Pregnant After Infertility: The postpartum emotions we need to talk about

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This is one of those probably not so popular topics in the infertility community – even among those who have had IVF babies. It’s a taboo subject, even among the fertile. And personally, I believe that it’s an even harder topic for women to discuss when they’ve gone through infertility treatment. What am I so cryptically alluding to? Well, it’s the dark side of motherhood. The thoughts and feeling we keep hidden to ourselves, for fear of looking like a “bad mom”. It’s postpartum depression, anxiety, fear, self-doubt, and sheer exhaustion.

I came across a series of comics that get surprisingly real about the darker side of the experiences of motherhood. It’s the things so many women experience, but sadly think it must be unique to them. In an age of staged social media posts where everything is all clean and made up to appear perfectly put together, with sunshine and rainbows endlessly glittering, it’s easy to think that we are the only ones feeling so overwhelmed by the changes that a new baby brings.

So, I’m going to talk about this in the context of pregnancy and parenthood after IVF because I think the situation is a bit different for us. When you go through infertility treatments you are trying so hard for that baby. You become desperate to conceive and the process begins to consume your world. We want it so badly, we are willing to do just about anything in our power to get the baby. The stakes are high. We are in debt. We have put our bodies through extreme measures, and when it works, we are the lucky ones. After all, we know that treatments don’t’ work for everyone.

And that right there changes things.

How can you go through all that IVF, end up being one of the lucky few that actually gets a positive beta and a healthy take home baby, and then have anything but good things to say afterward? But before I go any further, I want to acknowledge that this is where I worry I might get some slack. Because I know there are countless women who would gladly trade in the unbearable pains of one failed cycle after the next for the challenges that motherhood brings. And I get that. I’ve been there. But that’s not the dynamic I’m trying to set up here. This isn’t a competition of who has it worse. It’s not any kind of comparison at all.

Simply because we’ve gone through infertility does not mean that we are exempt from postpartum depression, anxiety, or any of the rest of the hard emotions that so often accompany new motherhood. But it feels like we should be. And that’s what can get us into trouble.

After I had my daughter (my first IVF miracle), I thought something must be wrong with me. I didn’t bond immediately. Honestly, I felt kind of numb. Where was that rush of oxytocin that everyone raves about? Why didn’t I feel overwhelmed by love? What was wrong with me? 754b7e60fd63b253b9c60c7207386ee7

Like any good psychologist, I analyzed my situation. I hypothesized that left over trauma from infertility, plus some significant birth trauma, along with a difficult temperament baby that didn’t quite mesh with my personality, bolstered by the usual sleep exhaustion and hormone crash all combined to rationally explain my experience. And I was probably on to something with all that, but it didn’t change it. I was left feeling like a bad mom, and the guilt over not being happier was overwhelming. I felt alone. Who would feel this way? Who would feel this way after being so blessed to have a successful IVF?! I was ashamed of myself. I knew a few other IVF mom’s and no one ever spoke the things that were in my mind. I thought no one else felt this way. In fact, when struggling with secondary infertility, other moms who had one IVF child and were trying for another often commented on how close they felt to their child and how happy they were with that one despite how badly they wanted another. I felt differently. Don’t get me wrong, I love my daughter fiercely. I’m a lioness mom who would protect my child at all costs. But that doesn’t mean that I didn’t continue to struggle.

My daughter was still nursing about every 1.5-2 hours at night at age two. Yes, I said age two. I was sleep deprived for so long that I’m not really sure how I functioned. Add to that the fact that my daughter is a fiery child. She is so self-determined, head strong, persistent, and intense. These are characteristics that, when she learns how to channel them, will take her far in life. I have no doubt she will grow up to be an amazing woman. But these characteristics make for one hell of a toddler. I didn’t think I would survive the third year of her life – or at least my sanity wouldn’t. I still thought it must just be me – I’m a bad mom. sub-buzz-2580-1540837959-3

But then I had a few real conversations with other moms that I respected. Moms that I thought had their shit together. Moms who had raised some pretty well adjusted girls and have great relationships with them. And out of their mouths came some of the things I never said out loud. I literally cried when one mom, who’s daughter is now an amazing teenager, said that the worst year of her entire life was when her daughter was three-years-old. She didn’t think she’d make it. Another mom told me that she sometimes can’t stand to be around her kids – she is all touched out and just wants some alone time. Another described her daughter as “spirited” and reminisced about how she struggled to emotionally connect with her.  I realized then that I wasn’t a bad mom after all – I was a normal mom. And some of the guilt and self-doubt started to lift. I finally started to feel like I was doing a pretty decent job of parenting. And, best of all, I started to feel the bond growing with my daughter. There are still bad days, of course. But I know that those are just bad days – I’m not a bad mom because of it.

These are the things that mothers need to talk about. We need to know that it’s okay to talk about these things. Sometimes we may need help with postpartum feelings, especially when depression and anxiety become suffocating. Sometimes simply finding out that motherhood struggles are shared can go a long way to normalize our experiences, give us a sense of support, and help us through the particularly rough days. Having conceived through IVF or other infertility treatments does not make you immune to these postpartum experiences and emotions.  In fact, it may even heighten the guilt, shame, and secrecy associated with these emotions. Sometimes these feelings can last years, especially when you keep them bottled and hidden. Mothers need support – from family, friends, other moms, and sometimes mental health professionals. All of that is normal.

There is no one size fits all to the experience of motherhood. Maybe for some it really is all flowers and kittens. Maybe. But I know from personal experience, kittens have some pretty sharp claws.

 

Note: The author (Karen Kleiman) and illustrator (Molly McIntyre) of the comic series are publishing a book based on the comics, along with some guidance for new moms. The book is called Good Moms Have Scary Thoughts. I’m looking forward to checking this out.

Pregnant After Infertility: On shame and infertility

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asdrubal-luna-485688-unsplashI want to talk about body shame and infertility. One of the most common sentiments that I’ve come across among women dealing with infertility is the idea that their body is somehow broken. Like their body has failed them. After all, we are women with all these reproductive parts, and we spend a lot of time dealing with periods, pains, and “lady stuff” – you would think we’d be able to get the pay out from all this bodily hassle.

Now, to be clear, infertility is not always related to a woman’s body. In fact, about one third of the time infertility is related to issues with the woman’s body, another third of the time it is due to male factors, and the last third is a combo of male and female issues or unexplained (www.asrm.org). I can’t speak from the male’s perspective, but when it comes to women, we tend to carry a lot of shame that our bodies aren’t doing what they are “supposed to be doing”.

Here’s my confession: I never felt this shame.  The truth is, I don’t think there’s any place for body shame in infertility. As a psychologist, I’ve spent many an hour sitting with people who blame themselves and carry crushing shame for all sorts of things that are in no way their fault. I’ve seen this with victims of sexual abuse and domestic violence, as well as among those struggling with PTSD, addiction, eating disorders, and the list goes on. Sometimes it’s even common everyday occurrences for which people carry an unreasonable weight. I see this, and I know it’s not their fault. I also see that self-blame and shame makes their difficult situation that much worse. It’s easy for me to see as an objective viewer, and I try to help them see it too so they can get out from under it.

And I see this so much with women who are carrying the burden of infertility – blaming their bodies and being ashamed to even talk about it.

But here’s the thing – this isn’t your fault. Fault implies that you did something wrong. And you didn’t. Infertility is a medical condition. It’s not a character deficit. Medical conditions happen – we are all dealt different things in life. We got infertility. Lucky us. But it’s nothing that happened because we did something wrong. So there’s really no place for shame in this.

I think the fact that infertility is largely a silent disease contributes, at least in part, to the experience of shame. Few people are talking about infertility. I’ve never seen a “run for infertility” in my community. I’ve never seen people walking around in public with infertility awareness ribbons pinned to their chest. Do these things exist for infertility? I know there are some public events, marches, and awareness events. But these are few and far between. The only reason I even know about them is because I’ve spent a lot of time deep in the trenches of infertility. But I don’t have to be a cancer survivor to know what a pink ribbon means or know about many of the events going on related to breast cancer awareness and support. Infertility doesn’t have much of a media presence.  We aren’t anywhere near the same scale that you see for other medical conditions, conditions that have shed their outdated skins of shame.

As long as people are either not talking about infertility, or at best whispering about it, then women (and men) will continue to internalize this disease and morph it into personal shame.

I understand that it’s not easy to be vocal about infertility. There is so much misunderstanding and people can be too quick to share their (often ignorant and sometimes downright hurtful) opinions. We are carrying such a heavy load when we trudge through infertility. Sometimes sharing our stories is simply too much  to add on to an already maxed out, stressful situation. At some point though, the scales must tip in the direction of disclosure and healthy discussions so that we can confront ignorance and raise awareness.

For my part, I’m going to keep talking about infertility – like it’s normal. Because, unfortunately, it is. When infertility affects 1 in 8 (and the numbers are rising), it’s something people should be talking about. Some may think it’s odd, but I bring infertility and IVF into many conversations about my daughter and my current pregnancy. When people I don’t really know say, “Congratulations!” – I say, “Thanks! We’re really grateful.  We had to go through so many rounds of IVF to get pregnant!” That response probably takes a lot of people by surprise. And to my surprise, I’ve never gotten a negative comment back (I’ve been waiting for one and I’m ready…just try me). What has happened more times than I can count, is this has led to conversations with strangers and acquaintances about their own struggles to conceive, the struggles of their loved ones, or questions about what my experiences have been. I’m happy to engage in all of these conversations.

Regardless of whether you are in a position to openly discuss infertility with others or if you are simply trying to make it through each day without crying, know that you have nothing to be ashamed of. All bodies work differently and none of them are perfect. That fertile myrtle you know might end up with cancer or a heart attack at the age of 60. Hey, I’m not wishing illness on fertile people, I’m just saying you never know what your genes have lined up for you. Infertility is part of our story. It’s in the cards we were dealt. There’s no shame in that.

Instead of blaming our bodies for what they aren’t doing, what if we take a moment and appreciate them for all they are doing? Think about it. When we go through infertility treatments, we are asking our bodies to do so much. We are asking our bodies to take in and tolerate massive about of hormones and medications, we are poking and prodding ourselves with needles and ultrasound wands, doing tests after tests, repeated blood draws. We are bruising our bodies and pushing them to their limits. All the while asking them to keep performing all their other duties necessary to sustain our lives. Instead of criticizing our bodies, what if we said, “thank you”? Thank you for trying, thank you for continuing to carry me, thank you for tolerating all I’m putting you through.

Be kind to yourself. Be kind to your body. There’s no place in infertility for shame.

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Pregnant After Infertility: How to get a BFP (it’s not what you think)

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If you’re in any online infertility support groups, someone will eventually ask the question, “What did you do differently when you got your BPF?” That’s a big fat positive (BFP) – AKA positive pregnancy test. Actually, you will come across this question repeatedly. Because everyone is desperately searching for that magic combo that will get them pregnant, or at least up the chances. For a long time I diligently read every response to these questions, scouring for the one thing that I could do differently – the key I had somehow been missing – that would finally make all my dreams come true.

And then I realized something.

It’s a slippery slope. Sure we all want to maximize our chances and try all the things, but at some point we start sliding into a very dangerous place. A place where we begin to second guess every single decision we make. A place where we beat ourselves up and ask, “if I only hadn’t eaten that cupcake…”, “if I only had started this sooner…”, “if I had only done x, y, and z…” then it might have worked.

And therein lies the problem.

We don’t know if it would have worked. But we sure do layer on the self-blame and guilt. Or we stress ourselves out searching for the elusive magical step that we’ve somehow missed in all our previous attempts, but if we could just find it, then the next time it will work. But then it doesn’t, and the mad search continues. And the guilt, frustration, hopelessness, and anger thickens.

I see well meaning women responding to these posts, listing all the things they did differently to get their BFP, and I bite my tongue. I get it. Really I do. I myself have done a ridiculous amount of things over the course of the years I’ve struggled with infertility. Do you really want to see my list? Honestly, it makes me feel a wee bit insane.  But I’ll share. I do want to preface this by saying I did not do all of these things at once. Each cycle was some combination of various strategies. Some I did for years, while others I tried and moved on from. They range from the medically directed to significantly more unconventional. But hey, I was willing to try ANYTHING. So here you go…

List of things I’ve done in my pursuit of a BFP (brace yourself):

  • Acupuncture
  • Yoga
  • Fertility-specific yoga
  • Castor oil packs
  • Fertility self massage
  • Emotional freedom technique (AKA “Tapping”)
  • Reiki
  • Meditation, including fertility-specific meditation
  • Affirmations
  • Craniosacral therapy
  • Crystal healing bed
  • Psychics
  • Prayer
  • Fertility spells/rituals
  • Identifying, working through, releasing blockages related to fertility, parenting, family history, sexual abuse
  • Psychotherapy
  • All the standard fertility tests and procedures
  • ERA (4 times)
  • Laparoscopy – removal of endometriosis, removal of scar tissue on Fallopian tubes
  • Surgery to remove fibroid
  • All the supplements as directed by my RE – DHEA, DHA, melatonin, Vit D, E, C, folate, ubiquinol, prenatal, myo-inositol, l-arginine
  • Western herbal treatments
  • Chinese herbs
  • Visualization
  • Changed all personal care, make-up, home cleaning, and kitchen supplies to non-toxic version with special emphasis on removing endocrine disruptors and carcinogens (including giving up some of my personal favorites like hair dye, gel nails, and most nail polish, *sigh*)
  • ICSI and no ICSI
  • Special medium/culture for older eggs (my RE said this gives older eggs/embryos more of the antioxidants and other nutrients they need to support cell division)
  • Protocol changes (though the vast majority of my cycles utilized the same protocol because despite my low AMH and DOR, I responded relatively well to a high dose protocol
  • HGH
  • Neupogen wash
  • PGS and no PGS testing
  • 3-day transfer, 5-day transfers, frozen embryo transfers
  • Caffeine free, no sugar, no alcohol
  • Occasional glass of wine (oh and that one time I got tanked – I needed that night!)
  • Juicing
  • All organic
  • Gluten free
  • Resting after transfer (my RE assigned 3 “Princess days” reserved for resting and pampering)
  • Not resting after transfer (whatever, I’m still a princess everyday)
  • Positive thoughts that the transfer worked
  • Lowered expectations/Negative thoughts that the transfer didn’t work

I’m freaking exhausted just looking at this list. It was a full time job. And I already have a full time job.

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And after countless cycles, do you want to know what I think really worked the 2 times I got a BFP? Here it is ladies…luck. Yep, that’s right. Random luck.

 

Now this isn’t to say that nothing matters in this process. I’m a firm believer that the skill of the RE (both in selecting and managing protocols, and in performing the egg retrievals and transfers) as well as the quality of the lab do make a significant difference in overall outcomes. However, all of my IVF cycles were with one RE and one lab. I think I had good chances because of my RE and lab, but clearly they were not able to miraculously make it work every time. Many times it failed and twice it succeeded. So I’m back to saying that luck was the deciding factor. Luck that the “right egg” was recruited and harvested in a given cycle, luck that my body didn’t go rogue and ovulate before the trigger, luck that Miss Egg was combined with the right Mr. Sperm that she seemed fond of, luck that the embryo hit a receptor site after transfer and implanted, luck, luck, and more luck.

I’m also not saying that nothing from my list mattered at all. Anything that supports good health – including physical, emotional, and spiritual health – are going to help you though infertility hell. Depression, anxiety, low self-worth, divorce – these are all more common among people going through infertility. Anything that can help you avoid or come out of those dark places is invaluable.

For me there were certain things from my list that helped more with my good health – things like regular acupuncture, yoga, meditation, psychotherapy, as well as others. Then there were things that ended up stressing me out thereby probably doing more harm than good for my overall health. Sometimes it was simply doing too many things from my list at once that stressed me out. I felt overwhelmed and spread too thin. That led to feelings of guilt that I “should be” doing more. That wasn’t helpful at all.

So my advice to anyone that is interested is this: cut yourself some slack. Find what supports your peace of mind and overall good health. Do what feels good for your body, mind, and spirit. And if or when it stops feeling good, reevaluate. Maybe it’s just not working for you anymore. And that’s okay. Because these things we do probably aren’t going to make or break our cycle. They may make or break you though. The cycle, well, that’s mainly luck.

And may luck be on your side.

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Pregnant After Infertility: Reflections on the things people say during IVF

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I’ll never forget the day I had my first ultrasound for this pregnancy. The fear and anxiety going in – just hoping that we would find a baby in there with a strong heart beat. All of the warm congratulations from the nurses, my RE, and other staff at my clinic. It was amazing.

But there was one comment made by one of the nurses that stood out at the time and has remained with me. She said, “You did it! You never gave up! And it paid off.” But what she didn’t know was that I kinda had given up.

Now that I’m obviously sporting a baby bump and it “looks” like I’m out of the danger zone, I’ve had others comment on the same thing. People who know how much infertility treatment I went through to get here seem to be saying, “you never gave up” in one form or another. I suppose it’s meant to be an affirmation or validation of some sort. It’s with good intentions, I know, but it always rubs me the wrong way.

What does “giving up” mean in the context of infertility treatment? Does anyone ever casually say, “Ummm, I think I’m good now. I don’t really want that baby. You can keep the medications. I’m done. Thanks.” No one casually throws in the towel when it comes to infertility. Maybe the term “give up” irritates me so much because it sounds a lot like failure or resignation. Simply quitting. It sounds like someone was too weak to continue.

But there is nothing weak about the women (and men) who go through infertility.

Honestly, I can think of few harder decisions that require more strength of mind than making the decision to stop infertility treatments. To choose to embrace the life before you, one that is not what you had planned or preferred, but can make something beautiful out of, rather than continuing down a dark and possibly quite unhealthy path.

And that’s assuming you even have a choice. For so many women and couples, the decision to end infertility treatment is made for you against your will. By insurance companies, lack of insurance, finances, medical conditions, age, and other factors out of one’s control. That lack of control can be traumatic. And being told to never give up when you don’t really even get to make the choice, can leave women feeling ashamed, confused, angry, or guilty. We don’t all have the luxury of “never giving up”.

In an environment that sings to the tune of “never give up,” discontinuing treatments, whether by choice or not, can leave a person feeling like they are doing something wrong. In the infertility community this starts to look like some form of peer pressure. Well-meaning women in IVF support groups readily tell other to “never give up” after any set back or negative test result. Sometimes I feel like shouting it’s not giving up! Sometimes stopping treatments, if the decision is up to you, is a healthy thing to do. Sometimes it’s healthy to choose the life you have rather than constantly hoping for or living for a “maybe” while the rest of your life passes you by.

For me, making the decision to stop began as a mindset not yet in sync with my actions. I had agreed with my RE to transfer my two unlikely embryos that I did not expect to take, and planned to do one last retrieval and fresh transfer afterwards. And then I decided that enough was enough at that point. I felt like I found the tipping point where maximizing my chances for success was going to become outweighed by the toll infertility treatments was taking on my mind, body, spirit, and relationships. Identifying that stopping point felt oddly liberating. Like a weight had been lifted from my shoulders. I began accepting what life would look like when IVF didn’t work, and I managed to see a light at the end of the tunnel (that wasn’t a train).

I realize that my road would have gotten rockier had my FET and last planned IVF hadn’t worked. I’m not naïve enough to think that I would have sailed through the finality of that loss without a huge crash, but I did have a support plan lined up for that outcome. Seeing a psychologist was a big factor in helping me come to terms with my stopping point, and although I ended my therapy while preparing for my FET – the ending was agreed upon and planned based on my progress – we agreed that if the final courses of treatment didn’t work, I would return to therapy to process my feelings and reactions to ending treatment and moving forward. Steps toward closure.

I’m not sure if this post is going to come off as negative or inspiring. I simply hope that it will help to open up the doors to acknowledging some of the difficult decisions that women face during infertility, provide a bit of insight into why “never give up” isn’t always helpful, and work to remove some of the shame and guilt that so often comes with infertility and treatment outcomes.

Pregnant After Infertility: IVF reflections and the needle shot

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PicsArt_09-17-02.02.50I saved my IVF needles. All of them. That’s a total of 6 egg retrievals, 2 fresh transfers, 2 frozen transfers, and 2 mock cycles. Some people, including probably everyone who has never gone through IVF, would think I’m a bit nuts for holding on to all these needles. But it’s oddly hard to part with something that you’ve put so much of yourself into. Something that symbolizes an experience, or maybe a part of you.

I even have my needles from my very first IVF cycle over 4 years ago – the one that brought me my feisty daughter. At that time I think it was just feeling a bit overwhelmed that kept me from taking the time to bring them back to my RE’s office for disposal. I didn’t have any grand plans for them. But this second time around, I did. I kept the needles from each cycle in a separate sharps container. I envisioned making one of those IVF baby announcements one day when it finally worked. You know, the cute pictures where all the needles are arranged in the shape of a heart with care, surrounding baby’s first ultrasound picture. Maybe a onsie or booties, too. I was so hopeful back then, and it made me smile every time I saw one of those pictures.

But as my failed cycles piled up, so did my needles. The idea that once symbolized optimism and success, morphed into something quite different. Now I have a giant pile of needles. I’m actually missing about 80 percent of my Gonal F pens because my nurse would discard them when I’d bring them in for her to combine the tails to get me an extra dose or 2 of meds. My pile began to feel chaotic as one cycle blurred into the next. The FET that finally worked consisted of 2 embryos from 2 different egg retrievals; I lost track of which sharps containers led to which of these embryos.

I’m left with a big pile of needles and no desire to shape them into something pretty.

Why did I keep these needles? Because when I look at this pile on my table I see my pain and strength. I see determination and perseverance. Countless hours spent crying in the arms of my loved ones, and even more spent crying alone in the bathroom when no one knew. Friendships fading away, while unexpected ones blossomed when I needed them most. Miracles. I see isolation and connection. The highs and lows that no one really understands unless you’ve walked in my shoes. Failure and success. Baddassery (especially when I self administered my first PIO shot). Luck – sometimes good, sometimes bad. I see hours of research and hard decisions made. Coping skills executed and eventually exhausted. Asking for help, and helping myself. Enduring more than I thought I could, and then a little bit more. Making a healthy decision of when to stop and finding peace with that. The emotional, spiritual, and physical tolls. Pride in myself. Somewhere along the way, infertility became a part of who I am. It is not all of who I am, but it has challenged and changed me in ways I never anticipated. And I’m different now. Oddly, I wouldn’t change that.

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Me and my almost 4 year old IVF baby and 17 weeks pregnant with my second IVF girl.

If all goes well, I will be a mom to 2 daughters. Yet in my mind, I will always be infertile. Despite the failures, I got the outcome that we all hope for. I am so very blessed. And, well, really I think I’m just lucky.

Pregnant After Infertility: The anatomy scan

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close up of pink baby booties

I had my anatomy scan last week. As the day approached, I had my usual influx of paranoia that my baby had stopped growing. In other words, I was afraid my baby had died. There I said it – the “D” word. I’m always afraid to type that word. As though saying it out loud, or in this case typing it out loud, could make it come true. But that’s the fact of my feelings – oddly I’m not afraid that my baby has any disease or growth abnormality. I’m afraid of finding a silent heartbeat.

As soon as the scan began and the heartbeat was present, I was able to relax. Then my Maternal-Fetal Medicine (MFM) specialist proceeded through the lengthy process of measuring and calculating every detail of my growing baby. Reclined on a comfy table, I watched in awe and enjoyed every moment. I loved having my scan with a highly experienced MFM, who also happens to be a geneticist. He was able to explain everything we saw, not only the structures but also assumptions about functioning, with precision backed by extensive experience and knowledge. It really is amazing how much they can tell based on these pictures. For example, when they see fluid in the baby’s stomach, they can make assumptions about how the brain is functioning because apparently swallowing is a much more complicated series of behaviors than you would think, which relies on a well developed brain.

And every bit and part checked out perfectly. Could there by something wrong with my baby that they cannot see? Well sure, I suppose. But the chances of that are very unlikely. So unlikely that I’m not going to worry about it anymore. I know my baby is healthy.  I will, of course, continue to worry about my healthy baby dying before every appointment, even though that doesn’t make any logical sense. I mean, why would that even happen? It wouldn’t be due to some fetal disease or deficit, but sometimes things go wrong in pregnancy for other reasons. I guess my IVF stress has to go somewhere.

One slightly annoying thing we found out was that I have an anterior placenta. On the plus side, this means that my placenta did grow away from my cervix, as my OB thought it would. That’s great news and I’m thankful. But, seriously – how do you freak out an IVF mama-to-be? Give her an anterior placenta so she can’t feel the baby moving as often as she “thinks” she should. It’s a rabbit hole I’m trying to not go down. How am I doing with that? Well let’s just say that the other day my hubby walked in on me Googling “haven’t felt the baby move in 3 days with anterior placenta” and he simply said, “stop it.” I’m trying to stop it, really I am. I haven’t Googled anything today.

And last, but certainly not least. We found out the gender! With IVF baby #1 we didn’t find out until birth and that was pretty amazing, but this time around we decided to do it differently. We saw the telltale three parallel lines, clearly showing that we’re expecting a girl. So my daughter gets her wish – a little sister. I get all teary just thinking about it. I really thought she would never get to be a big sister and I am so grateful. Of course now all of a sudden she says she wants the baby to be a brother – but 3 year-olds are fickle little ones.

Pregnant After Infertility: First appointment with the new OB

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tim-goedhart-334149-unsplashThis week I met with my new OB. He came highly recommended by my RE and many other moms in my area. He actually spent a good amount of time with me and did a much more thorough ultrasound than I was expecting. He also seemed sensitive to the fact that I wanted – no needed – to get right to the ultrasound part as fast as humanly possible. I don’t think the fear of loss gifted to us by infertility ever goes away during pregnancy, and possibly not even after birth. So like usual, I was pretty much in a state of panic as I walked into my appointment, fearing that the baby maybe be, well, you know. And so we got right to it.

With a tear of relief, I saw the familiar flicker of my baby’s heart beat even before my OB could get the words out. After all, by this point I know how to read the basics on an ultrasound – from follicles to heart beat. Then he went through and diligently measured all of my baby’s parts, sounded off measurements, and assured me that everything was normal, and there were no markers to be seen of any deficits or disease.

I did find out, though, that my placenta is covering or partially covering my cervix. He followed this fact with reassurance that this is really common at this stage, I’m 15 weeks pregnant, and the placenta usually moves around as the pregnancy progresses. He said in most cases, this will resolve itself, but if it’s still covering my cervix at 20 weeks then that could be a placenta previa. I’m sure he quickly realized his mistake in telling someone like me about this, as panic washed over my face. When I asked what that could mean, he said that I would need a c-section (a mute point for me, since I’m going to need one anyway) and could cause bleeding after 20 weeks. Although I hadn’t read much about placenta previa prior to this, I knew that it could also mean other “bad things”. But I’m doing my best to not go Google-crazy or think the worst. Hopefully, my placenta will pack its bags and settle in somewhere away from cervix land.

And speaking of my placenta (because that’s a phrase I use often), my RE had me come back the day after this ultrasound for one last progesterone check. I had been off all progesterone supplementation for 3 days so we were hoping to see that my placenta was pumping progesterone like a champ. After looking at my placenta and baby, my OB assured me that my RE would tell me my progesterone level is fine and I don’t need any more supplementation. But, no, that’s not what happened. Of course not. My progesterone level came back at 19 and I was told to continue using Crinone once per day until 20 weeks. At that point, I was told to simply stop. Not sure why we would stop then, but of course, I’ll be insisting that my OB check it again at that point. I’m not leaving anything to chance.I’m way too obsessive and controlling for that crap.

During the second trimester, a normal progesterone level is 17 to 147 ng/ml. That’s quite a range, and my level is in that range. I guess my RE continues to take a conservative approach with me, which I don’t mind. I mean, Crinone is a nasty little demon and I’d love to not use it, but hey – I’ll do it for the baby. I may completely forget what it’s like to have sex, but what’s a few more weeks? And in case you’re curious, yes you can have sex while on Crinone, but it leaves this chunky, waxy white substance in your vagina – think cottage cheese on steroids – that you have to periodically scoop out with your finger. Sounds attractive right? My fear is that if we have sex, the Crinone wax will get packed into places that I simply can’t reach. If I was planning a vaginal birth, I’d be afraid that my baby would be forever trapped behind a Crinone wax fortress. Good thing there’s another way out.

The last little bit of interesting information from my OB appointment, is that my OB asked if I’d like to have my tubes removed during my c-section. Wait, what? While preventing a natural pregnancy is laughable – as if that would ever happen – the main reason he offered to remove my body parts is that current research is finding that a majority of ovarian cancers actually originate at the ends of the Fallopian tubes. So the idea is that if you remove tubes you don’t plan on using anyway, you could prevent, or at least significantly reduce, your chance of developing one of the most deadliest forms of cancer. This info is completely new to me and I’ll definitely have to do some research. The procedure is called salpingectomy, and is not to be confused with a tubal litigation (i.e., “getting your tubes tied”). The former completely removes your tubes from your body, while the latter cuts, ties, or blocks your tubes and leaves them inside your body. I’ll post my finding on this topic in the future when I find out more.

So for now I have about 3 more week of peace until the panic returns the night before my next ultrasound. That one will be my anatomy scan, which is scheduled for my 18th week. I’ll be doing that with a maternal-fetal-medicine (MFM) specialist – the high risk pregnancy doc – not because I’m necessarily all that “high risk” (age blah, blah, blah), but because that’s who I saw last time around and so I was scheduled with him again. Besides the MFM has a much bigger ultrasound TV screen and the plushest exam table I’ve ever laid on. So yeah, I’ll take my anatomy scan luxury style.

Pregnant After Infertility: A day for me

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Tomorrow is the full moon and also happens to be a lunar eclipse. It’s apparently the longest one of the century, clocking it at a whopping 103 minutes of darkness – too bad I won’t be able to see it here in North America, but still it’s pretty cool. For those of us who celebrate the Wheel of the Year, it marks the lunar Lughasadh, which is the exact halfway point between the Summer Solstice and Autumn Equinox, and is celebrated as the first harvest festival. It’s a time of reaping rewards, abundance, and gratitude. And if all that weren’t enough, it’s also my 41st birthday. Yeah me! Bust most importantly to me, it marks the first day of my second trimester. A milestone.

 

So to celebrate the plethora of events tomorrow, I plan on taking some “me time”. I’m off work and going to spend the day alone. Now I know that may not sound all that fun, and yes I do have a fun day at the lake planned over the weekend with some family, but to me it’s perfect. A walk on a nature trail, a treat of a decaf latte and something yummy to eat, a gratitude meditation, maybe some Netflix. But mainly just letting myself relax, at least a little bit more, into this pregnancy.

 

I’ve bought a couple of baby things. Very few, but still it’s something. It’s hope that this baby is going to be okay and will actually be born safe and healthy. It’s so easy to let the little stings of anxiety tug at the back of my mind. If I don’t cut them as soon as I notice them, they start to pull me in a scary direction. Most of the time I’m good at letting it go, but sometimes I give in to Google and Facebook posts that highlight the hard reality of all that can still go wrong. But not tomorrow. Tomorrow is just for me and this baby.

 

After continued monitoring of my progesterone levels (I wrote more about what’s been going on with in my last post), it looks like it’s finally raising. At my last check (on 13w4d) it was 22.8. Still my RE wants me to stay on Crinone a bit longer. So I’m to continue inserting that horrid gel twice daily until August 3rd. Then I stop for 3 days and have my progesterone level checked again. We shall see if my placenta notices the change and ups it’s production. I’m still not in a danger zone, just low normal I suppose. But it does need to be a bit higher in the second trimester. Maybe it’s already kicked more into gear these past few days. Let’s hope so.

Pregnant After Infertility: Wake up placenta!

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A common question that you will inevitably hear repeatedly in any pregnant after IVF group is, “when did you stop progesterone?” Whether it be PIO shots, vaginal suppositories, or pills, the stress surrounding stopping progesterone support is real.  The fear, of course, is that you might stop too soon, begin bleeding, and the ultimate fear – miscarry. So when is the right time to stop?

See, we assume there is actually one right answer to that question (how silly of us), but, like all things infertility related, there just isn’t. Some RE’s have their patients stop progesterone supplementation as early as 8 weeks, while others have you injecting, inserting, and popping until a whopping 12 weeks. It seems like 10 weeks is a pretty common stopping point though. But we’re all afraid when the magic week hits. Some women are certainly relieved to finally be able to set the needles down and let the rear heal (and yes, it will get back to normal eventually). But still, there is that touch of fear. Or sometimes unrelenting anxiety.

So why all the variation in protocols? Well for one, if you Google “when does the placenta take over” you will get multiple answers. Of course. The responses tend to range from 8 to 13 weeks. Apparently, each woman can be a bit different. But clearly most RE operate under the assumption that that the placenta will be producing enough of the hormones needed to sustain the pregnancy by week 10. So we’re just supposed to trust that we fall into this norm, right?

There’s another factor that often isn’t talked about, and it has to do with how progesterone is normally made by the body in early pregnancy before the placenta takes over. In a non-medically assisted pregnancy, once the follicle releases the egg during ovulation, the follicle becomes a Corpus Luteum. That little corpus luteum has a big job – it produces all the progesterone needed to sustain the pregnancy until the placenta steps up to the plate. Now think about this. When we do IVF, we retrieve anywhere from a couple eggs (although a few struggle to even get one) up to a crazy amount of eggs that probably results in ovarian hyperstimulation syndrome. Let’s just say, for the sake of argument, that you retrieved 10 eggs. So now you have 10 corpus luteums pumping out progesterone. If one of those buggers can sustain a whole early pregnancy, just think about how much progesterone you’re getting with 10.

So the point of this dive into the ovaries is to say that if you do a fresh transfer following an egg retrieval, or even a natural FET where you ovulate first rather than being suppressed, you don’t actually need any progesterone supplementation. Yep, you read that right. At my last fresh transfer, when my RE said I wouldn’t need to do PIO, I was surprised. When we did my first IVF/fresh transfer 4 years prior, which led to my first pregnancy,  I did PIO for 10 weeks. So I asked him what had changed. He explained the ovary operations to me and also told me about a recent study that compared progesterone supplementation to no supplementation in women who had a fresh transfer. They found that both groups of women had comparably high levels of progesterone. So I was happy to forego the  dreaded PIO that cycle, but I still wanted more evidence for my own peace of mind. They obliged my paranoia and tested my progesterone levels even before my beta, and sure enough my progesterone was quite high.

So when women who have “ovulated” either naturally or through an egg retrieval say that they stopped PIO at 8 weeks, or whenever, it’s really not the same as it is for women who did a FET and were medically suppressed to keep them from ovulating before the transfer.  The former group didn’t actually need PIO in the first place.

The situation is quite different for those of us who did a FET and did not ovulate. We are completely dependent on those injections, or whichever form you take, to support the pregnancy until the placenta starts doing it’s job. And that’s why it’s so scary to stop in this situation. That’s why when I read that the placenta takes over anywhere from 10-12 weeks (or insert other time frames since there are differences depending on what you read), I’m left to wonder, “but what if mine hasn’t taken over quite yet?”

Apparently my RE is just as cautious as me. When I brought up my concern, without missing a beat he agreed with me and suggested we test my progesterone level. That way, we would be making our decisions based on what is actually going on in my body rather than relying on averages and assumptions. I appreciate that. So, at my second ultrasound we drew my blood since I had been off of PIO for 2 days. Apparently that’s enough time for it to be out of the blood enough to get an accurate reading of what my placenta is up to. The ultrasound was great – baby was growing on time, moving, and had a healthy heart rate of 158. Thank the Universe!

Later that afternoon I got a call from my nurse saying that my estrogen was great, and my progesterone was 15.2. She said above 10 is fine, but my RE would have liked it to have been closer to 20. She said mine was low-normal. So, for the sake of being cautious I was instructed to go back on crinone 2 times daily (great- twice the grossness. I fear I may never get all of that wax out of my vagina, but I digress) for one more week and then they will re-test my progesterone. Unlike PIO, which does show up in your blood, vaginal suppositories don’t make it into the blood stream. So by only taking crinone, I would be getting enough support where I needed it, but we’d still be able to keep monitoring just what my placenta is producing. Not bad, and I don’t mind the cautious approach. I know my RE is doing everything to make this work – we all tried so hard and for so long to get here.

Yesterday, one week had passed and I was re-tested. I fully expected to see a jump indicating that my placenta had kicked into gear by 11 weeks 4 days. But my level was 14.6. The nurse that called me, who was different from the first, basically said it was fine and I can stop progesterone. But I didn’t like that answer. I mean, if 15 wasn’t ideal, why would 14 be when the level should be going up? So the nurse checked with my RE, and reported back that he said to stay on crinone for 1-2 more weeks and re-test. So I’m scheduled to re-test in 2 weeks. By then I’ll be just over 13 weeks and my progesterone level should be consistent with the normal range for the second trimester, which is about 17 to 146 ng/ml. So here’s to hoping that my placenta does it’s thing and starts pumping more progesterone. If it doesn’t? Well, some say that is a reflection of an unhealthy baby that will miscarry, and others say that the baby may be healthy and continual progesterone supplementation helps to get to full term. I’m sure the answer varies pregnancy to pregnancy. At this point, I’m reminding myself that my level is still in the normal range and I have about 2 more weeks before I hit the second trimester, so there is plenty of time for that to increase. I also haven’t had any bleeding or cramping, which could (or could not) signal an issue with progesterone.

In case this post has peeked your curiosity about progesterone levels, know that they vary based on trimester and the normal range is pretty broad. Most RE’s don’t test when they discontinue your progesterone, and most women are perfectly fine. I’m overly cautious, and I guess I worry that my age (I turn 41 in 2 weeks!) maybe my placenta isn’t working as well as that of a younger, perkier placenta. Of course, then I remind myself that when I was younger and going through infertility the first time around I found plenty of other reasons to worry about why my body wasn’t working right. I think it’s simply infertility that makes us this anxious and we always find some reason to worry. In any event, below are the supposedly normal ranges of progesterone by trimester, and you can read more about early fetal development and hormones here.

Guideline to Progesterone Levels During Pregnancy:

9-47 ng/ml First trimester

17-146 ng/ml Second Trimester

49-300 ng/ml Third Trimester

* There are many averages for progesterone levels. These charts are a very broad guideline – speak with your health care professional for more specific guidelines for you.

** Remember – these numbers are just a GUIDELINE – every woman’s hormone level can rise differently. It’s not necessarily the level that matters but rather the change in level.

Source: American Pregnancy Association

Pregnant After Infertility: Out with the guilt and on with the symptoms!

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You know that guilt we carry around while going through infertility treatments? The part where we second guess each choice and worry that we’ve messed something up? I wrote about one of my guilt stricken moments a while back during who knows which round of IVF. That guilt doesn’t simply go away with a big fat positive (BFP), I think it just morphs into something new. Maybe even something similar to survivor guilt.

Let’s talk about that.

I can’t tell you how many times I’ve heard a woman who is pregnant after IVF express guilt over complaining about anything pregnancy related. Just the other day I was reading a post from a woman who was struggling with guilt because she felt bad over the fact that she wanted to complain about throwing up multiple times per day, everyday. Let me repeat that. This poor woman is vomiting her guts out repeatedly every freaking day, and she felt like she was being ungrateful if she let on that she wasn’t loving “puke fest 2018”. Wait, what?!

So I’m just going to say it. Just because we are pregnant after struggling long and hard with infertility, doesn’t mean that we should love pregnancy symptoms. And just because we don’t like nausea, vomiting, exhaustion, etc., does NOT mean that we are ungrateful to be pregnant. We are grateful. And we are so very sad and empathetic toward all the women continuing to fight the infertility battle.

But still, pregnancy symptoms are just as hard for us as they are for our fertile sisters. And they get to complain without the added guilt. In fact, they get sympathy for their symptoms. And so should we. Throwing up is not fun for anyone, regardless of how badly you wanted that baby or how long you tried.

It’s okay to not like this part. So let’s let the guilt go, ladies. You can be miserable during the first trimester, and any other part if it fits. You earned it. In fact, you went to hell and back to get here.

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We spend so much time, effort, and money chasing that BFP that we sometimes begin to idealize what it will finally be like when we become pregnant. We paint this pretty picture in our minds filled with rainbows in the sky, glitter raining down upon us, our baby bumps growing round while the rest of our body  glows like a magical earth goddesses, while we hold picture perfect yoga poses, and lovingly chuckle at our partners as they struggle to assemble the perfect crib. Oh and we’re craving nothing but veggies and fruit.

Yeah, that’s probably not going to happen.

So when early pregnancy isn’t quite what you imagined it would be during the years you were trying to conceive, please don’t beat yourself up over it. Let the guilt go! You have the right to be heard and to feel what you feel. Guilt free. Yes, you definitely earned it.