Therapy? Who me?

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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

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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?

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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.

Pregnant After Infertility: C-section without shame

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When I was pregnant with my first IVF baby, I wanted a non-medicated “natural birth”. The kind you see in beautiful pictures, with a strong woman in an almost trance-like state as she delivers her baby into her own hands. In this picture, she is surrounded by a team of supportive women, a village, who are there to help, yet not interfere. After all, this is natural and she is built for this. Her significant other is there, lovingly rubbing her back, in awe of the miracle unfolding. Yes, there would be pain, but nothing that she can’t handle. She is built for this.

I did everything within my power to set myself up for the “natural” birth I pictured. I read all the books, watched all the documentaries, hired a doula and midwife, spent hours training myself in self-hypnosis for birth. While I did decide to deliver in the hospital, I was surrounded by a team of nurses, midwives, and doula, who were there to be my village, as well as my husband. I was not induced. There was not a “cascade of interventions” causing any stalls or other mishaps. Everything was set up for the birth that I wanted. There was even mood lighting and aromatherapy.

And yet, I still ended up with a c-section. As it turned out, my body just wasn’t built for this.

imagesI’ve written previously about my birth experience here and some of my reactions to it. Ultimately, I’m okay with the fact that the birth didn’t go as planned. I learned some hard lessons that day, including how to advocate for myself when I though I might have lost my voice. I did end up finding strength that day, it just wasn’t where I had expected it to be.

I am truly grateful to have access to medical treatments to help me get pregnant, and medical interventions for helping me birth by child safely. I can never think of this without remembering that my Grandmother’s sister died in childbirth; this was around 75 years ago, give or take. There’s a good chance her outcome would have been different had she lived in a different time like me.

So when I became pregnant with my second IVF baby, I was faced with some choices regarding this birth. The OB that did my c-section was retired, but he had said that my bone structure was about 1.5 inches too small in diameter to ever give birth to a full-term baby. I went back to the midwife that was there during my delivery and spent over an hour discussing this with her. We spent a lot of time talking about the pros and cons of trying for a VBAC (vaginal birth after cesarean). Ultimately, there seems to be some higher risks with trying a VBAC and failing, thus ending up needing a c-section anyway, versus forgoing the attempt and simply planning a c-section. One of the scariest risks during a VBAC is a uterine rupture. However, when we discussed those risks, the actual prevalence rates of something like a uterine rupture happening were just so small, and the success rates of VBACs were rather high. Still we had to consider my unique circumstances that led to my c-section in the first place. It wasn’t due to anything that happened in the hospital, such as medications used, induction, rushed schedules, nor was it anything to do with the baby, such as position or size. It was simply me. My body.

At one point, she said to me, “I know I’m not supposed to say this being a midwife, but sometimes too much importance is put on having a vaginal birth. It’s your experience that matters most. It’s okay to choose a c-section.” She also admitted that she learned a lot from witnessing my birth. You hear so many stories about unnecessary medical interventions being pushed on laboring women, but my story was just the opposite. My team was so focused on a medication-free, vaginal birth, that they didn’t truly hear me when I knew something was wrong.

This time, I’m planning a c-section. My new OB agreed that that was the safest course given my particular history. And so, I shamelessly scheduled a c-section.

I won’t lie, sometimes I have to remind myself that this is a valid choice and should not come with any shame or guilt. Yet, I still find myself “explaining” or excusing my choice to have a planned c-section when I’m asked about my due date or planned birth. I annoy myself when I do that. After all, birth is an incredibly individual experience and no one has the right to tell another woman how to go about it. This is not a time for shaming. But I’m not immune to the stigma. In my culture, c-sections are often seen as somehow a “failure,” or at least “less than” a vaginal birth. Just the fact that we say “natural birth” to refer to vaginal deliveries is telling, isn’t it? It’s the connotation that comes with the word natural and assumes that anything else is unnatural and thus, not right. Yes, I know that a c-section is a surgery and so it’s not actually the “natural” way for a baby to exit the body, and yes, I do believe that often c-sections are unnecessary. But they can also be life saving. And they are still a method of birthing a baby. Women who have c-sections are not less than. I keep expecting to encounter someone who is going to try to “talk me out of it” and I’m well prepared to argue my point.

Yet, to my surprise, I have received nothing but the opposite reaction. Every person who knows I’m having a scheduled c-section has responded with some variant of, “well after everything you’ve been through, you deserve a less stressful birth.” They are talking about my infertility.  They know the year leading up to this pregnancy was markedly stressful due to multiple rounds of IVF. And so they are basically suggesting that I’ve “earned” an experience that is somehow predictable and safe. This reaction always sits oddly with me. On the one hand, I’ll admit that going into this birth “knowing” when and what is going to happen, having a plan that is scheduled and predictable, is somehow comforting and really is less stressful. Probably less stressful because I will be able to avoid the birth trauma that I experienced last time. (Granted, I know even a scheduled c-section can go rogue, especially if this little babe has a different agenda, but shhhhh, let’s not talk about that.) However, on the other hand, this reaction irks me. As if you have to “earn” a stress-free birth experience. As if a major abdominal surgery is even stress-free.

But what I do know for sure, is that a c-section delivery is a birth just as much as a vaginal delivery is a birth. I am not less than because I have had (and am having) a c-section. I’m still trying to wrap my mind around my emotions with this upcoming birth. It does seem like it may be a bit surreal to go into the hospital before labor begins, and then undergo this procedure and be handed my baby. I suppose I keep comparing it to my last birth where I didn’t have the c-section until after 32 hours of hard labor. So there will be more posts to come about my emotions leading up to this birth, as well as the choices I’m making to support a “family friendly c-section” (yes, that’s a thing) and my emotional well-being pre- and post-partum. Stay tuned…

Did you hear the one about the uterus transplant?

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rawpixel-585634-unsplashBut this is no joke. I’m so amazed and thankful to live in a day and age where reproductive technology exists, and continues to evolve, to help those diagnosed with infertility have a chance at building a family. I’ll say right up front that there are no guarantees that the treatments available will work for everyone, and in fact, they often don’t. Still, science gives us a chance at something that not too long ago, we wouldn’t even have a shot at.

Today I came across a headline that stunned me: “In a first, a woman with a uterus transplanted from a deceased donor gives birth.” I mean just wow – let that sink in. The article explains that there have been 11 babies born to women who have had uterus transplants from live donors (talk about a generous donation), but this is the first from a deceased donor. That opens some interesting doors. Personally, I’m all for organ donation. After all, I really don’t need my parts when I’m gone and if I could help the living, well, all the better. You can find the article here in Science News.

The uterus came from a 45-year-old woman who died of a stroke and had 3 children of her own. The recipient was 32-years-old and had a frozen embryo transferred into her newfound uterus, following IVF that was done a few months before the uterus transplant. She gave birth to a healthy baby girl. Congrats mama! IVF is hard enough, and IVF pregnancies can be marked with significant worry about all the things that “could” go wrong at any moment to take away all our happiness. But image the fortitude it takes to be the woman doing something like this? To be a scientific “first,” and all the fears that come along with those unknowns. She’s a rock star in my book.

I often wonder what reproductive technology will bring us in the decades to follow. What will be discovered to improve IVF rates? Hone PGS testing (because that’s one area with a lot of room for improvement and important potential if it can live up to the hype)? Improve donor egg and embryo success rates? Reduce repeat losses? Revive aging eggs? What will lift the veil on “unexplained infertility”? There are so many questions that still need answered. And so many treatments that can be improved upon. What will the future look like?

One thing is for sure, the future won’t be as bright until we have insurance coverage for everyone diagnosed with infertility. I know what an IVF cycle cost out of pocket, and I can only imagine what a uterus transplant would cost. Yikes!  I can’t speak to infertility treatment coverage in other countries, although I image all have their pros and cons, but here in the US, it’s abysmal. Shameful, really. When so many women and men cannot get the medical treatment they need for infertility, and money ends up being the limiting factor in the ability to address a medical condition and build a family, there is something seriously wrong with our values as a culture.

So as this amazing science evolves, I can only hope that we can get to a place where these reproductive treatments are available to those who are suffering and need them. We need this. kat-yukawa-754726-unsplash

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.