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The Not So Fertile Goddess

~ and here we go again…

The Not So Fertile Goddess

Category Archives: Pregnancy After Infertility

Pregnant After Infertility: A day for me

26 Thursday Jul 2018

Posted by thenotsofertilegoddess in Pregnancy After Infertility

≈ 2 Comments

Tags

Coping, gratitude, Pregnant after IVF

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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.

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Pregnant After Infertility: Wake up placenta!

11 Wednesday Jul 2018

Posted by thenotsofertilegoddess in Pregnancy After Infertility

≈ 2 Comments

Tags

placenta, Pregnant after IVF, progesterone levels

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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

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

25 Monday Jun 2018

Posted by thenotsofertilegoddess in Pregnancy After Infertility

≈ 4 Comments

Tags

Coping, Guilt, IVF, Pregnancy After Infertility

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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.

abdomen active activity belly button

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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.

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Pregnant After Infertility: The first ultrasound

19 Tuesday Jun 2018

Posted by thenotsofertilegoddess in Pregnancy After Infertility

≈ 6 Comments

Tags

8 week ultrasound, Coping, Pregnant after IVF, Spiritual pregnancy

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Last week I had my first ultrasound just after 8 weeks. I was terrified. While I hadn’t had any cramping or bleeding, I simply couldn’t let myself off the hook. I mean, women have missed miscarriages right?!  Oh and if you are wondering, a missed miscarriage is when the baby stops growing but you don’t know it because you didn’t bleed or cramp. Since old habits die hard, I googled all the symptoms of missed miscarriages, like any good infertility patient.  Apparently, it might be a missed miscarriage if all of your pregnancy symptoms completely stop. Or you can still have all of your symptoms and still find out that you’ve had a missed miscarriage. Just lovely. My symptoms had decreased, but I guess it could happen either way.

So with trepidation, I went to my clinic and my husband met me there. I swear it was like I was approaching the stage for a big presentation or race. All eyes were on me. As I walked down the hall, every staff person stopped and smiled at me reassuringly, wishing me luck, but it almost looked like they were nervous too. My clinic is relatively small, I think, with only 2 RE’s and everyone discusses the cases together. Each nurse or tech has been involved with me multiple times over the past 5 rounds of IVF, 2 FETs, 3 ERAs, and lots of tests and procedures. They’ve all had a hand in my reproduction. Strange, but also oddly heart warming.

My RE did my ultrasound and right away he found one tiny baby. He quickly assured me that the baby was measuring right on time and had a heart beat. Relief flooded me. The nurse handed me tissue for my tears. Then my RE measured the heart rate and it was right on target at 155. More relief.

After we were done, each and every staff person, from my RE to the receptionist at the front desk, came and hugged me. There were cheers and tears. It had been a long road. And the caring support felt great.

So here we are. Pregnant with a singleton and off to a good start. But still I think about the worse case. Infertility seems to wire us to think this way, and it’s something I try to let go of. Still, I had heard from the grapevine that once you confirm a healthy heart beat in the ultrasound, the risk of miscarriage drops to 5%. I asked my RE to verify if that’s true. He said that at this point, 8 weeks, the risk drops to 10%, then once you still find that things are going well at 10 weeks the risk drops to 5%, then gets even lower at the end of the first trimester. So I guess I have a 90% comfort level right now. I was hoping to be 95% confident, and yes that extra 5% seems like a big deal.

When the anxiety comes up, I logically remind myself that my chances for a successful pregnancy are great. Sometimes I mindfully let the negative thoughts float past me. Acknowledging them, but simply letting them float by without judgment. Most of the time I can do this. My husband said he wished he could spray me with a “dumb spray”. I know it sounds bad, but his heart is in the right place. He wishes he could take the fear away and turn me into one of those blissfully naive women who don’t worry about early pregnancy and can enjoy it. He knows the toll infertility has had on me, and how hard it can be to let the fears go and celebrate the moment.

I think it gets a tiny bit easier each day. This time around I’m more prepared for how this works. I’m grateful to be pregnant after IVF and I’m trying my best to enjoy the moment. I still don’t feel particularly connected to this baby, as I have this lingering notion in my mind that my pregnancy isn’t secure until after the first trimester. I know that horrible losses occur after the first trimester, but I’m not allowing myself to go there.

bookI have a book called, “Spiritual Pregnancy” that interestingly was written by an couple who both happen to be OBGYNs. I find this book unique in that it is written from a spiritual perspective, but authored by MDs. Not to say that MDs can’t be spiritual, but it’s not often what you find in sterile, clinical settings. The book contains lots of meditative practices and journaling ideas for connecting with your growing baby, yoga poses to support the different stages of pregnancy, info on baby’s growth, as well as many other topics to support connection and a mindful pregnancy and birth. I think anyone who has a spiritual pull, regardless of religious affiliation or lack thereof, could enjoy this book. I started reading the beginning section for the first trimester, but I find myself not really engaging in reading much while I wait for the second trimester. I guess I’m still afraid to connect with the baby in case something goes wrong.  I suppose I have some reading to do.

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The Liminal Space After A BFP

11 Monday Jun 2018

Posted by thenotsofertilegoddess in Pregnancy After Infertility

≈ 5 Comments

Tags

Coping, IVF, Pregnancy After Infertility, support

It’s only been 3 weeks since finding out that my FET actually worked, but it feels like a lot longer. Since my initial HCG beta, I’ve had 2 more betas and each had doubled appropriately. Each beta brought temporary relief and renewed confidence. All in all, I’ve been maintaining a decent level of calm, right up until about 3 days ago. Since then I’ve been beating back that feeling that, I think, goes had in hand with pregnancy after infertility. It’s the feeling you get when you know just how fragile something is. When you know how easily it can be lost. And how frequently “bad things” happen. How I wish I could be blissfully naive.

When I see women posting pictures of positive pregnancy tests, as they announce to the world that they are having a baby, I cringe in silence and hope that they really do end up with that baby. Or I roll my eyes and spat out, “idiot!” You know, it depends on how my hormone cocktail is affecting my mood that day. The reality is that those of us who struggle with infertility have a deeper level of understanding about what all can go wrong. And that makes the early weeks, even months, of pregnancy after infertility a peculiar time.

I feel like I have to pause to state specifically how grateful I am to be pregnant at all after my FET. So let me be clear – I am grateful. I would rather be riding in this anxiety boat than preparing the ships for another turbulent round of IVF, no contest. We all work so hard to hopefully get here. But I do want to acknowledge the strange liminal space that comes after a big fat positive (BFP).

The psychological impact of infertility does not go away with a positive pregnancy test. Sometimes, it doesn’t even go away when you get the baby in your arms. Trauma, depression, sadness, anxiety, fear, anger, guilt – these emotions can be carried forward. Sometimes their faces changes, but in some ways they may go with you. At least for a while. This concept caught me completely off guard when I became pregnant after IVF 4 years ago. In fact, it wasn’t even until the second trimester that I even realized how numb and detached I felt. That’s never how I imagined I’d feel after trying so hard for so long to get pregnant. And I was too ashamed about that to tell anyone.

The problem was that no one talked about it. So that’s why I’m bringing it up, because I know my experience isn’t unique. The infertility community is a wonderful support resource. But it can be hard to share anxieties and fears with those who are still struggling to get their BFP. And rightly so – I get that. Assumptions of happiness also come from family and friends, sometimes from our partners too. But I think it’s important for women to know that it is normal to not feel ecstatic after a positive beta. You don’t have to feel guilty for that – we’ve felt guilty about enough crap, haven’t we?

So what can we do when we are standing at the threshold of pregnancy land but we still feel like an infertile imposter?

First and foremost, I think just knowing that these feeling can happen and are normal is a huge step. I was literally blindsided, and when I realized what was going on I wondered why no one talked about this. As a psychologist I’ve worked a lot with trauma survivors, and I realized that there’s an analogy there. When you take a person out of a traumatic situation, we all know that there is going to be carryover effects. For example, when a soldier comes home from war, we know that simply being home and no longer being shot at doesn’t make all of the symptoms of post-traumatic stress disorder (PTSD) go away. Not by a long shot. I’m not saying that all women who go through infertility have PTSD, although some may. But, we can’t simply remove a woman from infertility and expect that she is going to be all smiles and have no remnants of the pain that she went through. Yet, a lot of people kind of expect her to.

When women talk about the unique experience of pregnancy after infertility – and not just the side with rainbows and kittens – we create awareness, normalize the whole continuum of the experience of infertility, and foster honest support. I’ve found some Facebook groups specifically geared toward pregnancy after IVF, but honestly they were harder to find than the infertility groups. I think these groups can be valuable since it provides a space for opening up about these feelings to women who can likely relate, without being insensitive to those who are still in the IVF trenches.

Lastly, I just want to say that we need to be kind to ourselves. That is true no matter where we are in this process, and it doesn’t end with a BFP. And this is particularly relevant to me today as I sit here anxiously awaiting my first ultrasound tomorrow. I’ve reluctantly analyzed every symptom in a futile effort to determine whether this pregnancy is still progressing – whether we’ll find a baby with a heart beat in there tomorrow. It doesn’t feel real. I don’t feel connected to this baby. I’m scared to, because what if… But I know that right now this is out of my hands. My body will do what it intuitively knows to do, and if this embryo is healthy then it will still be growing. If not, I will find a way to cope. I hope I don’t have to, but I will. If infertility has taught me anything, it’s how strong I am.

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