Tag Archives: Coping

Therapy? Who me?

15 Friday Mar 2019

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

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

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

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

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

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

Still it wasn’t enough.

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

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

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

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

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

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

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

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

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

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

06 Tuesday Nov 2018

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

11 Thursday Oct 2018

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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.

green club flower

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

26 Wednesday Sep 2018

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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: A day for me

26 Thursday Jul 2018

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

 

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

 

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

 

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

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

25 Monday Jun 2018

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alone bed bedroom blur

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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.

Pregnant After Infertility: The first ultrasound

19 Tuesday Jun 2018

Posted by in Pregnancy After Infertility

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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.

The Liminal Space After A BFP

11 Monday Jun 2018

Posted by in Pregnancy After Infertility

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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.

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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Next Up: FET (again)

10 Tuesday Apr 2018

Posted by in FET #2 (after IVF #6), Uncategorized

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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.