So today is CD 13, or more importantly the one and only monitoring appointment for my frozen embryo cycle. A frozen embryo cycle is so chill, practically boring compared to IVF. I'm guessing this is what clomid was like, but honestly I can't remember. No actually, clomid was more stressful because I was still worried about timed intercourse and those stupid sticks and "did I hold my bladder long enough?" and "oh my gosh, I have to pee, but I don't have an OPK!!!" Yeah, clomid was more stressful.
I have been so chill throughout this entire cycle... no worries, no stress. I forgot to take my three little blue pills the other morning and couldn't work up enough energy to care. "It'll be what it'll be" is kind of my motto. It's pretty much the complete opposite from "let me eliminate all bad things and eat only good things and rub my tummy and talk to my follicles and, and, and" that was IVF. Instead, I've somehow, unintentionally decided that there's not really much I can do to change the outcome of this. I'm pretty removed from the whole deal.
There was a moment yesterday when I started to stress and worry about today's appointment. I've never done an FET, so I had no idea what my lining would do. Would this pathetic protocol they've got me on of six little blue Estradiol pills a day really be enough to pump up my lining? As I've never been monitored off meds, I have no idea what my lining does all on its own. My worst lining ever was 6.2 and my best was 11.4. I started to worry that my FET might be cancelled and I began to realize that despite being chill and feeling uninvolved, I really do want to have the transfer. I just need to complete this transfer. Yes, I'll still have four more embryos, but the chance of success with either of the other straws is significantly less than with this straw. I need to complete this transfer so I can officially start thinking next steps. It feels like our future is frozen right now. The answers sit frozen in tiny straws in Jacksonville. They will either be our bring home babies, or we have more road ahead of us. Either way, I'm just ready to know. And ultimately, I just need to be doing something. Doing nothing feels miserable and makes me into an anxious, whiny, irritable person.
The monitoring today went well. I drove into Gainesville as neither of the hospitals in Athens could process Estradiol labs same day (lame). The ultrasound technician at the OB's office was a sweetheart... I'm sure she's used to monitoring baby bumps and all that kind of fun stuff, but she showed a genuine interest in my cycle and wished me luck. She reported that my lining was over 9mm... that's all I really cared about. I hit the car and let the tears fall... God, I want this. There's such a lovely, fluffy, squishy little home just waiting for those embryos. And I know they're subpar in terms of grading, but they're mine, and I LOVE them. I just want them to come home.
We're what feels like 2,000 milestones away from either of those sweet embryos coming home. They have to thaw well, the transfer has to succeed, they have to grow to blastocysts, they have to implant, they have to continue to grow... all of that before we even get to the pregnancy test, at which point we'll still have 1,995 milestones left to go. We're soooo far away, but for some reason hearing that my lining was lovely just made it feel like we're a teensy bit closer. Endometrial lining has really never been the issue for me (only on clomid), so I know we still have the REALLY BIG hurdles left to go, but man, I really, really want to succeed. I'm tired. I've run this race. I've fought the good fight. I'm so ready for this to be over. We're rapidly approaching three years of actively trying, most of which have been in the care of a Reproductive Endocrinologist. These have not been idol years... we've saved, we've prayed, we've tested everything (well almost), we've moved step by step through each of the procedures... I'm so tired and I know Sam is too. I just want to move on with our lives. God, I really, really want this to work.
I've already heard back from my nurse at the RE's office and she reported that my blood work is "great" and she's confident we're moving forward. I'm waiting to hear when I'll start the antibiotic and the Crinone (yuck). We're set to head to Jacksonville Saturday morning. I'm not sure exactly what time the transfer will be on Sunday, but I'm sure I'll hear some time today. Unfortunately we have to drive back after the transfer on Sunday. With Sam's job, we really can't take the extra days, but I'm planning to relax and rest the whole way back. And then the long two week wait will commence once again.
That's about it for now. I'll be sure to update after the transfer. In the mean time, head over to Julia's blog. Today is beta number two following donor eggs at CCRM. And check-in with Suzanne. Tomorrow is a BIG DAY and we're hoping Suzanne has a lovely, fluffy, squishy lining of her own. And please don't forget Holly. Let her know you're thinking about her as the due date of Brinly and Jude is Saturday.
Wednesday, March 12, 2014
Monday, March 10, 2014
Unsolicited Advice
I really don't know exactly what it is about the human race that causes us to need to give advice, but we all do it. We all want to be problem solvers specifically. I'm guilty of it too. Growing up, my nickname was "Mother Merritt"... I think it was in large part because I was a fixer. Tell me your problem and I'd find a solution, patch up the friendship, find you a date to the middle school dance, etc. Our advice and problem solving is usually well intentioned, but often times life would be better if we could all learn to zip our mouths. The more friends I have who gain the title of "Mom", the more stories I hear of rampant unsolicited advice. Neighbors, in-laws, mailmen, friends, cashiers, etc. give advice in the grocery store, at work, over Sunday dinner... it's really unavoidable.
Now I (obviously) don't deal with advice about Pampers vs cloth diapers, or sleep training, or temper tantrums, but unfortunately I often deal with unsolicited advice in terms of infertility. And the strange thing is that 99% of the time, I know it's from people who mean well and actually love us. Unfortunately, that's not always how it comes across. I wish people could hear their comments through my ears; hear what I hear.
There are always my favorite pieces of advice, the old standbys such as "just relax," "take a vacation," or "just adopt; you'll be pregnant in no time." I'd like to take this moment and share a little public service announcement if I may. If your advice begins with "just," keep it to yourself. There is nothing simple about infertility, and the fact that some people think they can simplify it and solve it with "just ______" is not only frustrating, it's insulting. Think about it from this perspective: Imagine you own your own business, and you're in the red for the third quarter in a row. If a friend says "just relax," does that feel helpful? And as to a vacation... have mercy. I'm certainly willing to take anyone's advice if they are paying, but unfortunately we spent almost 40% of our income last year on medical expenses. That doesn't leave a lot of room for Cancun or Vail. Sad trombones. And as for the weird wives' tale that adoption leads to a pregnancy... goodness, don't get me started. If that was really my intention, if the only reason I pursued adoption was so that I'd get pregnant, wow, let's just sum that up in one word: TERRIBLE. That is horrible advice, and I'd be a horrible person if I took it. Agreed?
Sometimes people have more "medically" related advice. These helpful people know of an herb or a tea or a pill that will fix me up in no time. Or I often hear from people encouraging me to overhaul my diet, eliminate all the food groups I actually like and eat brussel sprouts for the rest of my days because brussel sprouts (ick) have healing infertility properties or whatever the case may be. I'm never going to deny that eating healthier would benefit me... I'm pretty sure it would benefit anyone. However, I really don't think tea and kale are the cure to our infertility issues. Maybe I'm wrong, but I just don't. It's not that I don't want to hear about the magical pouch of joo joo or the wonders of lima beans... really, I'm not hating on being healthy. I simply don't want to be bombarded with "try this" or "have you thought about this?" constantly. No one wants to be judged: the fact that I ate three quarters of a container of Ben & Jerry's Salter Caramel Core ice cream doesn't mean I don't want a baby bad enough... it means I just heard about a whole heck of a lot of babied made the old fashioned way.
The last category of people are, sadly, the ones for which I have the least patience. These are the well intentioned people who say things because they need to sound spiritual, or hate silence, want to be encouraging, etc. Phrases such as "give it to God," "pray about it," and "let God take control" just about push me over the edge these days. For the most part when someone shares advice like this in person, I try to steer the conversation elsewhere, and thus far, I have withheld my initial reaction which is to punch them in the face. If the comments come via Facebook, I contemplate deleting the person, but I typically just go eat a cookie. Here's the thing I wish I could get across; it's actually kind of Biblical: examine your own life with an equally fine toothed comb, before you make assumptions about someone else. I guarantee that we all have areas of our lives that we should pray about more or relinquish control of... that's the nature of being broken people with messy lives. But I would never point out another person's area... it's kind of the whole "plank in the eye" idea here. And again, the fact that someone assumes that Sam and I are not praying about our infertility or that we don't relinquish our hopes and dreams to the Lord, well, it's insulting. We should all just make this deal with one another: "I promise I won't point out your marriage problems, money issues, child rearing problems, medical issues, etc. and offer platitudes for solving all of YOUR problems, so I'd appreciate the same. Okay?" It's really that simple.
As I said, I'm 100% sure I used to be as guilty as the next person of offering "advice" in the name of helping. But once you have an area of your life where you regularly receive this type of aid, I guess you just grow more sensitive to it. It just gets old. There is one thing I've learned over the years and it's this: the thing about unsolicited advice, in all situations, is that it's all about the delivery of the advice. Believe me, I've had some friends and mentors sit me down over a yummy lunch or a nice cup of coffee and say some really hard things to me over the years. Things about not wasting my present season, things about loving my husband better, things about putting infertility treatments on hold until we got our finances in order... those things were HARD to hear. But it is so much easier to accept advice when it comes from someone willing to take the time to actually share why they feel that way.
If you REALLY think that your friend needs to try an herbal concoction, well take her to lunch, give her the tea, and tell her why you think it's awesome. Even if she thinks you're crazy, she can't fault you for caring enough to do all of that. That speaks love way more effectively than a comment on Facebook. In the same way, if you earnestly care about a friend, instead of offering a quick "let God take control," try a coffee date, and give her the opportunity to talk. You will have created much more fertile ground for your advice, and you can offer to pray for her rather than offer wisdom at her. I'm telling you, delivery makes all the difference.
In terms of infertility specifically, the internet is filled with blogs and websites that offer help if you're wondering what you should and should not say to your infertile friend or family. I myself did one way back when... check it out if you need some helpful hints on what to say when there are no words. There are a lot of things that should just not be said because they are really never, ever helpful. But there are a lot of things that exist in a more gray area, and it's all about the way you deliver it. I imagine that this principle can be extrapolated into pretty much any area. Mothers everywhere are nodding their heads as they remember the "advice" from the well-meaning neighbor who just had to share about the dangers of some toy she saw in the yard the other day. Delivery is everything people... if it's a burning need down deep in your soul to help, find an appropriate way to deliver your advice.Your relationships will be better for it.
Now I (obviously) don't deal with advice about Pampers vs cloth diapers, or sleep training, or temper tantrums, but unfortunately I often deal with unsolicited advice in terms of infertility. And the strange thing is that 99% of the time, I know it's from people who mean well and actually love us. Unfortunately, that's not always how it comes across. I wish people could hear their comments through my ears; hear what I hear.
There are always my favorite pieces of advice, the old standbys such as "just relax," "take a vacation," or "just adopt; you'll be pregnant in no time." I'd like to take this moment and share a little public service announcement if I may. If your advice begins with "just," keep it to yourself. There is nothing simple about infertility, and the fact that some people think they can simplify it and solve it with "just ______" is not only frustrating, it's insulting. Think about it from this perspective: Imagine you own your own business, and you're in the red for the third quarter in a row. If a friend says "just relax," does that feel helpful? And as to a vacation... have mercy. I'm certainly willing to take anyone's advice if they are paying, but unfortunately we spent almost 40% of our income last year on medical expenses. That doesn't leave a lot of room for Cancun or Vail. Sad trombones. And as for the weird wives' tale that adoption leads to a pregnancy... goodness, don't get me started. If that was really my intention, if the only reason I pursued adoption was so that I'd get pregnant, wow, let's just sum that up in one word: TERRIBLE. That is horrible advice, and I'd be a horrible person if I took it. Agreed?
Sometimes people have more "medically" related advice. These helpful people know of an herb or a tea or a pill that will fix me up in no time. Or I often hear from people encouraging me to overhaul my diet, eliminate all the food groups I actually like and eat brussel sprouts for the rest of my days because brussel sprouts (ick) have healing infertility properties or whatever the case may be. I'm never going to deny that eating healthier would benefit me... I'm pretty sure it would benefit anyone. However, I really don't think tea and kale are the cure to our infertility issues. Maybe I'm wrong, but I just don't. It's not that I don't want to hear about the magical pouch of joo joo or the wonders of lima beans... really, I'm not hating on being healthy. I simply don't want to be bombarded with "try this" or "have you thought about this?" constantly. No one wants to be judged: the fact that I ate three quarters of a container of Ben & Jerry's Salter Caramel Core ice cream doesn't mean I don't want a baby bad enough... it means I just heard about a whole heck of a lot of babied made the old fashioned way.
The last category of people are, sadly, the ones for which I have the least patience. These are the well intentioned people who say things because they need to sound spiritual, or hate silence, want to be encouraging, etc. Phrases such as "give it to God," "pray about it," and "let God take control" just about push me over the edge these days. For the most part when someone shares advice like this in person, I try to steer the conversation elsewhere, and thus far, I have withheld my initial reaction which is to punch them in the face. If the comments come via Facebook, I contemplate deleting the person, but I typically just go eat a cookie. Here's the thing I wish I could get across; it's actually kind of Biblical: examine your own life with an equally fine toothed comb, before you make assumptions about someone else. I guarantee that we all have areas of our lives that we should pray about more or relinquish control of... that's the nature of being broken people with messy lives. But I would never point out another person's area... it's kind of the whole "plank in the eye" idea here. And again, the fact that someone assumes that Sam and I are not praying about our infertility or that we don't relinquish our hopes and dreams to the Lord, well, it's insulting. We should all just make this deal with one another: "I promise I won't point out your marriage problems, money issues, child rearing problems, medical issues, etc. and offer platitudes for solving all of YOUR problems, so I'd appreciate the same. Okay?" It's really that simple.
As I said, I'm 100% sure I used to be as guilty as the next person of offering "advice" in the name of helping. But once you have an area of your life where you regularly receive this type of aid, I guess you just grow more sensitive to it. It just gets old. There is one thing I've learned over the years and it's this: the thing about unsolicited advice, in all situations, is that it's all about the delivery of the advice. Believe me, I've had some friends and mentors sit me down over a yummy lunch or a nice cup of coffee and say some really hard things to me over the years. Things about not wasting my present season, things about loving my husband better, things about putting infertility treatments on hold until we got our finances in order... those things were HARD to hear. But it is so much easier to accept advice when it comes from someone willing to take the time to actually share why they feel that way.
If you REALLY think that your friend needs to try an herbal concoction, well take her to lunch, give her the tea, and tell her why you think it's awesome. Even if she thinks you're crazy, she can't fault you for caring enough to do all of that. That speaks love way more effectively than a comment on Facebook. In the same way, if you earnestly care about a friend, instead of offering a quick "let God take control," try a coffee date, and give her the opportunity to talk. You will have created much more fertile ground for your advice, and you can offer to pray for her rather than offer wisdom at her. I'm telling you, delivery makes all the difference.
In terms of infertility specifically, the internet is filled with blogs and websites that offer help if you're wondering what you should and should not say to your infertile friend or family. I myself did one way back when... check it out if you need some helpful hints on what to say when there are no words. There are a lot of things that should just not be said because they are really never, ever helpful. But there are a lot of things that exist in a more gray area, and it's all about the way you deliver it. I imagine that this principle can be extrapolated into pretty much any area. Mothers everywhere are nodding their heads as they remember the "advice" from the well-meaning neighbor who just had to share about the dangers of some toy she saw in the yard the other day. Delivery is everything people... if it's a burning need down deep in your soul to help, find an appropriate way to deliver your advice.Your relationships will be better for it.
Tuesday, March 4, 2014
On the Calendar
Well, it appears that IVF somehow brought my body as close to "normal" in terms of cycle length as I've ever been… strange. January's post-failed IVF cycle was 28 days. That never happens. I was expecting to start some time this week, but instead I started last Thursday night. My nurse said to call Friday CD 1 though as I needed to start Estradiol on the first day. So it's official, I'm less than two weeks away from a Frozen Embryo Transfer. Odd. After all the fuss with IVF, an FET feels pretty boring.
We're still not 100% sure exactly what we're doing with the embryos, growing all six to day 5, or transferring the best two on day 3. If I had to say today, we're transferring an 8 cell and a 9 cell embryo on day 3. My doctor really hasn't given much direction on this, but based on the comments from the IVF Nurse Coordinator, this seems like the wisest route. Basically she said if we really want to transfer something, it's our best bet as the doctor isn't sure that we'd even get a blast if we grew all six to day 5. Talk about a confidence booster.
Which pretty much sums up my feelings on the subject… I'm in need of a major confident boost. I know that there's a chance of success, and I know that once they transfer the embryos, I will have glimmers of hope no matter what, but going into this, I just can't really scrounge up a lot of "this is it" and "it's our time" type feelings. This feels more like the next step we have to take before we can move on to whatever the next, next step is. It essentially feels like a waste of money, time, and energy, but I simply can't discard or even leave those embryos behind. I said I'd give them all a chance and I feel required to do just that. So that's what we're going to do: we're going to give our next best two embryos, both graded 3 due to fragmentation of cells, a chance.
In the mean time, I don't know if I should feel pleased that I'm cool, calm, and unconcerned because this big weight of hope is missing or if I should feel terrible for a lack of faith, both in my God and my babies. I mean I fully believe that He can show up and do mighty things to bring one or both of these embryos home to me, I'm just not so sure that He will. If that's a lack of faith, well then call it what it is, but that's where I sit. I fully believe that Jesus can do ANYTHING, I'm just not sure if He'll choose to do the ONE THING I'm asking.
In the mean time though, I've racked my brain for hours trying to think of some success stories from day 3 grade 3 embryos… this is the time when you can tell me all those "my brother's fiancé's sister's best friend" stories. Really, lay them on me. I can't seem to really even find all that many ladies in my community with day 3 embryos… there are a few, but the grades are better. And that's kind of where my head is these days. I hear a success story, but then immediately think, "but she had day 5 embryos, and the doctor doesn't think mine will even make it to day 5, let alone the nursery". Or I'll read a story of a positive beta from day 3 embryos, but then my mind goes to, "but she had grade 1 or 2 embryos… they were pretty much perfect". When I call the clinic, even the nurses are always shocked to read the file that says day 3 embryos. "Oh, I just assumed you'd have blasts, honey; you're so young," they say, "I'm sorry." Yeah, me too lady, me too.
So that's where we are. I'm doing a lining and estrogen level check locally next Wednesday. If everything looks good, Sam and I will head to Jacksonville Saturday for a Sunday morning transfer. My protocol seems really wimpy and pathetic next to everyone else's extensive list of medications for an FET, so I'm just hoping that these teeny little blue pills are, in fact, doing something fabulous with my lining.
Send me your success stories friends! The FET is on the calendar for March 16th. I've got 12 days to get my head on straight regarding this transfer.
We're still not 100% sure exactly what we're doing with the embryos, growing all six to day 5, or transferring the best two on day 3. If I had to say today, we're transferring an 8 cell and a 9 cell embryo on day 3. My doctor really hasn't given much direction on this, but based on the comments from the IVF Nurse Coordinator, this seems like the wisest route. Basically she said if we really want to transfer something, it's our best bet as the doctor isn't sure that we'd even get a blast if we grew all six to day 5. Talk about a confidence booster.
Which pretty much sums up my feelings on the subject… I'm in need of a major confident boost. I know that there's a chance of success, and I know that once they transfer the embryos, I will have glimmers of hope no matter what, but going into this, I just can't really scrounge up a lot of "this is it" and "it's our time" type feelings. This feels more like the next step we have to take before we can move on to whatever the next, next step is. It essentially feels like a waste of money, time, and energy, but I simply can't discard or even leave those embryos behind. I said I'd give them all a chance and I feel required to do just that. So that's what we're going to do: we're going to give our next best two embryos, both graded 3 due to fragmentation of cells, a chance.
In the mean time, I don't know if I should feel pleased that I'm cool, calm, and unconcerned because this big weight of hope is missing or if I should feel terrible for a lack of faith, both in my God and my babies. I mean I fully believe that He can show up and do mighty things to bring one or both of these embryos home to me, I'm just not so sure that He will. If that's a lack of faith, well then call it what it is, but that's where I sit. I fully believe that Jesus can do ANYTHING, I'm just not sure if He'll choose to do the ONE THING I'm asking.
In the mean time though, I've racked my brain for hours trying to think of some success stories from day 3 grade 3 embryos… this is the time when you can tell me all those "my brother's fiancé's sister's best friend" stories. Really, lay them on me. I can't seem to really even find all that many ladies in my community with day 3 embryos… there are a few, but the grades are better. And that's kind of where my head is these days. I hear a success story, but then immediately think, "but she had day 5 embryos, and the doctor doesn't think mine will even make it to day 5, let alone the nursery". Or I'll read a story of a positive beta from day 3 embryos, but then my mind goes to, "but she had grade 1 or 2 embryos… they were pretty much perfect". When I call the clinic, even the nurses are always shocked to read the file that says day 3 embryos. "Oh, I just assumed you'd have blasts, honey; you're so young," they say, "I'm sorry." Yeah, me too lady, me too.
So that's where we are. I'm doing a lining and estrogen level check locally next Wednesday. If everything looks good, Sam and I will head to Jacksonville Saturday for a Sunday morning transfer. My protocol seems really wimpy and pathetic next to everyone else's extensive list of medications for an FET, so I'm just hoping that these teeny little blue pills are, in fact, doing something fabulous with my lining.
Send me your success stories friends! The FET is on the calendar for March 16th. I've got 12 days to get my head on straight regarding this transfer.
Monday, March 3, 2014
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:
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.
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.
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%. |
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. |
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.
Friday, February 28, 2014
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.
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:
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?
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!
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 |
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 |
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!
Tuesday, February 25, 2014
The October Baby
I never talked about this on the blog leading up to or during IVF because it was just silly... it's still silly. I try not too read to much into signs (maybe for this very reason), but sometimes things just feel meant to be. Anybody else out there feel this way? IVF in January was one of those things for me. You see, a mid to late January transfer would yield an October due date. Even more specific than that, an October due date before my own birthday.
Why on earth does any of this matter? Well obviously it doesn't really, but for a moment, you have to step into my strange logic where this kind of stuff does matter. Maybe a little background will help you to better understand:
Our IVF baby would have snuck right in with an October 2, 1014 due date (or so the handy dandy calculators tell me). More specifically, the October part seemed even more meant to be because October is a BIG DEAL around here. Apart from it being my favorite month, favorite season, and my own birthday month, it's also Sam's birthday month and my mom's. I can't really explain how or why exactly something that simple (and silly) made an October due date seem so appropriate, but it did. I was desperate to start IVF in December or January rather than February or March, not because one more month really made that much difference, but rather because once I had calculated and actually seen that early October due date, it just seemed too perfect. It somehow felt like the stars were aligning, and if I could just get that transfer to occur in the right window of time, all would be okay.
It was obviously not okay. Not okay at all. And now every time someone posts on Facebook or tells me that they have an October due date, I kind of cringe (i.e. wish I could stab my eyes out/rip my ears off). I fully recognize that all of this is silly. If we are blessed with a pregnancy from our upcoming FET, the due date would be somewhere around December I'm guessing. To pre-infertility Amanda, a December birthday seemed like a crime... "why would you do that to your kid? Ughhh, Christmas and birthday in the same month and then NOTHING for the next eleven?!?" To infertile Amanda, a December baby is amazing and a miracle and the greatest thing ever... that kid could come on Christmas day and I wouldn't care. Yet somehow, despite recognizing and admitting that this is all so silly, the loss of that October baby, it stings. I can't really explain it anymore than that it just seemed meant to be... but it wasn't.
Why on earth does any of this matter? Well obviously it doesn't really, but for a moment, you have to step into my strange logic where this kind of stuff does matter. Maybe a little background will help you to better understand:
I distinctly remember being in college, head over heels about Sam, and planning out our future in an art history course (yawn). The key to success hinged on spacing all five of our children out appropriately. But I couldn't simply start two years after the wedding with baby number one. No, no. I had a deadline...29.Why 29 exactly? I don't really know other than that's how old my mom was when she had me. I guess as a kid, I always felt like my mom was kind of an older mom (don't laugh). I wanted to be a young, hip, fun mom, so I arbitrarily decided that if she stopped having babies at 29, I would too. Now of course, the dream has changed. Mathematically there hasn't been a way for us to have five babies before I turn 29 for quite a while, but somehow that date, that year still meant something. For some reason, I still hung on to the age 29... It just changed to: have A baby by 29.
Our IVF baby would have snuck right in with an October 2, 1014 due date (or so the handy dandy calculators tell me). More specifically, the October part seemed even more meant to be because October is a BIG DEAL around here. Apart from it being my favorite month, favorite season, and my own birthday month, it's also Sam's birthday month and my mom's. I can't really explain how or why exactly something that simple (and silly) made an October due date seem so appropriate, but it did. I was desperate to start IVF in December or January rather than February or March, not because one more month really made that much difference, but rather because once I had calculated and actually seen that early October due date, it just seemed too perfect. It somehow felt like the stars were aligning, and if I could just get that transfer to occur in the right window of time, all would be okay.
It was obviously not okay. Not okay at all. And now every time someone posts on Facebook or tells me that they have an October due date, I kind of cringe (i.e. wish I could stab my eyes out/rip my ears off). I fully recognize that all of this is silly. If we are blessed with a pregnancy from our upcoming FET, the due date would be somewhere around December I'm guessing. To pre-infertility Amanda, a December birthday seemed like a crime... "why would you do that to your kid? Ughhh, Christmas and birthday in the same month and then NOTHING for the next eleven?!?" To infertile Amanda, a December baby is amazing and a miracle and the greatest thing ever... that kid could come on Christmas day and I wouldn't care. Yet somehow, despite recognizing and admitting that this is all so silly, the loss of that October baby, it stings. I can't really explain it anymore than that it just seemed meant to be... but it wasn't.
Saturday, February 22, 2014
Finding "The One"
How about we chat about something other than my uterus and the lack of habitation going on inside, shall we? It seems to me now that we're a week past Valentine's Day that we've arrived at a perfectly opportune time to talk about marriage. (You see it's opportune now, on a random Saturday in February to discuss because, well, because chatting about love and marriage should have zero to do with the date on the calendar... end rant.)
My church is finishing up my favorite series that Andy Stanley has ever done. If you haven't watched it, you should do yourself a favor and go watch all four sermons... they're that good. I first heard this series several years ago when Sam and I were engaged. I, like a lot of women (I like to think), was having a wee crisis of conscience. I knew that I loved this man I was betrothed to. I knew that he was absolutely, without a doubt my best friend. But I also knew that we both came from divorced families and that statistically the odds were even less in our favor than the average couple. And lets be honest, the odds of a happy ever after where you both grow old, and hold hands sippin' lemonade on the front porch are not that hot. It sucks, but they're just not. But our society and just about everyone who has been divorced will tell you that the reason for the divorce is that he/she was the "wrong one." So as my very own wedding approached I had this "how do I know if he's the one?" dilemma and I'm guessing I'm not the only one. In fact, thanks to this girl's very candid post about the moment she said I do, I know for a fact that I'm not the only one.
The Andy Stanley series, Staying in Love, allowed me to take a huge, deep sigh of relief. Strangely enough, it was the first time that I had heard a pastor discuss marriage and finding a spouse in terms of choosing someone and then deciding to make he/she "the one." All my life, I'd heard pastors, youth group leaders, Sunday school teachers, etc say that God would bring "the one," this perfect person that God created just for me into my life if I was just really, really patient. As we all know, patience is not my virtue. I naturally wondered how to know if I was actually ready or if I was hitching my wagon prematurely... was Mr. 100% perfect for me still out there?
Here's the thing: Sam is not perfect, and he's not perfect for me. I love him to pieces and I don't think he's the wrong one, but he's not perfect. And here's another thing: I'm not either. I'm not perfect and I'm not perfect for Sam. There are lots of areas in which we compliment each other: we like to laugh, we're both witty (one of us is a little more snarky, I'll let you guess who), we enjoy watching sports, binging on good TV, and we love to eat fabulous food. There are lots of reasons why I enjoy Sam and love him to death, but he's not a perfect man created just for me to compliment me exactly. I enjoy reading for hours... Sam doesn't read, ever, for anything. I can lie on the beach all day... Sam can last about 20 minutes before he gets antsy. I can easily save money for big things... Sam would rather spend his money on smaller, more frequent purchases. There are a lot of places that we bump heads... some are no big deal (you go swim in the ocean now, babe. I'll stay here.) and others are not so easy to tackle. I, like most girls, had my list of "criteria" that had to be met before I'd say I do… well guess what? Sam doesn't meet all of that. He got the tall and handsome part, but he's as white as they come… turns into a lobster at the beach. And there are things about Sam that I love, that I never knew to even put on the list. And I seriously doubt that if Sam had been the kind of guy to make a list, that I would have met all of his criteria (unless of course, it began and ended with: looks good in shorts). Regardless, my point is simply that we are not perfect for each other. But I'm still so thankful that I married him!
This notion of a perfect person, a soul mate, a partner specifically selected to match me exactly, kind of gets on my nerves.... and it gave me fits and anxiety attacks before I finally bit the bullet and said "you're the one." And sadly I think the church is just as guilty of perpetuating this myth as Hollywood. Movies and books and reality TV tell us that we'll know he/she is the one based on how we feel. But if those feelings go away... whoops! we chose poorly. Try, try again. We simply leave the "wrong one" in search of the "right one," or better yet, the "new 'the one'." Anyone who has been in a relationship long enough should be able to admit that this is bad logic... the feelings that come with the start of a relationship don't naturally continue. This is not Newton's First Law of Physics we're talking about... feelings of love, adoration, and butterflies in the stomach don't continue on without work. No, we're up against the Second Law of Thermodynamics, work is required to prevent the relationship from naturally moving towards chaos. I know, ultra bummer. How much nicer would it be if relationships required zero effort to continue and all the lovey-dovey feelings just multiplied exponentially? The truth is that when I said I do, I promised to make Sam my "one" and vice versa.
Unfortunately, this idea of waiting for Mr. Right is causing more and more women to wait later and later to get married (I don't think I need to explain the danger here, do I?). Now don't get me wrong, I get that some people simply don't want to get married, or don't find someone to marry until later in life. But statistics show a general trend of women (and men) waiting to marry later in life. And yes, I recognize that part of this is that additional schooling is now almost a requirement to survive in this society. But we have to admit that part of this change is simply a generational shift in how we view marriage. Now, if divorce rates were on a rapid decline, I might pause and question whether waiting later to marry might help, but unfortunately, Christian or non-Christian, young or old, divorce rates are awful. My point here is simply this: 22 or 28, 32 or 38, when you marry should have everything to do with feeling ready to commit to the partner for life. It shouldn't be delayed while you search for Mr. Right… he's not coming. Look at it this way: if you aren't married, and you're waiting for your person, your match made in heaven, would that someone look at you and call you perfect? If not, then I don't think it's fair to expect the man or woman you're looking for to be either. And if you are married, I'd challenge you to start thinking of your spouse as "the one," not because he/she is so perfect, not because she completes you, and not because he checks all the boxes, but rather because your wedding vows probably said something to the effect of "forsaking all others… till death do you part."
My church is finishing up my favorite series that Andy Stanley has ever done. If you haven't watched it, you should do yourself a favor and go watch all four sermons... they're that good. I first heard this series several years ago when Sam and I were engaged. I, like a lot of women (I like to think), was having a wee crisis of conscience. I knew that I loved this man I was betrothed to. I knew that he was absolutely, without a doubt my best friend. But I also knew that we both came from divorced families and that statistically the odds were even less in our favor than the average couple. And lets be honest, the odds of a happy ever after where you both grow old, and hold hands sippin' lemonade on the front porch are not that hot. It sucks, but they're just not. But our society and just about everyone who has been divorced will tell you that the reason for the divorce is that he/she was the "wrong one." So as my very own wedding approached I had this "how do I know if he's the one?" dilemma and I'm guessing I'm not the only one. In fact, thanks to this girl's very candid post about the moment she said I do, I know for a fact that I'm not the only one.
The Andy Stanley series, Staying in Love, allowed me to take a huge, deep sigh of relief. Strangely enough, it was the first time that I had heard a pastor discuss marriage and finding a spouse in terms of choosing someone and then deciding to make he/she "the one." All my life, I'd heard pastors, youth group leaders, Sunday school teachers, etc say that God would bring "the one," this perfect person that God created just for me into my life if I was just really, really patient. As we all know, patience is not my virtue. I naturally wondered how to know if I was actually ready or if I was hitching my wagon prematurely... was Mr. 100% perfect for me still out there?
Here's the thing: Sam is not perfect, and he's not perfect for me. I love him to pieces and I don't think he's the wrong one, but he's not perfect. And here's another thing: I'm not either. I'm not perfect and I'm not perfect for Sam. There are lots of areas in which we compliment each other: we like to laugh, we're both witty (one of us is a little more snarky, I'll let you guess who), we enjoy watching sports, binging on good TV, and we love to eat fabulous food. There are lots of reasons why I enjoy Sam and love him to death, but he's not a perfect man created just for me to compliment me exactly. I enjoy reading for hours... Sam doesn't read, ever, for anything. I can lie on the beach all day... Sam can last about 20 minutes before he gets antsy. I can easily save money for big things... Sam would rather spend his money on smaller, more frequent purchases. There are a lot of places that we bump heads... some are no big deal (you go swim in the ocean now, babe. I'll stay here.) and others are not so easy to tackle. I, like most girls, had my list of "criteria" that had to be met before I'd say I do… well guess what? Sam doesn't meet all of that. He got the tall and handsome part, but he's as white as they come… turns into a lobster at the beach. And there are things about Sam that I love, that I never knew to even put on the list. And I seriously doubt that if Sam had been the kind of guy to make a list, that I would have met all of his criteria (unless of course, it began and ended with: looks good in shorts). Regardless, my point is simply that we are not perfect for each other. But I'm still so thankful that I married him!
This notion of a perfect person, a soul mate, a partner specifically selected to match me exactly, kind of gets on my nerves.... and it gave me fits and anxiety attacks before I finally bit the bullet and said "you're the one." And sadly I think the church is just as guilty of perpetuating this myth as Hollywood. Movies and books and reality TV tell us that we'll know he/she is the one based on how we feel. But if those feelings go away... whoops! we chose poorly. Try, try again. We simply leave the "wrong one" in search of the "right one," or better yet, the "new 'the one'." Anyone who has been in a relationship long enough should be able to admit that this is bad logic... the feelings that come with the start of a relationship don't naturally continue. This is not Newton's First Law of Physics we're talking about... feelings of love, adoration, and butterflies in the stomach don't continue on without work. No, we're up against the Second Law of Thermodynamics, work is required to prevent the relationship from naturally moving towards chaos. I know, ultra bummer. How much nicer would it be if relationships required zero effort to continue and all the lovey-dovey feelings just multiplied exponentially? The truth is that when I said I do, I promised to make Sam my "one" and vice versa.
Unfortunately, this idea of waiting for Mr. Right is causing more and more women to wait later and later to get married (I don't think I need to explain the danger here, do I?). Now don't get me wrong, I get that some people simply don't want to get married, or don't find someone to marry until later in life. But statistics show a general trend of women (and men) waiting to marry later in life. And yes, I recognize that part of this is that additional schooling is now almost a requirement to survive in this society. But we have to admit that part of this change is simply a generational shift in how we view marriage. Now, if divorce rates were on a rapid decline, I might pause and question whether waiting later to marry might help, but unfortunately, Christian or non-Christian, young or old, divorce rates are awful. My point here is simply this: 22 or 28, 32 or 38, when you marry should have everything to do with feeling ready to commit to the partner for life. It shouldn't be delayed while you search for Mr. Right… he's not coming. Look at it this way: if you aren't married, and you're waiting for your person, your match made in heaven, would that someone look at you and call you perfect? If not, then I don't think it's fair to expect the man or woman you're looking for to be either. And if you are married, I'd challenge you to start thinking of your spouse as "the one," not because he/she is so perfect, not because she completes you, and not because he checks all the boxes, but rather because your wedding vows probably said something to the effect of "forsaking all others… till death do you part."
I don't for one minute feel like I've got this marriage thing all worked out. And I also don't believe I can judge why anyone would seek a divorce... believe me, I've had my reasons for endorsing divorce in the past, so if that's you, you'll find no judgment here. I know that marriage is not simply sunshine and roses, but I guess that's my point. Marriage isn't going to be perfect no matter who you marry. We are broken people with issues, baggage, learned behaviors, and all of that means conflict is inevitable. So my advice to anyone waiting to marry would be this: choose wisely for sure, but recognize that it's a choice, not manna from heaven. And no matter who you choose or when you choose, know that marriage takes work. For those of us who are married: my advice (to myself included) would be to be willingly to do the hard work required. Marriage can be beautiful and amazing... I'm so thankful for mine, not because it's perfect, but because I have a partner who is for me, and together we get to walk through life. There's really no greater gift.
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