Mosaic Embryos for the Win!

14 Wednesday Jul 2021

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Admittingly, it’s been a while since I’ve written here. My life has been filled with family, work, chaos, peace, and all the things life brings. I am grateful. I also want to occasionally run away screaming. But that’s normal, right? With two littles, and a husband starting up a new business, there’s never a dull moment. And I’m good with that (although I could use a few more ritual baths and date nights).

What caught my attention today is a new article from Embryoman. Side note: if you aren’t following him, you should be. He is a former embryologist who writes about the latest and greatest in infertility treatment technology from a scientific perspective. He has a knack for breaking down research papers, data, and outcomes with flair for everyone to understand. I appreciate his writing style and objective perspective. You can sign up for his free newsletter here, if you are so inclined, which is packed with accessible summaries of the most current infertility research. It really appeals to my research heart.

Back to the article in question. The headline read: No difference in euploid and mosaic embryo transfers! What’s that you say?! A recent study, that is pending publication, compares outcomes from transfers with euploid embryos (those are the “PSG normal” embryos you’ve heard so much about at the RE’s office and online support groups) versus mosaic embryos. Mosaic embryos are embryos where some of the biopsied cells come back “normal” and others are “abnormal” (meaning they have missing or duplicate chromosomes or parts of those). So there’s a mix of cells in the biopsy taken from the embryo, which leads doc’s to assume that the whole embryo is a mixed bag. Some mosaic embryos have a higher percentage of mosaicism, meaning that there are more abnormal cells present in the mix, and others have a lower percentage of mosaicism.

There’s been a lot of controversy surrounding mosaic embryos and PGS testing in and of itself. I must confess that I no longer have my finger on the current pulse of what common transfer practices are when it comes to PGS tested embryos. My most recent IVF baby is 2.5 years old (*gasp*) and I know how fast things change in the IVF world. When I was doing IVF, PGS testing was the norm, and, sadly, so was discarding PSG abnormal and mosaic embryos. I dove into every PSG-related article and study that I could find. I slowly came to the conclusion that PGS testing wasn’t right for me. I appreciated what PGS was trying to do, but I didn’t think that the science behind it adequately supported the treatment decisions that were being made. There was just too much they didn’t know. To ready more about my experience, the data I reviewed, and how I came to the decision that was right for me, check out this post. You can also read about how I ended up transferring an untested embryo and an abnormal embryo (*gasp again*) here and here, and the unexpected outcome of that transfer here.

Now back to that article. Embryoman explained that most of the studies that had been done previously looked at mosaic transfers after failed PGS normal transfers. The RE’s knew the PSG results of the embryos they were transferring, and when the mosaic’s failed, it was attributed to this flaw in chromosomes. But they were comparing PGS normal transfers (let’s call this group 1)  versus mosaic transfers after already having a failed PGS normal transfer (group 2). I’ve always said that the devil is in the interpretation when it comes to study results. It’s simply incorrect to attribute the failed mosaic transfer in group 2 to mosaicism with this study design. An alternative explanation is that there is a 3rd factor causing both the normal and mosaic transfers to fail in group 2 (remember the women had failed transfers with normal embryos before participating in those studies). So there may be something else going on that causes these women in group 2 to not have a successful pregnancy regardless of the PGS results of the embryo transferred.

In this new study, the RE’s transferred PGS normal and mosaic embryos without knowing which were which. This is called a blind study and reduces bias. It also means that they weren’t just transferring mosaic embryos to women who already failed with PGS normal embryos. The playing field was leveled. And the results are a big deal.

They found that there was no difference between the PGS normal group versus mosaic group in miscarriage or pregnancy rates, live birth rates, or prenatal outcomes. And if your jaw hasn’t dropped yet, they also found no difference between the groups when they further compared embryos with low (20-30%) or moderate (30-50%) mosaicism with the PGS normals. And of the babies born from mosaic embryos, none had any mosaic related abnormalities. Yes, that is a big, big deal.

Why is it such a big deal? Because for quite some time, and maybe still in some clinics, mosaic embryos were not transferred for fear of having a miscarriage or baby born with a disability. It’s a big deal because I know there are women out there who were told they would not be allowed to transfer mosaic embryos. There are women out there who, due to earlier testing methods, were only told that their embryo was either normal or abnormal, with mosaic embryos considered abnormal and cast aside. There are women who reached the end of their finances, emotional rope, or whatever the line may have been, who did not get to transfer embryos that could have brought them that baby they wanted so very badly with all their hearts. And for those women, I hold space. My heart breaks for them.   

For the women still in the trenches, I hope that this post gives you food for thought. Knowledge is power, and when it comes to infertility treatment we really do need to be our own best advocate. As I mentioned, I no longer know what is the most common practice in fertility clinics when it comes to PGS testing and transfers; and I know that in many medical fields, clinical practice tends to lag quite a bit behind scientific findings. But knowing that this research is currently being done gives me hope. Hope that clinics are keeping up to date on cutting edge research. Hope that they adjust their practices to be in line with new findings and recommendations. Hope that more women will have more chances with more embryos. Hope that you find you happy ending, whatever that may look like you for.

Building a Village

25 Tuesday Feb 2020

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sydney-rae-geM5lzDj4Iw-unsplashInfertility can be a very lonely place. Getting the right kind of support at the right time can make a world of difference when you feel like you are drowning in it. What is the right kind of support?

Sometimes it’s a kind friend who just listens, even if she has never been in the same situation.  Sometimes it’s a partner who holds you while you cry on their shoulder. Sometimes it’s a group of friends who distract you with a fun night out and never say a word about fertility or the lack thereof. Sometimes it’s a group of women on social media that you’ve never met in real life, but they understand the pain of another failed transfer like no one else in your life can.

Sometimes we need to vent, to feel understood, or to get advice from someone with shared experience. Sometimes we need someone brave enough to sit with us in our sadness without saying a word. Sometimes we need someone who can ask the hard questions. At different times we need different things. And the reality is, we need different people for these different things. Expecting one person to fulfill all our support needs is setting us (and them) up for failure. Why? Because each person brings a unique set of skills and life experiences to the table. And that’s fine, because we have lots of options out there to build our support system.

You may have family and friends that serve certain rolls in your support arsenal. That face-to-face contact is vital. Then there are online communities for solidarity and shared experience. These can be even more helpful when you find groups that are facing similar challenges as you, whether than be diagnostic issues or age-specific groups. I can’t tell you how much I learned from an IVF group for women 40 years and older. I’ve even developed friendships with women that I’ve met in these groups that have endured past IVF outcomes and births.

Through the process of it all, I found a couple more resources to add to my team; and I want to share those with you because it look me longer to find them and they can serve different roles than the rest.

The first is Fruitful Fertility. Fruitful Fertility is a unique mentorship program. It matches people who are experiencing infertility with “mentors” who have been there done that.  It’s free to join, and you submit information about your background, experiences, and values. Then they match you with a mentor based on a variety of factors, which could include age, diagnosis, primary vs. secondary infertility, treatments, geographic location, or other information. You’ll receive an email or notification in the app when you have been “matched” along with info about the other person and preferred way to contact (e.g., email, text). I like Fruitful Fertility because it takes the invaluable support you can get from someone who has shared experiences and facilitates a more personal one-on-one relationship, which is often lacking in online support communities. I didn’t find Fruitful Fertility until I was at the end of my IVF journey. So I became a mentor and have had the honor of working with four mentees over the past two years. Sometimes online infertility groups can become overwhelming. Fruitful Fertility helps you connect with someone similar to you, without all the distractions or drama.

 

The second resource I’d like to share is an app called Fertility Answers created by MedAnswers, Inc.This app gives you free access to fertility specialists. You can submit anonymous questions privately that will be answered by specialists in a variety of fertility-related disciplines, including RE’s, embryologists, psychologists, genetic counselors, acupuncturists, pharmacists and more. Got diet and nutrition questions – there’s an expert for that. Got questions about egg quality – there’s an expert for that. Need help with stress related to infertility – there’s an expert for that. It’s a great way to get a second, third, or even fourth (because let’s face it, we want all the info we can get) opinion on any of your fertility related questions. You can even schedule phone or in-person consultations with an expert that you connect with. I like the convenience of submitting private questions anytime, anywhere and getting knowledgeable responses. One of the things I found pretty amazing about Fertility Answers is that the app is the brain child of Alice Crisci, who is a cancer survivor and fertility activist. Through her hard work, entrepreneurship, and her own personal experience with fertility challenges, she created has created a one of a kind resource to support you in your journey. I’m passionate about infertility advocacy and as a way to give back to the community that provided me with so much support when I needed it, I volunteer as a psychologist for Fertility Answers.

If you’re interested in expanding your support team, I hope you check out Fruitful Fertility and Fertility Answers. We all need a village!

 

Life After IVF: 1 year after birth

13 Monday Jan 2020

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My second, and last, IVF baby turns one year old this week. And I’m feeling all the feels. It’s been a whirlwind of diaper changes, marathon nursing sessions, little sleep, cries, smiles, and firsts. I stare at my baby and my heart overflows with love. And as most say, I can’t believe it’s already been a year. Where has the time gone?

For once, my time has not gone to injections, doctor appointments, acupuncture sessions, or healing from surgeries and egg retrievals. Not once have I researched fertility supplements, ERA test implications,  methods for managing inflammation, or the merits and risks of PGS testing. I have not ordered, mixed, or recycled any medications or related paraphernalia. I have not lost sleep, nor daytime hours, to the all-consuming anxiety of pinning over the welfare of my embryos. I have not missed or rescheduled work meetings, or pretended that I knew what someone was saying when my mind was so very far away. I have not touched a pregnancy test.

My stomach and rear are free from bruises. My mornings do not involve intimate moments with an ultrasound wand and paper sheet. When I cry,  it’s from feeling overwhelmed in the moment – not from feeling like my heart has been ripped out of my chest once again. I think there are even whole days that go by where I don’t think about IVF even once.

How strange this is, given how much IVF used to consume my entire being?

So while I navigate being a mom of two littles, I’m also forging a new me. I know how lucky I am to be on the other side of IVF with two healthy daughters. So many don’t get here and my heart aches for them. Still, there is no denying how much my experience with infertility has changed me. I know I’m not the same person who decided to start trying for a baby nine years ago. And sure, who really is the same that they were almost a decade ago, infertility or not? But infertility took a spontaneous, fun-loving, spirited, energetic, somewhat naïve, newly minted Ph.D. graduate and changed the course of her path 180 degrees.

Now, I am more calculating, cautious, introverted, and serious. I have fewer friends. I miss parts of me that I’ve lost along the way, the parts that used to laugh more. I’m also braver, stronger, and a better advocate for myself. I know more about reproduction and the conditions that impact fertility than I ever thought I would. Likely more than my OB/GYN. I know I can handle more than I ever thought I could. I can ask for help, and I can help myself.

While the trauma of infertility is dulled now, having left most of it in the past, a touch of it lingers on. It will always be a part of who I am now. And that’s not necessarily a bad thing. Again, I know I’m one of the lucky ones that found the golden egg. Twice. And that also colors my perspective. So for me, I will always identify as “infertile with kids,” which I know will sound strange to many. But to those of us who have walked this path, we understand.

Happy birthday little one, from your Mom who loves you with her whole heart.

 

Fact or Fiction: The Truth About Getting Pregnant in Your 40’s and Beyond

26 Thursday Sep 2019

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When I went back to my trusty IVF clinic just months before my 40th birthday in pursuit of IVF baby #2, I didn’t realize how much harder it was going to be to find the golden egg. I had some vague notion that eggs get “worse” with age, but didn’t really know what that meant. No one was really talking about it.

In this guest post, Heidi Hayes dives into some of the myths and facts surrounding fertility in our 40’s. Heidi is the Executive Vice President of California Cryobank’s Donor Egg Bank. She has more than 20 years of healthcare experience and has worked extensively in the field of reproductive endocrinology. Having been unsuccessful at traditional IUI and IVF treatments, Heidi personally understands the struggles of infertility. After many years of trying to conceive, she ultimately built her family through adoption and donor egg treatment. She always believed that if she didn’t give up, her ultimate goal of becoming a parent would someday become a reality. You can connect with her here for more information.

Fact or Fiction: The Truth About Getting Pregnant in Your 40’s and Beyond

In a perfect world, human biology would allow women to conceive easily no matter their age. After all, every person is on their own timeline, and focusing on accomplishments like a career, travel, or finding the perfect partner can sometimes take precedence over getting pregnant. Unfortunately, biology often doesn’t work the way we wish it would. While there are many misconceptions about getting pregnant after 40, scientific research shows conceiving later in life can be increasingly difficult.

If you’re approaching your 40’s and are ready for a child, it’s crucial to understand the difference between reproductive facts and fiction.

Myth # 1: It’s Easy to Get Pregnant Naturally After 40

While there’s a chance for you to get pregnant after your 40th birthday, the likelihood of it naturally occurring is slim. In fact, studies show women over the age of 40 only have a 5% chance of conceiving each month. This difficulty is mostly a result of low ovarian reserves and poor egg quality.

Myth # 2: Healthy Women Don’t Have Fertility Issues

In most situations, maintaining a healthy diet and exercise routine is an excellent way to stay in shape and ward off potential ailments. However, no amount of running or kale will prevent your egg quality and number of eggs from deteriorating.

Every woman is born with a finite number of eggs. As she gets older, she loses some of those eggs every month. By the time she hits her late 30’s, her egg count will begin to decrease more quickly, making getting pregnant naturally harder to achieve.

Myth #3: I Can’t Get Pregnant Once I’ve Started Menopause

It’s a common misconception that menopause automatically means your days of conceiving are behind you. On the contrary, it’s entirely possible to get pregnant during its early stages.

While many women attribute menopause to the completion of their monthly periods, the process begins before this occurs. The perimenopausal stage lasts for approximately ten years and takes place before you stop having periods. During this time, you can get pregnant. However, the likelihood of this happening is quite small.

Myth #4: Age Doesn’t Affect a Man’s Fertility

The effect of age on a woman’s eggs is prevalently discussed in the medical community. However, this fact doesn’t mean women are the only ones who struggle. Male fertility is just as much of a risk factor in life.

Some of the effects age has on male fertility include:

  • Change in sexual function
  • Sperm motility
  • Sperm morphology
  • Seminal volume

Myth #5: Celebrities Don’t Deal with Infertility

Every year, mainstream pop culture shows us examples of famous women getting pregnant and having children later in life. While it’s possible some of them have gotten lucky and conceived naturally, there’s no miracle celebrity water to remedy infertility.

While some female celebrities have been open about their struggles with infertility, most treat it as the personal matter it is. Just because a celebrity is quiet about her conception difficulties, it doesn’t mean she didn’t suffer just as greatly as another aging woman.

Myth #6: Getting Pregnant After 40 Poses No Risk to the Baby

If a woman is blessed to become a mother after 40, the hard part is – regrettably – not over yet. Due to a variety of circumstances and conditions, older moms and their babies are at risk for several complications, such as:

  • Miscarriage/Stillbirth
  • Low birth weights
  • Chromosomal defects
  • Premature birth
  • Gestational diabetes

Myth #7: It’s Impossible to Have a Child After 40

While an older mother certainly faces more issues when trying to conceive, it doesn’t mean it’s impossible. Whether a woman can get pregnant naturally or not, there are options available for her to become a mother. Adoption and frozen donor egg IVF are two of the most popular alternatives used by couples and individuals.

Each of these solutions comes with a wide array of benefits; however, many women find egg donation to be their next best option.

When many women are ready to have a child, it’s not just the baby they’re looking forward to. A great number have patiently awaited the chance to carry a child and bring them into the world. With frozen donor egg IVF, they can turn this goal into a reality.

Getting Pregnant After 40: The Hard Truth

There’s no doubt about it; getting pregnant naturally after 40 is no easy task. If you’ve spent your life dreaming of having a family and finally feel ready, don’t let your age dissuade you from trying.

No matter what biology has to say on the subject, a life of lessons and experience make women in their 40s ideal candidates for motherhood. When you’ve blown out the candles on your 40th birthday cake, just remember: your next chapter as a family could be right around the corner.

Age and Fertility

08 Thursday Aug 2019

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I was wasting some time awaiting a work meeting by perusing Facebook. I came across a post that I’ve seen in some variant countless times before. A woman asking about her fertility prospects based on age. Usually these post are in various infertility-related groups, but this one was in a mom group. The poster was asking what her chances were to get pregnant again naturally. She conceived her first without troubles, but is now 35 and feels like her biological clock is ticking. This question prompted a cascade of responses along the lines of “I got pregnant with no problems at age [something over 35].”

Well isn’t that nice. All the fertile myrtles giving “don’t worry about it” advice.

Now I could have kept scrolling,  but I just couldn’t resist. Because this irks me.

Obviously you’re going to get some pretty wildly different answers depending on the audience – you ask a mom group about getting pregnant and the answers will be rather different that what you find in an infertility group. But sampling bias aside, I’m bothered by the facts, or lack thereof, being doled out.

Because the thing is: age affects egg quality.

Regardless of how many celebrities over 40 are having babies. Regardless of how old your grandma was when she conceived your mom. Regardless of how healthy we are, how many miles we run, how clean we eat…fertility still declines with age.

Now that’s not to say that our lifestyles don’t matter. Our choices obviously impact our health and can work for or against us. But even the healthiest among us have aging ovaries, and this affects the quality of our eggs. On average, infertility begins a slow but significant decent around age 35 and take a steep hit around 40. Here’s another resource to help you be informed.

Yes, fertility declines with age. And we can’t escape it.

We do need to be educated about it. We need to be able to make informed decision about our fertility. We need to talk about the facts.

My niece is considering going to medical school. She’s in high school now and certainly things may change. But I was talking to my sister about it and brought up the fact that there’s a new trend in med school now where women are taking some fertility preservation means, like egg freezing. They’re doing this because med school, residency, and early careers tend to consume your most fertile years. My sister looked at me like I was talking crazy. She never considered the future of her daughter’s fertility, and has certainly never talked to her about it.

I’m no stranger to this concept, having spent my more fertile years as a doctoral student. While some of my infertility issues were not age related, age did become a major contributing factor and was the prime reason I endured so many rounds of IVF the second time around. I wish I would have known this way back when. Maybe I would have gone to the reproductive endocrinologist sooner rather than later. But hindsight, you know.

So there I was, staring at the computer screen, scrolling through all the “don’t worry about it” responses to that woman’s post. And I had to do it. I had to share the data. Not to scare or worry, but to inform. And so, among a long string of Polly Anna responses,  was my truthful response. Maybe someone noticed.

Life After IVF

26 Wednesday Jun 2019

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Am I stuck in low-grade reaction mode?

I was reading a post recently by herbalist extraordinaire Maria Toll titled, “Reaction Mode, Yikes! Sit, Sip, Breathe.” She explains that in our fast paced modern life, where we operate under a multitude of pressures, it’s easy for our bodies to get stuck in a low-grade reaction mode. This reaction mode stems from the hard-wired fight-or-flight response (or more accurately called the fight-flight-or freeze response) controlled by our sympathetic nervous system. Basically, this response is how our bodies are built to react to significant stressors.  Like a lion attack. This nervous system response allows our bodies to shut down “unnecessary” functions and respond to the immediate threat in front of us. It’s what helped our ancestors survive.

It’s what helps us survive modern day traumas too, like rape, war, car crashes, fires. Like IVF. Because IVF and pregnancy loss are traumatic. This flight-fright-or freeze response helps us get through the pain as best as we can in the heat of it all. But what happens when the traumatic event isn’t an isolated incident? What happens when we deal with this stress day in and day out, for years?  That kind of prolonged stress response has a big impact on our bodies and emotions.

Now I’m on the other side of infertility. I have two daughters that are IVF miracles. I’m done. No more baby making for me. No. More. IVF. EVER. I’m lucky I made it to the other side. I exhale and think that everything is fine. Finally.

But as I was reading Ms. Toll’s post, I began to think…what if I am still stuck in low-grade reaction mode? As a psychologist, I know that that kind of prolonged stress does not simply vanish when you remove the person from the stressor. On the most severe end of the spectrum, people can develop Post-Traumatic Stress Disorder (PTSD) from their battle with infertility. Others may become depressed, anxious, or have other reactions. It changes us. We all walk away from IVF with a unique reaction, shaped in part by our own stories, outcomes, support system, and experiences. But without a doubt, all of us have been living under the pressure of isolating, heart-wrenching prolonged stress.

I still catch myself holding my breath. Tense and waiting for what will come. I’m still trying to find my way back to myself. I find my moments of calm – when I’m nursing my perfect baby and it’s just the two of us, when I light a candle and sip tea, when I walk barefoot in the grass, when I listen to the birds as I stroll my baby. These moments give my body a break from the tension that seems to hide in the background. In those moments I breathe deeply and exhale.

NIAW #InfertilityUncovered: My Story

26 Friday Apr 2019

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Social-11It’s that time again – this week is National Infertility Awareness Week. Resolve – an excellent resource for all things infertility – encourages us to share our story this week. So here goes…

I’ve always had a feeling that I would have a hard time getting pregnant. I don’t have any idea where this notion came from, but I never gave it much thought in my 20’s. I was too busy – busy with college and graduate school, then establishing my career and getting settled in life. It took some time, but I finally found a man that was a good fit for me and we made a home together. By that point I was in my early 30’s and we were ready for kids. Without any logical reason why, it came as no surprise to me when a year and half passed with no signs of pregnancy.

I went to my OBGYN and without hesitation she referred me to an infertility specialist. And that’s when I slammed on my breaks. The mere thought of going to a reproductive endocrinologist (RE) was intimidating, not to mention crazy expensive because it wasn’t covered by my insurance. I was caught off guard. I had never known anyone who had gone through infertility treatment. I assumed there had to be something my OBGYN could do – tests, a diagnostic work-up, some treatments – but she basically sent me packing and wanted nothing more to do with me. Looking back I know this doctor clearly wasn’t experienced in working with infertility and could have used a few more lessons in bedside manner. But at the time I was simply confused and scared.

I spent the following year convincing myself that I didn’t want to have children. I knew several women who chose to not have children, and I envisioned a carefree life with lots of traveling. My husband went along with it, but gradually snuck the topic back into our lives. Apparently he could see what I was refusing to see – that deep down hidden in a place I didn’t want to talk about – I desperately wanted to have a baby. Shortly thereafter, a friend told me about how his wife saw a local OBGYN who prescribed Clomid and they got pregnant right away. And this doctor was covered by my insurance. It sounded like just what I needed, so I quickly made an appointment and began treatment. I remember that first round of Clomid and how excited I was thinking that this was our magic ticket to parenthood. *sigh*

One year of back to back cycles on Clomid or Femara and still there were no double lines in sight. I was given the illusive “unexplained” diagnosis after passing every diagnostic test thrown at me like a Boss. Eventually I agreed to an exploratory laparoscopy. I’ll never forget waking up from the surgery and having the nurse tell me that the doctor wants to talk with me. The nurses wouldn’t give me any other information and naturally I assumed that my uterus was as barren as the desert.  Fortunately the news wasn’t as bad as that, but it was a little odd. My doctor discovered endometriosis, which he downplayed and said it wasn’t in any location that should prevent me from getting pregnant; still he removed it. That was unexpected but not the odd part. He told me I didn’t have an appendix – odd because I’ve never had it removed – and in its place was a significant amount of scar tissue that had grown onto my right fallopian tube and was pulling it out of place rendering it not functional. My husband and I made jokes about my apparent alien abduction and stolen appendix. But I prefer to think that I’m so bad ass that I ate my own organ. Because who needs an appendix anyway? The doctor cut away the scar tissue and my tube returned to its correct location. I was so hopeful that this surgery was the answer.

But I continued to not be pregnant – month after month despite the medications. We even tried IUI to no avail. After a year and a half of monthly treatments, I got tired of doing the same thing and expecting different results. So even though my OBGYN thought we should keep trying and was hesitant to refer me to an RE because he thought they “pushed IVF too much,” I simply couldn’t go on like this. I made the call and scheduled a consult with the local infertility specialist. A call I wish I had made all those years ago. Unlike my OBGYN , the RE said the reason I’m not getting pregnant is due to the combination of endometriosis, which negatively impacts egg quality and can cause inflammation, and non-functional fallopian tubes. I asked how that could be since the dye tests showed my tubes were open. He explained that just because they’re open doesn’t mean they work right. All that scar tissue, and of course when you cut away scar tissue you are left with more scars, and inflammation from endometriosis impacts how my tubes work. Oh and I had diminished ovarian reserve too. Joy. He was confident that IVF was the treatment for me.

So finally after 4 years – with a one year break in the middle – I began IVF. Well, after one more surgery to remove a polyp – there’s always one more thing, isn’t there? For my first IVF I had 7 mature eggs retrieved, all fertilized naturally, and on day 5 I had 3 early blastocysts. Since they were a bit slow growing, I was 36 years old (so quality was just starting to decline), and I had that polyp removed (which basically left a spot in my uterus where nothing could implant), my RE suggested transferring all 3 embryos at my day-5 fresh transfer. And so we did. I was in absolute shock when I got the positive beta results. I now have a rambunctious, very opinionated 4-year-old daughter.

I truly though I’d never do IVF again after that hellish journey. But as time passed, the desire to grow our family became strong. It took a long time for my cycle to return. When it did I hoped to be one of those magical unicorns that get pregnant naturally after IVF. I wasn’t and I wish I had gotten into my RE sooner than I did. Just a couple months before my 40th birthday I had another egg retrieval. Technology had changed the way my clinic operated since my last IVF, and now they encourage PGS testing and frozen embryo transfers. I ended up with one PGS normal girl that round. We were so excited and completely assumed it would work. Such a difference from our first round when I was convinced it hadn’t worked. And when she failed to implant the floor dropped out from under me. The next two rounds of IVF ended in zero blasts – nothing to test. Following that we got 2 embryos and both were PGS abnormal. That’s 3 round of IVF with nothing to transfer. That means zero chance of pregnancy. I might as well forgo the torture of all the treatments and procedures and just have sex.

Then we switched course. After much research and discussions with my RE, we opted to forgo PGS testing and do a fresh 3-day transfer. When we arrived at the clinic for the transfer we learned that we had 4 embryos growing strong, so we transferred all 4. Once again I was filled with excitement and anticipation. But it was negative. Again.

By that point I had pretty much lost hope and was simply going through the motions. I wanted to make sure that I tried everything I could to give my daughter the sibling her heart desired and my husband and I the baby we longed for, but I no longer expected that it would work. I met with my RE again to discuss our final options. Mentally, I was coming to terms with making a healthy, albeit hard, decision to end treatments. To my surprise, there was one embryo left over from the previous fresh cycle that I didn’t even know about. Crazy, right? Apparently there was an embryo that was really lagging behind on day 3 when we did the fresh transfer, so rather than transferring it with the other 4, the lab let it keep growing to see if it would make a comeback or simply peter out. Well, it continued to grow and was frozen as an early blast on day 6. My RE suggested we transfer that late bloomer along with one of my PGS abnormal embryos from a couple cycles ago. Yes, you read that right – abnormal. The abnormality was minor and he thought it might correct, but would not result in an unhealthy pregnancy. If this unlikely FET didn’t work, then we would do one final retrieval and fresh transfer, and then be done with it all. Based on research statistics, my RE thought that doing that one final cycle would bring us up to our maximum chance for success rate – more than that would likely simply result in more of the same failures.

With that, I agreed and proceeded with the FET. I had zero expectation that it would work, given the two embryos we transferred. And so when I saw the 2 lines, I began shaking. I couldn’t believe it. I proceeded with caution, of course, as infertility warriors do. But week after week, test after test, good news continued to flow. My second healthy baby girl was born 14 weeks ago.

I began this blog when I set out on my second go round with infertility. It was my effort at keeping a hold of my sanity and my sense of self during all the trials of infertility treatments. Writing has been an invaluable resource for me. I hope that some of my stories and thoughts have resonated with others too. We all need a support system, and that support comes in many forms. I plan to continue sharing some of my past experiences and perspectives, and whether you are new to the intense world of infertility or a seasoned IVF warrior, I hope that you find at least a little piece of support in this blog.

Therapy? Who me?

15 Friday Mar 2019

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heather-ford-493955-unsplashI want to talk about mental health and infertility.

I remember my very first IVF cycle 5 years ago. I was sitting in my Reproductive Endocrinologist’s (RE) office talking about what was to come. At this point I had already been through the usual – countless tests, gateway drugs (you know, clomid and femara), IUI, surgeries – and racked up more failed cycles than I care to think about. I was desperate, lonely, and afraid. My RE asked how I was doing, and I made some off handed joke about medication-induced mood swings. Instead of laughing with me, he got serious. “Don’t do that. You’re a psychologist and I know you know the emotional impact infertility has on people. It’s not the medications – it’s infertility. It’s painful.”

And he was right. I did know. Sure, all of us who have ever fought in the infertility trenches know intimately the roller coaster ride that these medications force us to ride. Sometimes the side effects from these medications are so strong we feel like we don’t have any control. Maybe we hide in the bathroom and cry at the smallest slight. Maybe we turn into a raging infertile Godzilla. But even if we took all the meds away, we would still be left with the pain. The pain is a part of infertility.

My first battle with infertility was raw and scary. I was charting unknown waters. I was afraid that I would never become a mom. That fear was all consuming. Being a psychologist myself, I tended to hang out with other mental health professionals. One of my good friends, who also happened to be a psychologist, was an invaluable support person. He wasn’t doing therapy with me, that would be unethical as you can’t be your friend’s therapist, he was just being a good friend who always said the right thing. He wasn’t afraid to ask or sit with my emotions. While this helped me tremendously during my IVF cycle, I wasn’t prepared for what was to come after I got that BFP (big fat positive – aka positive pregnancy test).

What came next was joy, relief, excitement, as well as fear and anxiety that were so strong I had difficulty truly embracing my growing baby. And it didn’t stop there. After my miracle baby was born, the trauma from infertility was still present. It was an unspoken trauma, because who wants to talk about still not feeling right after you “won the battle with infertility”. But there it was. And it impacted my ability to bond with my baby after her birth. Sure there were other factors at play – a traumatic birth and difficult temperament baby – but the pain of infertility wasn’t easy to shake even afterwards. It took me a long time to recognize that carry over effect and move through it.

Then came my second run in with infertility. This time around I was 40 years old so we had to pile egg quality issues on top of my regularly scheduled infertility programming. It was a hard battle. I did another 5 IVF cycles and 2 additional frozen embryo transfers. It was a very different experience from the first time around. No matter what the outcome, it wouldn’t change the fact that I was a mother. But that reality also didn’t negate how badly I desired another child. How badly I wanted to give my daughter the sibling she so desired. If someone had told me in the beginning how many IVF cycles I’d do, I would have adamantly disagreed. It’s hard to imagine going through it so many times…before you have. This time around though, I was more prepared for what was to come – or at least what I thought might come. I took preventative measures by arming myself with a variety of coping strategies that I knew resonated with me. Starting this blog was one of them, and reflective writing has been invaluable.

Still it wasn’t enough.

I remember at one point, I think it was after a cycle where none of my embryos made it to blast, thus we had nothing to test or transfer. I was devastated. I was also starting to notice myself snapping at my daughter, and being irritable toward my husband. It was more so than what I would normally experience on the medication roller coaster. I realized that I had exhausted my coping skills and I didn’t want to be this person. I realized I needed professional help. And so this psychologist sought out a psychologist for therapy.

I live in a small enough town where the mental health community is relatively small, so I had to find someone that I didn’t already have connections with and that I could truly trust with my confidentiality. At first I felt awkward being on the other side of the couch, so to speak. But I found someone who came highly recommended, although he didn’t have much experience with infertility. Given my limited options, I decided that his therapy skills would make up for his lack of infertility knowledge, and I could educate him on the latter. And so we began our therapeutic relationship. He helped me work through my fears and anxieties, challenging my assumptions and helping me adjust my view to see the whole picture. We also worked through some of my feelings of inadequacy as a mother, which were partially impacted by infertility and partly due to my own, ahem, perfectionism and expectations. I was able to gradually see some things in a new light, and most importantly, I was able to come to a place where I knew I would be okay regardless of the outcome of IVF. Not that a bad outcome would be easy or painless, but that I would be able to survive it and find myself whole at the end.

We actually ended therapy during the preparation for a frozen embryo transfer (FET). I knew that I could return if I needed it. But at that point, I recognized myself again. I was more connected to my loved ones around me. I saw the end of our infertility treatments, and I felt confident about when we would stop treatment. And I knew that if we did stop, I hadn’t left anything on the table. It would be okay. So we parted ways.

And then my unlikely FET worked. This time around, while I still had some level of anxiety about miscarriage, I was eventually better able to enjoy my pregnancy. I believe that being in a better headspace with the emotional affects of infertility not only helped me with that, but also set the stage to bond better with my baby after her arrival. I’ve written before about how hurtful the carryover affects of infertility can be when it comes to parenting. It’s something few people talk about because, in part, we worry we are being ungrateful and selfish. I’m thankful that therapy during my infertility treatments helped change this for me.

So why did I want to talk about mental health and infertility? Because I want to say that there’s no shame in getting some professional help. Infertility is hard. No matter how well put together we are, how independent we are, how smart we are, how strong we are, it’s still hard. If you are just starting out on this road, or even already in deep, I encourage you to do some soul searching and write out what things might look like if you weren’t doing well emotionally. Make a list. For me, I knew that being short tempered with my daughter and husband were on that list. Maybe you think you can handle IVF, and maybe you can, but how would you know if you were struggling? What would it look like? Maybe you’ve struggled with something in the past. Maybe you know what depression, anxiety, and consuming anger feel like first hand. What are the signs for you that would let you know you are headed there again? Then tuck this list away. Sometime when you are in the heat of a cycle or trying to deal with a loss or negative test, bring out the list. Or maybe when you write it, you may realize that you are already there.

Then consider seeking some professional help. There are many choices out there – psychologists, social workers, marriage and family therapists, etc. If you have insurance, see who is covered. Ask people for recommendations in your community. Google or call to find out which have experience working with people struggling with infertility. Your RE or nurse may even have suggestions for providers in your area that specialize in infertility. Then call one or more of them and interview them! As a psychologist I know that one of the most important aspects of a successful therapy outcome is the goodness of fit between the therapist and client. It’s important that you feel comfortable with the therapist and that you have a good working relationship. So ask them questions before you sign up for a session. Some questions to ask could include:

  • What’s your experience working with people with infertility?
  • Describe your therapy style? What treatments do you use?
  • Do you offer a free or reduced rate first session to see if we are a good fit? (Yes, many offer this and it’s okay to ask.)
  • Do you have a sliding fee scale? (Important if you don’t have insurance coverage.)
  • Ask about any religious/spiritual or cultural experience that may be important to you. (For example, some people may prefer a therapist with a similar religious background as them.)

At your first session, see how you feel with the person. Is this someone you think you jive with? Still, understand that it’s hard to get to know someone in one session and trust takes time to develop. Rarely do people feel comfortable enough to emotionally expose themselves in one session. But can you feel some potential there? Does the therapist seem like they care – are they present and attentive during session? Do they keep personal talk about themselves to a minimum? (This is about you, not a time for a therapist to make it all about them. Yes, there are bad therapists out there, just like in every profession.) If something feels really off, then try a different therapist. Some people  try out one therapist and then, when they have a bad experience, completely write off therapy for good. But just like any relationship, not all are meant to be. It may take more than one try to find the therapist you like. Don’t let one bad apply spoil the bunch.

There is no shame in seeking mental health help. Quite the contrary, sometimes getting help is the strongest thing you can do. Did I mention infertility is hard? Yes. And none of us are immune to that.

Pregnant After Infertility: A birth story

19 Tuesday Feb 2019

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This is what it all lead up to. A birth. A birth that was very different from the birth of my first IVF baby, both in body and emotion. My first daughter’s birth was chaotic and scary. Given the trauma of the first, we decided the safest option was a planned repeat c-section. For a while there I didn’t think we’d make it to the scheduled date. During this pregnancy I was admitted twice to the hospital. The second time was just shy of 35 weeks and was prompted by a scary bleed at 2AM and contractions. They were able to stall the contractions and stop the bleeding, gave me two steroid shots to mature baby’s lungs in case she did come early, and released me after two days. But we made it.

We arrived at the hospital bright and early at 5:30 AM on Jan 18th to check in for my c-section that was scheduled at 7:30 AM. It was odd knowing when it would happen. For the two weeks leaving up to the date I lit a selenite infused candle for purification and cleansing. I meditated on releasing fears and any stagnant or negative energy. I talked with my unborn child and explained to her what was going to happen during the birth and after. I wanted us both to be prepared and in harmony. I felt ready when we went to the hospital.

Having a planned c-section is worlds apart from my experience with an emergency c-section. The mood was light, joyful, and tingling with excitement. That doesn’t mean that it was all easy peasy. Last time, under emergent conditions, I didn’t care what the surgeon was doing, I didn’t think about whether the anesthesiologist would miss and paralyze me (hey, I’ve hear of it happening) – I simply wanted the baby out. But this time I was acutely cognizant of everything that was going on.

birth morning

My last pregnant picture. Early in the morning before leaving for the hospital. So bitter sweet.

My husband wasn’t allowed into the operating room until after I received the spinal anesthesia and the procedure had started. I was accompanied by a kind nurse who held me while the long needle was inserted into my back. Then I laid there, naked from the waist down on a narrow cold metal table and stared up at the bright lights overhead. I felt vulnerable – seriously, why was I naked with all these medical people in the room? Couldn’t they have put a sheet over my lady bits while they discussed and prepared? I suppose I had to stay sterile or something. The lights were so bright and the room was freezing. I was acutely aware that I was about to be cut open and that sometimes things go wrong. I distinctly felt like I had been abducted by aliens. Or at least, what I would assume an alien abduction might feel like.

Then the tugging started as my body was pulled this way and that. I couldn’t see what was going on but I knew that this was the result of being cut open. I felt no pain, and was rather surprised that my body didn’t bounce right off of the narrow table. I suppose I was strapped down, though I didn’t see that either. My arms were free on my side of the curtain. Then I began smelling the distinct smell of burning flesh and realized they were cauterizing me as they cut. I was scared. This was the main event. Would my baby be okay? Would I be okay? I silently recited a meditative prayer/visualization that I learned so many years ago. Over and over. Asking the Universe for protection. Willing it so.

Finally my husband came in. He reassured me that everything was fine. My anxiety eased up a bit. And then I heard her. My daughter’s first cry. I knew she was okay. She was born at 8AM. It was only a few short minutes before they handed her to me. The medical team was responsive and respectful of my request to do skin to skin and breastfeed as soon as possible in the operating room. Once I had my new, perfect baby on my chest and she began nursing immediately, the rest of the procedure faded to the background. From that moment, I kept my daughter with me – from OR, to observation, to recovery – she was in my arms. It was surreal. 15539

Another highlight came when my parents brought my 4-year-old daughter to the hospital later that day to meet her baby sister. I had been waiting for that. It was something that I thought might never happen – that my daughter would get to become a big sister. Deep in the trenches of infertility, there were many times when I thought I would never have a child, let alone two. Both of my girls are IVF miracles. When the baby was handed to my older daughter, I simply watched and was so very grateful.

first meet

The first meeting. Sisters forever.

All in all, this birth experience was exactly what I had hoped for (minus the alien abduction part). It was calm and I felt more in control. It was not traumatic. I think these differences made it easier to bond with my baby. Another big factor that eased post-partum adjustment was my emotional and cognitive state in relation to infertility. The first time around, I was traumatized not only by the birth but also by infertility. Infertility was a silent trauma that I had not resolved despite IVF success. I believe that trauma carried over into my experience of new motherhood. It affected my postpartum emotions, my confidence in mothering, and my ability to fully bond with my baby. It took quite some time to recognize and address those carry over effects. After all, few want to talk about the pain of infertility once you have “success”. It makes you feel like you are being ungrateful, especially when you know how many are still struggling. But that carry over trauma is real and does need to be addressed when it hangs around.

This time I had done so much more work on the emotional side of infertility, that I was actually in a pretty good headspace when I became pregnant. While infertility will always be a part of my experience, and has certainly shaped who I am to some extent, it no longer consumes me. Now I can move forward, refreshed and renewed. Honestly, I sometimes have a hard time remembering who I was before infertility – its changed me so much. I’m not trying to go back to who I was before, we can never really move back in time, nor would I want to. I am stronger now than I was before. But I would like to reconnect with the lightness and playfulness I once felt. I suppose now I’m moving forward, as a mother once more, but wiser, more confident, and with opportunity for discovery.

Pregnant After Infertility: Where do babies come from?

03 Thursday Jan 2019

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hubert-mousseigne-661465-unsplashI recently came across a question in an online infertility support group and was drawn in by the responses. The question was: do you plan on telling your children that they were created through IVF?

I read through the responses divided into yes and no camps. Those that favored the “no” side gave varied reasons. One woman feared that her child could be bullied if it was known, since we live in a world where criticisms of assisted reproduction can be harsh and many people are ignorant. Another said that IVF conception (and the resulting baby) is no different than any other conception. While other women were unsure and thought they would keep it a secret unless their child grew up to have infertility problems of their own, at which point they would share. Some felt that young children wouldn’t understand IVF anyway, but they might tell them about it when they were older.

On the flip side, women countered that creation through IVF is part of the child’s story and they should know. Many wanted their children to know how very wanted they were, as indicated by the great lengths their parents went through to conceive them. Others expressed the opinion that education is important and science is cool, so they want their children to know.

The reasoned responses went on, and clearly it is a personal choice.

Honestly, to ask this question never even crossed my mind. My first IVF baby was about 2.5 years old when we began the grueling succession of IVF cycles in pursuit of baby #2. The question I asked myself was whether or not to let my daughter know that we were trying to make a baby. For us, making a baby meant IVF. There just wasn’t any other way. The two are inextricably connected, so if we told her that we were trying to make a baby, then knowing about IVF would be a given.

Ultimately, we let our daughter in on it. We told her we were trying to make a baby, and without skipping a beat she expressed her desire for a little sister. A desire that didn’t waver for the entire year of non-stop infertility treatments that lead to my current IVF pregnancy. I knew there were dangers of telling her what we were trying to do. After all, so many things could and did go wrong. There were many failures. I wanted to protect her from that. But I also wanted her to know that I was desperately trying to give her the baby sibling she so very much desired. And then there was simply the reality of the process. The medications and transfers impacted our breastfeeding relationship. Although she did continue to nurse through treatments, there were times when my milk would decrease or we would take breaks during the two week wait for my own (likely paranoid) reasons. There were times I couldn’t lift her, per doctors orders. I spent much time at doctor appointments. And lets face it, I can’t even poop without my daughter busting in on me (yes she can unlock a door with objects that aren’t even keys), so the idea that I’m going to administer 4  or more shots daily without her knowing is laughable.

So instead, I decided to embrace it – and bring her into the experience. She loved being a helper and was tickled to help me do my shots by wiping my belly with the alcohol swab. She knew what it meant when she would get to nurse again after the two week wait was over – that there was no more baby in my belly. And when it finally worked, as scared as I was of a miscarriage, we still told her. And she was ecstatic that she was finally going to get to be a big sister, and I desperately hoped she really would.

In our world this is simply normal.

My daughter understood all of this, a simplified version, to the extent possible at a very young age. I’ve joked that when she finally experiences sex-education in school and hears about the birds and bees, she’s going to raise her hand and say, “yeah, that’s NOT how babies are made!” Of course, I’ll have told her all about reproduction in it’s many forms long before school does. Because I want to make sure she gets the right information. I don’t think a complete conversation about reproduction can be had without talking about all of the variability that comes along with this complex topic. I also believe it should include dialogue about the common problems that can go along with females’ cycles, many of which may impact fertility, as well as male infertility issues.

My mom had painful periods and this was presented to me as normal. Just the curse of being a woman, I suppose. But then, as I trudged through years of infertility, tests, and surgeries, I learned that it’s not necessarily normal. In fact, painful periods can be caused by endometriosis, hormone issues, or other factors. Imagine my surprise when  an exploratory laparoscopy found endometriosis in my body. It never even occurred to me that I might have endometriosis. I didn’t even know anything about it. Then imagine my surprise when, after removing it, the pain that plagued me during my period vanished. My periods were pain free. I didn’t even know that was a thing.

I want my daughters to know that they were conceived through IVF. I want them to know that infertility is unfortunately common. I want them to be educated about sex, in all it’s many forms. I want them to be educated about choice, consent, rape, and options. I want them to know about human reproduction, how it really works, and why it sometimes doesn’t. I want them to know about what a healthy period is like and what things can impact that. I want them to know all this and more – without shame or embarrassment. So that they will always have a voice that can be heard and a body that is their own.

I hope that future generations of women and men understand these things and can face them without shame or secrecy. That, in my opinion, is how change begins to happen. And when it comes to the world of infertility, there is a lot of change that needs to take place – from opening up dialogues, to increased research and insurance coverage. We have a way to go, but education is a necessary foundation.