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The Problem with Manifestation

18 Friday May 2018

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It seems that where ever I go I find commentary about how we create our own realities. In spiritual circles the notion of manifestation, or the Law of Attraction, is everywhere. In essence, it’s the idea that by utilizing the power of the mind to focus on your desired outcome, and taking some action toward that outcome, your desire will become your reality. It’s like sending all of your positive thoughts and intentions out into the Universe, and being rewarded with your heart’s desires. And I admit, I’ve done my best to sing to the manifestation tune. I’ve visualized, I’ve sent intentions out to the Universe, I’ve been confident in an outcome, I’ve done my part. But can it ever really be that simple?

As a psychologist, you find countless examples of the power of the mind to “manifest”. What psychologist hasn’t knowingly smiled and thought, “yes, of course that’s what’s happened – it was a self-fulfilling prophecy”? Trust me, we say things like that.  A self-fulfilling prophecy is when one’s deeply held beliefs and expectations subconsciously effect our behavior and ultimately lead to an outcome consistent with our beliefs. One example of this is the placebo effect, which is when you expect something to happen and then it does. Take medications for example. In medical research, patients may think they are taking a certain medication, but really they are given a sham pill. Nevertheless, the outcomes look the same as it does for the patients taking the real medication. But since the people taking the sham pill, or placebo, believed it was a real medication, it ended up having the same effect. The placebo effect is actually a pretty common occurrence in scientific studies, thus illustrating the power of the mind. And then there’s the research on the perception of pain that shows that one’s thoughts about pain can actually impact their sensitivity to pain. Or how about ulcers? It is well known that ulcers can be caused by stress. Read: the brain can manifest physical illness.

It’s easy to start wondering what role manifestation might have in infertility and getting pregnant. Am I the reason I’m not getting pregnant? Am I not willing it hard enough?

These ideas get reinforced in the world of infertility in various ways. There are fertility meditations and visualizations designed specifically for conception, IVF, FET, and healthy  pregnancies. Don’t get me wrong, I love meditations. I’m a big fan of Circle and Bloom’s IVF and FET series, and have used them during multiple cycles. I think they are beautifully healthy ways to cope with the stress that goes hand in hand with infertility treatments. And that is hugely important. But is there another message being conveyed here? Is there a subtle pressure telling us that if we just visualize that embryo implanting strong enough…

The mantra said to women going through infertility treatment is, “Think positive!” When I was an IVF virgin, I was all on board the “just think positive” train. I tried my best to manifest like a goddess. Baby dust sparkled out of my vagina when I walked. (And if you don’t know what “baby dust” is, then you really are new here). As time passed, and I accumulated more infertility treatment experience than I ever thought I would, I found myself hanging off the back of that positivity train, kind of bouncing off the ground. I was feeling beat up by it. Then I simply let go and sat on the ground as I watched the train fade into the distance. I’m still not entirely sure what I think of it all.

But there are a few things I know for sure.

When it comes to infertility, and possibly other things in life, this idea of manifestation via the Law of Attraction has a really dangerous underbelly. It’s the underlying message that the reason I didn’t get pregnant is because I didn’t try hard enough. Because I didn’t think positively enough. I didn’t will it enough. I am to blame. I caused this.

That’s self-blaming, guilt provoking, and shaming. And complete bullshit. I did not cause this infertility.

People say, “Think positive!” in an effort to encourage us. To support us. We even say it to each other. Sometimes it’s said because the speaker is uncomfortable with our pain and doesn’t know what else to say. Sometimes we don’t want to tell the truth. Sometimes it’s all we have to hold on to. But those words can so easily be turned upside down when they’re received. Those words can become fears and anxieties: “Could this fail because I wasn’t positive enough? Did I ruin this?” It’s an insidious game that gets played in our minds. All too often infertility is marred by blame and shame.

I’m not telling anyone to not think positively if that’s helping them cope. What I am saying is that it will not change the outcome. IVF will either work or it won’t. And the determining factor won’t be how positive you were. So if you aren’t feeling particularly positive, don’t beat yourself up over it! Feel what you need to feel. And if you’re feeling extra positive, that’s great too. Just watch where you sprinkle that shit.

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Do you trust your RE?

15 Tuesday May 2018

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When you become involved in the online infertility community, you learn a lot about what happens with other women during treatment cycles. You quickly find that different doctors subscribe to different beliefs, strategies, and practices. Not all doctors or clinics are created equally. And sometimes the differences seem to teeter on negligence.

Just recently, in fact, I heard from one woman that her RE is recommending that she cancel or convert her IVF cycle to an IUI because her lead follicle grew too much and is “overripe”. She has several other eggs that are prime size for retrieval, but her RE subscribes to the idea that the healthiest eggs (that is, the ones most likely to become a baby) are the ones that respond first to stimulation meds, so if you miss your lead follicle(s) you may blow your whole cycle. Compare this to RE’s who purposely “sacrifice” lead follicles to allow smaller ones to catch up in hope of gaining a bigger harvest. Their belief is that with more eggs retrieved, you have a better chance of getting the baby. Two very different approaches, with potentially very different outcomes. This woman is stressed and torn about whether to forfeit this cycle or proceed.

Another women is fuming because for the second cycle in a row, her RE wasn’t able to retrieve all of her eggs due to issues with the dose and timing of the trigger. So her mature eggs are stuck in her ovaries. The RE should have known better and made adjustments after the first cycle.

Then there are the tests that should have been done, but never were. Protocols that weren’t individualized for women, who were treated like numbers instead. The examples can go on and on.

Some of this discrepancy is no doubt due to limitations in the research. Some things just aren’t fully known yet when it comes to assisted reproduction (or reproduction in general for that matter – the birds and the bees was clearly too simplistic). But a big part of that discrepancy also falls on the shoulders of the RE. They simply are not all built the same. And the most disturbing part for me, as someone in the health profession, is that not all RE’s stay up on the current research or are even qualified to understand the research (it takes training in research methodology and statistics to really understand the studies that are published. Just because it’s published doesn’t mean that the research design and/or statistical analyses fully support the conclusions drawn in the study). So some RE’s unfortunately aren’t up on the current findings, and some really don’t understand the findings that they read. I don’t mean to pick on RE’s – it’s like this in any discipline that attempts to bridge the gap between research and practice.  And then there’s the RE’s personal experiences, which can influence how they practice.

I often joke that I should be awarded an honorary degree in reproductive medicine after everything I’ve been through and all the studying I’ve done. Seriously, I know more about reproduction than my OBGYN. But all joking aside, I’m not an RE. I rely on my RE to advise me, make the best decisions for my individual case, be knowledgeable about current research, and care about making this work for me. And I do. I trust and respect my RE. I actually think he’s awesome for so many reasons.

And that gives me a sense of peace. I know that if this doesn’t end in a baby, it’s not because my RE wasn’t skilled enough or should have done something differently. That isn’t to say that I wish we wouldn’t have done some things differently, but I do believe that we did the best we could at each step with the information we had. And when we got new information, we changed things up accordingly.

Going through IVF is easier when you trust and believe in your RE.

It really is. In life we often have to advocate for ourselves, and I want to encourage women to speak up during infertility treatment. Ask questions – as many as you need to until you feel satisfied with the answers. Don’t be shy. And if you don’t feel comfortable with your RE – if you don’t believe in their skill and trust them – consider finding a new one. I know that’s not always an option. You may be restricted by insurance, geography, or other factors. But if you have the option, exercise it. If you don’t have the option,  it makes this difficult process that much harder.

How to Plan a Pregnancy IVF Style

07 Monday May 2018

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I came across a lovely article recently in Fertility Road Magazine titled How to Plan a Pregnancy. It had lots of helpful information about health, lifestyle choices, and tests that you can do to optimize your body and chances for successful conception. I’m glad that this information is out there, and I agree that these are all important issues to think about and plan for before getting it on. But for whatever reason, maybe it’s the hormones I’m currently injecting, I found myself chuckling about what I might say to someone about how to plan a pregnancy IVF style. So here goes, but reader beware, the sarcasm is strong with this one.

Step 1: Check with your insurance to see if they cover infertility treatments.

Read all the fine print to see how many procedures and medications are not actually covered. Oh wait, your insurance doesn’t cover infertility? Yeah, probably not. Move on to step 2.

Step 2: Find money.

Check your bank account to see how much money you have saved. You should also revisit your budget to see if there’s any money you can set aside to fund your treatments. This might include making decisions about necessities versus luxuries. Do you really need cable TV? How about those dinners out? Can you ride a bicycle to work to save on gas? Do you really need soap? Yeah, you’ll be stinky and bored if it means getting a baby. Don’t forget to check under the couch cushions for change. It adds up.

Step 3: Check your schedule to make sure that you have time for infertility treatments.

Do you have a work trip coming up? A family obligation? Planning a vacation? Wait – vacation? You can’t afford that anymore. You basically need to cancel your whole life for the next few months. You’re going to busy with lab draws, ultrasound appointments, and googling how to make PIO shots less painful. You won’t have time for anything else.

Step 4: Call your RE to make an appointment.

Be prepared to find out that the clinic’s timeline for when you can start IVF does not in any way match up with your anticipated schedule as outlined in Step 3. You can begin to rearrange your life now. Again.

Step 5: Surprise!

You need one more test. It will take one month to get the results, so your start date will be delayed. Rearrange your life again.

Step 6: Order your IVF medications

This is going to cost an inordinate amount of money. Good luck with that.

Step 7: Wait for your period.

For those of you who have a regular cycle that starts exactly on the same day every month (what? they exist), this will be the first time in your life that your period is late. Get excited because you just might be pregnant while waiting to start IVF! Just kidding. Your period will start the day after you get excited. For those of you who have never had a regular, predictable period, this will be the longest cycle of your life. You may need to get a shot or take pills for 5 days to jump start your period. These pills turn you into a raging bitch.

Step 8: Your period finally arrives.

For the first time ever, you’re thrilled to bleed all over your new Victoria’s Secret panties. Time to call the clinic and go in for your baseline ultrasound and lab work.

Step 9: Inject yourself daily with your prescribed cocktail of medications.

This step also involves crying because you saw a Facebook photo of a cute puppy sleeping with a baby, yelling at your significant other because he/she left the cap off of the toothpaste, crying some more for no actual reason, gaining ten pounds, then injecting yourself some more. Try to avoid the bruises while injecting.

Step 10: Shave your legs and lady bits so you’re prepared for multiple vaginal ultrasounds weekly.

Note that your partner will get excited in the beginning when you shave because they’ll think they’re getting lucky later that night. But they won’t be. You have been cut off from having sex anymore. So lay back and enjoy the ultrasound my dear, because that’s the only action you’ll be getting any time soon. But don’t get too excited, this wand doesn’t vibrate.

Step 11: Egg retrieval day.

Kick back and relax, you’ll be getting a nice cocktail of anesthesia in your arm. It will be the best sleep you’ve gotten since you started infertility treatments. When you wake up you’ll either get wonderful news about the bounty of perfect eggs that were retrieved and you’ll feel elated that all your effort has been rewarded, or your heart will be ripped out as you’re told that they got 1/10th of the number of eggs you expected. It will be one or the other. Oh and your male partner, if you’re using one, will need to jack off at some point during this day. Gee, he has it rough.

Step 12: Wait.

Wait to see how many eggs fertilized, wait to see how many make it to blastocysts, wait to hear PGS results, make up shit to wait on. It doesn’t matter. This step will take the longest. No, I lied. Step 14 will take the longest so read on, but this is a close second.

Step 13: Embryo transfer.

On this day you’ll get the first precious picture of your “maybe baby”. It will look like a blob of nothing, but you will cry with joy anyway as you picture this blob in a bonnet. You and your partner will stare intently at the ultrasound screen to watch as this tiny embryo is inserted through a long catheter into your uterus. Your RE will point out the spot in your uterus where the embryo is placed. You will swell with emotion and love, but you won’t actually be able to see anything where the RE is pointing (although you’ll both pretend you do). This is normal. Note that if you have gone through this step multiple times in the past, you will realize that the best part of this day is the valium.

Step 14: Engage in the dreaded two week wait (TWW).

Over-analyze every twinge, change, fluid, swell, burp, craving, and sneeze. Compare these “symptoms” to every list of early pregnancy signs that you can find on the internet. Make sure you use multiple search engines to maximize the number of lists retrieved. Each time you pee you will need to have good lighting in the bathroom so you can adequately scrutinize the toilet paper after you wipe to look for any sign of implantation bleeding. Squeeze your boobs several times a day to determine if they feel sore, until they become sore. You’ll find yourself shifting from elation and optimism that this cycle has finally worked and you are pregnant, to absolute certainty that it has failed. This will be the longest two weeks of your life. By beta day you’ll be a blubbering shadow of your former self.

Step 15: Beta day

This will either be the best day or worst day. If it’s the best day and you get a positive result, you will proceed to an entirely new list of paranoias and procedures. Congratulations! If you get a negative, you may find yourself back at Step 1. But look at the bright side: you’ve done it before so the next time will be easier! Right? RIGHT???!!! (Ha ha ha you poor fool.) Good luck.

Hope you enjoyed this, but if you didn’t it was probably the hormones.

In Other Words: Day #3 of a 3-day quote challenge

02 Wednesday May 2018

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Rounding to a close, today is the last day of my 3-day quote challenge. It’s been fun to share my some of my favorites because, let’s face it, during this infertility journey we all need a little inspiration and perspective. So before moving on to my last quote, a reminder of the rules:

    1. Thank the person who nominated you. One last thanks to CW from Almost Pregnant for tagging me. Be sure to go check out her blog if you haven’t yet. You’ll find great stuff there.
    2. Post a quote for 3 consecutive days and explain why it appeals to you.
    3. Nominate bloggers to participate in the challenge each day. My final tags are Silently Screaming and Serenity. Be sure to check out their blogs.

Today’s quote is a reminder of just how badass we all are – especially us infertility warriors.

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It’s simple but packs a big punch. During infertility treatments it’s easy to forget how tough we are when we focus so much on what is going wrong – with our bodies, our plans, our relationships, our eggs. But think about all the things we do in the pursuit of our dreams. We sacrifice. We endure pain. We get poked and prodded. We fall, and then we rise and do it all over again. We really are badass. And we shouldn’t forget it.

In total I’ve gone through 6 IVF cycles. I’ve always given myself the subcutaneous belly injections during the stimulation phase. Those were easy. Well, as “easy” as any of this ever gets. But I’ve always had my husband give me the intramuscular shots (IM). You know, the ones with the giant needles that go in the rear. Now, I’ve got plenty of booty, but still I always feared that if I stuck myself with that tree-sized needle I just might go too far and hit bone. The needle looks that big to me. I’ve had to do both progesterone in oil (PIO) and estradiol valerate intramuscularly. These shots have to be given at certain times. I have literally driven to my husband’s work site to have him give me an injection. (Umm, awkward much?) I’ve panicked when I thought he wasn’t going to be home in time to give me the shot. He’s turned down overtime to be home at the right time to administer my shot. It’s ridiculous.

This cycle I said fuck that. I decided to do the IM shots myself. I’m tired of waiting and worrying. I’m tired of being afraid.

So last night, while my husband was driving home late from work, I prepped my gigantic needle and gave myself the shot in my ass like an IVF boss. And then I smiled. Because I’m tough like that.        

If you missed Day 1 or Day 2, please check them out.

In Other Words: Day #2 of a 3-day quote challenge

01 Tuesday May 2018

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As the quotes continue to roll in the blogging world, I’m back for day #2 of the 3-day quote challenge. But first, a reminder of the rules:

  1. Thank the person who nominated you. Thanks again go out to CW from Almost Pregnant for thinking of me. If you haven’t checked out her blog you really should. It’s smart, informative, and witty.
  2. Post a quote for 3 consecutive days and explain why it appeals to you.
  3. Nominate bloggers to participate in the challenge each day. Today I’m tagging bloggers Dani of The Great Pudding Club Hunt and Allison of My Journey Creating Life. Another set of great blogs worth checking out.

Selecting a quote for today was easy. This is one is from Viktor E. Frankl who significantly shaped the face of psychology and my training. He was a neurologist, psychiatrist, and survivor of Nazi concentration camps. Through his unique lens as a psychiatrist, he observed and experienced both the darkest and brightest of the human condition during his imprisonment. His famous book Man’s Search For Meaning is harrowing and inspirational. The first half of the book is a must read for anyone who has ever had to endure and overcome. The second half of the book dives deeper into his conceptualization of psychotherapy and theory called logotherapy, which was heavily influenced by his personal insights into struggle, pain, and finding one’s meaning in life. While the theoretical half of the book is more academic, the first part of the book certainly stands on it’s own. While obviously a tragic subject, his insights are profound, easy to connect with, and apply to anyone struggling to move past pain.

Now for the quote…

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

~ Viktor E. Frankl

I’m come back to this quote many times in my life. And I’ve seen the truth in it in every person I’ve worked with. There are things that happen to us in our life that we have no control over – circumstances, the actions of others, abuses. We can live like victims, feeling helpless to our pain and circumstance. And there is a place for sitting with and honoring that pain in us. But that is not the whole picture.

If you put 20 people in the same situation, you will find that although there will likely be some similarities, ultimately you will have 20 different responses. And that is because each individual gets to choose how they think and ultimately how they will react. We all have a unique back-story that influences how we perceive things. But in the end, no matter where we’ve come from, the choice moving forward is up to us.

I choose to not let infertility beat me. And that doesn’t necessarily mean that I will get the baby that I’m after. That part I really don’t have control over. But I do get to choose how I will respond at the end. And that will shape the person I become.

If you missed the quote from Day #1, you can read the post here.

In Other Words: A 3-day quote challenge

30 Monday Apr 2018

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There are times when some else captures the sentiment so eloquently that we just have to repeat them. I love a good quote, so when I was tagged by blogger CW of Almost Pregnant to participate in a 3-day quote challenge, I decided I was up for the fun.

Here are the rules for the challenge:

  1. Thank the person who nominated you. So, thank you CW from Almost Pregnant for thinking of me. Not only is this a fun way to share some quotes that help keep me going through this crazy journey of life and infertility, but it also means that someone’s reading my blog and actually thinking of me. And that’s pretty cool.
  2. Post a quote for 3 consecutive days and explain why it appeals to you.
  3. Nominate bloggers to participate in the challenge each day. Today I’m tagging bloggers A Womb is a Place to Store Dreams and Fighting Infertility. I’ve enjoyed both of these blogs and encourage you to check them out.

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I have a little book called Courage that has sat on my bookshelf in my office for years. It’s a book with blank pages, and on each page there is a little quote at the bottom that touches on the book’s theme. It was given to me during my pre-doctoral psychology internship where I was doing assessment and therapy at a student counseling center at a private University in the mid-west. That year I worked with several college students, mostly women, many of whom were struggling with eating disorders, traumas, and body image issues. I loved working in that setting because it was a time in these young women’s lives when they were truly setting out to find themselves and begin carving out their individual paths in this world. It was a time of opportunity. Many were following their dreams or deciding just what their dreams truly were. Although this was an exciting time, it was also a scary time for those that were venturing off alone for the first time. And, like anyone, they brought their personal experiences and insecurities with them. I was grateful for the opportunity to be a part of their growth and journey.

By the end of the academic year, as my internship came to an end and I was moving on to the next phase of my career, I had developed close working relationships with several of the students. I remember one woman in particular – she was a pre-med student with plans to pursue her dream of becoming a medical doctor. She was organized and had tight control on her emotions, well achieved in every way. But what no one would have guessed from her strong outward presentation, was her inner struggle with her own confidence, self-esteem, and body image. That year she rose to her own personal challenges and together we uncovered her inner strength. I have no doubt that she is working somewhere right now as a highly skilled, compassionate doctor.

When we had our final therapy session and said our goodbyes, she was well composed as typical, but I could tell she was holding back just a bit. She ended up returning later that day saying that she couldn’t leave our goodbye at that, and she presented me with a little gift. It was the Courage book. She said that over the course of the year, I had helped her find her courage and so she wanted to give me some courage back in case I ever needed it. It was a heartfelt gesture and much appreciated.

Little did she, or I for that matter, know just how much I would need courage one day.

So here we go with a quote for day one from my little book of courage.

“The turning point in the process of growing up is when you discover the core of strength within you that survives all hurt.”

~ Max Lerner

When I think about the women (and men) that go through infertility, including myself, I am amazed by our inner strength. It’s a strength that we don’t always realize that we have, and often can’t see it while we are in the depths of our struggle. But it’s when we open up that piece of ourselves and see our value, just as we are – with our scars, our broken Fallopian tubes, “old” eggs, endometriosis, with or without children, etc. – that we find our core strength. And at that point we see what we are capable of and know who we truly are. That is the unexpected gift of infertility.

Infertility changes us. But through our own strength, we will survive and grow. We will become.

#flipthescript

22 Sunday Apr 2018

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This week (April 22 – 28, 2018) is National Infertility Awareness Week (NIAW) sponsored by RESOLVE The National Infertility Association. This year’s theme is #flipthescript, which you can read about here. I’m flipping the script in a way that people often don’t want to talk about, but it’s a perspective that should also have a voice.

They tell you to never give up. Always have hope. Keep trying.

And so we do.

We try everything. We pay tens of thousands of dollars out of pocket on treatments that have no guarantee of working. We sacrifice our time to make appointments and drive to clinics. We get poked and prodded. We change our lifestyle – what we eat and drink, how we exercise, what products we use, when we have sex. We spend countless hours researching and advocating for ourselves. We try every strategy from yoga to supplements to meditation to embryo glue. We hope. We pray.

It begins to take on a life of it’s own. Finding our fertility becomes a full time job. And then, it becomes consuming.

We begin to separate from family and friends who don’t quite understand or know what to say. We see pregnancy announcements and go to baby showers, then cry secretly in our bathrooms. Eventually we start avoiding them completely. Our world begins to get smaller as our one focus grows. We become desperate to have a baby. And we do everything.

For many there is the big pay off at the end – we get the miracle baby, healthy and sweet smelling. All of our efforts are rewarded. We say it was all worth it. And we mean it. That’s the happy ending that everyone tells you about.

But what happens when that happy ending is nowhere in sight? When your life has become something you no longer recognize? When your fluctuating emotions seem to control you? When your desire has morphed into an obsession? When your debt has risen and you’re simply exhausted? How long are you supposed to keep going?

Is it ever okay to stop treatments or should you really never give up?

In the early days of my infertility, I held onto the “never give up” mantra with an iron fist. And after 3 years of infertility and multiple treatments, my first IVF was a success. My beautiful daughter was born healthy and strong. At that moment I thought my journey was over and I had won. While I always wanted at least two children, I never wanted to go through infertility treatment again. It took so much out of me. It changed me. But as the years passed and the pain faded, my desire for one more child resurfaced.

Dealing with secondary infertility now, I’ve done five more IVF cycles and two frozen embryo transfers, and I’m realizing my ending may look quite different this time around. While my journey is not completely over yet, the outlook is not bright. For the first time, the “never give up ” mantra may be doing more harm than good.

Then I had an epiphany.  When a want becomes a need, then morphs into an obsession, sometimes it is healthier to let it go. It’s not giving up. It’s making a healthy choice. It’s not saying “no” to a dream, rather, it’s saying “yes” to the life I have.

I’ve spent so long holding onto a picture of my future, that I’ve lost focus of the present. I can change the picture of my future. I can take back my life. There will, of course, be sadness and loss for a dream that was never realized, but in time I will heal and I can find me again. I’m right here surrounded by blessings.

There will be life after IVF, and it will be good.

 

Next Up: FET (again)

10 Tuesday Apr 2018

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My follow-up consultation with my RE yesterday was packed full of good information and even a surprise. So first the surprise: we have one frozen blast left over from my last cycle! Sure I’m ignoring the fact that it’s been a month since my egg retrieval and fresh transfer and no one mentioned to me until yesterday that I have a frostie. Seriously, why did the nurse not call me with that update?! Anyway, I’m going to ignore that slip up and focus on the fact that I have a surprise bonus embryo that I wasn’t counting on. Of course it’s not tested and it’s an early blast graded “BC,” which isn’t the prettiest embryo but still has a 90% chance of surviving the thaw. I asked if BC embryos still make babies and my RE said, “yes”. In fact, just for fun, he looked back to my cycle 4 years ago – the one that resulted in the birth of my daughter – and we discovered that she was also an early blast graded BC. Maybe my crappy looking embryos fair better than my high quality ones. Okay, I’m grasping at straws here. I was 36 back then and I’m 40 now, so the chance that this little BC is healthy is lower. But still – it’s a chance.

My RE recommended using what we have and doing a frozen embryo transfer (FET). Using what we have includes a little frozen PGS “abnormal” girl too. Yes, you heard that right. My RE is recommending that I transfer a PGS abnormal embryo. But first a few points to clarify. We did not do Next Generation Sequencing (NGS) so the results are either normal or abnormal – all mosaics are labeled as abnormal. Knowing what I know now, I would have tested using NGS so that the results would have specified whether the embryo was mosaic and the percentage of mosaicism. But I digress. In any event, I have a lot of respect for my RE (and his knowledge base) because he isn’t quick to dismiss all abnormal embryos. He took a close look at the details of the results and saw that this particular “abnormal” embryo only has a tiny segment of duplication on the short arm of chromosome 17. He said that a small percentage of the population may be walking around with similar minor abnormalities  and no one knows it because we never tested for that sort of thing before. This particular partial duplication will not lead to the birth of a child with an abnormality. Maybe my embryo will even have a superpower. Okay, that’s probably not true but I’d like to think so. The embryo may not implant or might be an early miscarriage (no different than what happens with so many pregnancies both IVF and unassisted) or the embryo could develop into a healthy baby. Both of these embryos are long shots simply due to my age-related quality issues, but it’s a chance. So the plan is to transfer both for my upcoming FET.

Going into this consultation I was prepared for the FET recommendation. I was also prepared to call it quits afterward if the FET fails. Over these last several weeks I’ve come to a place where I’m at peace with not having another child. I never thought I’d say that. And I’ll write specifically about how I shifted to that mindset in a later post. For now though, my RE convinced me to try one more egg retrieval and fresh transfer if this FET ends in another negative beta. My husband and daughter are both strongly rooting for another child, and my husband was also hoping to do one more fresh transfer.

My RE told me about some studies that followed women over the course of up to 12 (gasp) complete IVF egg retrieval and transfer cycles. The studies found that the chance for success increased over the course of 3 cycles, but plateaued after that. Meaning that after 3 complete cycles, the results don’t often change much. It should be noted that multiple FETs with eggs collected during the same retrieval only count once – that is, you can do several FETs and that doesn’t count against the 3 cycle benchmark. Of course there are exceptions to this rule, but when weighing the pros and cons of when I want to stop, I’m not going to keep doing this forever in the hopes of breaking the odds. Taking all of my cycles together and the particulars of my results, my RE said that if it were he and his wife, he would do one more IVF and fresh transfer after the FET. He said if we do that and still it fails, then I can feel confident that I didn’t leave anything on the table. No looking back and wondering. No regrets.

I like the sound of that. It makes sense. I think with the “break” of doing a FET first – since there’s so much less prep work for a FET – I can muster up the strength for one more IVF cycle. I don’t want to look back one day and wonder, “what if”. This plan seems like it will satisfactorily exhaust our options with my eggs. And if the journey ends there, I’m okay with that.

On a side note, I want to mention that I mustered up the courage to ask the scary question I had been avoiding. The “does repeated rounds of IVF cause cancer” question. My RE gave me a confident “no” and explained that the hormones used for this are naturally occurring in the body so the body knows how to process them. It doesn’t cause cancer. When I asked specifically about estrogen-sensitive cancers, he explained that again the answer is that IVF will not cause them. Prolonged estrogen can cause estrogen-sensitive cancers to grow (get bigger) but will not cause them. But he specified that it really does have to be prolonged exposure – the short bursts we use for IVF isn’t considered prolonged even when we do it multiple times. So I’m putting that fear to bed and thankfully moving on.

The Moments That Give Us Pause

03 Tuesday Apr 2018

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StockSnap_COT4YSOLEHThere I was, sitting at my desk having a perfectly good day. It had been a while since I was on Facebook and so I decided to see what my friends had been up to. And as a scrolled there it was – my dream. A woman holding hands with her husband and toddler, a beautiful pregnant belly growing obviously under her dress. Everyone in the picture was smiling with what could only be described as bliss.

I’ve seen this picture a million times in my mind’s eye. Only in my picture, I’m the woman. This was supposed to be my future. But today this picture was of a friend who is not much younger than I am. I was happy for her, yet also sad for the loss of my dream. I know I am not quite done with infertility treatments yet, but the end is very near and our last efforts are a long shot at best. So I am preparing for, and on most days accepting, this loss.

It did make me wonder, though, how some older women get pregnant so easily and others are fighting an uphill egg quality problem due to age. I began to get irritated. Maybe even angry. On the one had you see all these stories of women getting pregnant well into their 40’s, many even seem to be natural conceptions. Everyone knows a mom, friend, or friend of a friend who had a healthy baby after they passed age 40. On the other hand, any fertility expert will warn you that egg quality dips after 35 and plummets after 40. That doesn’t mean that there is nothing that can be done to help improve egg quality. But I feel like I’ve done all the recommended strategies – supplements, healthy clean eating, removing toxins and endocrine disruptors from home care and beauty products, weekly acupuncture, etc. – and still my egg quality has been dismal. I’m not sure why these strategies seem to work for some women and not others. I’m not sure what the norm is.

To many women, stories of others conceiving in their 40’s gives them hope. And in the beginning of this journey they gave me hope too. In fact I delayed seeking infertility treatment for about 5 months because I had so much hope. But at this point those stories don’t give me hope. Call me a pessimist, but I prefer the term realist. I think it really comes down to perspective. While we see these great stories of pregnancy success in older women, what we don’t see posted are all the stories of the women who didn’t become pregnant. Now I know we do see many negative outcomes in IVF support groups for women over 40, but still, what about all of the women who are silent? Can you imagine what it would look like if we knew how many women tried and were unable to conceive in their 40’s? How much would those stories outweigh the successes? Would that give us a more realistic picture of our chances?

When I thought that age was just a number and it didn’t really impact fertility, I felt hurt, confused, and depressed when my IVF’s failed. I simply couldn’t understand what was going wrong. When I take a more balanced perspective and realize the positive stories of conception in older women are exceptions not the rule, then I don’t get so down and hard on myself when things fail. I know that now, I’m the norm – unfortunately. It’s still sad and part of me wishes I would have been able to try when I was younger. But I also know that life circumstances simply didn’t work out that way for me, and I wouldn’t necessarily change them.

I may never get my dream picture, but I will adjust and heal. I will enjoy life and all my blessings. But I think there may always be days when I see my dream manifest in other people, and I will take pause and hold loving space for that loss.

Thoughts on Approaching the End of the Road

27 Tuesday Mar 2018

Posted by in IVF #6 with Fresh 3-day Transfer, Uncategorized

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How do you decide when to stop infertility treatments?

I got an email from my IVF nurse coordinator saying that it is good that I’ll be talking about my options with my RE on the 9th, but she also indicated that my RE is leaning toward recommending we do a frozen embryo transfer (FET) with my PGS “abnormal” embryo that we still have on ice. Since we didn’t do Next Generation Sequencing, we have no way to know whether this embryo is mosaic or not. It has one small issue that would either result in a failure to implant, early miscarriage, or self-correct and turn into a healthy baby. There’s just no way to know. It won’t result in a live birth of a baby with a chromosome-related disorder. In my mind, I’ve been saving this option in my back pocket for our last ditch effort before discontinuing treatment. It is a long shot after all, but still a possibility. So I don’t want to leave this one embryo behind, but I’m not expecting it to work. Honestly, I really thought my RE would recommend one last egg retrieval and fresh transfer before going with this long shot FET.

I know it’s my choice. My body, my money, my choice. So I think I could talk my RE into one more IVF try. That’s what my husband wants to do, but he is open to hearing what the RE’s rationale is. But if my RE ends up recommending transferring the PGS “abnormal” embryo rather than another IVF fresh transfer, then he is basically saying that  I’m at the end of my road with my own eggs. He’s saying that the chances for success with my eggs is so low that it’s not worth going through another cycle.

But it’s still my choice. So how does one make that choice?

It’s a heart heavy equation. You weigh your dream against your finances, the physical impact of the medications and procedures, the emotional toll this takes on you, the effect on your relationships, and you try to figure out just how much more you can take. Or how much you want to take. I think I can take much more, but honestly, I don’t know that I want to. Many women won’t have to make this decision because IVF will work before they reach their limit. But some of us do have to make the decision.

People tell you, “don’t give up.” Never give up. But I think that is naive advice at best, and potentially harmful advice as it can make you feel like a failure or guilty if you stop. Not everyone can afford endless rounds of IVF. I’m lucky to have insurance coverage or I would have had to stop due to finances long ago. But that still doesn’t mean I should never give up. I’m fighting an uphill battle against age. I could do this 10 more times and have less chance of success each time as I get older and my egg quality decreases. But honestly, the factor that is weighing heavily on my heart is quality of life. I’m tired of my life revolving around IVF cycles. I’ve missed conferences and trips. I’ve missed time with my family. Often, I feel like I’m missing life. Every decision I make revolves around my fertility – what I drink and eat, when and how I can exercise, when I can go out of town, what I read, the appointments I fit into my schedule, how emotionally connected and present I feel with those around me. Some days, many days, during IVF I don’t even feel like myself anymore. The hormonal fluctuations are real and they change how I feel and perceive things. It changes how happy I am in life.

At the end of all of this, whether it works or not, I will still have my life to live. And my life is filled with so many blessings. Not the least of which is my daughter from my first IVF years ago. And I want to enjoy all of the blessings in my life, and sometimes that’s hard to do when I’m so deep in IVF hell.

So I have to weigh out all the factors in my equation and decide when it’s time to stop. After this last cycle failed I found myself feeling really good about the idea of doing one more egg retrieval and fresh transfer, then the last FET with the PGS “abnormal” embryo. If I did those 2 cycles, I felt that I would be satisfied knowing that I didn’t “leave anything on the table”. I would have given it my best shot without sacrificing myself.  Doing more cycles beyond that tipped the scales too much and didn’t feel worth it. But am I ready to go straight to the FET with the PGS “abnormal” embryo? Can I forgo one more retrieval and fresh transfer and still feel okay about my decision if I end up not pregnant? I’m not sure. That ending almost feels too abrupt. But I won’t lie – there is a part of me that feels relieved at the thought of not having to go through another whole IVF cycle. I want to be realistic about my chances.

I’ve done 6 IVF cycles in total. I know some women do many more than that. If I didn’t already have my daughter then I know I would be willing to do more. But part of me feels like I’m missing out on fully enjoying my daughter’s life because I’m so caught up in infertility treatments and the hormonal emotional roller coaster that goes along with this. But I want to give her a sibling so much, and we want to expand our family. However, the truth is she may very well be my only child – how much do I want to miss out on? I could say that I’m not really missing out on anything with her, and maybe that’s true for some women. But it’s not true for me. The medications and the emotional ups and downs do impact me, and negatively affect my relationships and my ability to really enjoy life. IVF is hard. It gets depressing. It becomes all consuming. If can even feel addictive.  And I’m tired of paying that price.

It is okay to stop. That doesn’t mean that you are giving up or are a quitter. It means you are carefully weighing all the factors, which are unique to you, and making a smart, healthy decision. That stop point is going to look very different for different women. And that’s okay.

I suppose I’ll wait to hear what my RE ultimately ends up recommending and what his rationale is before I make my decision. I feel like I’ll have to make a quick decision after our meeting since I’m already on birth control pills to get ready for my next cycle – whether that be another IVF or the FET – and I don’t want to drag out being on those pills. Will I feel like I’m done if I do only the FET? Will I regret not doing one more IVF? Do I want to do another IVF even if the chances for success are so low? Those are the questions I have to weigh.