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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When The Whole World Is Pregnant

 

When the whole world is pregnant…it can feel overwhelming.

 

When the whole world is pregnant…mixed emotions ensue.

 

Happiness is always the first emotion to escape.

 

Ohmygodthat’ssoexcitingwhenareyoudue??!!!!

 

Followed by…

 

I’m so happy for you.

 

Because you are.  You want your friends to have more and more babies.  You want their dreams to come true.  And you want to be there every step of the way, from pregnancy tests to holding that sweet little baby wrapped just tight enough…

 

There’s just one tiny little problem…

 

You want that too.

 

Boom!  Jealousy hits when the lights go down.  It attacks in an instant.  It manages to break free, even when you’re certain that you have it cornered.

 

How can they all be on #2?

 

When will it ever be my turn?

 

I’m quitting Facebook…and Twitter…and Pinterest…and…

 

It’s not long before the guilt sets in.

 

I really am happy for everyone else.

 

I want them to have happiness too.

 

I’m not a horrible person.

 

Followed by anger and self-loathing, of course.

 

I hate being bitter and jealous.

 

What is wrong with this godforsaken uterus?

 

I’ve gained a million lbs.

 

My face looks like that of a 13 year old.

 

My clothes will never fit again.

 

And I still don’t have a baby.

 

And then the tears finally escape.

 

It’s hopeless.

 

I’m helpless.

 

Nothing is working.

 

I just want one.  One sweet little baby.

 

When the whole world is pregnant, emotions run high.  Feelings shift by the minute and threaten to overwhelm your day.

 

When the whole world is pregnant…you have to take care of you.

 

Check out.

 

Watch that episode of Friends for the 37th time in two months.

 

Eat those dark chocolate M&M’s.

 

And drink that Cabernet.

 

When the whole world is pregnant…

 

You just have to survive.

 

 

 

Share Your Story: Pregnancy Envy

A couple of weeks ago, Lane shared her infertility story with us.  Today she shares what it feels like to long for number two while surrounded by pregnant moms every which way she turns.  Let’s all show Lane some much needed support today…

Pregnancy Envy

By Lane Gulotta

I had lots of meetings today. Four out of those five meetings were with Moms. Collaborating with Moms is one of my favorite things to do, except when they are pregnant. Meeting with Moms who are pregnant is distracting. I sit and stare at their expanding waistline trying to size it up and wonder if they are in their second or third trimester. I wonder if they are having a boy or girl. Single, twin or high order multiple pregnancy? Does her stomach look like a watermelon or a basketball? Throughout these distractions I smile approvingly and give appropriate congratulations.

After all, I am a Mom.

I am a Mom who has a beautiful and precocious 11 month old son. But, I am a Mom who wants more than that. I desperately want more children and that takes me back to something I never thought I would feel again: pregnancy envy.

It has finally struck again! Now that I know what I am missing, pregnancy envy is twice as strong this time around while we are trying to conceive (TTC for those of you who are new to this whole infertility thing). This envy is consuming me and causing me to lose sight of the fact that I already have a son. I should consider myself lucky, but I don’t. I am greedy and I want more children running around my house. I miss the newborn cry and reminisce for the time when I saw a first smile, heard a belly laugh or saw those adorable dimples.

Pregnancy envy makes me want all of this again. It makes me miss my swollen ankles and not being able to sleep on my stomach. It makes me miss wearing full panel maternity pants. (I finally admitted it! I am still convinced that none of my friends read our blog so this will be a true test of that.) I would give anything to look at the clock at 7:30 pm preparing for “morning sickness” to strike or wake up most of the night because my little one has the hiccups. Pregnancy envy makes me want every single symptom that I loathed while pregnant, even the unspeakable ones!

I am taking this month off of fertility treatments. After a very rough course of side effects and a near mental break down last month, I need a break to regain my composure, gather my emotions and come up with a battle plan.  I need to tuck the crazy lady away and come up with a practical plan to defeat her. Let’s be real; I need a break from Clomid and lots of Cabernet. This is no longer a game. We’ve upped the ante and are going to battle to win.

Come next month I will win. I will not waive a white flag!

Thank you once again, Lane.  You are not alone in this, and sharing your experience will help so many others.  Raising my glass of Cabernet!

Share Your Story: Club MomMe

Allow me to introduce you to Lane, one of the lovely moms behind Club MomMe.  Lane cofounded Club MomMe with her friend and fellow Junior League volunteer, Rachel, during her first pregnancy (they were both pregnant at the same time).  Club MomMe is a supportive an educational site that aims to help ease the transition from me to MomMe…

But it hasn’t always been easy for Lane…Lane is here to share her infertility story.  Please leave her some support here.  Lane is a great support for moms in the blogging world, and also a friend.  

Mother’s Day Reflections

(This post was originally published on Club MomMe on May 16, 2012)

Byline:  Lane Gulotta

Mother’s Day is a celebration. A joyous occasion of bringing life into this world and coming together with family to give thanks to a woman (or women) in our life who have molded us into the person we are today. This is how we celebrated Mother’s Day. As we walked around Chicago together as a family of three I looked the part of the doting parent. What on earth could be wrong on Mother’s Day? What couldn’t be? Thanks to Hallmark, all Moms are supposed to be happy and give thanks on Mother’s Day.

What others couldn’t see this past Sunday was that I was mourning. I mourned the loss of a child just one week before this holiday, the slim prospect of having another and, yet another uphill battle with infertility to conceive again. And, an uphill battle it has been. Although we are only on our third round of treatments for baby number two (the first was eleven rounds) it has been significantly harder emotionally and physically during this second course of treatments. I feel guilty taking time away from a son we worked so hard to conceive to try to have another. Is this fair to him? Is this fair to me? What about my husband? He is an integral part of this and what are these treatments doing to our relationship?

You see, the decision to try to have another child and our failed attempts at it hasaffected us all in different ways. But most importantly it has shown me that mourning the loss of a child and the yearning for a sibling for our son are all natural emotions that women feel. These emotions make us stronger, bolder, more confident and more loving. They make us compassionate and understanding. They make us grandmothers, mothers, wives and sisters. They make us. They make me.

I have not figured out how to manage and balance the grief and yearning that I feel. But, I have come to understand that life is simple. We live and we die. In the process we all become mothers along the way. Some may be later than others and not through the most conventional ways. Do not give up hope. Until that time, celebrate the women in your life. Teach your nieces and daughters compassion and how to love. A special woman in my life did and I am ever thankful for her grace and patience. Without her I could not have celebrated Mother’s Day.

Thank you Lane:  For your beautiful words and positive spirit despite such a big loss.

Share Your Story: Elizabeth

Today on “Share Your Story”, Elizabeth reveals the pain of fighting secondary infertility.  Again.  Infertility, in all of its forms, is devastating.  While I know the pain of aching for the first, I also know the difficulty of struggling for another.  Please show Elizabeth some support as she shares her story today…

My oldest son turns 5 in just a few days….so hard to believe.
When we decided we were ready to start a family, we both thought it would only take a few months.  Nope, got pregnant with my first baby boy on the 1st try….we were shocked!
I was almost 28 at the time.
I wasn’t quite ready to give my body up again that quickly, so we didn’t start trying again until he was 19 months or so.  It happened so fast the first time, so my husband had some good swimmers, right?  Not so much.  That year was so hard – not only was I dealing with back issues and pain but I also had to take a couple months off from “trying” to have surgery and recover.  I felt like I was throwing those months away.
About 9 months after we started trying for baby #2 with no success, a friend told me about her chiropractor friend who was just starting up her own business.  She specialized in allergy clearings and women’s fertility, helping women conceive through acupuncture.  I thought why not?  I read a little about success rates with conceiving while doing acupuncture.  It was expensive so I decided to go against the recommended weekly visit and go every other week.  Well, after 3 more months of getting acupuncture every other week and I still wasn’t pregnant, and we had reached the 1 year mark, I decided to start going weekly.
Low and behold, the month I started going weekly, I got pregnant and 9 months later, delivered my 2nd baby boy in September, 2010.  I am convinced that weekly acupuncture  treatment is what helped me get pregnant.
Now, it’s been 9 months of trying for baby #3, and still nothing….again.  We started trying 1st chance we could post baby #2, when he was 10 months, because we knew how long it took for him.  My husband and I would like to try for a girl, but i’ve also always wanted 3 kids.  I don’t have an appointment with my OB for another month but at that visit I will be asking her what she thinks.  It’s very frustrating when I do temperature charting, and use a fertility monitor.
What could be so hard when the monitor tells you every month which day to, well, you know!  ;)   Is it my diet?  Not enough exercise?  Has using my laptop on my lap every night done damage to my eggs?  You can’t help but question everything.  I’m always just asking WHY?  And many months I feel alone because I feel like my husband’s opinion is a 3rd would just be a nice to have, so he doesn’t seem as upset each month when it doesn’t happen.
In the meantime, I just keep praying God will answer my prayers!
Thank you, Elizabeth.  I know there are many others out there struggling with secondary infertility.  Hopefully this story will help them feel a little less alone.

Share Your Story: Jessica

Byline: Jessica Blanco-Busam

Jessica wrote this story on April 23, 2012.  The next morning, she had two embryos transferred.  One didn’t make it through the thawing, and she is waiting for results on the second.  Please send Jessica good thoughts while she waits for news.

This is my first time sharing my story in a public forum. It’s funny, because tomorrow will be my final attempt at getting pregnant for the second time.

After many years of painful periods and hearing from my doctor that I had a low pain threshold, I convinced her to do an exploratory laparoscopy. She tried to assure me that everything would be okay. Unfortunately, I knew better. It turned out I had stage IV endometriosis: scarring all the way up to my diaphragm and down to my intestines, bladder, rectum, you name it. I was 26 years old and luckily, happily married. My husband and I knew our plan to wait until 30 wouldn’t do anymore. We had to try immediately and we were told IVF was the way to go.

I switched doctors, got on lupron to improve my chances, had another surgery where my appendix and one fallopian tube were removed, and then went through my first cycle. I almost quit right in the middle of the transfer because the doctor could not get the catheter into my uterus and was causing me such indescribable pain (talk about messed up anatomy and too much scarring).

It failed, but I was blessed enough to get pregnant on my second try. Complications lead to a c-section during which my doctor said the endometriosis was even more extensive than before. How that happened after being period-free for 10 months is beyond me. I guess I’m just lucky that way.

In 2011 we knew it was time to try again. Our son deserved to have a brother or sister. My doctor said I would need a laparotomy instead of a laparoscopy to give me a fighting chance at getting pregnant again. That February, I had the surgery. He had to get an oncologist in on the surgery because the damage was more severe than he could handle. He did the best he could but said a hysterectomy was my best shot at ever helping the endometriosis. Basically, good luck getting pregnant again.

We failed 3 times: we had an FET, then an IVF cycle, then another IVF cycle. Each time my body did worse and worse with the meds: OHSS, painful and difficult transfers, you name it. I looked like and felt like the walking dead.

I was a miserable human being, truly a shadow of my former self. It was beginning to wear on me – and on my marriage.

My husband and I had the talk. We decided this FET would be our last attempt. My son needs me, my husband needs me, my students need me. My life will not revolve around failed attempts to get pregnant and 14 day periods during which I’m on codeine for the first 3 days just to be able to walk and hopefully make it to work. I pray that tomorrow 1 or more of my 3 embryos will thaw and that I will get pregnant. Of course it’s a stretch – a huge one given my history with this horrible disease.

As sad as it is, I know it probably won’t result in a pregnancy. But the finality of it all, the fact that a hysterectomy is in my future at the age of 30, gives me hope. I can move on. I can get that “quality of life” I’ve longed for, for so many years. And I have my miracle baby and he is amazing. That’s my story. I’m not sure if it’ll help anyone at all, but maybe it will.

Jessica- you are incredibly brave to share this story with others.  Please leave Jessica good thoughts in the comment form.  You do not need to be a blogger to leave a comment, you just need a name and an email address.  And be sure to join us over in the Forum, where we are already sharing stories and providing support.  

When One Isn’t Enough

Secondary infertility can be a lonely road to travel.  Don’t get me wrong; I know first hand that primary infertility is lonely as well.  But the second time around was lonely in a much different way.

I was ambushed with emotions that were difficult to share without hearing, “count your blessings” or “you’re lucky you have one” in response.  I knew that to be true.  I was one of the lucky ones.  I battled infertility and survived.

But I desperately wanted a sibling for my little girl. I wanted another small voice in the house.  I wanted another baby to hold.  I was lucky once again.  I did get my second chance.  But the third time?  Not so lucky.  Again, count those blessings.

3 million Americans are currently battling secondary infertility.  3 million.  That’s a lot of couples walking this road, but not necessarily together.  That’s a lot of, “count your blessings” and “you’re lucky to have one”.  That’s a lot of loneliness.

Women struggling with secondary infertility experience a range of emotions and feelings, including (but not limited to):  Disappointment, shock (it wasn’t so hard the first time), guilt (I already have one; I don’t want this to affect my existing child), isolation (I can’t talk to people about it without be minimized), depression, anxiety, and anger.

It can be hard to cope with these emotions when one or more children need your love and attention at all times (it often feels this way).  It can be hard to keep a marriage strong when young children zap most of your energy and infertility treatments and/or stress zap the rest.  It can be hard to feel heard and understood when people are quick to respond with clichés and point out what you have.  It can be hard to find support when you know that others are still battling primary infertility, and you already have one or more.  It can just be hard.

There are steps you can take to help reduce the stress and isolation associated with secondary infertility:

1.    Label it:  The best way to understand what you’re going through is to call it what it is. Acknowledge that you are experiencing secondary infertility.  Label the feelings that you are experiencing.  This is not to say that you should tell everyone you know (unless you want to).  Labeling it makes it real. Labeling it makes it a diagnosis versus a secret.  Labeling it might help you begin to confront it head on.

2.    Grieve:  Sometimes secondary infertility comes in the form of multiple miscarriages, other times it means months and months of trying with no results.  Either way, it’s sad and overwhelming at best.  Give yourself permission to grieve the losses and/or the loss of the family that you are trying to create.  Grieving the current circumstances does not mean that you are giving up on adding to your family, it simply means that you are allowing yourself to experience the feelings associated with the infertility.  Often times, couples experiencing secondary infertility try to avoid the stress by focusing on what they have.  While this might help them to get through the day and enjoy the small moments, it doesn’t take away the stress, anxiety, and depression that often result from infertility.  Give yourself permission to confront and cope with those feelings.

3.    Focus on your marriage:  Infertility affects the whole family; it is not an individual battle.  Often parents go to great lengths to protect their existing children, sometimes at the expense of their own relationship.  Plan date nights and time to reconnect with your partner.  Talk about your struggle and how it’s affecting your marriage, but be sure to make room for discussions that do not revolve around family expansion and monthly cycles.  It can be hard to step away from infertility once you’re in it, but it’s very necessary to keep your relationship thriving.  Try to tap into the reasons that you fell in love in the first place.  Get away if you can, or plan a staycation if you can’t.  The best thing I ever did the first time around was to take a leave of absence from my job and go on tour with my husband.  We found each other again during those six weeks and were stronger for it.  Make room for couple time.

4.    Routine:  Children pick up on stress quickly and will respond with behavioral changes, sleep issues, potty training issues, and eating issues.  The best way to help your child during this time is to develop and stick to a structured routine.  Take the guesswork out of each day to reduce the stress for your child.  Plan special outings and make an effort to focus on your child during playtime.  Sometimes a daily tea party is all it takes to help your child know that everything is ok.  Find those small moments and take a break from the infertility thoughts to just be in the moment.

5.    Exercise:  Less stress improves fertility.  That’s a fact.  Daily exercise can help reduce stress and anxiety and improve symptoms of depression.  That’s another fact.  Find a way to work in at least twenty minutes of daily exercise to help reduce your stress.  If you’re trying to get pregnant you are not worrying about weight loss, but you should be thinking about stress reduction and good health.  Choose an activity that you enjoy.  If it’s a chore, it won’t seem worth it and you might avoid it.  Find a friend, join a class, or start a group…just get some exercise.

6.    Increase your support network:  Although secondary infertility is mentioned on occasion, primary infertility takes up most of the media coverage on the subject (not that there’s that much to begin with).  This can make it hard to discuss the subject with others.  Reach out to close friends and family members.  Consider joining a group (many hospitals and religious organizations now have groups for women battling infertility).  Consider individual or couples counseling.  The fact is that secondary infertility is extremely stressful, and it’s very difficult to go through it alone.  There are many therapists trained to work with couples and individuals living with infertility.  Ask your OB/Infertility Specialist or check with your local hospital for a referral.  Talking about it helps.

7.    Be honest:  Infertility remains a secret society, which makes it hard to get the support that you need.  Break the silence.  Tell family and friends what you need.  People don’t always know what to say, but they can learn.  Describe your feelings, the treatments you are undergoing, and specifics about how people can help.  If you can’t make it to yet another birthday party because it’s too overwhelming…say that.  If you need a night out with a friend, ask for it.  Your support system can only be as supportive as you allow it to be.  Ask for help and be specific.

8.    Find an outlet:  Everybody needs an escape once in a while, and the TV will only get you so far.  Write, read, take a cooking class, take up photography…you get the point.  Find another outlet that allows for some “me time” and helps you focus your attention elsewhere for a while.  I read a lot the first time around, I baked a lot the second, and now I can’t stop writing.  If you do choose a TV break each day, I truly recommend the Ellen Show.  Ellen DeGeneres helped me through many long, lonely nights before Riley finally arrived, and for that I am eternally grateful.

How has infertility touched your life?     

Note: This post originally appeared on my other site, Practical Parenting, on November 4, 2011.