel joke…a rude reminder of our empty bellies?

I scanned the room for an open seat and found one in the corner next to the vending machine. This was the perfect seat! It didn’t completely shield me from the eyes of passersby in the hallway, but it did make it much harder for them to get a good look at my face…especially if I had it buried in a magazine or glued on my I-phone. I reached for a magazine to pass the time, distract myself from the pregnant bellies, and to simply make myself appear occupied. Fit Pregnancy and Parenting were all that littered the tables and chairs. Clearly, the magazines were for the benefit of the pregnant clientele. To an already sensitized women this felt like a slap in the face. I made a mental note to bring my own reading materials in the future.

Side view of expectant woman consulting female doctor in clinic

As I sat in the fish bowl I continued to pray and hope that I wouldn’t been seen by anyone I knew. Although keeping my head down made me feel better, curiosity overcame my shame. I scanned the room trying to decipher who was infertile. Who was like me? Who was jealous of the women with huge bellies and uncomfortable waddles? It was somewhat easy to tell. All of the women struggling with infertility brought something to read or to do. They kept to themselves and in general kept their heads down.Three patients sitting in doctor's waiting room

Children played at the little table and chairs situated just for them at the front of the room. Seeing mothers pregnant for the second and third time reinforced my grief and longing. I just wanted one baby. I wanted to be a mother. I wanted to love a being that was made from me.

As I sat alone, with an empty uterus, I felt even more hollow. I had been staring at my i-phone for at least 30 minutes now, pretending to be concentrating on something very interesting. Instead, my mind had been wandering, well not exactly wandering, it had been fixated on my childless state. I was starting to feel slightly angry. Who in their right mind would combine a prenatal and an infertility waiting room? I was primed to give patient feedback on that scenario!Hospital Corridor With Chairsdating and relationships concept - stressed woman with man outsi

The sound of my name lurched me out of my self-focused thoughts. It was my turn to find out my fate. I looked around hoping that I would see Dave walking through the door, but I was only met by an unfamiliar face asking my date of birth and the confirmation of my last name. We walked a short distance down a sterile hallway into a rather large office. An enormous desk barely filled the massive space. A table with three chairs was situated toward the back of the room. The room was not as sterile as the hallway, but it did lack a sense of comfort and light. The walls were void of windows, making the space feel slightly claustrophobic even though it was so large.

I was greeted by the head of the infertility department. He was nice but very matter of fact. All of this was new to me but very repetitious for him. I was the next patient on his schedule, the next one to get through. I wasn’t very interesting. My story was the same as a zillion other patients. I was just another infertile patient signing up to do whatever it took to make a baby.

Being by myself without my partner wasn’t necessarily uncomfortable; It was just annoying. What was more important right now than our fertility? In my mind, nothing. But, being married to a physician means that their patients come first. Dave was probably stuck in the operating room saving the life of another patient. But, I wasn’t just another patient. I was his wife. I was his life. Medicine needed to back off. I needed him. I needed him to be on time. I simply needed his presence.

As a resident you have no control over your schedule. You are a slave to the system. You are a slave to the attending. You are necessary, yet devalued. I understood all of this. Several months before I had been a resident. I didn’t blame Dave. I blamed medicine. It had already taken so much from me. It had stolen my most fertile years. It had stressed my body with a lack of sleep, nutrition, and balance. It had strained my emotions. It had taken my husband from me on countless nights. I blamed medicine, and I hated medicine; but, in the same moment, I desperately turned to medicine to fix me.

The paper work was spread before me. Spread sheets breaking down the medication regimens, the pricing, the timing, the wavers, and the risks of trying to get pregnant. A knock on the door stopped the buzzing in my ears and forced me to look up from what would soon be my new role- infertility patient. Dave smiled a quick apology my way while exchanging pleasantries with the attending. He sat down, and I quickly tried to catch him up on what we had already discussed.

love, family, phychology and relationship problems concept - youHe was eager. He was a little too enthusiastic and a little too optimistic. My goodness, he was the infertile one, yet I was the one undergoing infertility treatments. This was a little more than unfair in my book. Yes, he had a minor surgery, but that was once and done. Who knew how long this process would take! I could only handle cautious optimism right now.

After discussing the IVF agenda, the attending opened up the conversation for questions. I had a multitude of questions. I had been educating myself on IVF and ICSI (intracytoplasmic sperm insemination). I wanted to know our options, our odds, and our risks. I wanted the minute details. I was encouraged by our odds. I was relatively young. I was healthy. I wasn’t overweight. I wasn’t too skinny. I had normal cycles. Dave’s sperm were beautiful even if few. We could make a baby!

One of the most significant risks with IVF is ovarian hyperstimulation. This is when the medications cause the ovaries to create too many follicles that house the eggs. The ovaries get very large and they spill fluid into the belly. Because the ovaries get so large, they can sometimes twist on themselves cutting off the blood supply and killing the ovaries. This is a rare complication, but ovarian hyperstimulation can land you in the hospital and even in the operating room. I knew the risk was low in general, but I just wanted to make sure that my risk was low. The infertility specialist reassured me that I did not have any of the conditions or features that would predispose me to hyperstimulation. Although there was always a potential for this and many other complications…my risk was low.Home Finances

We were ready to get started. We signed on the dotted line and handed over every penny we could jiggle out of our bank account. I was determined. I didn’t care how many cycles we had to do, I was going to get pregnant! I was in this for the long haul. I was pretty sure that based on our situation we would get pregnant with the first IVF cycle. Why wouldn’t we? Now all that we had to do was wait for my period to start.

From The Mom in Me, MD

Our Infertility Journey (1.4): Show Me The Money!

IVF…IVF…IVF…I slept, ate, drank, and breathed the same thought over and over again…IVF. Wasn’t there another way to get pregnant? An easier way? A less expensive way? As soon as our reproductive endocrinologist uttered the words intrauterine insemination (IUI), I was ecstatic! But, before I was even able to share my enthusiasm, she shot down my hopes with the number 10. Crying woman

10-15% success rate for us with IUI? My heart sank once more. I didn’t want to waste anymore time, and we couldn’t afford to waste any money. Since we would be paying out-of-pocket for everything that insurance didn’t cover (which our doctor informed us would be most things) she advised us to think through our options carefully. IUI was more than a long shot, and at $1,500 a cycle, it sounded like money down the drain. But, one cycle of IVF (in vitro fertilization) would cost us around $15,000! Talk about sticker shock! I almost fell off of my seat! With my husband still in residency and my student loans coming due, how would we be able to afford that? Was it worth trying intrauterine insemination at what now sounded like such an affordable cost? But, what if it didn’t work and we still had to go onto IVF? Again, my mind was racing.

Dave and I needed to make a decision quickly because my work up would depend upon which intervention we chose; if IVF, then they would need to make sure that my uterus looked good. If we wanted to do IUI, then we would need to check the ovaries and fallopian tubes as well. IVF skips the egg release into the fallopian tubes, so a simple camera into the uterus (hysteroscopy) in the office could be done instead of an additional test with dye through the fallopian tubes (hysterosalpingogram). Our reproductive endocrinologist told us that we could think about it for a few days and then give her a call to schedule.

The same day that we found out that IVF was our only real option for having children, I was scheduled to leave for Michigan to volunteer with my sister’s non-profit which runs performing arts camps for disadvantaged children in inner-city Detroit. On top of being devastated by our situation, I had not shared our struggle with infertility with anyone yet, including my family. It was too personal. Somehow, it felt embarrassing. I felt inadequate and like we were broken.

In the midst of being unable to have a baby, it seemed that everyone increased the frequency with which they asked when or if we wanted a baby. My polite answer was always the same, “Yes, we would love to have a baby, but we will just have to see. Dave is still in residency, and I am working on my Masters in Public Health while practicing medicine at the same time. We are just so busy. We want to make sure that we are able to give a baby all of the attention it needs.” Our story, which had once been true, now felt like such a lie…a line just to get us by.Happy Family On The Beach. Mother And Baby Daughter

Patients loved asking me if I had children while I examined their own children. It was always an innocent question. My answer was, “Not yet!” with a smile. Their response was always, “Oh, really, but you are so good with kids! You should really have a baby.” My mental response… “No kidding!” while I politely smiled and tried to change the subject.Beautiful Mother And Baby outdoors. Nature. Beauty Mum and her C

My mother in law would jokingly ask when we were going to give her a grand baby. Since Dave was an only child, we were her only hope for grandchildren. Somehow her question made me want to point the finger at her son and say, “It isn’t me. Ask your son why we can’t get pregnant.” That sounds horrible to say. It sounds like I am the mean wife blaming her husband, but in the midst of pain and grief comes some anger.

In addition to everyone asking when we were going to get pregnant, everyone around us was getting pregnant…at the drop of a hat. Stories such as, “Well, I had just stopped the pill for half a day” or, “We weren’t even trying”or, “It is such bad timing but…” Although I was happy for everyone about to add to the human race, their fertility only cemented my devastation. I won’t lie; The painful reminder of our silent infertility did create moments of jealousy.

Now, back to my Michigan trip. In addition to the pain of working with little children (as a constant reminder that I may not be able to have my own), I had the added pleasure of starting my menstrual cycle. Yes, just to confirm once again my inability to conceive. My family noticed that I was not my usual self, but I tried to put on a brave face and just said that I was working some things through. All I wanted to do was to go home so that Dave and I could decide on our next step. I didn’t want to be away from him at a time like this. I wanted to make a decision and move forward.

When I finally got home from Michigan, I spent more time than I should have looking at medical sites on infertility. I looked at our chances of success based on the statistical breakdown of causes leading to infertility. I was consumed. After lengthy discussions over just a few days, Dave and I decided to proceed with IVF. We poured over our bank accounts and tried to figure out where the money would come from.Young woman shows her empty pockets, isolated on white

The Infertility clinic had advised me to call our medical insurance to find out about coverage. The conversation with the insurance company still makes me fume. The woman on the other end of the phone felt that she needed to educate me on the definition of infertility. She informed me (with her vast amount of medical knowledge) that infertility was not actually a medical problem. Therefore, treatment was not covered by insurance. NOT A MEDICAL PROBLEM! I calmly asked her if it was not a medical problem then what type of problem was it. She conceded that infertility was a medical problem, but that treatment was not medically necessary. “Not necessary for whom?” I asked, because according to my reproductive endocrinologist it was necessary for me!Money in syringe

I guess her point, which she eventually got to was that having children was not medically necessary. Hmm, interesting. I could have insurance cover procedures to tell me that I couldn’t have children, but I couldn’t get them to help me get pregnant. It seems that preventing pregnancy is medically necessary since birth control is covered, but on the flip side, helping someone get pregnant is not necessary. This is a little counterintuitive. If a woman should be able to manage her own reproductive health and sexuality…shouldn’t she be able to get the assistance she needs to have a baby? From my perspective, comprehensive women’s health care should include enhancing fertility not just limiting it. Regardless, our conversation did not change the system or my access to infertility care. Instead, I was tersely informed that I would be a self-pay patient.

From The Mom in Me, MD

 

Our Infertility Journey (1.3): My turn to be the patient!

Young beautiful woman with depressionI stared at the computer screen, overwhelmed, dazed, and mad that we had wasted time trying to fix something that was a long shot. I regretted waiting to meet with the Reproductive Endocrinologist. That should have been our first stop instead of our last-ditch effort. Paging through countless infertility clinic profiles online was getting me nowhere. I needed to make an appointment somewhere…and I needed to do it NOW. I wanted to be a mother more than anything! I didn’t have any time to waste. Each second-hand strike on the clock was another moment counting against me, my ovaries, and my sanity.

I picked up the phone and made the call. I was sitting in the middle of the hospital cafeteria, surrounded by coworkers and strangers. It was the only place that I could get good reception and the only time that I had during the day while the infertility office was open. Not ideal! I’m already known to speak softly, and since I didn’t want to announce to everyone eating lunch that I needed an infertility appointment, my voice (which I thought was booming) was probably a faint whisper. The secretary on the line couldn’t hear a word of what I was saying. I felt my face turn ten shades of red as I turned up my volume. “I need an infertility appointment…I can’t get pregnant! Sex doesn’t work!” Had I really just screamed that at the top of my lungs? I quickly looked around, expecting to see shocked stares. Instead…nothing. No one even met my glance. My secret was safe, but strangely that only made me feel more isolated.Young sad woman alone in a black stone beach.

Hearing the woman’s voice on the other end of the phone jolted me back to reality. Three months? That was the next available appointment? Four months to get in with the doctor I preferred? The secretary reassured me that if a cancellation came up they would let me know. “Right,” I said to myself… like I would be top of the call list. I knew how these things worked. The only call I would be getting would be to reschedule to a later date…and I was right!

Four and a half months later,  my infertility appointment finally arrived. I was nervous but excited to finally get some answers and come up with a “get pregnant” plan. Choosing which infertility specialist to see had been challenging. Word of mouth was how I finally decided on my physician. Knowing OB/GYN residents who had worked with the doctors in the reproductive endocrinology practice was the most helpful. They were able to give me the inside scoop on personality, bedside manner, procedure skill level, and expertise. I had chosen a female physician who came highly recommended. I was told that she was “to the point,” but she was great at what she did. I needed great. I wanted amazing bedside manner too, but if I had to choose between success at getting pregnant and feeling cozy without getting pregnant… I was 100% for success.

Choosing a female physician wasn’t coincidental. As a female physician, I tell my male patients who are uncomfortable with a woman examining them that since I see so many body parts all day long, nothing shocks or embarrasses me. Penis, vagina, testicles, breasts…it’s all part of the job. However, as a patient, I wanted a female physician. Somehow, I felt like it would be just a little less uncomfortable discussing my most intimate concerns with another woman.Honeymoon couple romantic in love at beach sunset. Newlywed happ

Although Dave was able to make it to our first appointment, I still felt slightly alone and uncomfortable. Anytime you are discussing infertility it just gets touchy. Trading in my white coat for a patient gown wasn’t my idea of fun either. At that point in my life, I wasn’t much of a crier. Yes, at home, I could have as good of a melt down as anyone, but never in public. I recounted our story feeling hopeful that the Reproductive Endocrinologist would simply say, “No, problem. We will get you pregnant in no time.” I knew that she would want to rule out any female factor contributing to our inability to get pregnant, but I was “pretty” sure nothing was wrong with me. My cycles were like clock work. I never missed. Deep down, I was hoping that there was nothing wrong with me. I am not sure why it made it easier, but it did make it just a little easier to know that I wasn’t the reason we were infertile. I wasn’t mad at Dave. It wasn’t his fault. But, somehow, it made me feel better to know that it really wasn’t my fault. Looking back, it is strange to think that it would make a difference; but, when you can’t get pregnant you get this feeling of shame…this ultimate sense of barrenness. It is hard to describe other than as a feeling of insufficiency and brokenness. Being able to say out loud or even say to yourself that,  “Nothing is wrong with me,” somehow makes being pregnantless a little less painful.

Our Reproductive Endocrinologist confirmed my thoughts on our next step. I would need a full work up, and Dave would need additional testing to see if there was any other reason for his low sperm count other than the varicocele. While sitting in the exam room, I noticed a fancy ultrasound sitting by the bedside. The vaginal probe was covered in blue medical gel and then carefully covered over with a condom. Very appealing indeed! Even more appealing, when she informed me that the probe and I would be making a very intimate acquaintance in a few moments. I was asked to undress from the waist down for the ultrasound. Feeling more than half-naked in my gown, socks and that paper-thin sheet, I dreaded what was to come next. It is funny how uncomfortable I initially felt about the ultrasound probe. 20-30 condom covered ultrasound probes down the road, vaginal ultrasounds felt as routine as brushing my teeth…okay, maybe not that normal!

With the ultrasound done, I was told to get dressed so that we could discuss results and options. If you don’t already know this, the one wipe and tiny tissue box the nurse leaves you to clean up the blue gel is pathetically insufficient. I actually discovered one reason to love the paper-thin sheet…extra large towelette! To my relief, I was told that the ultrasound looked great. Finally, some good news! I’m a bad news first kind of girl, so what came next threw me completely off guard.Worried woman looking at a pregnancy test in the bathroom.

I was expecting that we would start with intrauterine insemination. Dave would give a “sample.”  I would poke myself with a few shots…they would squirt the sample into me…we would get pregnant. To my dismay, this idea was quickly shot down. Because of Dave’s low counts the physician matter-of-factly told us that our best and only option was to go straight to IVF (in vitro fertilization), and not just IVF, but a more specialized type called ICSI (intra cytoplasmic sperm insemination).

As I mentioned, I am not a crier. Medicine teaches you to develop a thick skin. You can’t treat patients effectively if you cry with all of them. It teaches you to desensitize while at the same time to show sensitivity. Remove yourself one step away or you will become consumed and lose rationality and perspective. It teaches you these things, but when your heart is broken all in one moment for yourself, it is hard to keep from crying. I started swallowing so many tears that my nose began to run. All I could think of was IVF! Somehow, that felt like a punishment, a worst case scenario. IVF was a last resort, not the first step.

From The Mom in Me, MD

 

Rub a Dub Dub Ayla’s Playtime in the Tub: bath time must haves and safety tips

Ayla LOVES bath time. Who wouldn’t with a bath full of fun toys? Time to share our favorite bath time picks from toys, to soap, and towels! Let’s get splishin’ and splashin’! What to Sit In? When looking at baby … Continue reading