Little reminders are everywhere, it seems.


Just when I’m certain that I’ve moved on, that I am finally putting the past behind me and just enjoying each moment…that past comes crashing in.  Flashbacks consume my every thought, and tears become sobs before I can even process what triggered my emotions.


Infertility never leaves us.  Whether or not our babies find us, the pain of infertility lingers in the background, waiting for the right moment to pounce.


It was a day like any other.  Hot, sunny, without a cloud to be seen.  I stared out the window as the kids colored, wondering if I could skip the grocery store run since the babysitter called in sick.


No, I couldn’t.  I needed ingredients for those birthday cookies… 


I put shoes on the kids and strapped them into the car, very much against their will.


We just want to play with you, Mommy.


Me too, little ones.  Me too.


We made a game of the grocery list, sorting by size and color.  We used teamwork to get the heavy items into cart and compared numbers on the price tags.  We found a way to make it fun.


We laughed, we smiled, we made the most of the otherwise boring errand.


And then, in the checkout line, past and present collided.


As I reached for my credit card (that had somehow slipped out of my wallet and into the pocket of my favorite Coach purse), I found something that I hadn’t seen in a very long time.


I pulled my hand from my purse to find an ultrasound picture.  The last ultrasound, in fact, before I lost that very last baby.  The one who would have made #3.  The one who would be nearing his first birthday.  The one who left an unbearable hole in my heart.


I froze, suspended in time.  With glassy eyes I stared at the picture, unable to make a move.  I could feel the line growing behind me.  I could see the kids staring up at me in anticipation.


It was an innocent prompt from the cashier that brought me back to life for a moment.


Did you already swipe your card?


Switching to autopilot, I paid for my groceries and found my way home.


Later that night, as the kids slept peacefully, I curled up on my bed and finally let the sobs escape.


Infertility never leaves us.  It hides out for a while; hanging out in the recesses of our souls, but it never truly leaves us.


All we can really do is just keep swimming.


To Talk or Not to Talk

In the very beginning, when I was consumed with shock and emotion, I didn’t want to talk about it.  I wanted to remain strong.  I wanted to fight my own battle.  I wanted to move forward.


Part of me felt embarrassed (was this really happening to me?)  Part of me felt alone.


And, at the end of the day, a large part of me wanted to just wake up from that seemingly never-ending nightmare as soon as possible.


And so I remained silent.  Apart from a couple of close friends, and even those conversations were infrequent at best, I remained tight-lipped about the medical mystery that followed me around like a brand new puppy.


I was infertile.


I was unable to keep those little babies in my womb for long enough to get them to term.


I was petrified to utter the words out loud.  I couldn’t bear to make it any more real by sharing my struggle with those around me.


I floated through my workdays like a ghost, a fraction of the competent, eager clinician that worked her way from therapist to clinical director in just a few years.


I longed to confide, really confide, in someone other than my husband.  I needed a lifeline.  At times, I tried.  A couple of friends were no strangers to miscarriage, but they had their babies by then and I was reluctant to burden their only free moments with the sadness and hopelessness that came to define my days.


I spoke to my mom in medical terms, sharing the latest updates (which, for the record, were few and far between.)  I cringed every time the words “second opinion” or “switch doctors” came through the line.  I wasn’t in need of more opinions; I was in need of a baby.  And, perhaps, a little support.


But I didn’t say that.  I didn’t cry out loud and ask for help.  I didn’t yell or scream or make a scene.  I didn’t do any of those things.


I remained strong on the outside, putting on my brave face every morning only to melt into a puddle of sobs and helplessness each night.


I remained silent.


I remained alone.


I remained helpless.



Over the past couple of weeks, there has been a considerable amount of chatter about Khloe Kardashian and Lamar Odom’s struggle with infertility. Is he right to seek silence on such a personal topic?  Does she owe it to world to share this story given that she has allowed the rest of her life to play out on reality TV?  Is she, in fact, infertile or is it nothing more than a publicity stunt meant to boost ratings for an aging show?


Does any of this really matter?


I’m not a huge fan of reality TV…particularly the kind where self-declared celebrities drive around Los Angeles in their black SUV’s whining about every little thing.  We all have things, reality people…


But infertility is a big thing.  It’s a very big thing.  It changes relationships and tests your strength.  There isn’t anything easy, or little, about it.


Whether or not Khloe Kardashian is headed down the lonely road of infertility, the decision to talk or remain silent belongs to her and Lamar.  It’s a personal choice on a very personal matter, and I wouldn’t blame them either way.


I do hope she finds the right support though.  I was afraid to speak up when I needed more, and, if I had to do it all over again, I would probably be a lot more vocal.


The squeaky wheel gets fixed (and hopefully some much needed social support).


Note:  I have never seen an entire episode of Keeping Up with the Kardashian’s, just a few clips of the family banter here and there (most often in the SUV’s).  Although that kind of entertainment just isn’t for me, I do wish Khloe and Lamar well along their road to parenthood and hope that the public eye allows them some privacy to cope with the ups and downs of infertility.



Ask Dr. Marc: Weight Gain and Infertility Treatments

Dear Dr. Marc,

Nice to meet you my name is Marianella.  I live in Costa Rica and I have 34 years, almost 35. My case is not like the other cases. I have a son…for IA…after he was born I decide to get pregnant and went for 6 IAS…nothing happen, so the Dr. send me to the fertility specialist… He made me a laparoscopy…clean on fallopian tube and he told me I had endometriosis.. I (2 focus) we did with him 2 IAs more…and nothing.

Desperate, I stop the treatments. I gain 27 pounds in this 2-year process… and I am losing weight since I decided it to stop. The Dr. told me not to let go the birth control pills and maybe do a FIV. Right now I am not in position of invest…my husband lose his job…and is really hard to find another one.

In all my IAs I had 2-4 eggs 18-25, most of them break …other made cyst..

So my question:
What can I do more? Is the FIV an option for me? Or the TIFG? Can I have option to get natural pregnant??? Is my weight affecting me?


Hola Marianella,

I am sorry that you have had such a string of bad luck; hopefully we can straighten some things out and get you on the right tract for the future.  Lets address things one at a time:

1. The fact that you became pregnant through insemination (AI as you said) previously, bodes well for you now.  Importantly, we need to figure out why insemination worked for you in the past.  Was there an issue with your husband’s sperm?  If so, that issue may now be worse.  Just because they have used his sperm for inseminations recently, does not mean that they have performed a complete evaluation of the sperm.  You should have your husband’s sperm evaluated completely.

2. Your history of endometriosis is important.  We know that endometriosis can contribute to infertility.  Although it sounds like your endometriosis was not severe in the past (only 2 focuses) it may have progressed.  With your history, it may justify another laparoscopy, or at least an HSG (hysterosalpingogram) to be sure that your tubes are still open.  I would do this before any more treatment.

3. Weight can be an issue.  We know that it is harder to get pregnant for women who are significantly over or under weight.  Ideally your BMI should be between 20 and 30.  To check your BMI you can go to (www.nhlbisupport.com/bmi/).

4. IVF is the best bet for you now.  After 6 inseminations with 4 to 8 eggs each time, you have exhausted the usefulness of insemination.  As for cost, IVF is more expensive than IUI, but it is not more expensive than multiple IUIs.  From that point of view, it is probably more cost effective to not do any more IUI and save up for IVF.

5. Natural pregnancy is always a possibility!  To that end I want to share a story of one of my recent patients.  She had gone through multiple IUIs over a 2-year period and never conceived.  Subsequently, the couple resigned themselves to IVF and took off a year to save up enough money.  She was supposed to come in this month with her period to start medication but her period never came!!! Low and behold, she was pregnant!!

The point is that you should not give up Marianella! Formulate a long-term treatment plan, save up for IVF and while you are getting prepared for the treatment, continue trying the old fashioned way!

Good luck,

Pura Vida,

Dr. Marc



The Perfect Handstand

There is nothing perfect about infertility.


In fact, you might say that infertility is one big mess of imperfection.  Truly, when it comes to infertility it’s all about what’s going wrong.


Treatment of infertility can feel like a guessing game for some.  Try these shots, take these pills, and get your levels checked on these days at this time.


There isn’t a lot of control to be found when it comes to infertility.


But there is the handstand.


It doesn’t take an infertile to know the folklore surrounding the legs in the air post sex tactic.  Most pregnancy hopefuls have read about this one in a magazine or in a blog post, or, at the very least, have seen it played out in a movie or TV show.


The story goes that if you left your rear end in the air for five to ten minutes following intercourse, the sperm will get to the right place.  This, of course, sounds positively absurd.  Teen moms everywhere can probably make a solid argument that this extra step isn’t actually necessary.


And yet, we do it.  Infertilies and fertiles alike lift our rears in the air night after night with hope of speeding up the conception process.


When I first entered the baby-making game, my sperm directing efforts were half-hearted at best.  They swim, for heaven’s sake, how much direction could they possibly need?


After the second miscarriage, I really began to work on my form.


For a while, my husband humored me by holding my legs up for me.  How he managed to put up with me continues to amaze me to this very day.


When that wasn’t “working”, I decided to take it to the next level.  Clearly I needed to try a real handstand.  If I could manage to hold my legs perfectly straight in the air, the sperm would have no choice but to find the correct destination.


You might think I’m joking.  I kind of wish I could say I am.  Have I mentioned that infertility involves just a little bit of crazy?

But that’s neither here nor there.


It took some practice and a little bit of determination (not to mention a husband full of good humor), but in time I perfected my handstand.  Balanced slightly on the side of the bed, I found a way to hold my legs perfectly straight in the air for a very, very long time.


I was a gymnastics dropout…this is kind of a big deal.


Conception attempt after conception attempt, I slithered my way down the side of the bed and to the floor to get into perfect handstand position.


The result?  It did absolutely nothing when it came to conception, but my arms were super strong.  Who doesn’t want super strong arms?


Besides, it gave me a very small feeling of control during a very long and out of control process…and that can go a long way toward keeping just a hint of sanity in tact.


What do you say, ladies?  Care to try the perfect handstand?



When a Friend Miscarries…

Miscarriage is devastating.


It’s painful (physically and emotionally), confusing, and heartbreaking.  It leaves a couple feeling lost, sad, and broken.


And then there are the hormones.  Pregnancy hormones tend to surge quickly, and they crash just as fast when the pregnancy ends.  Many women experience symptoms of depression and anxiety following a miscarriage, and those crashing hormones certainly don’t help.


Many miscarriages come with warnings:  Bleeding, cramping (sometimes even contractions), and a sudden decrease in pregnancy symptoms are all warning signs that can occur.  But some miscarriages are classified as missed miscarriages…this kind of miscarriage occurs without a woman knowing it.


The truth is that none of that really matters.  The truth is that miscarriage is devastating no matter when it happens, how many symptoms preceded it, and whether or not it occurs during primary or secondary infertility.


Miscarriage stays with you.  No matter how many months and years pass, no matter how many babies make it to term, no matter how much social support surrounds you…miscarriage stays with you.


It can be very difficult to be on the sidelines when a friend or family member suffers a miscarriage.  It’s hard to know what to say, how much space to allow, or what how to act.


In some cases, friends and family members simply step aside because they’re not sure what to do.  This can lead to feelings of loneliness for the person who recently miscarried…even though the intention was most likely to give that person some time to regroup.


There are a few things you can do to help a friend or family member who recently experienced a miscarriage:


Listen:  The single best thing that you can do for your friend is to listen.  Resist the urge to focus on the positive and just let your friend vent and cry as much as necessary.  Grief following a miscarriage can involve anger, sadness, and depression.  Allow your friend to move through her grief at her own pace.


Bring dinner:  Your friend might not be able to ask for help or company, as recovering from a miscarriage is overwhelming at best, but she will most likely appreciate a dinner delivery and the chance to talk.


Make it a movie night:  Chances are your friend is wearing a daily uniform of yoga pants and an old sweatshirt right now…put on your cozy clothes and come prepared for a RomCom marathon.


Help out:  When you’re that overwhelmed, keeping up with the grocery shopping, laundry folding, and dishes doesn’t always happen.  Offer to help.  Your friend might decline the offer…but it’s always nice to offer.


Take a walk:  Chances are your friend has been cooped up and hiding out.  When she’s feeling a little better physically, offer to have a weekly walk with her so that you guys can just get out and chat.  End it with a coffee or smoothie to keep the quality time going.


Share books:  Reading is the great escape.  Drop off your favorite books when you’re done with them to provide a little extra escape for your friend.  Added bonus:  Instant non-miscarriage related conversation during those walking dates.


Be yourself:  You don’t have to tip toe around your friend just because she’s going through something terrible.  In fact, she’s counting on you to just be you so that she can have some feeling of “normal” after such a terrible loss.


Avoid personalizing:  Even if you follow all of these tips, your friend might still hide out and ignore the phone.  She might even lash out once or twice.  Try not to take it personally.  Coping with miscarriage feels impossible in the beginning and we all make mistakes along the way.  Try to recognize that your friend is overwhelmed, devastated, and exhausted.  Give her time and just continue to offer to be there when she’s ready.


Pour the Cabernet:  Always remember the wine.  Enough said.  (If it’s really hot…bring white.)


If you’re here, you are already an amazing friend.  Clearly you care enough to find the best possible ways to help your friend cope.  Keep on doing what you’re doing and you will certainly help your friend get through this very difficult time.

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