Pregnant Women are Smug

DISCLAIMER: Firstly, not all pregnant women are smug, and if you survive infertility hell and become pregnant or are an adoptive parent, you have earned the right to be smug. The title references a song from the folk duo Garfunkel and Oates who are sort of a female version of Flight of the Concords. They sing about everything from the ease of accessing medical marijuana, the inability to perform a good hand job and unexpected pleasures whilst go-kart racing. This particular song was inspired when one member was visiting with three pregnant friends and one asked her "So, what do you even do all day?" Perplexed by the question, but before she could even respond, the Smug Pregnant Friend (SPF) interjected, "I can't remember what I even did before I was pregnant, as it all seems so meaningless..." I highly recommend watching the Youtube Clip of their performance if you need a good laugh, and can relate to having an SPF who seems to reference her pregnancy every chance she can (you know, just in case you forgot) or who subtlety implies that her life is superior to yours now that she's great with child.  Again, not all pregnant women are smug, but it's great that someone called out the ones who are.

I first discovered Garfunkel and Oates and this song while randomly flipping channels and stumbled on their featured performance on Comedy Central's Half Hour Comedy show just a week or two before I flew out for Myrtle's shower. I watched the clip on my phone before the shower started and I sung the song in my head at times during the shower. To be fair, with the exception of one moment, Myrtle really wasn't smug at all during her pregnancy. When she came out to visit, she explained that she takes her prenatal vitamin during dinner and placed the bottle on my dinning room table and asked me to remind her to take it. Well, on the first night we went out to eat and returned home around 11 pm, when she discovered that she hadn't taken her vitamin. Her first response was to blame me for not reminding her. I simply pointed out that it wasn't time sensitive like birth control pills and she could just take it now (and shut up). She protested that she couldn't as she had already brushed her teeth (?) and she continued to chastise her husband and mine individually for not reminding her about her vitamin. Geez, were we going to have to prompt her to feed the baby once he or she arrives? Seriously, why couldn't she just have quietly taken the damn vitamin. She was one more mention away from having the line "Maybe the Dingo ate your bab-ah" thrown at her. Maybe I was being over sensitive, but I suddenly felt like such a loser for diligently taking my prenatal vitamin when I wasn't even pregnant.

Anyway, this post was inspired by my interaction with the most smug pregnant woman that I have ever met, which considering how many pregnant women I interact with everyday is saying something. I was attending Husband's company holiday party. I feel this requirement should be included in the marital vows: Do you take thee in sickness and in health and agree to spend an awkward evening with a bunch of people that you don't know, don't have any common interests and the food may or may not be any good? I had wandered over to the food table where I was soon joined by two other women. One was approximately 6-7 months pregnant and she looked as if she was in her mid, if not late 40s. My first thought was that she probably had many years of infertility issues and now was finally expecting her rainbow baby. The other woman was gushing all over her pregnancy, so the pregger gave her all her details. This was her third and she was 44. When she mentioned the ages of her other children, I quickly did the math in my head. She had her first when she was 39, second at 41 and now third at 44 or 45 depending on how old she would be at the time of delivery. Wow, thanks to science, I thought to myself, but was wrong again. She went on to describe that all her conceptions were spontaneous. When she and her husband first tried, they succeeded on their second or third attempt. When that baby was a year old, her Ob/Gyn advised her to try as soon as possible if she wanted a possible second and she conceived that month. They debated about having a third for a while, but once they made the decision to take the plunge, she stopped breastfeeding and conceived two months later. Now I was truly impressed, I don't think I've ever had a patient with two spontaneous (and successful) pregnancies after the age of 40. I could almost allow her to be a little smug with that accomplishment. However, she took it to a whole new level. "I'm living proof that you can do it," she started to explain "You can wait to start your family later in life." If she didn't already comprehend how rare her situation was, she expressed how oblivious she was, "I don't understand how people struggle with fertility. You just have to understand the science and get the timing right."

 We weren't trying to conceive at that time, but as a professional in women's health, I was extremely offended by her lack of sensitivity and oh, say general awareness. I usually don't reveal what I do for a living at these functions, as I've got into some heated arguments regarding some of the more controversial topics in women's health and I feel that I have to be on good behaviour as these are husband's colleagues. However this time, I couldn't hold back. There are so many fertiles who think that conception should be as easy for everyone else as it was for them, but the fact that this women didn't seem to appreciate that she was the exception to every norm and rule of expected probability that really got to me. I started to lecture that it's more than just science and timing, there are many more requirements; quality sperm and eggs, patent tubes and a functional uterus. Not to mention that even when all these conditions are satisfied, nearly half of infertility is still unexplained. "And what do you do?" She demanded to know my qualifications. She wasn't humbled at all. "Well, I didn't have any of those problems." she said. Smugly.

 I walked away and headed to the bar to numb myself with a strong drink. I would later learn that she's a high ranking scientist within the company and apparently no one challenges her. (Fortunately, she works in a different department than Husband, so I didn't have to worry about any threats to his job) Not only had I stood up for women experiencing infertility, I had earned some credibility among Husband's scientists colleagues. This party might be enjoyable after all...
                             

An Unconventional Relationship

A few years back, one of my older patients asked me if my mother and I were close. I paused before responding, which she interpreted as an answer of no, but I was thinking that it depended on how one defined a close relationship. As I became an adult, my mother and I successfully transitioned our relationship to a genuine friendship, one that is based on love and mutual respect. She is my confidant, the one I turn to for career advice, or when I need to complain about my in-laws. We shared a few private laughs over Myrtle's poor wardrobe choice for her engagement photos. We go shopping together, we bake cookies.  We just don't discuss any personal details.

When I was growing up, I observed even at a young age that Myrtle and her mother seemed too close, which felt a bit awkward to me. As an only child, your life is in a fishbowl, and I felt the need to hide what I could. Not that I had anything major to conceal, but I just didn't have the need to share every detail that occurred during the school day with my parents in the way that Myrtle did. As we both entered into our teenage years, Myrtle and her mother became even closer, which prompted many to wonder how Myrtle would handle leaving home (not well, was the eventual answer) and encouraged me to become even more independent from my parents.

Myrtle was the first to start her period, which was devastating to my pre-teen angst. Menarche would visit me a week later while I was at summer camp, inviting my mother, as well as Myrtle and her mother, to speculate if I made it up a la Nancy from Are you there God, It's me Margaret. Despite my protests of  "this is miserable, why would I lie about it?" I still had the feeling that no one believed me, and I questioned it myself as three months went by and I hadn't had another period. My mother was wondering the same thing and came out and asked me one day, "So, did you get your period again?" I shook my head and she responded, "Oh poor Jane," in a rather demeaning tone, "You haven't crossed the bridge to womanhood yet" and just to be a little more condescending, she tapped my cheek with her hand. Fuck You, I thought, but reached for my best know-it-all voice and pointed out that it was common for girls to have an irregular cycle in their first few years. Ha, I knew my physiology of menstruation even then. More so, I knew there was no point in sharing any information with my mother if I wasn't going to be believed.

AF would decide to make her next appearance within that month as I was taking gymnastics classes. Co-ed gymnastic classes, mind you. I only had one option; procure some tampons and learn to use them. I most certainly would not be asking my mother for help. I would figure it out myself. I had a regular baby sitting job every Friday night, so I stole a few tampons as well as the instructions (where was the Internet when I needed it then?) from her bathroom. I quickly got the hang of it, and once I did, there was no going back! In fact, ever the budding gynaecologist, I convinced many friends to erode their hymens with the best invention in the world. I knew I would arouse too much suspicion as the mother of my baby sitting charge would wonder why I needed to use 3-4 tampons within a 6 hour period every Friday night. Fortunately, (thanks to tampons!) I was selected for the gymnastics team, which trained at the high school once a week. Practices at the high school meant access to a vending machine that dispensed tampons! I would steal dimes from my dad's change jar and empty the machine. I wonder if the custodians ever noticed that they had to refill the machine every Wednesday morning...

This was my routine until I was able to drive and shop for myself. However, around my 14th birthday, our family went to visit my Grandmother. We were shopping at the Star market and as we passed the aisle of sanitary products, my Grandmother asked my mother if I had started my period -embarrassingly, right in front of my dad too. When my mother replied "no", my Grandmother suggested that she take me to a doctor. I wanted to yell right in the middle of the Star market "I've had my period for two years, you bitch!", but I quickly realised she probably thought I still hadn't started my period as she didn't have to buy me any pads. Worried that she would take me to a doctor and it would be revealed that I obliterated my hymen with virginity tampering tampons, I came up with a new plan. A month or two later I discovered her shopping list and added 'pads for Jane, please put them in my bathroom'. She obliged and we never spoke of it. To this day, she would likely answer that I started my period when I was 14, and not 12.

As I recount these memories, I'm struck by how one off-hand comment seemed to influence the direction of our relationship and if I do become a parent, I realise how easy it is to screw up. My mother and I would never engage in close personal discussions. We never had the sex talk. Once I went off to University, I became involved in many women's groups and started working at a family planning clinic, so she knew I had found sources for accurate information. When Husband and had been dating for a few months, she wrote in a letter, "have you taken any serious steps yet? I'll be happy for you if you did!" I never answered her, but felt somewhat pleased that she gave her endorsement for pre-marital sex. When she reached menopause, she made a ceremonial attempt to give me her supplies of sanitary products. I laughed to myself, as thanks to my Mirena IUD I probably had gone longer without a period than she just did, but I quietly accepted her offerings and brought them to the clinic for patient use.

I would later discover that our non-disclosure policy works in both directions. Months after the event, I learned from my dad or maybe Myrtle's mother that my mother had some postmenopausal bleeding and was worked up with an ultrasound and endometrial biopsy. "Why didn't you tell me any of this?" I asked, probably more bothered by the fact that I wasn't consulted as a second opinion. "Well," she explained "I really didn't know too many specific details or what was going to happen, and I didn't want to look stupid in front of you." Facing a possible cancer, this was my mother's primary concern...

So maybe our relationship is not one that many would define as close, but I appreciate our friendship for what it is and not what it isn't. If I do get pregnant within the next year, I'm not sure how much about our infertility or treatments I'll reveal. If we come up empty at the end of our journey, I'll likely disclose much of our story, just so she knows how hard we tried to make her a grandmother. I feel that either way, we'll start a new page in our relationship.

Staying in the Closet

The greatest challenge about going home to visit my parents will be how to navigate any conversation that addresses the issue of procreation. My parents are under the impression that we (namely me) are not interested in having children. That we're too career driven, too engaged to the freedoms of a child free life and resistant to the sweet charms of a young one. When we started TTC, and when I thought fertility was mine to command, I wanted to keep them in the dark so that we can unveil one of the biggest surprises in their lives.  Admittedly, it is a bit petulant on my part, but as almost nothing in this procreative pursuit has gone according to my intended plans, I want to hold on to this aspect. Perhaps it is the only detail in my control. There are a lot of other pragmatic reasons for keeping my parents out of the loop; My mother doesn't always display the most tact and I can envision her blurting out something like, 'Well, you shouldn't have waited so long!'. More importantly, I don't want to endure her asking any inappropriate questions. Myrtle was practically still smoking the post coital cigarette from her honeymoon when she announced her pregnancy, and yet my mother asked  "Did Myrtle have to do anything to get pregnant?" Yes, she had S-E-X, I explained to her, referencing the birds-and-the-bees conversation we never had when I was younger. My own infertility panic hadn't set in at that time, but I did take note to her line of thinking; woman at the age of 36 is pregnant -must have had help. I know my parents have been dealing with their own feelings of jealousy following the arrival of little Myrtle, and I don't want to coat those feelings with added disappointment from an infertility diagnosis. I'd rather let my parents believe that their future grandchild is being denied by my stubborn attitude rather than our biological limitations. Most importantly, I don't want to invite any additional pressure on ourselves. I don't want my parents to wonder if we are delivering news any time we phone. I don't want them to follow the disappointment of failed cycles. I know they would likely offer financial assistance, which would be very generous of them, and not to seem ungrateful (especially if we need to accept their hypothetical offer someday) but it would add another layer of awkwardness. Maybe there will be a day when I share this experience with them, but for now, I need to keep this fascet of our life to ourselves. I think we were offered a pass with a comment from a family friend. Earlier this year, she was recounting that her newly married 38 year old younger sister announced to their mother that she and her husband were trying to conceive. "Idiot!" the friend expressed, "You don't tell the parents that you're trying for a baby -that's asking to have problems!" Husband and I just looked at each other, acknowledging that you don't need to disclose your intentions to have problems, but we were relieved for my parents to hear that it can be customary not to inform the parents.

Closer to Fine

As I had the day off, I went swimming immediately after my sonohystogram. It had been nearly a month since I had been at the pool. Following a two week break for the holidays, I came down with a bad cold and then we entered one of the worst cold streaks in recent history. My swim group meets at 6 AM. Before I started swimming, I never considered myself to be a morning person. I once tried going to the gym before work and nearly fell asleep on the treadmill. However, swimming in the morning is so invigorating, especially when you're sharing a lane with 3 or 4 other swimmers as our coach is yelling at us. Every now and then, we'll be near the end of a set, and I'll hear her call "last one!" (which I should know by now really means the penultimate one), and I'll use every last bit of energy for the final lap, thinking I'm just yards away from touching the wall and easing into a cool-down. Then, she'll announce, "Okay, one more time!" There are some days when I'm able to throw down my best time of the day during this bonus final lap. I head to work carrying a feeling of invincibility and I feel ready to take on anything that will be thrown my way.
During my no good, very bad week, I felt that I was presented with a gut check to determine if was actually fine, or whether I had just been telling myself that I was fine. Once I had granted myself permission to accept that maybe I wasn't really fine, I was able to see what changes I needed to make. The first was realising that I needed to take time off from work, the second was getting back in the pool.  I was finished with my appointment in time to attend the noon swim class. As soon as I dove into the water I was reminded why I love swimming so much. The water felt amazing and the sensation was enhanced by having sunlight on my back. After taking a few warm-up laps, I broke into a sprint for a few yards. It makes me appreciate the feeling that I'm flying. The other great aspect of swimming is that is allows for partial sensory deprivation. I can't hear much when I'm in the water, which means I'm alone with my own thoughts. Particularly if it is a day of interval training, I can do some of my best thinking in the pool. Although I shouldn't have had work on my mind, since I was out of the office for the day, I flashed to some of the events from the week. Co-worker was on my schedule for her new OB visit, which was her way of revealing the announcement. As our colleagues reacted, I stood next to her and smiled, feeling like an unattached bridesmaid at a wedding who wonders if it will ever be her turn. More importantly, I didn't have the urge to hide in the bathroom and cry, as a week earlier, I had feared that I would. I also had a patient who presented with an unplanned pregnancy and needed options counselling and interestingly, it was after completing her visit that I realised that maybe I am truly feeling normal again. My emotional hangover had finally lifted.
I guess sometimes it's hard to understand what really makes us feel normal. Whether it be getting up early in the morning to swim when it's cold and dark, or realising that professionally I am good at a job that can be difficult for me personally at times. I think it's just more important to embrace whatever it is that brings you closer to fine.

Everything I wanted to know about my Uterus...

In anticipation of my upcoming sonohystogram, I scheduled an appointment to get my bits waxed. I've always done this for all my gyn exams, even before I stated seeing Dr Somebody that I Used to Know. Then I read on Overworked Ovaries that Jen S prepared for her appointment by getting a pedicure and I was inspired to do the same. As a consequence of years of sports, I have such horrible toes and I never saw any point to getting a pedicure, since I would quickly ruin the work of the manicurist. Then, I recalled how when I was in school, my mother used to advise me to dress well on the day of a big exam. Her theory was that if you have a positive self image, you'll feel more confident approaching the test. I decided that by covering the embarrassment of my flawed toes, I could feel even better about myself, which could help me as I received the news of my results.

So about my uterus... It's been a pretty peaceful co-habitation for most of my life. My menstrual cycles were rather benign. No cramps that kept me from missing school or sporting events. No heavy bleeding that caused the humiliation of stained clothes. When I started birth control pills during my quest to be deflowered, there wasn't too much change with my happy-go-lucky period. Then during a routine visit, it was discovered that my blood pressure was 150/110, and I was ordered to stop the pill immediately. Not wanting to face the weight gain with Depo Provera, or the reduced efficiency with condoms, I started researching other alternatives and discovered the Mirena IUD. Hypertension would become the best thing to happen to my reproductive life! Not only did I have a method that was more effective and convenient than the pill, but the period that wasn't too bothersome disappeared completely.

After more than ten years of amenorrhea, I was prepared for AF to return with a vengeance when my IUD was removed. I went to Costco and purchased a large multi-pack of tampons. (Seriously, why did it take manufacturers so long to come up with the multi-pack box?). AF announced herself with barely a whisper. I only need 3-4 light tampons on my first day. The second day I can get by with one pantyliner and on days 3 and 4 (if there is one) I'm just noticing a few spots on the TP. Even during my miscarriage, I hardly had any bleeding. I've scoured all my texts books and there is little written regarding the 'pathology' of hypomenorrhea. I can't recall even having a patient complain about a menstrual cycle that is 'too light' and 'too short'. I gave Co-worker all my medium and super tampons and she went through both boxes before I finished the box of light absorbency ones.

My RE thought it was likely a normal variant. As I was ovulating, I wasn't hypothalamic, and I didn't have any risk factors that would contribute to Asherman's syndrome. It was noted that I may have a slight septum during my initial evaluation, and he had agreed to evaluate with a sonohystogram. The saline infused ultrasound confirmed it's presence and estimated 25-30% depth. He noted that it isn't always clear how much a septum of my size contributes to infertility or pregnancy loss, but he recommended moving forward with a hysteroscopic resection. For the record, I had scheduled a sonohystogram in August, wanting to evaluate my uterus while we waiting for Husband's Clomid to take effect. The appointment needed to be rescheduled and I wasn't able to come in during the required time. My RE examined the films from my hystosalpingogram and thought the septum if present, was only slight and likely insignificant and deferred the sonohystogram at that time. But I am digressing... I'm pleased that he was decisive with the decision to go forward with resection, rather than taking a more conservative 'wait and see' approach.

I must admit I am a little surprised. A part of me thought I'd go in and learn that my uterus is normal and I've been over analysing my scant flow. I feel validated that I pursued having this study done, although it now means another procedure and more waiting. Better to wait and do it right with my new and improved uterine cavity.

Welcome to the Occupation

A few friends IRL have asked what it has been like for me to work in obstetrics while we're struggling to conceive. For the most part, it doesn't bother me. I've been in this job for so long, and for the majority of my career I wasn't interested in procreating. I learned a long time ago to divorce myself from the emotional aspect and view pregnancy as a clinical process. At the most, I'm finding it hard to distract myself right now. I see all of our newly pregnant patients and perform their initial ultrasound. It's truly a privilege to be able to share that experience with those couples who have a viable pregnancy and when it's a heartfelt, happy moment. Lately, I've been wondering if I'll ever have that experience on the other side of the ultrasound wand. At the point in time when I wasn't interested in getting pregnant -and even in the early months of trying to conceive- I had a blasé attitude toward my own potential ultrasound. It's what I do all day, so wouldn't be anything surprising or exciting. Myrtle and a few other friends tried to tell me, 'but it will be different when it's your own!' I couldn't appreciate it at that time. 'No, it will still look the same...' I countered. Co-worker suggested that the appreciation during my scan would not necessarily be seeing the ultrasound images (which are so familiar to me), but seeing Husband's reaction to them. Okay, I relent. If I ever have a viable pregnancy, I will perceive the experience of seeing our baby for the first time as a big deal. I may even shed a tear or two. Previously, I had also rejected the notion of doing the "3-D" novelty ultrasound. It's a lot of money to obtain creepy alien-like images of your baby. I changed my mind when I saw a mother with her daughter during her first ultrasound. I want my mother to have this experience too.  There were a few instances this year when I had a newly pregnant patient who had the same last menstrual period date as I did, and her ultrasound images confronted me with a reminder of what could have been if our procreation was successful. Following my miscarriage, I had a few patients who had an LMP a day or two off from mine, but so far no one with the exact date. Then one day I had a patient who hadn't restarted her period after stopping breastfeeding, and she had no idea how far along she was. I was using our older ultrasound machine, which doesn't automatically calculate the due date. While the patient was getting dressed, I went back to my office and spun her measurements in the gestational wheel of fortune. There it was. 5 August 2013. I laughed quietly to myself and set the wheel down. This particular patient was diagnosed with diminished ovarian reserve and endometriosis during her infertility work up. After successful IVF, she delivered twins less than a year ago and consistently used progesterone only birth control pills while breastfeeding. Ever reminded that fertility is a such a fucker.

I'll try anything...

After rejecting all the bullshit advice from well meaning friends and family, "just relax," "keep your legs up after sex" or "wear socks!" what advice to you take from fellow infertiles? Admittedly, we're a pretty biased group. Following months, if not years, of failed attempts and treatments, it's hard not to believe that what you ate for breakfast contributed to the success, once it is achieved. Some alternative treatments  most often employed include acupuncture and vitamin supplements. The data is light, due to limited studies evaluating supplements, and difficulty analysing acupuncture effects without a true 'placebo' comparative. I came across a journal article that examined many different uses of acupuncture in an Ob/Gyn setting. While the authors noted that the use of acupuncture for infertility is increasing, the only statistically significant benefit was reducing pain during egg retrieval. Co-worker's RE recommended that she start acupuncture. Co-worker asked if she had some statistics to show that it helps achieve a pregnancy, but her RE claimed that it would help her with her painful periods and she asked her "what do you have to lose?" Um, money? thought Co-worker who was finding the bills for her fertility treatments daunting. She had been dealing with her heavy and painful periods since she was a teenager and had learned to cope. She wanted answers to why she has heavy periods and if it was contributing to her infertility and was frustrated that her RE was deferring her laparoscopy and was insisting on doing "one more IUI". It was the one that was successful in impregnating her with twins. A few weeks later, I encountered a local acupuncturist at a holiday party and decided to do a little recognisance work. She identified herself as an "infertility specialist", which I questioned if it was like the title 'Assistant to the Regional Manager'. Acupuncturist who specialises in infertility seemed a little more accurate. I asked a few specific questions on how acupuncture is thought to benefit fertility patients (specifically about increasing blood flow to the uterus) and when during a treatment cycle (i.e in the follicular phase, just before or after IUI or transfer?) should it be performed? She didn't answer any of my questions, but just discussed how all her patients get pregnant, and then she continues to see them and she flips breech babies and induces labour. Really? No one has a 100% success rate. Maybe she didn't want to answer my questions as I was disturbing the 'delicate genius' at a party, but I expected a little more substance from a 'fertility specialist'. She handed me a handful on her business cards. While not completely skeptical, I also wasn't convinced. I decided that doing acupuncture would cut into my exercise time, which also promotes relaxation and improves blood flow.
I was also a little hesitant to start supplements. When Husband first received the results of his semen analysis, he headed to GNC and purchased everything the Google reported would improve sperm counts and quality. Unfortunately, neither the supplements nor Clomid improved his semen analysis much, and the drawer in our bathroom still smells like dried leaves, as I suspect he's stopped taking them. However, I have heard some women reporting improvements with their follicle counts or lab results. Additionally, I was in the 'what do you have to lose?' mindset. Non Sequitur Chica posted a list of doctor recommended supplements on her blog. I picked up all the ones that target blood vessel and endometrial support for about $75. As long as I'm waiting to start treatment, I might as well try to make the most of it. I've also read that some women have tried eating pineapple during the time of embryo transfer to help thicken the uterine lining. I like pineapple and could very well be eating it at that time anyway. If grapefruit juice can cause significant drug interactions, is it that unreasonable to think that other foods could work in weird ways?

Welcome ICLW!

Thank you for stopping by my blog! This is my second time participating in ICLW. I met so many awesome fellow bloggers last month, and I'm really excited to meet some new bloggy friends. Here is the cliff notes version of our story so far and my blog:
Husband and I started TTC in the Autumn of 2011. We had a few false starts, but as I work in women's healthcare, I figured it would happen quickly as I 'know what I am doing'. After only a few months, I became impatient and started using Clomid -still no success. In the meantime, my childhood BFF, Myrtle, practically conceived on her honeymoon and my cousin had a spontaneous pregnancy at the age of 41 while she was "relaxed" in Hawaii. Myrtle is the typical well meaning friend who tries to be supportive, but says all the wrong things. While my cousin, now a two time infertility survivor, forgets what it is like to be in those shoes. There are many posts that address my attempts to cope with their pregnancies, while struggling to achieve one of my own. So why can't the one in ob/gyn get herself knocked up? We discovered that my Husband has moderate male factor infertility and my ovaries are inconsiderate, inconsistent little bitches, who take pleasure in keeping up guessing. He's got limited bullets and I'm a moving target. We met with the reproductive specialists last summer and were encouraged when Husband was noted to have mild hypogonadism and was started on Clomid, with the hope of increasing his count. I kept joking that he was going to ovulate, but he didn't and unfortunately his count was only slightly improved. We received the verdict that we would most likely need IVF -possibly with ICSI, but could give IUI a good faith try for a few cycles. The day before I was scheduled to start our IUI cycle, I got a BFP. Yes, we were one of those stories you hear about. Unfortunately, I miscarried when I was six weeks along. There are many posts that address that event, as writing in this blog really helped me get though that difficult time. Logistics have prevented us from trying for a spontaneous conception in the few months following my miscarriage, so we're anxious to start IUI in February or March. We're planning to do 3-4 cycles of IUI, and if they don't work, will start the IVF process in Autumn after taking a few months to pause and see if we have the miracle conception that lets us avoid IVF. We're going to Hawaii in September (albeit with my parents and in-laws...), but everyone seems to be telling me it will happen there. I mean, no one is infertile in Hawaii -right?

A Marathon versus a Sprint

I joined an online infertility forum when I realised that I needed to vent my frustrations regarding my infertility and Myrtle's upcoming delivery. One of the most helpful comments I received was "it's a sprint for others and a marathon for us". Not only was it a brilliant analogy, but it accurately fit our situation. Myrtle ran track for one season and was a sprinter and I am a distance runner. I did my first half marathon in 2009. I was inspired when a seemingly un-athletic woman in my office revealed that she had done a few marathons (she walked, but it's still covering 26.2 miles). So, I signed up for a "disease race" (term coined by my swim coach who gets inundated with fund-raising requests) and completed a twelve week training program and raised $1,000 for The American Heart Association. I was keen to do another one and maybe consider training for a full marathon, but we started looking to buy our first home. In 2010, we became homeowners and renovation projects consumed all our free time for at least a year. Then, Myrtle invited me to be a bridesmaid in her wedding, which provided the motivation to get back into fitness. I completed two triathlons and re-discovered the fun of racing. I signed up for many 10K events, aiming to do at least 1-2 per month. It's a comfortable distance for me and I figured that I would still be able to partake in the earlier stages of my pregnancy. When the pregnancy thing wasn't happening, I decided to increase my distance and registered for a half marathon. I confess I was trying to tempt fate a bit, but suddenly the race was a month away and I wasn't pregnant and hadn't trained very much. Husband and I were worried if I would finish under the official cut-off time, but to my surprise I ran it in 2:14 -eight minutes better than when I properly trained. Once I discovered that I could prepare for a half marathon in 3-4 weeks, I continued to schedule events to console myself when I received a BFN. Recently, I decided that I needed a new challenge and I found a unique 18 mile run, which is scheduled in May. I can't say I'm trying to tempt fate, as the race organisers allow a full refund (albeit race credit) if you cancel up to ten days before the event (it's a woman only race, and that policy was probably based on possible pregnancies). However, it will be good to focus my training on a new goal. I thought a bit more about the comparison between distance runners and sprinters. Yes, sprinters get much attention. Almost everyone can name Usain Bolt as the Gold Medal winner of the 100 metres in the recent 2012 Olympic Games, but only dedicated runners know that Stephen Kiprotich won the Marathon Gold (along with his friends and family). I also thought about how impressed I was when I learnt that someone I worked with was among the 1% of the population who have completed a marathon. It's a triumphant accomplishment. Almost anyone can run a 100 yard dash. Only a few have the strength to endure a marathon.

The thin line between love and hate...

It a volatile relationship with AF. On the months when she punctuates your two week wait, you hate her. However, when you need her to arrive in order to start treatment, she's your new best friend. It's also possible to love and hate her at the same time. AF finally arrived, my required one 'normal' cycle before starting IUI and also I can now schedule my sonohystogram. Hours before she made her appearance, I had finally made up my mind about going back home. I decided it would be good for me to go. Although it's not the ideal destination, it may be our last opportunity to have a bit of a holiday for a while. Once we start fertility treatments, it will be harder to plan a a get-away around my cycle and monitoring appointments. I decided to go for only 6 days -rather than the entire 10 days that Husband scheduled. It would be less stressful for me to have more time to tie up things at work before going, plus a weekend to myself would be nice. When it comes to visiting family, some times less is more. This break would give me some time to play in New York, catch up with old friends, meet Myrtle for lunch (see her without little Myrtle first) and visit with my parents for three and a half days -just the right amount of time. I got a ticket for a great price and felt at peace with the decision I agonised over. This was just the repose that would be beneficial for my mental health. Then AF arrived. Naturally, the first thing I had to do was to check my fertility forecast. Unfortunately, it does project that Husband and I will be on opposite coasts of the country when I ovulate this cycle. Thanks Mother Nature, I could have used this information a few hours ago. I shared this with Myrtle, who asked for an update, and by the way, still does not know the difference between IUI and IVF despite 5 or 6 detailed explanations. "I think you should try anyway," she advised me. "You never know...". I cut her off before she could say anything else. There is nothing that annoys me more than hearing the words 'you never know'. Firstly, yes I do know. Not only is this what I do for a living, but it's what I've been working on for over a year. Secondly, I realised that Myrtle has never used a fertility monitor to identify when ovulation is imminent. She has no idea what it is like to POAS daily to follow where your cycle is on a day-to-day basis. She thinks you merely have to have sex to become pregnant -with socks on. Following the miscarriage, Husband and I were tempted with the idea of continuing to try to conceive spontaneously. We conceived on our 7th attempt, although it took us nearly a year to be able to have seven valid attempts. The logistical issues of the past two months have confirmed and validated our decision to move forward with IUI. I don't know if I could handle another month of waiting for my O day to arrive at a time that is completely inconvenient and possibly miss yet another attempt. It is our goal to have a baby, not to conceive spontaneously. Besides, if the treatments don't work we'll have all the time until menopause to try to make it happen naturally.

A night at the gay bar...

Almost everyone who grew up in the 80s remembers the opening theme song to the long running show Cheers:
"Making your way in the world today, takes everything you got,
Taking a break from all your worries, it sure would help a lot"
I think just about anyone would embrace that notion, but I disagree with the next few lines in the famed lyrics:
"You want to go where you can see, the troubles are all the same,
You want to go where everyone knows your name"
No. Sometimes you want to get away to a place where no one knows your name and no one shares your troubles. That place is a gay bar. The initial appeal of a gay bar is that any woman can go to dance with her friends and not endure any unwanted attention. Added perks include the fact that all the men in attendance are rather attractive, well dressed and most can actually dance. There's virtually a contest among them to see who has the best upper body. You can claim to be the hottest girl in the room as it's your word against... well no one else's, since no one is looking at any of the few women in the bar. Best of all, you can almost guarantee that no one is talking about their appointment with a reproductive specialist, fertility monitoring, egg quality or semen analysis (well, possibly in a different context). My friend H and I had found the formula for two straight married white women with no rhythm to be welcomed guests at our nearby gay bar. Bring a coffee for the guy at the door (and sometimes have your cover charge waived). Tip the bartender generously. Offer the DJ a Red Bull, and he may play a request (usually Dancing Queen or in memory of the late Davey Jones, Daydream Believer). The gay bar had become our retreat when one of us had a bad week at work and always seemed to renew the bonds of our friendship. So, it was fitting that we were at the gay bar when I first told H that we were trying to conceive. H and I met and became friends at the time in my life when I didn't think I wanted to have children. She was committed to being child-free and not only was this something we had in common, she had reassurance that she wouldn't lose a friend to the motherhood. As awkward as it is for one friend to have a baby while the other is infertile, it's just as hard to have a baby when your close friend is not planning to have one. It changes the dynamics of the relationship, no how much you deny that it won't. I knew I had to tell her that I would be breaking our unspoken pact right away. H was surprisingly supportive. "Hey, if that's what you want, then that's cool" she told me. Months later, when we were back at the gay bar, I disclosed our fertility troubles. "Oh, I'll put you in touch with M!" (a friend from home who also dealt with infertility) "You two will have a lot to talk about!". The next day she introduced us over email and I had someone else to assure me that I didn't have to experience infertility alone. I learnt that you can never underestimate the ability for people to surprise and impress you. As I was coming to terms with infertility I had discovered frustration in friendly sources and surprising compassion and support in unexpected places. A gay bar is the perfect sanctuary to escape your infertility worries for a while. Time to go glitter up!

Should I Stay or Should I Go...

It has been a no good, very bad week. To start, I caught Husband's cold and have been feeling miserable. As it has been exceptionally cold, I haven't been swimming. Actually, I haven't done any exercise in over a week, which has contributed to my misery. Work has been really busy. I haven't taken any vacation time since I got back from England in early August. Our office was only closed on Christmas and New Year's Day, but all of my colleagues took some personal time around the holidays and one has been on an extended vacation, leaving me to cover in their absence. I'm starting to feel like Peter Gibbons in Office Space. As my progesterone level officially confirms I'm in my luteal phase, I've been feeling rather hormonal and especially emotional this week. I had a few moments when I felt like crying and I erupted into a fit of anger when I discovered that Husband didn't bring the rubbish bins in from the curb. Alas, I had made it to Friday. Just had to get through the next eight hours and I could escape into the weekend. While driving into the parking garage, I swipped a concrete post, scrapping and denting the passanger side of my car. I wanted to burst into tears and it wasn't even 9 AM.
Throughout this week, I have been contemplating if I should go back to east with Husband and visit with my family. I know I need to take some time off from work before I burn out, but I don't know if this is a break that will recharge me. Returning home and spending time with parents is not a proper vacation. Additionally, I don't know if I'm ready to face Myrtle and to see her in her new role as a mother. It pains me a bit to admit that to myself.  Plus it's really cold in Connecticut.
However, it would be comforting to see my parents. Even though I'm not ready to share anything about our fertility project yet, I'd like to spend some time connecting with them. I'm a 36 year old woman who still wants her mommy. I know I'll eventually have to encounter Myrtle. Six, nine months down the road, if I'm still not pregnant, will it be any different? I can't avoid her forever. Also in the decision making equation is the fact that I could be ovulating during this time. Part of me fears this could place extra pressure on Husband (not to mentiont the awkward location) or if I go and it doesn't work, will we look at the cost of my flight as money that could have gone to our first IUI cycle? (or for my car repairs...) But what if ...

You can't win if you don't play...

So, I haven't actually seen any of the movies in the Godfather trilogy, but I am familiar with famous quote '"Just when I think I'm out, they pull me back in!" Although I've never been involved in the mafia, I can identify with that feeling right now. I knew it was still a long shot, but I confess I was a little more hopeful after my miscarriage. I've known of 7 or 8 patients who conceived with the first ovulation following a miscarriage, although the most recent patient had a chemical pregnancy, and I don't think any of these patients had underlying fertility issues.  Did I really expect that getting pregnant once would resolve our infertility issues? More so, did I really believe that our first pregnancy would be successful and we would live happily ever after? Just a few hours after having my blood drawn, I received a call from a medical assistant in my RE's office informing me that my HCG level is finally zero. Ironically, this was the quickest response with the results that were least clinically relevant. My progesterone level was 14, indicating that I ovulated some time in the past week. Unfortunately, it was a bang-less week. One night husband was out with some work friends, the next night I met up with some friends visiting out of town. We stayed home on New Year's Eve, but after two glasses of wine, I was sound asleep by 10:30 and missed seeing the clock strike midnight, which officially means I am old as well as lame. I tweaked my groin muscle during my New Year's Day 10K and was out of commission, which coincided with Husband coming down with a cold (aka "manflu"). I feel like we are the sorriest conception seeking couple ever. The consolation prize is knowing that I did actually ovulate and now I have a 6 day window to expect AF. While I'm happy to see that my ovaries are back to work, I was kind of hoping the anovulation would continue a little longer and then I could possibly manipulate AF's start with Provera and avoid being fertile while Husband is away. Now I'm almost certain that at the moment when I'm ovulating, Husband will be on the east coast playing Wii bowling with my father.  I don't know why I'm so disappointed about missing a chance to conceive spontaneously when we've accepted that we need treatment, but it just makes the possibility of pregnancy seem that much further away. You have to be in it to win it.  At least the advantage to being back in infertileland is the opportunity for further diagnostic testing. On my initial evaluation, it was noted that I may have a slight uterine septum. Although it was thought to be unlikely to contribute to our infertility or cause problems with a possible pregnancy, I'd rather not have this question mark hanging over my head as we start treatments. There's no doubt that I would prefer to have an ultrasound that shows a baby growing in my uterus, but I'm happy to be proceeding with the sonohystogram at this time. Sometimes you have to take a step back to be able to move forward.

The Reflexive Responsive Pregnancy

Do you remember being in grade school and if you were wearing the same clothes as another kid, or playing with the same toys or games, you could be labelled as a 'copy cat'? Some times that behaviour doesn't leave the playground. I think most of us have observed situations where we've speculated that someone became pregnant, just because her friend or family member is expecting. Someone who hadn't indicated any plans for pregnancy, and may not even be in the best place to have a baby, but quickly conceived after the friend made her announcement. Maybe it's a feeling of not wanting to be left behind, or wanting the children to grow up together, but I suspect there's also an element of jealousy and insecurity. Many years ago I had a patient who came in for her yearly exam. She wanted to manipulate her birth control pills so she wouldn't have her period during her younger sister's upcoming wedding, but she asked about IUDs and other forms of long acting birth control as she and her husband didn't want kids any time soon, if at all. A few months later, the younger sister came into the office for a pregnancy test. She was in shock over her honeymoon conception. Three months later the older sister also presented for pregnancy testing. I wondered if the younger sister's pregnancy influenced her to change her mind in regards to their family planning. The younger sister stopped breastfeeding around 6 or 7 months and came into the office to discuss birth control and the older sister accompanied her. Her last period was 35 days ago, still likely to be irregular, but warranted running a pregnancy test. It was positive. Sure enough, the older sister had a positive pregnancy test three months later. I knew that was not a coincidence. It's such a different world for fertiles. I can't imagine what it must be like to command your own fertility, especially when it seems to be a reflexive responsive conception. Copy-cat.
Update on Co-worker: she's nine weeks along and although she feels like crap, the babies seem to be doing well. She broke the news to her mother on Christmas day by having her open a framed picture of the ultrasound photos. Her mother burst into tears of joy and hugged both Co-worker and her husband. About fifteen minutes later, after she had settled down and dried her eyes, she asked "Why did you frame two pictures?" Co-worker had to explain, "...because there are two babies..." The tears and hugs erupted again. However not every pregnancy announcement is as much fun. Co-worker was dreading telling her Sister-in-Law (SIL). Co-worker's SIL is the kernel of truth that contributes to negative stereotypes of only children. She's selfish, self-absorbed, self-centred, jealous and insecure -and those are her good qualities. On her first attempt to conceive, she became pregnant with boy/girl twins. She would go crazy once she learns they won't be the only twins in the family. Co-worker decided to break the news in stages, first disclose the pregnancy and then reveal that she's got two on board. After learning of Co-worker's pregnancy, the SIL listed all the ways that pregnancy and caring for one baby would be so much easier, just so everyone would know that every situation is always all about the SIL. She pressed Co-worker at least three or four times with the question, "Are you sure you're only having one?" A few days later, at a family gathering on New Year's Day and before Co-worker could drop the bomb about the twins, the SIL announced to everyone that they were trying to conceive...

Awaiting Ovulation...

My supposed mid luteal progesterone level came back at 0.7. Not only did I not ovulate at the time I thought I did, but as of Day 19 I hadn't ovulated at all. Looking back, I suspect I was too anxious to start again after my miscarriage. I had misinterpreted all the cues. The EWCM was likely left over from the pregnancy, the twinges of pain were likely muscular aches from swimming and the lustful thoughts for the male nurse in the elevator probably reflects the fact that I've been with the same person for fifteen years. My hormones levels were probably still scattered and likely triggered a false positive on the fertility monitor, implying that I should have stuck to my initial instinct not to use it. I thought I had an understanding with the Universe: I could accept the disappointment from my miscarriage as long as I could move on as quickly as possible. Now I feel like I'm flying blind. I don't know if I ovulated since having my blood work done (not that it matters, since we haven't had sex during that time) or if I haven't ovulated yet (not that it matters, since Husband self-indulged today). It seems like such a foreign concept, no cycle tracking -just hope you're in your fertile time, have sex and maybe get pregnant. I have to remind myself that for most "normal" couples, this is their experience with the procreation process, but it seems so inefficient and futile to me. The most frustrating aspect of the ovulation uncertainty is the fact that I won't know when to expect AF. Although the two week wait is agonising, at least there is an end point. In my situation, there is no joy with the absence of AF. Each passing day without her means more waiting and more plans are put on hold. I've been looking ahead on the calendar. Husband has to go back east for work toward the end of the month and will be away for ten days. I've resigned myself to the fact that I'll probably ovulate during that time. As I have a lot of vacation time saved up (thinking I would use it for maternity leave) I'm tempted to go with him. A few days in New York would be fun, but Husband has already arranged to spend some time with my parents, which is not conducive to baby dancing. It now means two months of missed chances. It's hard to know which is worse -trying to conceive and meeting the BFN or being denied the opportunity entirely.

The Vanity Project

I've dealt with body images issues for most of my life, as do many with double X chromosome syndrome. In my early adolescence, I was starting to pick up the description of being "big boned".  Fortunately, I was directed toward sports and not only added muscle tone to my frame, but I gained the self esteem and confidence to accept the way I looked. Nearly a decade later when I was in my mid twenties and was working in a hospital ward, I would sometimes hide in the locker room when I needed a quiet space to do my charting. The locker room shared a wall with the nurse's break room and one day I overheard a group of nurses discussing what parts they would chose among their colleagues if they were to design an ideal body type. To my surprise, they collectively decided that they would want my legs on this hypothetical woman. Once I knew that someone else wanted what I had, I felt that I had permission to appreciate and actually be happy with my own body. As I wasn't interested in having children at that time in my life, preserving the body that I had was additional motivation not to become pregnant.  I have a colleague, who is a certified personal trainer for pregnant and postpartum women, and I asked her what to expect if I ever had a baby. "Well," she told me, "You'll get your figure back, but be prepared that your body will go through major changes" I took a minute to process her words. So I'll look okay in clothes, but be wrecked naked? "Yep, that's pretty sums it up" she confirmed. I resented Mother Nature for placing such an unfair burden on women. If it's not hard enough to endure the physical effects during the nine month gestational period, why must women bear scars and blemishes after the baby is born? Not to mention society makes women feel pressured to get that figure back right away, while mastering motherhood and returning to work. However, as I turned 35 and the ovaries were kicking up my maternal desires, I started developing crow's feet around my eyes and the waistline wasn't as forgiving if I missed a workout. Whether I had a baby or not, I was going to lose my attractiveness and flattering figure. The more I came around to the idea of wanting a baby and wanting to be a mother, it all seemed less of a sacrifice. That and I also accepted the notion that there is no shame in plastic surgery. Just days before I got my BFP, I noted I was at the lowest weight I had been at in years. I felt happy with the way that I looked, and it was not because anyone else was feeding me any compliments. 'Now, watch I'll get pregnant' I thought to myself. Believe me, I wasn't disappointed in the least and if I were still pregnant, I wouldn't care what number is on the scale. However, a few weeks after my miscarriage and just before New Year's, I was at work and I overheard a colleague say "I wish I could rock a dress like Jane..." Suddenly, I had the motivation to avoid the cookies in the break room.  As 2013 began, I resolved to be committed to good eating and exercising habits, primarily for health reasons, but with a dash of vanity. As long as this body is bumpless, I'm going to flaunt it.

Minor Annoyances

I am fortunate to live in a large city and I had a choice of several REI providers. I know there are couples in other parts of the country who have a 2-3 hour drive to find one reproductive specialist. Our short list was narrowed to two groups that accepted my insurance. Both offices were about the same distance from our house, although the morning traffic was worse getting to one and the other was a little closer to the pool where I swim each morning. The decision was influenced when Husband's urologist sent him to our current provider's office to do his semen analysis and he felt comfortable wanking there. Sold. I could look past the fact that my RE bears a striking resemblance to an ex-boyfriend (not the devoutly religious swimmer) as I do genuinely like and respect him. However, I'm getting more impatient with his office staff. I prefer to use email to communicate, as I find it to be more convenient and in theory should be more efficient, but I'm now doubting this strategy as there have been multiple occasions when my messages aren't being read completely. I sent a message last week about obtaining authorisation for my sonohystogram and haven't heard anything back. For the most part, I feel that I am fretting over minor details, but I'm concerned about the larger picture. If they can't take care of the simple things, how can I trust that they'll put the right stuff in my hoo-ha? The day after Christmas, I received a voice mail from a staff member whose name I didn't recognise. She informed me that my last HCG level was 16 and my RE wanted it to be repeated next week to confirm it reached zero. Seriously? I wouldn't make someone repeat a draw with a level of 16. However, I was curious to know my progesterone level one week after the peak fertility indicator to confirm if I did in fact ovulate. This was my negotiation; I would repeat my HCG level if I could also check a mid-luteal progesterone. I sent an email asking to have a progesterone level added and for the request to be faxed to the lab. I also asked for someone to notify me when this was done, so that I wouldn't waste a trip to the lab. Two days went by without a response. I called the office on the morning when I was intending to have my bloodwork done. A woman's voice answered, but she didn't identify herself. I said I was calling to confirm if the progesterone was added to my lab order, and if it was faxed to the lab. She put me on hold while she went to get my chart. Then she placed me on hold again while she went to check on what was ordered. Finally she returned to inform me that I needed to have an HCG level drawn next week. I asked if the progesterone was added and she confirmed it was. So my message was read. I asked if it was faxed to the lab and she confirmed it was. "Did anyone see my note about contacting me to let me know this was done?" I asked. Silence. No apology. No explanation. I hung up the phone. I sure am working my way to be labelled as a "difficult patient". Maybe I was over reacting and I am confirming that I did ovulate before my progesterone level has even been drawn.

The 2013 Challenge

I started the New Year by conquering a mountain. Well, technically not a mountain, but a steep hill with a gain of nearly 1,000 feet in elevation. For the second year, I participated in a New Year's Day 10K trail run. Last year, I didn't look at the course map before the race started and was so unpleasantly surprised by the terrain that I disabled my timing chip, so I wouldn't register a time. This year my goal was just to enjoy the beautiful view that awaits us at the top of the hill and soak in all the positive energy from the other runners (who are now walkers/hikers at this point). It's hard not to feel optimistic as the New Year dawns. Post race, Husband and I returned home for brunch and I began to work on painting our kitchen cabinet doors. When we were planning our kitchen renovation, Husband wanted to install new cabinets, but ours were in good shape and I didn't want to double the price of the renovation (a wise decision given that we may need those funds for IVF). So we decided that I would paint them. Last February, I started by stripping all the cabinets and facings, and then we took our time selecting the paint colour. I painted the casings in June, but once we got back from England in August, we went into full renovation mode and painting was put on hold. We had all the appliances installed by election day and by Thanksgiving I had moved everything back into the kitchen. Now, the final step of the project was to finish painting the cabinet doors and trim. Husband and I joked that the process of painting the cabinets has been taking as long as we have been trying to conceive. Thus, the challenge of 2013 was issued. Which would happen first: a pregnancy or finishing the cabinets? Here are the stats for those of you who are playing along at home. Fertility project: Me, age 36, FSH 7.1, E2 32, AMH 4.53, AFC 9-10, irregular cycles, possible uterine septum, thin endometrium, one pregnancy -miscarriage at 6 weeks. Husband, age 38, low concentration (range 14-17 million), low morphology 1%, motility 50-60%, mild hypogonadism with slight response to Clomid. The cabinets: twenty doors. I have a rack that allows me to paint both sides at the same time and holds four doors. Each door gets a coat of primer (sometimes needs two coats) and then 3-4 finish coats and 2 coats of a clear protective polish.  For the trim, we have to borrow a special laser level from my dad to identify the lowest point in the ceiling. We still have to select the moulding, do the math on how much we need and add 15-20% for cutting errors. Then all pieces will need to go through the painting process prior to installation and will need touch ups after the caulking. I'd prefer to do this part first as I'm growing tired of seeing the paint spots on the wall and ceiling that are waiting to be covered up by the trim. I do most of my painting on the weekends, but will sometimes do some sanding and prep in the evenings after work. So which goal will be reached first in 2013? I'll keep you posted. Happy New Year to all!