Thoughts on Infertility from the Other Side

This blog has become what I always thought it would be (with a lot less blogging than I imagined). You see, I never set out to be an infertility blogger. I didn't really set out to be an anything blogger. I just started blogging. While a lot of infertility bloggers struggle with the space they've created once they bring home a child, I'm not. Or at least not in the same ways. This space is mine and it's the space I've created to write about my life. In this current season, blogging is HARD because finding time to do anything is hard, let along string together two well thought out sentences that someone might actually want to read. But blogging about my son, his milestones, our adventures...it feels natural. This is the life I always thought I would lead (well except that I was six years younger and twenty pounds lighter in my dreams, but hey).

While blogging about my son and our life together (or more accurately his monthly updates...let's be real) feels normal and good in this space, I haven't forgotten my roots. Infertility is in me, down deep. I'm blissfully happy, overwhelmed at the grace given to me in the form of this beautiful boy, but I am still infertile. Thoughts on infertility don't consume me, but I do still think about infertility. Pretty regularly actually. My thoughts are probably two fold...part from being a mother on the other side of the waiting and yearning for a child, and the other from having chosen adoption to get there.

What are my thoughts on infertility now that I'm a mom? Well for starters that season of my life SUCKED. I may still be infertile, but I'd rather be infertile with a child than infertile without every. single. day. While I may absolutely go through another season of longing and waiting to add to my family, I can't imagine that anything will be as miserable as those first four years.

Secondly, nothing about my body has changed...it's still just as broken as ever, but my outlook on this broken body and the crappy circumstances of infertility is so much more optimistic now that I have Garrison. But I remember those days, the ones where I honestly wasn't sure if I'd ever hold a child and call him son or daughter. That was the darkest season of my life.

While that season is definitely over, I am still infertile. My body is still broken, still not functioning the way that a woman's body should. I will have to make my peace with that or allow it to haunt me, but either way, adopting Garrison or any other child will not change my body. And, unlike the recent upsurge of those surprisingly pregnant after giving birth from a successful IUI or IVF treatment in the community, adoption will not reset or convince my body that it does in fact know what to do. I am still just as infertile today as this time last year when we started the adoption process, and the year before that as we prepared for IVF. Garrison didn't change my broken body. I imagine that in some ways pregnancy and birth after infertility are healing. At least, I always thought it would be. My body's triumph over this stupid condition...adoption does not provide that same sense of victory. I don't hate my body, that's really not the issue. Sure, I wish it was less pudgy, slimmer, with curves in the right places rather that where they currently reside, but I don't look at my body and think FAILURE should be tattooed across my forehead. However, adoption isn't changing the way I see my body...and it's probably never going to. My breasts will likely sag (even more than they do now), but I will never look at them with joy or pride for the nourishment that they provided. I'll likely have a stretch mark or two, but they won't be the sign of a warrior, proud of the life she carried inside. Rather they'll just be the lingering reminder of one too many pints of Ben and Jerry's. I am still infertile both in definition and in spirit, despite the adorable blue-eyed boy perched on my hip.

Despite the almost daily reminders of my infertility, it is not the all consuming presence it once was. And interestingly enough, Garrison is not a reminder of my infertility, which many have voiced as a question to me. I don't look at Garrison and think of my infertility or even his adoption into our family...I just see my son. The daily reminders of infertility are the same things they always were--pregnancy announcements, the fertility friend app on my phone ("Did you know that charting your cervical fluid can help you pinpoint your most fertile days?" Umm, yeah, NO.), the box of used needles from my IVF cycle in my linen closet, the packets of Pregnitude that fall out of the medicine box, pregnant women. They all still remind me of my condition just like they always did. Pregnany belly bumps still hurt like crazy. It's not exactly a knife in the stomach any longer, but it's still a good firm kick. The largest part of my free thoughts go to Garrison and planning and dreaming about the future, but there are still (and maybe always will be) triggers. So yes, I absolutely feel infertile and yes, I still think about infertility pretty regularly; however, I no longer feel completely consumed or trapped by my infertility. I have found my path to my family and it has freed me to dream about growing a large family again.

What are my thoughts on infertility after adoption? I don't think anyone, infertile or otherwise, really knows how they will feel about adoption until they've lived it. It's part of the fear. "How will I feel looking into the eyes of a child that it not biologically related to me?" You can't really say until you do it. "How will I bond with this child who did not grow inside of me?" There are 1,000 different experiences and no one can say how the bonding and attachment season will go until you're neck deep in it. I really struggled with the idea that adoption was a calling and I wasn't sure if I was called...maybe adoption wouldn't "work" for me because I just simply wanted to adopt. Interestingly, adoption is changing me, changing who I am and what I dream about. Adopting made adoption my calling. The presence of infertility in my life no longer seems like the end of my story. It's a big freaking part, but more importantly it's the avenue, the walls of the river, if you will, that funneled me to my family. I still can't say that I would chose infertility, but I can say that I'd chose my son every day, and if infertility is the only way I'd find him, I'd walk that road again just to hold him in my arms.

What are my thoughts on biological children/pregnancy after adopting and becoming a mom? Before adopting, I was 100% confident in me need to experience a pregnancy at some point. I knew that after our first adoption I would return for IVF, donor eggs, or donor embryos because experiencing a pregnancy and giving birth was extremely high on my priority list. Now? It's really not. Would I like to experience all of that? Abso-freakin-lutely. Am I willing to spend the next five years chasing that dream? No, I'm really not. There are other ways to build my family, ways that currently excite me so much more than pursuing round after round of treatment. And this is in no way a slight against those seeking treatment. I get it. I was full steam ahead with ART once upon a time too. What I do wish, so deep down in my soul, is that those who are still waiting and wondering if they will ever hold their child would find the way to that child. Whether that's through medication, lifestyle change, prayer, acupuncture, adoption, fertility treatments, surrogacy...whatever the path is, I hope everyone finds it. My path didn't look anything like I thought it would, and my path continues to change even now. My son is changing what I want for my future, what I want for our family, where I want my money to go, and how I want to spend my days as we build our family.

The desire to give birth to a biological child is still there, but it has very little to do with wanting a child to share my DNA...actually it has nothing to do with that at all. It also has very little to do with wanting to carry a child. As I mentioned, I would like that experience. Very, very much. However, ultimately my desire to get pregnant and give birth comes from a desire for God to heal me. Sara Hagerty writes in Every Bitter Thing is Sweet, "I struggled, instead, with knowing that God could heal me, but he didn't." That's really the whole deal right there. I wrote about Sara's book earlier this year and said that I wasn't sure who I'd be if my fertile years run out and he never chooses to heal me. Will I still love God? Will I be bitter to the depths of my core? It seems much less severe today after becoming a mom, but like Sara, I still wrestle with that question. I want to be pregnant and give birth not because I'm desperate to look into a pair of green eyes with a head full of hair, but rather I yearn to see my God do the impossible in a tangible way.

For me, adoption has been the greatest blessing. Garrison is healing parts of my heart that have been broken for so, so long. I wasn't sure if I'd really ever by happy again, and this little boy is making morning sunrises and the changing seasons and so many other things glorious and new again. He's also changing my heart, allowing me to begin at the very smallest level to look from my own pain, which often causes us to look inward, and begin to look out and see the pain around me. Adopting Garrison is opening my eyes to the plight of the orphan in new ways. Now I cry over orphans and children in foster care...literal tears. It's no longer just a sad story for me, it's a desire to help in a real and tangible way. I long to scoop up the oppressed, marginalized, ignored, and forgotten, along with those who were deeply loved but whose birth family could not provide and bring them home. If I had to guess today, I doubt our family will look like the average family...and our kids certainly won't look like us. I imagine all of the kids will be blended in color, ethnicity, origin...and likely even how they join the family. Donor embryos and adoption (likely international) are the most probable ways for us to continue our family, and I seriously could not be more excited about the opportunities and possibilities before us.

Ever Onward

May has somehow begun to represent infertility to me. May obviously comes on the heels of National Infertility Awareness Week each year. May also supplies my least favorite holiday... you guessed it, Mother's Day. And to add salt to the wound, May always ushers in an anniversary for us. This May marks three years of trying to conceive.

It's funny really, at one full year of trying to conceive, I was beside myself. The anxiety was at an all time high; I was desperate for a positive pregnancy test. I remember crying in the bathroom every single solitary time I saw just one pink line. Last year, I was coming to terms with just how difficult conceiving would be for us... how long and deep and wide this trench really is. This year, I think I've finally, finally accepted our infertility. Don't get me wrong, it still pisses me off. When I think about the 8 bazillion babies that are conceived without trying, without even wanting... I just want to scream. When I think about women confronted with the decision to abort or give their child up for adoption, I just want to die... why would the Lord even allow the pregnancy to a woman who doesn't want/can't take care of a child when Sam and I (and so many others) are so desperate for a child? It just doesn't make sense. But if I don't try to understand the BIG "why" questions, I've come to terms with infertility. I'm infertile... like woah, infertile. Unless the Lord sees fit to bless us with an absolute miracle akin to the virgin birth, we will require further medial procedures and countless more dollars if we want a biological child or the experience of a pregnancy. It is what it is.

That first year, I couldn't imagine spending another year trying to conceive. The thought was more than my mind could comprehend. It was simply impossible. Last year, I recognized that a third anniversary was certainly possible, but I was hoping that something would turn out. I knew that we had a laparoscopy and potential IVF coming, so surely something would give within a year. This year however, I fully expect for their to be a fourth anniversary. I recognize that we could potentially escape this pit by then, but I don't really expect to. Like I said, I've finally come to terms with our infertility.

It's a humbling place to be, to admit that you have zero control over your ability to procreate. I could have intercourse every day for the next 365 days, but that doesn't guarantee anything. We could spend 30, 40, 50 thousand dollars (if we had it) in the next year on the latest and greatest treatments with the best doctors in the world, but it doesn't guarantee anything. We could very well be sitting in this exact same spot next year no matter what actions or steps we take. Humbling indeed.

I'm curious at what point do these "anniversaries" stop? Do you stop counting at 4? 5? 6? How about 10 years of trying to conceive? Do you stop counting then? Surely when the clock strikes midnight and you officially turn into a pumpkin, with zero ability to conceive, you stop counting the years. Will May always hold special significance of my failure to conceive? Will this month always represent this season of life and everything we missed out on?

Ever onward, I guess.The years tick by, but I'm in good company, and for that, I'm eternally thankful.

Adoption in a TTC World

As I contemplate adoption and what that would look for my family, I continue to "worry" over one thing. Well, there are obviously lots of things to worry over, but there's one reoccurring thing regarding this blog. It seems to me that there's an unspoken idea in the TTC community that adoption is "giving up". I don't think anyone intentionally thinks this (maybe I'm wrong), but there's an undertone. Comments following failed cycles tend to remind the blogger that IUI and IVF takes time… "there's always next time, so don't give up. Keep trying and it will work, eventually."  Again, it's not blatant. I don't think it's even intentional, but we (I'm including myself here) often put forth this idea that adoption is in some way settling or giving up, that we should keep trying to conceive until the last nail is in the coffin.

The more I think about it, the more I don't think it's really this community specifically, it's everyone. There's just this general perception that for an infertile couple, adoption is second best. I've had lots of comments from friends and family in the last few weeks. Things like, "I wish we could give you the money for IVF so you can have another shot at your own kid." or "I think IVF will work if you keep at it. I mean, you're both so young." The more I look and think and listen, the more I recognize this ideology: adoption is often the second choice, so adoption is giving up. I've really had to take a step back and look at myself. Do I feel that way? Is that how I feel about adoption? Will I look at my adopted son or daughter and think "second best"? If there is one thing I'm learning about adoption, it's that it requires you to answer some really hard questions.

I've decided with full confidence that I can love a child that is not of my blood as if he/she was. So in that sense, adoption doesn't feel like giving up at all. Any option that ends with my arms filled rather than perpetually empty seems like a win to me. However, I do wonder if I might still long for a pregnancy even after we've adopted. It has long been a desire of mine to be pregnant, not just to have children. I recognize that I probably have a really glorified image of pregnancy, but I would still like to experience it. I also understand that infertility has probably robbed me of any ability to fully enjoy a pregnancy, as I'd worry until the bitter end. But again, I would still like to experience it. I feel like a successful pregnancy and birth would be very healing for me after all of this mess. It would allow me to love like my body again. Thus, while I wouldn't describe adoption as settling, it does obviously lack the ability to fulfill this particular dream.

But we're kind of getting off topic here... back to that worry. I worry how adoption would affect this blog. I don't want to lose these relationships. I can't tell you how much you all mean to me. Tears literally (and I do mean literally) come to my eyes when I think of all of you. I have no idea where I would be if it wasn't for the outpouring of love and support that I've received here over the years. And I don't for one second feel as if anyone would intentionally cut me off for pursuing adoption rather than IVF, goodness no, you are better people than that. But there's a noticeable trend in which like finds like. DOR ladies tend to have a lot of DOR blogs in their blog roll. Donor egg tends to congregate with donor egg. Even CCRM patients find other CCRM patients. I've never really gravitated towards one situation over the other. Maybe that's simply because I've never had a diagnosis. Selecting blogs to follow for me usually corresponds to one of the following A- compelling story, B- really good writer, C- blogger pursues me… and I'll be honest and say, I tend to gravitate towards names, photos, and clean design (aka, no curlz font). I know, I'm hard to please, my point is just, I've never set out to find "X" type of blog. But I'm sure that if we pursue adoption, I will seek out more adoption bloggers. I will want their advice and their support. But I would feel absolutely crushed if I became an outsider to those actively trying to conceive. I would still cherish the comments of those trying to conceive, and I hope that mine would be welcome to any of you as well. This space is important to me. Your friendships are invaluable to me. But I can't help but wonder if some people might be disappointed in my choice, if they might think I was giving up too soon.

I really loved how Mel put it in her post leading up to NIAW. She describes us pretty well when she writes,

I would argue that we’re not really the booting sort. We’re more of the cold freeze or the ignore or the not listening sort. I own that. You need to own it too. I’m not saying we do it on purpose, but we do it inadvertently, and the effect of this is for people to feel excluded. We have adoptive parents who not only have to convince outsiders to use positive adoption language, but they need to convince insiders too.

I am certainly guilty of the above from time to time. But I'll also add that I think all of this is a give and take in the blog world… if you announce you're adopting and then close up shop, of course that feels incomplete and unfinished to everyone you leave behind. A similar situation seems to occur with new moms. They wrestle with the space, and often stop blogging all together or start a new blog. So yes, those still trying to conceive can't freeze out the women who choose adoption just like neither can freeze out new moms.

Mel goes onto explain how and why she coined the term ALI (adoption loss infertility). She writes,

I specifically made it enormous and general so it would include everyone on the blogroll… Every single person on that blogroll has their foot in one of the three rings in this venn diagram, and some stand in all three circles… That definition — coining the term “ALI community” — was meant to remove everything that makes our individual diagnoses and situations unique and differentiating and instead bring us all together as a single entity working toward mutual support and understanding so it can extend to the outer world.

I don't think people really get it when I try to explain this space to them. Until you've experienced it, until you've witnessed it, you can't understand the power and the beauty of a community like this. I don't ever want to leave. You people are beautiful to me and this place is special. That alone makes it worth fighting for. So no matter which direction we decide to go from here, I'm committing to do my part. I'm reaching out past my comfort zone; I'm choosing inclusivity at every opportunity. I'm agreeing that if you've got (or had) even one toe in any of those three circles, then you belong, and nothing will change that. Won't you join me in supporting those who have resolved whether via adoption or ART? Won't you join me in supporting all of the various family building opportunities and reaffirming that every choice is valid?

Friends, I don't know what the future holds for my family. We might decide to adopt, bring home a child and later return for those precious embryos in Florida, only to find success in the final transfer. Conversely, we might go for the FET next, fail, move forwards with IVF at CCRM, bring home a baby, and then decide to add to our family via international adoption. If I had to guess, I still believe that we will pursue adoption and biological children at some point. In what order that will take place, I can't really say. I guess my point is that no matter how we build our family, no matter if we bring home three babies, one baby, or no babies, I am infertile at heart. These years have affected me down to my soul. Infertility is etched so deeply into who I am now, I simply wouldn't know who I am without you. When  I think of myself, I think of myself as a Christ follower, a wife, an infertile… I think of myself as part of a whole, a part of this community. And absolutely nothing about our next steps will change that.

Fertility: A Downhill Slide

So hopefully, the last post on fertility vs infertility helped to explain why it appears some people can't seem to stop procreating, while others can't start… it's all a long continuum from fertile to infertile. One thing that's kind of HUGE that I didn't touch on (the post was already lengthy) is the relationship age has on the spectrum. It's kind of a sensitive topic for me… I think you'll see why.

By the definition of infertility, all women are headed that direction. If the definition is simply the inability to become pregnant with unprotected sex within a year, I bet you can guess which part of the population is 100% infertile. Yep, menopausal women. And unless you've found a way to ward off the dreaded change in your body, you're headed towards "infertility" too. Let's look at a chart for all the visual learners out there:

Find your age: The black line is the likelihood you'll conceive in a year,
the green line is the rate of infertility. I was SUPER lucky to fall into that 5%.

Here's the thing I really hate about charts like this and the label "infertile": There is a really distinct difference between me, 28 and unable to conceive after 32 cycles and countless medical procedures and my mom, 57 (sorry mom) who is well past menopause. We're both unable to conceive, but I have no real explanation, while she, she's simply too old. I personally feel like there should be a difference in the diagnosis or terminology or something. Many of my friends and I, who were diagnosed with infertility at the height of our fertile years, we are different from other women who are diagnosed with infertility because they are a few years if not mere months away from menopause. It may suck for both parties, but we are different. One group has an abnormal and unnatural occurrence within the body, the other has a body behaving exactly as it should. To call me and a 50 year old woman the same thing in terms of ability to procreate is just kind of dumb.

But how does age relate to the fertility spectrum? Well, unfortunately, no matter who you are, it's pretty much just like the title says: a downhill slide. Most girls start their period in their teenage years, 12 is currently the average in America, but somewhere between 10 and 15 is normal. For a few short years, a girl's body is regulating, meaning most girls don't start off with regular, monthly cycles. And even when they do have a cycle, they don't always ovulate… the system is kind of working out some kinks. The problem of course in terms of teen pregnancy is that when teenagers do ovulate, most of them, will have excellent eggs. Egg quality really doesn't get much better, to the detriment of many an American teenager. But that's a different topic all together. A woman reaches peak fertility about 20… the eggs are stellar (normally) and the body is in rhythm (most of the time). That peak fertility window only lasts a few years. In fact by 24, the downhill slide has already begun. I know, believe me, I feel your pain. The good news is that initially it's a slow decent; unfortunately it picks up speed later.

Now many of you are probably thinking, "but I know someone who got pregnant at 42, 45, 47" or whatever and she never did IVF. Well first of all, don't be so sure. A lot of women may choose not to share their personal journey towards a child quite so outspokenly as I have. Hollywood is RAMPANT with women utilizing Assisted Reproductive Technology in secret in their later years. But you're also right. You probably do know someone who had a child in her forties without ART. That's because even at 45 our handy chart says there's a 5% chance of conception. Basically, out of 100 45 year old women, 5 will become pregnant within a year. So yes, it does happen. It's just a lot less likely to happen than at 25 or 35.

"What about Sarah from the Bible?" some of you may wonder. She was 90! If she had a baby at 90, it must be possible at 40, 50, 60 and so on. You're right, Sarah was old. In fact, Sarah was so old that when she heard she would have a child, she laughed. (I have quite a few ideas about that laughter, but that's for a different post). Sarah's story is in the Bible in detail because it was a MIRACLE. If pregnancy late in life was the norm, Sarah would most likely have received one simple line: "And Sarah, Abraham's wife, gave birth to a son."… the end. Could it happen again? I think so, absolutely… and it would still be a miracle because it's not only unlikely, it's impossible without divine intervention.

Okay, so back to the average, regular, mostly fertile woman. At 24 the downhill slide begins, but it's not something she's going to notice. She'll simply slowly start to have fewer eggs available while at the same time the eggs that are available become lesser quality. This degenerative process by which eggs are lost regardless of ovulation, pregnancy, or even birth control is called atresia. What does this mean for the average woman's chances at conception? Well on a macro scale, the above chart tells us that a woman my age should have around a 78% chance of conception within a year. But on a micro scale, the average, normal, fertile woman has about a 22% chance of conception.

Find your age: The percentage is your chance of conception per month
(if you're normal).You'll note the decline picks up dramatically later.

Now you understand why, despite fearing that you'll be just like me, it's unwise and unnecessary to run for the doctor if you aren't pregnant in three months. Out of one hundred 28 year old women, 22 will be pregnant at the end of the first month… they are either Wonder Fertile Woman, or they shacked up with Super Sperm Man, or everything was just darn perfect. But the other side of that statistic tells us that at the end of the first month, 72 of the 100 women will not be pregnant… so if you're not, you're in good company, and not necessarily (or even likely) in company with me. Breathe easy. One thing to note is the chart is again the AVERAGE, but most importantly it's the average for a normal, functioning woman meaning that women like me are not skewing the numbers. You may certainly find that your chances are higher than this... you might be 28 and have a 27% chance of conception each month. Likewise, you might be 28 and have a 20% chance each month... both are normal functioning women.

So what does all of this tell us? Well, for the average fertile person, unless you are ready to have children at 22, you're likely going to miss your most fertile window. And unless you are akin to Michelle Duggar, you are unlikely to have multiple babies in your forties. But the good news is that there are quite a number of relatively fertile years in there. I certainly wish I could wave a magic wand and increase fertility and extend it a few years, but as I cannot, either for myself or for you, it's wise to know what you're up against and what the future most likely holds. As you age, no matter who you are, you will move further down the fertility spectrum. Someone may be at the far, far left end of out spectrum in her twenties, but in her late thirties she will most certainly be less fertile. She will require more time and/or more resources to become pregnant. She might find herself somewhere in the middle of our spectrum... requiring LOTS of sex and maybe even a few pills. Someone who was more average in her twenties, maybe requiring 6-9 months to achieve pregnancy, will most likely require even more time and/or resources in her late thirties.... both can still get pregnant, but both have been affected by age as well.

Unfortunately, age is not the only factor in infertility, but it is certainly a factor. Every woman is headed towards the inability to procreate, some of us just arrive there ahead of time. Some women have diagnoses for things such as Diminished Ovarian Reserve or Premature Ovarian Failure. DOR is a natural occurrence… we're all headed there. But it becomes a major problem when you receive that diagnosis at 25 or 30 rather than 45. POF is the loss of ovarian function before 40, and unfortunately it can occur as early as fertility begins as some conditions are present at birth. In both of these instances, when the diagnosis comes during your fertile years, it means that the "normal" no longer applies. Your body may be 25, but your ovaries are behaving like they're 45. Therefore, you essentially have the same chance at conception as a 45 year old.

For myself, my infertility appears to be unrelated to my age, either my actual age or the age my ovaries think they are. There's no way to know, but I may have been equally infertile at 16 and 20 as I am now. My doctor says that if egg quality is my issue, there were really no indicators. For most women with egg quality issues, there are red flags such as hormone levels. Typically egg quality is in direct correlation with egg quantity. If you google egg quality, you will find that just about every article discusses the direct link between egg quality, quantity,  and age. Anytime you find an article addressing poor egg quality and young women, you'll read about indicators like high FSH or low AMH leading to a diagnosis of one of the above conditions, DOR or POF. I have neither of these. I am a one of the rare women who appears to have ample eggs, but a higher than normal proportion of poor quality eggs. Remember the chart with the red and green dots, well it appears I have a lot more red than green. So even when we do IVF, the odds of us scooping up 5 green eggs are low. We do not, at this point, know why. As to whether my infertility will worsen at a faster rate than a normal 28 year old, we don't really know. But as I've been given worse odds than the average "normal" 45 year old for conception on my own, I don't really think it matters.

So what's the point of all of this? As I stated before, I'd like to assure my friends who are just starting out and afraid of what it means when one cycle fails, that things are most likely incredibly normal and your baby is on the way. I hate to think that my own story will become a terrifying drama played out in the bedroom of my friends… sort of. I say sort of because, while I don't want to scare anyone, honestly, if my story causes you to kick the birth control to the curb 6 months or a year before you're both "ready," I won't feel bad. Yes, the odds are that you'll get pregnant 3-6 months before the opportune time, but really is there ever a perfect time? And if by chance you're one of the ones who finds yourself not pregnant within the first six months, and you're starting to wonder and worry, well when that pregnancy test shows positive at the the eleventh month, you'll thank me for getting you started sooner. You're welcome.

Fertility: A Spectrum

This topic has been on my mind and bugging me for quite some time, but it's kind of hard to put into words. I'm going to try anyway, because I have nothing else to talk about these days.

Fertility and infertility initially seemed like simple ideas to me: fertile meant able to get pregnant and infertile meant not able to get pregnant. In my head, this was just a yes/no, either/or kind of deal. But I've come to learn that it's really not like that at all. Fertility doesn't start and end with the flip of a switch. At first it seemed you're either on this side of the line or that side of the line. But the reality is that there is no line, not really. Doctors have created a definition of infertility that hinges on the inability to get pregnant after a year of unprotected sex. If you do get pregnant you're in the fertile camp, if not, you're infertile. But seriously, the definition is pretty obscure. If you're 35 or older the definition suddenly changes to only six months of unprotected sex. And what about if you get pregnant (again and again) but you miscarry within that year, what then? It's a mess I tell you.

Part of the reason this topic is on my mind is that I get asked about infertility A LOT. And not in a "Hey, how are things going with that infertility nonsense?" kind of way, but in a "Hey, so I've been trying for 4, 6, 8 months and I'm not pregnant. Do you think I'm infertile?" kind of way. Part of the reason I get these questions (I assume) is that I appear fairly knowledgeable about this junk... why thank you (takes gracious bow). I've spent more time researching this than I put towards my undergraduate degree, so I feel like I should be pretty darn knowledgeable at this point.

The other reason they ask is fear. My story is like a train wreck... everybody's interested. But also, to girls in their twenties (and most likely thirties), my story is terrifying. And I totally get that. I hate hearing obscure, rare, awful stories of someone's terrible disease or circumstance because I'm automatically terrified that it will happen to me. It doesn't matter that the chance of a stroke caused by child birth is exceptionally rare... I heard the story and now I'm terrified it will happen to me. Rare cancers that strike young, healthy people with no symptoms... just don't tell me about it. I totally understand that hearing or reading about a girl who can't get pregnant at 25 (26, 27, and now 28) is kind of shocking and terrifying at the same time. So now as friends start trying, when it doesn't work in three months, they immediately think of me and go "on no, not me too!"... no shame, I get it.

But here's the thing I'd really like to get across: Just because your best friend got pregnant the first month and you still aren't pregnant after four, does not, in any way, mean you are destined to be me. Your best friend and I, we are literally at different ends of the spectrum. I'm thinking this calls for a diagram.

The Fertile Spectrum: a chart showing time and/or resources required to conceive

As you can see, this is not to scale.... at all. There are wayyyyyy more people on the left side of this little chart than the right. But there were just too many fun stages to put on the right for them to all fit. So when I say that I, who sits somewhere between "IVF: your only hope" and "Not Gonna Happen" is at the other end of the spectrum from your best friend, I really mean it. The other thing to note is that I didn't mark the "INFERTILE" line in there with a big red line. That's because the diagnosis of infertile will hit for some at different points along the spectrum. But here's the biggest point I want to make: your friend and I, we're opposites, but the odds are you (my just thinking about, starting to, looking forward to trying friend) fall in the middle. Again, chart is not to scale, so not the middle, middle, but the "middle"... meaning shacking up one time may not do the trick, but you're also unlikely to require IVF, or any treatment really. The average 20 something has about a 20-25% chance of conceiving each month... that's the average. Remember what we learned about averages... there are people above and below that. You've got me, who's tanking the numbers and pulling the average way, way down. But you've also got Suzie Q who gets knocked up every. single. time... she's definitely got higher odds than 20%.

Here's another thing to note: remember that ol' saying, "it takes two to tango"? Well it's true. You can be uber fertile, but if your partner is completely sterile, it's not going to matter. In the same way, your partner can have super sperm, but if you don't ovulate, his swimmers are lost at sea. You with me? So if neither of you are Wonder Fertile Woman and Super Sperm Man, then you will most likely not get pregnant in the hot tub with your bathing suits on. I know, it's such a bummer. If you're both closer to average, you'll have to have intercourse in the fertile window... and it might take a few times. If however, he really is Super Sperm Man, then the fact that you're more average will still work out pretty okay. And if he's lacking the cape, but you're rocking some super woman thigh high boots, then things will most likely be okay for you both too, The problems start when one of you is down on the other end of the spectrum. Or, if both of you are what my doctors like to call "subfertile" then it may take you both a little longer.

I used to HATE that word... subfertile. Ughhhh. I wanted to punch them all in the face. But now, I kind of get it. It certainly doesn't apply to me, but it probably applies to a lot of people. There's a third "category" if you will... it's not either/or. It's not fertile/infertile. It's fertile, less fertile, less fertile still, even more less fertile, infertile, super infertile, and not gonna happen infertile. So the fact that you and your honey have done the deed five months in a row, and you've peed on more sticks than you can count, please don't lose it. I know that my story is scary as hell, but your situation and mine are (most likely) vastly different.

Lets's take a second and look at each partner here. I found this image the other day and I think it's kind of awesome. Take a look:

Average 20 something ovarian reserve:
Red dots are bad eggs and green dots are good eggs

Okay, so we all know that a woman ovulates one egg every month.... Imagine with me, that you closed your eyes and selected just one dot. Is it green or red? If it's green, then you ovulated a good quality egg meaning it's mature, it has all of the chromosomes needed, and it has a shape/size/surface sufficient for fertilization. Good for you, you have a fighting chance at pregnancy this month. If however, you landed on a red dot, things are not looking so hot. Something is less than stellar about that egg and you are unlikely to conceive this month, even if your partner has super swimmers. Here's the thing: everybody has good and bad eggs... everybody. The more eggs and specifically good eggs you have, the more fertile you are. Some women have very few eggs, some women have tons of eggs. Some women have a high proportion of good quality, others have a crummy proportion of good quality.

What about the dudes? There's a spectrum for them as well. And the guys somehow get a less stringent grading policy, which I believe is part of the reason Male Factor Infertility is less common. Let's look at another high tech chart, shall we?

Super Sperm Man is on the left, Male Factor Infertility on the Right

You'll see that on the chart, I actually did put a red mark on this one. Again, I don't think there's a light switch here or an either/or system at work, but rather I marked the line to show that it is way, way, way far away from the middle. That's my estimate for where the Male Factor diagnosis comes in... everything to the left is "normal". "Normal" in no way means average... something Sam and I failed to grasp in the beginning. Take morphology for example: morphology is the shape to the sperm. Any two headed, two tailed, freakishly large, or exceptionally small sperm are excluded from the count. The criteria says that a man's morphology is normal as long as 4% or more are normal. But that's far from average. A man with 4% morphology is in the 5th percentile, meaning 95% of men have higher morphology rates... but he's still considered normal. It's weird, I know. But it doesn't take a rocket scientist to see that the guy way on the extreme left has better chances than the guy closer to the red line. They're both "normal" and neither likely need treatment, but they don't have the same odds.

So how do you know? When do you FREAK THE HELL OUT and when do you swallow a massive dose of chill and wait it out? Good question. The text book answer: if you're under 35, wait a year. If you're over 35, give it six months. However, I think most of my infertile sisters would say there should be a few asterisks out beside those guidelines. So here are your asterisks:

* If you don't have a period, you don't ovulate regularly. End. of. story. If you don't ovulate, you can't get pregnant. So, if you haven't had a period in some 130 days, run, don't walk to your OB. If your OB says everything is fine, find a new one. It is not fine, and it is not normal to not have a period. It doesn't necessarily mean that the world is over and you will never conceive, but it does mean your months are being wasted... you can't give it twelve chances if you only have a few periods a year. You get me?

** If your average monthly cycle is well outside the norm, you should probably pay attention and think about talking with your doctor. 28 days is standard, but if you're cycle is 26 days and then 30 days, don't stress. If however your cycle is regularly 20 days or 40 days you should probably mention that to your doctor.

*** If by chance you actually know when you ovulate (based on OPKs, BBT charts, or other body indicators) and you regularly only have 10 or less days between ovulation and your next period, go see your OB. The luteal phase (post ovulation) must be long enough to give an embryo a chance to implant and send signals not to shed your lining. In similar fashion, if you're regularly ovulating waaayyyy late, like after day 20 of your cycle, you should talk to your doctor. Your lining (and the egg) are most likely less than stellar after three weeks.

**** And lastly if you have signs of other issues like Endometriosis, PCOS, or Hyperthyroidism, you should talk to your doctor. All of these conditions can affect your quality of life and health even outside of trying to conceive, so it's important to get an accurate diagnosis and to treat the issue. But treatment will also (most likely) help you conceive if that's your goal.

My ultimate goal here is to say to those who are worried that they will end up just like me, the odds are small... so small. Infertility is fairly common, so feel no shame if you find yourself with that diagnosis, but even with the diagnosis, there's a lot of ground to cover before you're me. However, while I'd like to ease some fears, I don't want to say "don't ask, research, or question". I had a hunch way before we reached the year mark that something was up... no one believed me. So if you have reason to believe that something is wrong, tell someone. Like I said, there's no reason to wait a year for help if you know you have stage IV endo, only one tube, and you have abnormal cycles. If you think somethings wrong, find out so you don't freak out unnecessarily.

And I have a feeling my infertile friends will have a few more asterisks of their own to add, so check the comments!

To Try, or Not to Try

Confession time: I haven't really been trying to get pregnant. Gasp! I know! What kind of infertile am I? The IUI kind of spoiled me. I'm sure it sounds strange to most people, but on some level, an IUI is a break from the monotony that is timed intercourse. It takes some of the stress out of the picture. It doesn't matter whether he feels like it, or if I'm into it, it just happens. There's no need for candles, or mood music. It's as close to a guarantee as you can get. I mean not a guarantee of success, but a guarantee that sperm an egg will have a fighting change.

I guess the failure of the IUI, the failure of my body to do what it was supposed to (again) even with four (maybe five) beautiful, plump follicles and an extremely lush lining has made me question what the heck I think I'm doing every month with all this timed intercourse and charting and ovulation testing. But if I'm being really honest, this started before the IUI. During my April cycle I was given strict orders NOT to get pregnant because of the laparoscopy. And it was lovely. I still kept my BBT chart that month, but I didn't test with OPK's and we didn't time intercourse... it was refreshing.

May's cycle started and we spent much of June preparing and hoping for a successful IUI. And while I won't say that IUI's are stress free (see here for evidence of my stress level), IUI's do remove the stress and the obligation to get it all right. The monitoring gave me confidence that we wouldn't miss ovulation and the actual IUI procedure allowed us to kind of chill in the baby dancing arena... again, refreshing.

So after two months of just not fooling with timed intercourse and all the stress, the next month kind of just happened. I didn't test for ovulation, I didn't worry with timing intercourse. And while you can imagine my shock when I wasn't pregnant, I kind of just didn't care enough to put in the effort throughout the month. I'm terrible, I know. I whine all day about wanting a baby soooo badly, but when it comes to putting in the time, I'm not interested. Pathetic. This month has happened almost identically. I'm charting (sort of), but I haven't tested for ovulation and I haven't worried about timed intercourse... I'm pretty confident in the outcome of this cycle already. In fact, I think I've taken like 5 prenatal vitamins in the last two months. I have religiously taken prenatal vitamins for two years, and now, I just can't seem to work up the energy. How much energy does it require to take a vitamin, you ask? Umm, effectively none. The bottles sit on my nightstand. There is also always a beverage of some kind on my nightstand. It is all of an arm's length away. And yet, every night I think, "what's the point?", and my arm just can't seem to bridge the great expanse of space between bed and table.

I'm not really sure what this says about my psyche at the moment. Is this a faith thing? A "if He wants me to be pregnant, He'll make it happen" thing? Or is this an "if IUI doesn't work, nothing I do will work either" kind of thing? Because that's the other option. We've been at this for two years now. And for the vast majority of that, we've been trying hard, really, really hard, to get pregnant. We've done six medicated cycles, four of those were IUI's, and yet all have been an absolute bust. So you can see why the thought is there... if two years of timed intercourse and fours cycles of IUI didn't work, our only hope is IVF. And if that's true, then shouldn't we just live? Just enjoy? We are already living under such heavy restrictions in other areas of our lives as we prepare for IVF, so shouldn't we give ourselves a break here, where our efforts seem fruitless?

What do you think? If it was you, would you take a break from the charting, testing, and baby dancing? Would you put your baby dreams on hold until IVF? Or would you go the exact opposite direction? Would you get fired up to give it everything you've got before handing over that GIANT chunk of change? To try or not to try, that is the question.

Wishing Away the Days

What's new? I've been wishing away days, weeks, months, heck, whole seasons of my life I'm pretty ashamed to say. But now that we're here: 8DPO, 7DPIUI, I'm wishing the days away like crazy. I just have to get to Saturday (yea, yea, I know I originally said Monday). If it's negative, I'll cry, throw an excellent pity party, and then retest on Monday, at which point if it's still negative, I will dissolve into a puddle. Offers are being taken now for volunteers to scrape the goo (what's left of me) off the sidewalk. BUT, if it's positive... oh geez... I will not wait for Monday, I will drive myself straight on down to Atlanta (without an appointment) and demand a beta. I will not wait for Monday again... I've been down that road before and terrible, awful, no good, very bad things happen.

I'm pretty sure that I've had every early pregnancy symptom at least once in the last week... but who am I kidding? My guess is that so have you because the symptoms of early pregnancy are the symptoms of LIFE. I've decided that my contribution to the TTC community will be this: once I complete this TTC roller coaster, I'll have so much money I won't know what to do. So, I'm going to create a new test... a test for actual conception: i.e. did sperm meet egg?... Now sure, it'll be crazy sad to get a positive on this new test only to get a negative, which would mean it failed to implant. But at this point, I've just GOT TO KNOW.

I'm also interested in discovering safe alternatives to over-dosing on sleeping pills or requesting a medically induced coma to allow for a solid two weeks of sleep. Because really, I don't need to be awake for this. I'm worthless. My head is somewhere else and my body is functioning an autodrive as it searches EVERY neural/physical response within my body for signs of life (it's too early to feel a kick, right? I should cross that one off my list.). And no, I don't need to keep myself busy... I'm working a full time and a part time job... I'm plenty busy. This does not equate to a distraction. It just equates to time that I must be awake... the goal is to be asleep, wahhhhh!

But a big shout out to a quite a few girls who survived the 2WW and received good news! Go on over and tell Amanda, Infertile265, and Laura congratulations on their positive pee sticks and beta results! Good luck ladies, we are all pulling for you!

And that's all I've got folks... I told you: it's all on autopilot.

Spotting Symptoms

So I know what most of you are thinking... I can't possibly be checking for pregnancy symptoms yet. And I'm  not, believe me I'm not. This is more about how whenever you have a reason to actually check for symptoms, they are EXTREMELY abundant. This is the first month in a very long time that there is a significant chance (can you call 10% significant?) we might get pregnant, but that is absolutely no reason for eight billion symptoms to come out of nowhere. It's just not.

Take yesterday for example: 1DPIUI (one day post IUI) I woke up to the WORST HEARTBURN EVER! Now granted, I never get heartburn. I've never even taken a tums before, so my tolerance for such terribleness may be kind of low, but to me, it was awful. The sensation was all the way into my chest, terribly uncomfortable, and would not go away. Of course one of the medications I'm on says not to take any type of antacid... lovely. I finally called the doctor to see if this is a side-effect of anything because well, I'd had NOTHING that should cause heartburn. And don't you know, the medicine (doxycycline) that states in plain English on the bottle not to take antacids is the culprit. Nice. My nurse recommended that I take the evening pill earlier, so that I don't lay down after taking it. She also said to ignore the pharmacy's instructions, to go take a tums, and to eat a little something when I take the pill. Oh and milk, she said to drink milk... but that ain't happenin'.

My point is this: heartburn is a well known sign of pregnancy. Maybe not the earliest sign you might get, but still, a woman trying to conceive will wonder...

Then there was this morning: 2DPIUI I didn't feel awesome. Kind of warm, kind of, well off, but not stay home from work sick. I was almost finished getting ready, I took Sterling outside, I started to feel really, really lightheaded. I thought I needed to sit down. I headed inside. All of a sudden in the midst of, "I'm going to pass out" came "I'm going to throw up". And I did. And I NEVER get sick. Never.

Everyone knows that vomiting your guts up is a sign of pregnancy, particularly the type of nausea/vomiting that occurs in the morning... it's called morning sickness for a reason, you know?

So what's a woman to do? I mean seriously, I'm 2DPIUI, maybe 3DPO (three days post ovulation). If, and I do mean if egg met sperm, that beautiful mass of cells is still in my fallopian tubes. They haven't even implanted! There is no rush of hormones flooding through my system to trigger all of these "symptoms". And this my friends, is why the 2WW totally blows!

Play nice universe, play nice. I'd like to survive the two week wait with my sanity intact.