Left Behind

Early on, I promised myself that I wouldn’t let it change me.  There are no guarantees that life will be easy, after all.  Sometimes struggle is just part of the deal.

 

And for a little while, I even believed it.  I took the blows as best I could and then picked myself up and started again.  I would prevail; I just knew it.  Together, my husband and I could conquer anything.

 

I put my energy into feigning some version of normal.  I met up with friends for coffee, dinner, and movies.  I talked on the phone, wrote long and detailed emails, and remembered every birthday.

 

I tried.  I wanted to ensure that everything would remain the same.

 

But I was suffering in silence.  Sure, a few very close friends knew about the miscarriages, but I was reluctant to burden them with my constant thoughts and fears.  I talked about it when they asked but, for the most part, I remained quiet.

 

I did the asking.  And when they began to have first, second, and third babies, I asked about the babies.  I bought gifts, oohed at the appropriate moments, and held those babies close.  I snuggled them close as if they were my own.

 

I soaked it up.

 

It was a cool, December afternoon when I paid a visit to the newest baby born to someone in my friendship circle.  The sun cast a warm glow through the crack in the chestnut colored blinds.  I sat, huddled into the far corner of the oversized white sofa, snuggling her baby girl tight.  With wide eyes and an open mouth, she considered me with curiosity.  After struggling to free her tiny pink hand from the swaddle, her arm shot up toward my hand, as if she wanted to make contact.

 

While my friend regaled me with stories of her birth, I sat quietly and stared at her little girl.  It would be impossible not to smile in the face of such beauty, miracle, and little.  With a tight grip reserved for fire fighters and new babies, she clamped her warm hand around my little finger and held on for dear life.

 

I was in awe of her, as I was with every new baby that entered my life.  I could have held her for hours.  When she began to fuss, I walked her around the house to give her mommy just a little more time.  And then I left them to bond and find their way together.

 

I took a deep cleansing breath as I stepped out into the sunlight; new babies are good for the soul.  The colors seemed just a bit brighter as I scanned the landscape along the walkway and back to my car.

 

It wasn’t until I got into the car and bucked my seatbelt that my emotions caught up with me.  One moment I was aglow with love and the scent of a new baby, I could still feel the weight of her in my arms.  The next I was a sobbing mess.

 

I sat there for what seemed like hours, crying into my steering wheel.  Wishing, wanting, and being left behind yet again left me feeling lost and alone, no matter how hard my friends tried.  I cried for my losses, I cried for my shattered dreams, and I cried for the friendships I wasn’t sure I would be able to maintain.

 

With mascara stained cheeks, I finally found the strength to drive away.  I made my way home in a daze, not thinking or feeling, just driving.

 

It was then I realized that I had changed.  My friends were moving forward with their loves, expanding their families and starting new adventures.  But I was stuck in limbo, left behind and full of frustration, anxiety, and great sadness.  I was unable to connect because the aftermath was too emotionally taxing.

 

I stayed in touch as much as I could, and attended outings when I felt strong enough to socialize.  But, for a long time, I often chose to isolate.  I read hundreds of books, watched the same movies ten times over, and exercised my feelings away.  I waited for my time to come.

 

Despite my best efforts to the contrary, infertility changed me.  It left me hollow, anxious, and alone.

 

It left me feeling…

 

Left behind.

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Ask Dr. Marc: IVF and Breastfeeding

Dear Dr. Marc

Is it safe to go through IVF while breastfeeding? I have extensively researched the safety of the meds for me to take so that it doesn’t harm my daughter who’s nursing, but my doctor seems to think it could decrease my chances of getting pregnant (as in, decrease my response to the meds).

Thanks,

Nursing Mom

 

Hi Nursing Mom,

You pose a very interesting question with both medical and ethical implications.  The benefits of nursing are significant for both mom and baby.  Some maternal benefits include faster recovery after delivery, weight loss, lower long term chance for breast and ovarian cancer and lower risk of cardiovascular disease.  For baby, the benefits include less short-term illness like ear infections, less long term illness like cardiovascular disease or obesity, less allergies and even a slightly greater IQ!  To achieve these benefits, nursing should continue for a minimum of 6 months

Despite this long list of benefits and the fact that I encourage all of my patients to breast feed, I feel that IVF and nursing do not mix.

The main problem is due to the hormones prolactin and oxytocin, which are integral to milk production and release.  These hormones, produced by the pituitary gland, affect many organs throughout the body including the uterus, brain, intestine and ovary.  They are the reason why most women do not ovulate, and thus do not conceive, while breastfeeding.  One can think of these hormones as nature’s birth control.  Additionally, there are some rare types of brain tumors that produce prolactin, not coincidentally; infertility is one of effects for women with these tumors.  Lastly, some experts believe that elevated prolactin levels play a role in miscarriage.  For all these reasons, it seems like a good idea to keep prolactin and oxytocin levels as low as possible while trying to conceive.  In your case, that means cessation of nursing.

My view is that IVF requires such an enormous investment in terms of time, emotion and money, that it makes sense to make every effort to optimize the environment as much as possible.  My advice to you is to decide whether it is more important to continue nursing, or to try and conceive.  This decision should be based on your age, the amount of time you have been nursing and the reason you need IVF.

Despite my opinion that IVF and nursing do not mix, nursing during IVF is probably not dangerous.  If you decide to undergo a cycle and continue to nurse, you will probably just have a lower chance for success and maybe a slightly higher chance for miscarriage.  If you are okay with these risks, then I think your doctor should respect your wishes.

Good luck Nursing Mom,

Dr. Marc

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Empty

I was bleary eyed, exhausted, and hysterical when I walked into the office that morning.  It was a cool but sunny January morning.  Truly, I had no idea what I was walking into.

 

Just two days before, I was told that my pregnancy had ended.  I was 13 weeks pregnant, and ready to tell the world.  It didn’t occur to me, not even for one second, that I would be telling a much different story.

 

Or hanging my head in shame and self-doubt, and avoiding the world for a while.

 

I gripped onto my husband’s arm and spoke in whispers that morning.  Words seemed nearly impossible to form as I struggled to make sense of what happened.  What is it something I had eaten?  Did I exercise too much?  Not enough?  How did I get there?

 

An unfamiliar doctor entered the room.  In a cold demeanor she outlined the procedure without making eye contact.  She was clinical, short on words, and ready to get it over with.

 

When she left the room for a moment, I sobbed to my husband.  My baby deserved better.  I wanted my real doctor; I couldn’t handle this substitute.

 

Within minutes she returned to administer the Valium.  I slipped into a drug-induced state of partial alertness, aware of sounds and sights but not feeling much of anything.  I stared helplessly into my husband’s eyes as I willed the moment to pass.

 

The low hum of the machine echoed through my soul as it sucked the lost life from my womb.  Would I ever be able to escape that sound?  Would it remain with me for years to come?

 

And then…it was over.

 

Time seemed to slow down as I limped my way back to the car.  Although the Valium had yet to completely wear off, my senses were heightened.  Conversations between strangers in the elevator sounded far too loud.  The sun beaming through the catwalk windows threatened to blind me.  The scent of the musty parking garage turned my stomach.  I was powerless to escape any of it.

 

And then…I was left to heal.

 

For days I existed on tea and toast as I watched the world go by from the safety of my home.  I begged the phone to stop ringing, slept in minutes, and cried often.  My body healed slowly, growing a little bit stronger each day.

 

Eventually, I rejoined the world.

 

I dressed with care that first day back to work.  Black on black with just a pop of color from under my sweater.  I wanted to hide any evidence of the loss that seemed to follow me everywhere I went.  With careful precision I applied eyeliner, eye shadow, and mascara.  Would makeup hide the pain that enveloped my soul?

 

I slipped into my office and collapsed onto the couch intended for my clients, a ghost of my former self.  I scanned my desk for paperwork and stared down the blinking phone.  The voicemail would have to wait for another day.  For a day when other people’s problems seemed more pressing.  Would that day ever come?

 

I trudged through that day, allowing busywork to free my mind from self-defeat for a while.  When the sun began to set and the familiar voices of co-workers faded away for the day, I made my way back to my car.

 

I drove home in silence, watching the scenery pass me by.  As I pulled into my brick lined driveway and looked up at the darkened house, it finally hit me.  It wasn’t sadness, anger, or helplessness that I felt each moment of the day.  It wasn’t longing, guilt, or desperation.

 

I felt empty.  Like the dark house with closed shutters that stood before me, not a light on to indicate signs of life, laughter, or family and full of things that couldn’t be seen from the outside.

 

Empty.

 

I just felt empty.

 

 

 

 

 

Ask Dr. Marc: Estrace Priming

Dear Dr. Marc,

I’m currently on Estrace 2mg twice daily as part of an Estrace priming protocol.  My FSH went from 6.7 in 2010 to 17 last month (wah).  Even though I’ve done this, gotten pregnant and have a gorgeous little girl I am still nervous as hell to do this again.  I don’t know much about Estrace priming, can’t seem to find any good info on it and am wondering if anyone else has done it and maybe Dr. Marc can comment.  I know it’s for poor responders like me but not sure the rationale (even though I’m a pharmacist – a DOCTOR of pharmacy – I become very dumb when it comes to hormones and infertility and endocrinology).

Thanks!

 

Hi Estrace priming,

It is amazing how years of training can disappear in an instant, once a clinical situation become personal!

The rationale behind Estrace priming is based on sound physiology in and works quite nicely for some patients.  The bottom line is that the estrogen prevents your body from recruiting follicles too early (a common problem as ovarian reserve declines).  By limiting early recruitment, there are more follicles available at the beginning of your stimulation.  Additionally, the follicles tend to be better synchronized.  Therefore, they should all be ready at the same time and hopefully give you more high quality embryos.

Without going into too much detail, there are several hormones which participate in the communication between your brain and ovary.  One of those hormones, inhibin, acts to suppress (or inhibit) the release of FSH from your brain in the last week of the cycle.  As ovarian reserve declines, the production of inhibin in that last week of the cycle also declines.  This decline allows your brain to start releasing FSH earlier than it normally would.  The FSH then stimulates the ovary in the last week of the preceding cycle, and by the time the third day of the next cycle comes around, there is already a follicle or 2 that is bigger than the rest.  We call this dys-synchrony and it is one of the reasons, of lower egg yield in low responders.

With estrace priming, the estrogen pills, which also suppress FSH release, essentially replace the inhibin.  Theoretically, if the estrogen suppresses FSH, then the follicles should all be the same size when your period begins.  IF the follicles are all the same size when stimulation begins, there is a better chance that they will grow at the same rate and be ready at the same time.

I hope that is clear.  If not, rest assured that estrace priming is a safe and relatively effective technique that can help with egg yield.

Good Luck,

Dr. Marc

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Lost and Found

My friend Lane, from Club MomMe, asked me to stop by today and talk a little bit about why I started this site.  Lane is no stranger to infertility either, and she has even shared her story here.

Here’s a little to get you started…

In the very beginning, I didn’t feel so very alone.  Don’t get me wrong, I wasn’t screaming, “I’m infertile!” from every rooftop, but I didn’t feel like an outcast either.

Truth be told, I didn’t use the word “infertile” for quite some time.  Doctors, books, websites, and family members were fond of reminding me that one miscarriage didn’t mean I was headed toward infertility.  It simply meant that I was unlucky.  I was in the 25%…even if a miscarriage at 13 weeks isn’t actually all that common.

A dear friend of mine experienced two miscarriages before her first child was born, so I knew that I wasn’t alone.  I confided in her, and a couple of other friends, when I needed some consoling.

For a while, it just felt like something I had to get through.  I was sure that once I was able to get pregnant again, the miscarriage would just be a thing of the past.

But then the second miscarriage happened.  Once again, it took me by surprise.  There wasn’t a cramp in my uterus or a spot of blood to be found that might have indicated that things were not actually “progressing on schedule”.  11 ½ weeks.  I was stunned.

Even then, I didn’t call it what it was.  Because one is bad luck, and a second is super bad luck…but you really need a third to earn that title “repeated miscarriages”.

Unless you go months and months and months with no pregnancy.

Then you’re both unlucky and infertile.  Particularly if your eggs are old (read: anything over 30).

One year passed.  The months dragged on.  The anxiety mounted.  Hope quickly dissolved.  It was exhausting.

And then the phone calls came:  Back to back, two of my closest friends announced their second pregnancies.  I was pregnant when they were pregnant with their first children…they just didn’t know it at the time.  We were supposed to do this together.

I struggled to make sense of it.  I didn’t know how to respond.  I was happy for them.  In fact, I was over the moon.  But I was also anxious, jealous, and depressed.  How could they possibly be going on number two when I couldn’t, for the life of me, have a number one?

That’s when the isolation set in.  Even though my friends checked in regularly and hoped against hope that I would get there soon, something felt different.

Life changes when you have one and are expecting another.  Your world shifts.

Suddenly, I felt very alone…

Please stop by Club MomMe to continue reading this post.

Share Your Story: Just Stop Trying and It Will Happen

Today I want to introduce you to Tracy.  Tracy has been on the infertility roller coaster for quite some time.  Her ability to keep her spirits up and cheer for others along the way is truly inspiring.  She began blogging as a form of catharsis, but quickly realized that if we all stick together we can help each other along the way.  Did I mention that she’s also funny?  With the tagline, “Barren and blogging.  Don’t be jealous”, you know you’ll find some humor along the way!  You can find her over at Just Stop Trying and It Will Happen.  Please show her some love and support here today as she shares her story with all of you.

My infertility story began about three and a half years ago.  The husband and I were newly married, and eager to start a family.  We let things go for a couple of months, not really trying to try.  When nothing happened after about six months, and my two closest friends who had been married within a few months of me were expecting their first babies, I started to get frustrated.

I escalated to ovulation predictor kits, and learned a lot more about my body.  After a few unsuccessful months of that, I escalated again to taking my basal body temperature every morning.

Every month brought disappointment, frustration, and jealousy over others’ ability to produce children at will.  I peed on more things than I can count, and that has yet to end.

After we had been actively trying for about 18 months, I went to my new ob-gyn and asked for advice.  She asked me to show her on a calendar how often the husband and I were having sex, told me that was not adequate, and told me to have sex every other day.  If nothing happened within a year, I was to report back to her for further treatment.

At this point, I was 29.  My clock had been ticking for a while… I was ready.  Not in a year.  Now.

I made an appointment with a new ob-gyn that day, and saw her the next week.  She ordered a whole barrage of blood work for me, a a semen analysis for the husband, and sent me for an HSG to be sure my fallopian tubes were not blocked.

After everything came back normal, I was officially diagnosed with unexplained infertility.  I like to call it Invisible Infertility.  Ugh.

I started a two month stint on the entry-level dosage of Clomid, and found that despite the side effects, the meds helped me to see a more clear ovulation occurring on my BBT chart and with the OPKs.  Since I was prescribed the meds through my ob-gyn, I was not able to be monitored aside from a blood test at the beginning and end of each month.

When the second month of Clomid was unsuccessful, the very kind ob-gyn advised that I see a reproductive endocrinologist.  I made the appointment, and waited the three excruciating months for the consultation.

The meeting was brief.  We talked about my testing, medical history, and knowledge of the conception process.  In the end, my insurance would not cover much of anything, and we opted to try more medicated cycles.  I started what would be a six month Femara and Ovidrel diet, along with monitoring ultrasounds and blood work.

When the November 2011 cycle came to an unfortunate, but not unexpected conclusion, the husband and I decided to take the holidays off to enjoy being unmedicated for a bit.

In January 2012, I heard a radio advertisement offering a clinical study for women with unexplained infertility.  I figured I’d call and check it out… I mean, what could it hurt, right?  So I called.

After a series of questions over the phone, I was invited up for some preliminary blood work and to fill out some paperwork.  I found out about a week after the call that I’d been accepted into the study, and would receive four fully-funded IUI cycles, complete with medication and monitoring for my participation in the study.

I was randomized for medication at the beginning of February, and of the three options (Clomid, Femara, and Menopur), I was chosen for the pills.  I’m still not quite sure which pills, and I won’t officially know until after the study concludes.  I have a sneaking suspicion that it’s Clomid, however, based entirely on the horrendous hot flashes and night sweats.  I also get an HCG trigger 36 hours before my IUI, and I follow the IUI with Prometrium.

Last cycle was tough.  We not only got news of a very close family member who is expecting their first child, but we also suffered a chemical pregnancy after what was the most promising cycle I’ve ever had.  It was a very hard time for us, but I didn’t want to lose momentum and opted to continue onto the next cycle.

I am currently waiting to start monitoring for my thrid IUI cycle, and expect the procedure itself to take place early next week.

Come ooooooooon, lucky number three!!

So that’s my story so far.  I started blogging for catharsis, and through that process have met some of the most amazing, caring, supportive people in my life.  I hope to inspire others to share their stories as well, and to ask questions about the treatment process, the emotional toll, and how we cope with the stress month after month.

Above all else though, I hope to be a mother.  One of these days, it’s bound to happen, right?  :)

Thank you, Tracy.  Sending you lots of support and pregnant thoughts!