When Infertility Updates Go Sterile

Sometimes it’s just too hard. Too hard to swallow. Too hard to breathe. To hard to share. Thus, my recent silence.DSC_2682

After our primary infertility struggles and IVF success catapulted me into the crazy, hectic, wonderful life that motherhood brings; I became an open book about our infertility journey. I hadn’t had the emotional support that I desperately needed while going through round after round of complicated infertility treatments. To be honest, even an army of supporters probably wouldn’t have been enough. With infertility…the best intention, the nicest phone call or text, the sweetest gift, the most compassionate comment…somehow it’s still never quite enough. The pain, the chronic patient role, the longing, the sorrow-it all outweighs the support. (for those showing support…please don’t stop! I’m just ranting.) I wanted to be real for other women struggling with similar issues. I wanted to break down the stigma that infertility builds and then reinforces with steel beams. Woman hiker on a top of a mountain

But, then I became an infertility patient once again. Optimistic…determined…nervous…and hopeful. At first sharing felt second nature. Our first frozen IVF success turned miscarriage made it a little harder. Repeated disappointments have continued to zap my desire to share. Instead, I’ve found myself withdrawing from the spotlight. In a way hiding. Clinging to privacy once again, as though it is a better comforter or coping mechanism to deal with my grief. My hope is still real, but the painful question of “Will it ever work?” plagues me each day. Blame it on the hormones. I do. But, my heart knows that my silence has simply been a way to quell my grief. Writing is acknowledging. Putting things into words makes them real…acute…like pouring salt into a wound. I like to think that I’m strong, but a girl can only take so much.

So, please forgive my silence. I don’t mind your curiosity. I love your support. But, to answer your question…No, we are not pregnant. Our most recent IVF cycle was more than promising. With 9 embryos to show for my efforts (yes, “MY.” I’m taking all of the credit. My husband would agree.) and the best cycle of stimulation yet, I was certain that it would work this time. So certain, that when we received the call 1 hour before our embryo transfer that none had survived to day 5, I went into something of a tailspin. NONE?? A statistical anomaly? A lab error? We made good embryos consistently. Only 10-15% not 100% should have arrested in development. WHAT? WHY? HOW?

The answer: ????????? Laboratory Fertilization Of Eggs In IVF Treatment

I hate the unknown. I hate the uncertain. As a physician, I want answers…reasons…solutions. I want to fix. I want to heal. I want to have a baby!!!! Instead, I’m starting from scratch once again, this time with a new doctor. Joy of joys. The idea of entering a third infertility establishment as a new patient just makes me feel warm and fuzzy all over again. Here goes!

Thanks for listening. Thanks for reading. Since silence hasn’t done the trick, I’ve decided to clink on the keys a little more going forward. My prayer is that for those struggling you will know that you aren’t alone. I’m here in the trenches with you. My prayer for myself is that even in the darkness I will not lose sight of the light…no matter how small it’s glimmer. I will hold onto hope, not blindly, but with the understanding that even if things don’t work the way that I long, there is still a greater plan. God may not answer my prayers the way that I want, but my story may just be the game changer to impact someone else. And, that uncertainty makes me smile. family, charity, healthcare, health. christmas, x-mas and happy

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What to Expect when Trying to Expect…IVF update from our April Embryo Transfer…

I had been crossing everything before our embryo transfer…fingers, toes, eyes…just about everything except for my legs. These were the last of our frozen embryos. If just one of them stuck we could wave our infertility treatment days goodbye. Only three were remaining, and while the quality wasn’t perfect, they were still little forces to be reckoned with.

I started my progesterone shots (YIKES THOSE ARE BIG NEEDLES), lupron shots, my estrogen patch, my estrogen pills and my routine blood work and ultrasounds. This had just worked several months before. Well…sort of worked. A 5 week pregnancy ending in miscarriage still counts as some sort of progress. It could work again. I had been praying for a miracle. Statistical success rates, odds, likelihood, all inconsequential in the presence of a divine intervention.Happy Family On The Beach. Baby Girl Hugging Her Mother

My typical outlook for infertility treatments has always been cautious optimism. I prepare myself for the worst because it’s so much easier to deal with the disappointment when things don’t work out. Why I decided to change my perspective this last time I’m not sure. For some reason the idea of a changed coping mechanism sounded refreshing. It would work. It was going to work. In spite of the odds it was going to happen. I was going to get pregnant and carry that pregnancy until I had a full-term healthy baby. I was going to have a story of triumph in spite of the odds. This was a simple miracle for God. What reason would he have for denying my request?

The embryo transfer went perfectly. Of the three remaining embryos, two survived the defrosting process. And, of those two, one looked incredibly promising. The catheter slid into place easily and within moments two precious little lifeforms were floating around inside of my uterus. Now came the waiting game. I was hopeful. I was actually incredibly excited. I even felt pregnant. I was tired, moody, hungry and sure that it had worked. I wasn’t cramping, and I wasn’t spotting.

And…I also wasn’t pregnant. Two home pregnancy tests and then a blood draw B-hcg level of less than 1 confirmed that my miracle had not happened. Disappointment has been followed by a firm resolve that there is a reason for everything. I don’t understand it, but instead of letting grief swallow me up (for more than a few weeks), I’m looking forward with hope once again. Since all of our frozen embryos are gone we must start from scratch with a fresh IVF cycle. This journey is far from easy, painless, or inexpensive; but, my desire for another child trumps the obstacles and challenges before me. I refuse to let infertility define me; but I am allowing it to shape me into a stronger woman, full of faith, hope, and love. This may sound trite or contrived, but trust me, this refining process has been neither trite nor contrived.

The struggle with infertility can be all-consuming. It can be and is devastating. I’m not going to sugar coat a horrible diagnosis. However, I can’t let it ruin the beautiful things that I do have in life. Infertility wins if I let it have that hold on me. I refuse to let it win. I am stronger because of it. I am a better mother because of it. I have a deeper respect for other’s pain and suffering because of it. I am learning to let go of the things that are beyond my control because of it. I am trying to make beauty from ashes. Some days I succeed…and for now that’s all I can EXPECT while I’m waiting to EXPECT!

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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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Miscarriage in the Making?

I’m not sure which is worse…having an altogether failed IVF cycle or having the false hope of a positive pregnancy test followed by a miscarriage. Three years ago I just wanted to get pregnant. I wanted to know that it could happen, but now that I have a rambunctious two year-old, I just want another baby. I know I can get pregnant. I don’t care about pregnancy success; I want “baby in my arms” success!Mother breastfeeding the little baby

Christmas Eve day when I received the glorious and shocking news that our frozen IVF cycle had actually worked, I was over the moon! A little spotting had thrown me off, convincing me that I couldn’t be pregnant, but when our b-hcg numbers were rising nicely I allowed myself the luxury of optimism. Not cautious optimism…good old-fashioned optimism. I was pregnant! We had never had a miscarriage before so why would we now? We wouldn’t have to dish out thousands of dollars for another IVF cycle! We wouldn’t have to coordinate road-trips out to our infertility specialist. We were going to have another baby! Would it be a boy or a girl? What color would I paint the nursery? We needed a name! I even started budgeting for a new crib, clothes, and bedding. I promised myself I wouldn’t go overboard like we had with my daughter.

And, then it happened. The spotting started again and this time it didn’t stop. My b-hcg levels were continuing to rise, but they were now in the low normal range. When my spotting turned into full-blown bleeding I began to panic. The news that had made my Christmas perfect was now making my New Years a nightmare. I was standing in the parking lot at The Magic Kingdom when a phone call from my infertility specialist confirmed my worst fear that my latest blood work was not trending appropriately, and all at once the magic began to fade. Nothing definitive could be said except that I might be having a miscarriage, or I could have an ectopic pregnancy. I still don’t know that answer. I’ve been waiting…waiting to finally pull in my drive way after a two-day road trip home from Florida, waiting to get repeat blood work, waiting to have my ultrasound, and waiting to meet with my OB/GYN. I won’t know anything certain until tomorrow, but I’m pretty certain already that this pregnancy is a miscarriage in the making.Beautiful young woman in bed, with hot water bag on her tummy

It feels like such a waste! Such a let down! Such a cruel trick! Over 60 intramuscular progesterone shots (quite a few of which I have given to myself), countless subq lupron shots, surgery, and an embryo transfer all for what? It would have been so much easier to not get my hopes up only to be devastated. But, for now, I continue to stab myself with 1 1/2 inch needles twice daily just in case this baby decides to stick around. Please stay…pretty please! This mama would love you silly!

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When You Lose What’s Most Precious…the baby that should be in your arms

It is all more painful than words can express. And, yet, I write. I write in REMEMBERANCE of pregnancy loss, infant loss, and infertility-the lost hope of ever becoming a mother for the first time, or the shattering disappointment of losing what would have been a precious and treasured addition to your family.Concept Of Love And Family. Hands Of Mother And Baby

I first felt the twinge of longing for a baby when I was still just a baby myself. For many women, the desire for motherhood starts as early as our toddler years. Even now I am reminded of this innate longing as I watch my two-year old daughter feed, change, and rock her baby dolls. It is all so natural, and yet for many of us, getting pregnant, staying pregnant, or carrying a baby to full term delivery are far from natural.  Even many of the seemingly “fertile” moms among us have been touched by the devastation of miscarriage and stillbirth-countless times over. In my own neighborhood moms have been touched by stillbirths, miscarriages, infertility, and premature delivery. According to statistics from the CDC, the history of your street is probably similar to mine with 1,003,000 pregnancies ending in either stillbirth or miscarriage and 27,500 infants not making it to their first birthday each year in the United States.Melancholy And Sad Young  Woman  At The Window In The Rain

And, while the WHYS and WHAT TO DO’s are incredibly important, taking the time to reflect, remember, and grieve is also important. As I head back into infertility treatments, I am blessed to say that my diagnosis has changed from primary infertility to secondary! After years of trying to conceive naturally, and 5 cycles of complicated IVF with numerous failed embryo transfers, I am blessed to be called “mama” by the sweetest little girl in the world. And, while already being a mother has changed my infertility outlook, secondary infertility is still painful and challenging. My frozen embryo transfer is only several weeks away, but instead of excitement, I am reminded of the grief that comes with each failed cycle. The catch phrase in the infertility and pregnancy complication world is always “cautious optimism.” Oh, how I would love to replace that phrase with ECSTATIC ENTHUSIASM for something that is guaranteed to work!Love and new life concept. A woman's hands forming a heart symbo

Even though my previous embryos were tiny clusters of 8 cells, they were still my “babies.” With each transfer I saw a glimmer of hope. I had new life inside of me. That life would grow into an amazing person! But, when nausea turned into spotting and cramping time and time again, the devastation and disappointment was almost too much to bear. I’m not sure how to prepare myself this time for the possibility of a failed transfer, the cruel tease of a miscarriage (where hope is given and then snatched), or my overwhelming fear of once again delivering a preterm baby who this time may not survive.Divided couple are separated by white wall but holding hands

I should be a pro at coping with infertility and preterm delivery grief and loss, but this time around I’ve decided to FEEL rather than just cope. Life is made to be felt. The beautiful things are made to be seen, the horrific to be despised, and the devastating to be endured with strength. I refuse to become cold to my pain. Instead, I will remember my losses with a heavy heart but look to my blessings with overwhelming gratitude. I have found an inner strength, stronger than anything I could muster alone, fostered by friends, strangers, my faith, and a desire to inspire others enduring similar journeys.

Join me by raising awareness, giving a voice to loss, and sharing your story. Encourage others to donate to cutting edge research that could establish healthy pregnancies, prevent miscarriages and preterm deliveries, and save the lives of preemies. I recently decided to partner with March of Dimes as a local Ambassador. Check out their website for more details, for resources on dealing with grief, and for ways that you can get involved. For additional resources on pregnancy loss, miscarriage, still birth, and infertility, take a look at these amazing sites. If your grief has turned into lasting depression it may be time to seek professional help.

The American Pregnancy Association

Resolve: The National Infertility Association

The Mayo Clinic on Pregnancy Loss

In the spirit of remembrance, click HERE to enter to win a memorial bracelet or necklace of your choosing from Fertile Gems. Crystal, the designer and Etsy shop owner has graciously offered to give away a piece of her Always & Forever jewelry line to a mom who has suffered loss. This small token may take you one step closer to healing along your journey.

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Fertility Gems’ Always and Forever Memorial Jewelry #Giveaway from The Mom in Me, MD

In the spirit of pregnancy loss remembrance, click here a Rafflecopter giveaway to win a memorial bracelet or necklace of your choosing from Fertile Gems. Crystal, the designer and Etsy shop owner has graciously offered to give away a favorite piece (completely free of charge) from her Always & Forever jewelry line to a mom who has suffered loss from miscarriage, pregnancy or infant loss, or stillbirth.

In addition to entering the Giveaway, head to the Fertile Gems shop and to her Facebook page to look through the selection of memorial jewelry you could choose from. Each piece is adorned with a remembrance charm and a swarovski crystal in the birthstone color of your choosing. Some women choose the color of their baby’s anticipated birth and others choose the month of their loss. While this small token won’t bring your baby back, it may take you one step closer to healing along your journey. Crystal has also graciously offered to send me a piece from her collection. I look forward to wearing it in the coming challenging weeks! My opinions are always my own. So, I will be sure to let you know how I like the piece.

And, for the personal story behind this giveaway check out my most recent post HERE. THIS GIVEAWAY HAS ENDED. CONGRATS AUDREY CARRANO!!!

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destigmatizing infertility in a baby booming culture

Beautiful young woman with pregnancy test. In bathroom.

In my previous blog I alluded to the fact that the inability to get pregnant is laced with stigma and shame. 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.

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.

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.

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. Additionally, 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