Don't Count Your Eggs

It Takes A Village to Make a Baby

So this Lil' Ole Blog was nominated for RESOLVE'S Hope Award for best blog! It was nominated last year but didn't win. Now we've got One More Shot (pun intended, that's the name of the documentary Noah and I have been working on)! So if you have a moment, please click here to vote. 

Now that that's out of the way...

I wrote a more formal piece I thought I'd share. If you're new to this blog, welcome, this sums up our "journey to parenthood" in a (kind of long) nutshell. If you've been following for a while, thank you, and perhaps reading this written out can give a little hope/perspective/reminder that miracles do happen.

Here goes... 

When my husband, Noah, and I set out to make a family in 2010, just after I turned 30, we assumed it would be a straightforward process involving just the two of us, and maybe a decent bottle of wine. We’d been together for ten years at that point, married for two, and fairly settled in our careers, the next natural next step was a baby. 

So we started “trying.” It was fun at first, until “trying” turned into “failing,” which quickly turned into “obsessing.” I bought books and ovulation test strips, and a basal body thermometer. I made Noah keep all electronics far away from his private parts and forbade hot tubs and tight boxer briefs. I meditated, checked my cervical mucous, and stood on my head after we did the deed. And each month when it proved ineffective, I cried. 

We spent a about a year doing this dance. When I talked to my OBGYN about our difficulties, he assured me I was young and needed to “just relax,” the worst two words a baby-crazed woman who can’t get pregnant wants to hear. He told me I was normal based on nothing but my history of good health. So we spent another six months or so “trying” and “failing” and then my OBGYN prescribed Clomid, the fertility gateway drug used to super-boost ovulation and increase the chance of conception.

Clomid did nothing but turn me into a raging lunatic for a month, and it was then that we decided we needed more help. After a year of trying unsuccessfully, we were officially deemed infertile by definition. So we went to see an infertility doctor, a reproductive endocrinologist, at a fancy office in Beverly Hills.

Dr. N knew how to deal with women like me--frustrated, confused, anxious, slightly crazed. Noah sat in the consultation completely silent as I showed Dr. N my monthly ovulation charts and some basic hormone tests I had done, as well as Noah’s semen analysis. All our preliminary test results looked fine, but there were a lot more tests to do. None of them were covered by insurance, and none of them were cheap. Though Dr. N was hopeful for us, I was considerably young in the infertility world and we seemingly had healthy sperm and a functional uterus. The next few months became a time of figuring out what we had and what we needed to make a baby.

I had a hysterosalpingogram (HSG) done, in which ink was inserted into my uterus and Fallopian tubes to see if the tubes were open. That test revealed some concerns about my tubes which were later confirmed in a laparoscopic surgery, which were later disproved by another HSG that showed two open functioning Fallopian tubes. One problem with these types of imaging tests is that they aren’t always consistent, since the body changes. We will never really know if there was an issue with my tubes, but we found that wasn’t the main problem anyway. After some blood tests and ultrasound evaluations, I was diagnosed with Diminished Ovarian Reserve (DOR). That meant my egg reserve was low and my ovarian functioning was compromised. 

DOR is one of the more challenging infertility diagnosis, as the success of conception through infertility treatments depends on having that one good egg. While part of me was relieved to have solved the mystery of our conception challenge, another part of me knew this was not good. DOR is not a very common diagnosis for women in their early 30’s, but it is seen more often. According to the American Society for Reproductive Medicine, “about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.”

Our best chance seemed to be in-vitro fertilization (IVF), in which my ovaries would be medically stimulated to produce as many follicles containing eggs as possible, which would then be extracted and combined with Noah’s sperm and implanted back into my uterus. The process would take about 2-3 weeks and would cost about $10,000, plus medication, which would be about another $5,000. Once the decision to do IVF was made, I started preparing my body. I changed my diet and saw an acupuncturist for weekly treatments, including herbs, with the hope of increasing my low follicle count. After a handful of frustrating setbacks and several months  of acupuncture, my follicle count increased by 1/3 and we were ready to begin medication. For ten days Noah injected a cocktail of hormones into me several times a day. It was a nightmare. We essentially had to board up the windows and lock the doors to wait for the emotional tornado to pass. The day of our aspiration, the procedure where the eggs are removed from my body, Dr. N retrieved five good quality eggs, three of which fertilized beautifully the next day. The day we got the call that three had fertilized was one of the high moments of our fertility journey. Noah and I felt our babies were coming, and we debated how many embryos to put back in.  The implantation of multiple embryos is what often accounts for the increased number of multiple births with IVF. We decided we would put in two, be fine with twins, and have one left over to freeze for a frozen embryo transfer (FET) at a later date. 

But with the highs also come the crashing lows. The following day the doctor called to let us know that the three fertilized eggs were not dividing properly, meaning they were not becoming embryos. He proceeded to monitor them for the rest of the week, giving us daily updates on the slightly shifting status, but the prognosis didn’t look good. Finally, after about a week in limbo, we were told there was nothing to transfer back into my uterus. All that effort washed down the drain.

I knew this was a possibility, but I didn’t believe it. How could we spend upwards of $15,000, inject so much medication into my body, and go through the emotional roller coaster of hope and despair, only to have nothing to put back in? I didn’t even have the chance to be pregnant. The doctor told us our chances were slim because of my ovarian issues. He told me I might not respond well to the medication, and that there was a chance of having nothing to transfer back in. He also told us all we needed was one good egg. He was right on all accounts. 

For people who are ambivalent about having kids, this whole process may seem insane. Actually, much of it is insane, but for a gal like me who has always dreamed of being a mother, who taught preschool and first grade and then became a psychotherapist primarily working with kids, not having a family was just not an option for me. Adoption was a possibility, but I really wanted to experience pregnancy and birth, and  Noah preferred trying for a genetic child, so we planned to first do what we could to get pregnant, and then we would reassess. 

When we first entered the elite world of assisted reproduction, we knew nothing about it and knew no one who had experienced infertility. But the more open we were with our own difficulties, the more people we met who also struggled. People were writing into my blog from all over the world, sharing stories of how certain family building options, like surrogacy or egg donation, are illegal, and how different laws in different countries prohibit single women from accessing treatment. There are 7.3 million people in the U.S. who are struggling with infertility, and millions more around the world, yet how was it something we never heard much about? We learned that although infertility is a medical condition, there is a lot of shame associated with it, and it’s often a diagnosis not covered by insurance. 

The months following our first unsuccessful IVF cycle were brutal. We’d come up empty handed and didn’t know what to do next. We met with Dr. N for a follow-up meeting and he said something like, “If you had won the lottery and IVF wasn’t as emotionally and physically exhausting as it was, I would recommend doing another round.” IVF is often most successful after several tries. But knowing our financial situation and the outcome odds of using my eggs, he recommended donor eggs. 

I wasn’t yet ready to have the donor egg talk. A proven anonymous egg donor can cost upwards of $30,000.  It also meant carrying a child that was not genetically related to me. We still weren’t sure if I could even get pregnant, and I wondered if there was actually a problem with the ability of my uterus to carry. It would be an expensive and time consuming endeavor to go through a cycle with an egg donor only to find out I couldn’t carry a baby to term. 

Noah and I began investigating adoption. We had heard the comment, “Why don’t you just adopt?” from many people during our pursuit of parenthood, as if there were a baby store where one could go and pick out a baby of their choosing. Adoption is a great choice for many, but it is also time consuming (it takes an average of 15 months), expensive (for us, at a non-profit adoption agency it would cost around $30,000), and contains its own risks. We were open to it, but it was not our first choice. We had started doing monthly medicated intrauterine inseminations (IUI), a cheaper yet less effective fertility treatment, when my younger sister offered to donate her eggs. 

Though Dr. N warned us of the risks of using a donor who was genetically related to me and had never had children, all of my sister’s preliminary test results came out good. She had eggs and her hormone levels were good. Noah would have a chance at a child genetically related to him and I would have a chance to carry our baby, which would also be closely related to me. And it would be about $10,000 less than an anonymous donor. This seemed like the best choice for us, and so I started applying for grants that might help fund this endeavor and we began to plan for a time my sister could move back home for two weeks so her eggs could be harvested.

We ended up getting a grant from the Baby Quest Foundation that covered about half of the medical procedure and helped with the cost of medication. My parents offered to help us financially, my sister, of course, was helping us physically, and I continued to see Gilli, my acupuncturist, who now not only treated me, but also my sister, in preparation for our donor egg cycle.  Suddenly our baby-making efforts became a family and extended-family affair. 

I’ll spare the details of the egg donor cycle; I will say it didn’t work. While we did get to our first transfer day, none of the three embryos we implanted took. Neither did the single frozen embryo transfer we did the following month. 

Noah and I were both shocked and devastated. We were emotionally, physically and financially depleted. By this point, we had spent the better part of three years trying to make a family, and all we had to show for our efforts were credit card bills and a few extra pounds around my waist. 

Infertility impacts all areas of your life as you become addicted to the hope of one day being able to have a baby. Once you’ve started treatments, it’s hard to walk away—you’ve invested so much into the process, and are lured to stay the course by the carrot of success that dangles in front of you. According to the European Society of Human Reproduction and Embryology (ESHRE), an estimated five million babies have been born as a result of Assisted Reproductive Technology (ART) since 1978, when the first baby was born through IVF. Data collected by the International Committee for Monitoring Assisted Reproductive Technologies estimated that, “around 1.5 million ART cycles are now performed globally each year producing around 350,000 babies.”

After my sister’s egg donor cycle proved unfruitful for us, Noah and I went back to the drawing board. We tried naturally for six months while we began to readjust our goals. Our goal was no longer just getting pregnant; it was becoming parents and getting out of the exhausting lifestyle of a couple going through infertility. A recent online article from US News and World Report cited a Danish study that found infertile couples who fail at treatment were three times more likely to get divorced. Psychological impact surveys have shown women with infertility experience anxiety and depression similar to those diagnosed with cancer and other major illnesses. Noah and I knew living like this for much longer was not going to be good for anyone. So we weighed our various options, the cost of said options, and the time commitment of each, and landed upon our next baby making endeavor: embryo donation.

Embryo donation is essentially when the remaining frozen embryos from a couple’s IVF cycle are donated to another couple. Often couples have left over embryos they pay to keep in storage. There are approximately a half a million embryos cryopreserved in the U.S. Once a couple has successfully completed their family, they have choices as to what they want to do with their embryos. The least common choice, is to donate them for another couple’s use. Needless to say, finding a donated embryo is not the easiest process, but nothing in the world of infertility is. I set out to find an embryo match for us, and within a few months, I found a set of two embryos in another state. They had been created by an egg donor and the husband of the infertile couple who had donated the embryos, and they happened to be my ethnic mix. Something felt right.

In July 2014, we did a frozen embryo transfer and lo and behold it worked. We made it through a touch-and-go pregnancy and a slightly traumatic birth, and now have the most amazing 4 month-old we could ever imagine. She is 100% the baby that was meant to be ours. 

Sometimes life throws you a curveball, and you have no choice but to swing for the fences. We struck out many times before we finally hit a home run. We had to learn how to make the best decision with what we had in front of us. We had to learn how to be patient and persistent, hopeful yet realistic. We had to learn how to re-conceptualize the idea of what makes a family. And after many years, we finally made it to the other side. It just took a bit more than a decent bottle of wine and one magical night. And would I do it all over again to end up with the baby girl we have? Absolutely. 

What is Alternative Family Building?

Noah and I are getting ready to launch an Indiegogo crowd funding campaign (mark the date, March 1st, because we will need your help in spreading the word!) for our documentary about infertility, our journey to parenthood, and alternative family building. As we've been preparing to go live with the campaign, we've been talking a lot about what alternative family building really means.

Noah and I had to seek an alternative way to make a baby, because a glass of wine and a wild night (or even a mediocre night) wasn't going to cut it for us. Years of confusion followed a diagnosis of diminished ovarian reserve and we documented all of it and interviewed others who also had to use modern technologies or other people's body parts to create a family. None of us who have to go down this route do so happily. We do so because we have to. Noah and I didn't wake up one morning and decide to pursue embryo donation, we went through a step by step decline into complete despair before we found a resolution to our infertility crisis and climbed our way out of a pit. 

I looked up the word "alternative" and found a definition of "available as another possibility." And I liked that. We live in a time where there are other possibilities-- medically speaking. Emotionally speaking that's a different ride for people. In 2012, when Noah and I first started IVF, I don't know that embryo donation would have been a possibility for us. We were too scared, too attached to our genetics,  too weirded out by all of it, too heartbroken to allow our hearts to be open to a baby not genetically connected to us. The possibility and science of it existed, but not in our world yet. Much of the process of alternative family building is knowing what alternatives feel ok for each individual. 

And really, that's been our journey to parenthood. A process of learning to compromise, to be present, to look at the possibilities and be flexible with making a choice out of a handful of choices we may never have fathomed or wanted. To understand what science has to offer and get comfortable with the alternatives. To sit with the reality of our situation-- emotionally, physically and financially, and decide what is most important.

These are decisions and choices that the majority of people don't have to make. But a lot of people do. 7.3 million people in America and millions more around the world.  Five million babies have been born with the help of assisted reproductive technologies as of 2012. That's a lot of people seeking an alternative to a glass of wine and a wild (or mediocre ;)) night. 

Some day soon, a lot of these alternatives won't seem or be perceived as so far off. But in order for that to be so, we have to keep the conversation going and normalize that millions of people have to seek treatments and third part help in order to have the most basic, and in my opinion, most important human necessity-- love and family (I guess food and water is up there but you know what I'm saying).  

Noah and I and, in about a month (hopefully), Momo will be a normal family created in an alternative way. Though I don't know how much we will think about or focus on that piece. We will be a family created by love, determination, support from others, and a few drops of complete miracle. In some ways, it makes me feel proud-- prouder than if Noah and I did just get lucky one night.

Everyone out there in this struggle should feel proud. However you are looking at your alternatives-- from single motherhood to IVF to third party assistance to living child-free-- you should feel proud of your journey and your process. 

Please check out the film website and subscribe if you want updates. Follow us on twitter @onemoreshotdoc. Like us on Facebook.

And on March 1st tell your family, tell your friends, and hopefully through the month of March we can reach our Indiegogo fundraising goal so we can create this feature length film.

What Causes Diminished Ovarian Reserve?

Last night (I have no idea why this popped up for me last night while watching the most recent episode of Master Chef Jr.), I realized that out of all my Google searching for answers/solutions to my infertility, I never actually Googled what causes diminished ovarian reserve? Could that be? Could I really have Googled everything under the sun about my condition except the why? 

I remember getting the news from my RE that my AMH level was a disaster (.03) and that my antral follicle count was low (5-6), and I remember asking why and getting a look from him that was like, "Girl, why doesn't matter, you're up Shits Creek without a paddle!" Ok. Clearly my RE didn't say that. He seemed kind of shocked himself at the time that at 32 my numbers came back so low. But if my memory serves me right he didn't know why and just wanted to focus on what we could do. Unfortunately there isn't a ton a person can do to get back lost eggs. I did acupuncture and herbs for months and I actually did see some improvement in my follicle count, but I didn't get the results we wanted during our first IVF cycle. We didn't get any result, we had no embryos to transfer back in.

The why is often unexplained. Even if you have a diagnosis. A diagnosis of unexplained infertility is especially hard because there is really no why! No one knows. It just is. Some people have eggs and sperm and a seemingly functioning uterus and yet their doctors look at them and shrug. 

As humans we want to know why. We just do. Maybe I was too freaked out when I first got my diagnosis to really think about the why, because suddenly the clock was ticking and I had a lot of other things to figure out. Like the how-- how were we going to get/afford/figure out how to build our family. I also knew that the why could never really be answered and wasn't going to help the situation we were in.

So I Googled it today. What causes diminished ovarian reserve, and the best answer I found was on the site of a reproductive center in Tennessee that read: "Women with diminished ovarian reserve were either born with fewer eggs than average, lost them more quickly than average, or over time the eggs accumulated more damage than average." 

BUT WHY!!!?????

Finding out the why isn't going to help me, but it could help other younger women if we knew what was at the root of this. But perhaps there really is no real reason, no real cause. Genetics, environmental stressors, life style-- who knows what exactly plays a factor. All of us develop and age at different rates. Our hair goes gray and our skin wrinkles in a way that's specific to our own bodies. Perhaps the same is true for our ovaries. 

It doesn't matter anymore, I've bypassed my ovaries. But it is something I think about from time to time. But not in a why me kind of way. It's not in a why is life so unfair kind of way. And it's not in a what did I do to cause this way either--that's super unhelpful. It's a curiosity that I wish there was more research going on about-- prevention of infertility. Early education. Early testing and detection. That's what we really need. 

Is there a secret to a BFP?

I've gotten a few emails from people lately asking what I did differently to make this last transfer work. I think it's very sweet that anyone thinks I did something magical to make this work, as if I had any control over the situation. But I understand the question. I've asked it to dozens of people who've had success and have gotten so many different answers I could hardly keep track. Eat a pineapple for five days after transfer, only drink warm beverages, keep your feet warm, don't push when you have to poop, don't shower for the first two days, do acupuncture, take a zillion herbs and supplements, do hypnosis, do bed rest, don't do bed rest... It's crazy making!  I did a lot of these things each time. I always ate a pineapple and kept warm. After my first transfer I did super strict bed rest and slept on the couch as my doc didn't want me to go up stairs. My second transfer I went upstairs and slept in my bed. Neither worked. If there was a secret to getting a positive beta, I swear I wouldn't hold out. 

There are three things I did every time that I think can only be helpful:

1) I did meditations and let go of whatever happened before and believed that this was it. I named my embryos and imagined them blossoming in my belly. I sent them love and opened my heart to them. This did not bring success any time but the last time, but I did it anyway, because it helped me imagine the possibility of a positive outcome. 

2) I ate the pineapple core. Why not, it was yummy. And I kept warm. The pineapple and warm socks seemed harmless enough to do each time, but I swear, if someone told me that a face mask of porcupine quills and a skunk poop sandwich would get me that BFP I would have done it.

3) I took it real easy for the 2ww. Permission to lay around, thank you very much.

I did these things because I thought they would help our outcome, but they didn't always. The answer to the question of what worked for us this last FET, I think, was that I let go of our genetics. That's the honest truth to why I think Momo worked.

I've written about how we knew to move to donor eggs and about the emotional and relational challenges of moving to embryo adoption, and while none of these are easy decisions, I think letting go of our genetics, specifically my eggs, and focusing on our priority, being parents, is what worked this time. 

Moving to third party reproduction is a very personal choice. Because I have a specific diagnosis of Diminished Ovarian Reserves and I know my ovarian functioning is compromised, it was perhaps a little easier for me to move away from my eggs. It was  harder for Noah, because his sperm is good. But in the end, we couldn't afford an egg donor, and we wanted to get off the Island ASAP, and we found Momo. When I found Momo, I kind of had a feeling.  Momo's batch of embryos was "proven" in a way. The anonymous egg donor that created Momo has three kids of her own and helped multiple people have babies, including Momo's full biological sibling. Good eggs are much more likely to equal a BFP. That's a fact. So when I think of why this worked this time, I feel like that is our answer. But I also believe that maybe Momo is just meant to be our baby. I hope so.

I know people who did multiple transfers of good quality embryos that didn't work and when they were down to their last wonky two, they end up with twins. I know people who swear by acupuncture and herbs, and I to believe that can only help. I know folks who did 10 days of bed rest and others who went back to work that same day. Both ended up with positives. So I guess the moral is there really is no prescription. Each person has to do what they feel is best for them to know in their hearts they did every thing they could. I did everything I could each and every time, and finally something worked. 

Sending lots of love this Friday! Much luck to anyone about to have a transfer. Do whatever it is you need to do to feel like you gave it your best shot, but know there is a lot of pure luck involved too. Wishing you all so much luck!

DO count your eggs!

I just finished reading a book that recently came out called It Starts With The Egg by Rebecca Fett. It's all about egg quality and the various things, from environmental toxins to vitamins/supplements to diet, that can impact egg quality. The book draws from 500 scientific studies and gives the reader an understanding of the science of a developing egg, as well as an analysis of what the current research shows. The author has a background in molecular biology and biochemistry, and when she was diagnosed with diminished ovarian reserve (DOR), she set out to research what she could do to increase her chances of success.  The end result was that after making changes to her diet and lifestyle and adding specific supplements, she went from having just a few follicles in her ovaries to having about 20. On the day of her retrieval, the doctor harvested 22 eggs, out of which 19 became good-quality blastocysts. This hardly sounds like the outcome of someone with DOR.

Reading this book both freaked me out and made me feel more informed. I was freaked out by how many toxins we are all exposed to, and how unregulated a lot of it seems. Yes. Keep away from BPA and plastic tupperware, but scented lotions and nail polish and receipts? AHHH! Though we can't avoid all things toxic, becoming more aware can help us make the better choices. We are all looking for more ways to feel like we have some control over our situation, right? Perhaps making specific changes and taking certain supplements (CoQ10 anyone?) can help. It certainly can't hurt.

Though I don't believe there is a prescription for getting pregnant or having a successful IVF cycle, I do believe being healthy and cautious about what we put in, on, and around our bodies is important. I also believe that different bodies require different levels of intensity when it comes to this stuff. I do my best to stay away from empty carbs, processed foods, caffeine and alcohol, and I eat lots of veggies and take herbs and vitamins. I've done a lot of this stuff (much of what is outlined in this book) for over two years now and haven't seen much improvement in my ovarian reserve. But other people, like the author of the book, do have significant improvement! And there is evidence that supports it. This book gives a lot of great information and specific action steps for anyone interested in improving egg quality. 

Every body is different, and what works for one person may not work for another. Sixteen-year-olds get pregnant on a steady diet of hot cheetos and diet Coke! We can't make ourselves too nuts about everything, but we can do whatever is within our power to give ourselves the best chance. Then we can at least know we did everything we could. 

Dos and Don'ts of Donor Websites

Our new favorite pastime is trolling donor egg websites. Noah and I can spend hours going through profiles and thinking about what kind of baby he would make with these strangers. It's crazy to think about how we got to this point. I vividly remember being really upset that I would have to go on Clomid to up my egg ante so we could try to make a baby. That was over three years ago. Now, here we are, typing in our password to have access to endless pages of girls who could possibly contribute 50% of DNA to a child that would grow inside me. I would think I'd feel more...sad, but I don't. Through the  struggle of trying to build a family, I've had to let go and process the many losses, redefine my goal (to be a mom, not to have a biological child), and create a new normal over and over again. 

Laying in bed clicking on "Donor #663, Asian" is my new normal. Trying to decide if it would be strange to give birth to a child that is a completely different race than I am is our before bedtime discussion. Processing the possible loss of my ethnic heritage in a child that is not made from my egg is what I'm wrapping my head around. There are a lot of things to consider when moving on to egg or embryo donation, and in the end, I feel like there is only one thing that matters. That it works and we get a healthy child. We will love that kid so much. This much I know.  But part of the acceptance of making a family in this way is thinking about all the implications. It's thinking about what we will tell this child. It's being open to whoever and whatever this child may be. It's knowing they may be genetically predisposed to things that have nothing to do with Noah or me. And it's being fully okay with all of it.

Seeing my ovaries the other day during my sonohysterogram really sealed the deal for me. I had two follicles in one ovary and one large one, ready to be ovulated, in the other. Three total. I'm not yet 34. My ovarian reserve has diminished significantly since I was first "diagnosed" with Diminished Ovarian Reserve. The tank is running low and my ovarian functioning is compromised. I know this. I accept this. I don't give up on the hope that maybe there can be a diamond in there, but I know that considering a donated embryo and trolling donor egg websites is what we need to do to focus on making our baby and getting us off IF Island ASAP.

So as I make online egg shopping my new favorite hobby, I have to give myself a few...parameters so that I don't go nuts. I'm sharing them here with you.

1) Don't get angry at skanky looking donor photos. Noah and I have found that there is a fine line between donor egg  profile photos and dating profile photos. It usually goes..."here I am next to tree, here I am at prom, here I am with my dog, here I am in short shorts on a bicycle, here I am in a bikini, here is a semi-professional model shot with my hair blowing in the wind and my belly button exposed." I DON'T WANT TO SEE THE BELLY BUTTON OF MY POTENTIAL EGG DONOR! But alas, there it is, so don't get upset. When I first started looking at these sites I thought it was all kind of creepy, now I just laugh and try to look for the best looking gal who doesn't seem insane.

2) Don't be weirded out when only a baby picture is posted. It's weird. Noah feels totally gross trying to fathom what a baby would look like made from him and a picture of some baby. It's not very helpful but I understand the anonymity. 

3) Don't get caught up trying to find someone that looks like you. Often people get to the point with this where they just say, "brown hair, brown eyes? Fine. Done." It's overwhelming to look at so many profiles, there may just come a point where it doesn't even matter as long as there is no major family medical history.

4) Don't spend more than 30 minutes on the site. Your brain will feel like it's exploding.

5) Do find a way to have peace with the situation, whatever one you may be in.

6) Do feel grateful that whatever medical intervention, especially those including third party reproduction, is available to you. Unless it isn't, and in many countries it isn't, and that's B.S. in my opinion. Then you can be pissed. It's extra hard when certain procedures are technically available but financially unavailable. I understand that and it sucks. That may actually be our situation here with egg donation. Though you may need to make some compromises one way or another, where there is a will, there is a way.

7) Do find a friend, preferable on IF Island too, to share photos and feelings with. It helps to have someone to bounce thoughts off of and the laugh with.

8) Do remember you will find a way to complete your family. It may not be today, it may be with some slutty eggs, it may mean your kid may be a math whiz you completely don't relate to, but you will love that kid with all your heart and soul.

Happy egg hunting to anyone in a similar boat, and good luck to all those embarking on a different ART adventure that has taken much compromise and sacrifice. Hopefully the pay off is just around the corner.  

Good Egg Hunting

It's funny how differently I see people now, especially women. I no longer pay much attention to what a gal is doing or saying, her clothes or her shoes (I feel like shoes kind of say a lot about a person). I just focus on whether this person would make a good baby with my husband. Sounds totally perverse, right? 

At yoga class, I think, ohhhh, she seems healthy and has great skin, I wonder how old she is? At the market, hmmmmm, she's got a great smile and looks around 20, she'd make a great baby with Noah. It's crazy! I never thought I'd be standing in line waiting to pay for blueberries and checking out women who would make good babies with my husband! Never say never right?!

It's a strange thing when nothing seems strange anymore. I was thinking about all the different levels of letting go that has to happen before a person can laugh at their situation. There is NOTHING funny about infertility, but there are times when finding some humor can really help. And the ability to let go is absolutely imperative.

I've had to let go of conceiving naturally, of thinking my family would happen at a certain time in a certain way. I've had to let go of what that family may end up looking like, and I've had to let go of my own biology. I've been trying to let go of the past experiences, of the anger and sadness and losses. I've been working on letting go of the sound of my doctor's voice saying the word "unfortunately," and the sound of my own hysterical tears. I've had to let go of ideas of what could have been and what should have been. I have to still let go of feeling like no matter what happens now I'm somehow "behind" the developmental milestones of all my friends. I've had to let go of the money spent and the current limitations of our financial situation. I've had to let go of thinking I have any control over this. I've had to let go of the unfairness of living on IF Island for so long. 

When I'm able to let go and free myself of the past disappointments and the present expectations, I can really be open. I can be more open to the idea that we will have a baby, it may just look nothing like either one of us. I can be open to the additional people who may come into our lives as a result of a baby that doesn't start out with pieces of our DNA. I can be more open to the time it may take. I can be open to the idea that a family is a group of people who love each other, and a baby is a little miraculous person with tiny fingers and toes. 

I'm not saying I'm open all the time, nor am I claiming to have totally let go of all my...stuff. But the more I can try to open my heart and my mind to my story unfolding, the better I feel. I can then look at our options with an open mind so we can figure out the next game plan without panic or anger. 

Wishing all those with heavy hearts and minds some peace and love and openess this weekend. 

Secret Antral Follicle Count: Donor Eggs Phase 2

Yesterday Hana called me around noon. Her voice sounded excited, but she was whispering, as if she'd just gotten away with stealing candy or something. She was at the hospital, where she is on OB rounds as a third year resident. 

"Hey, so I was on my lunch break and found an ultrasound technician," she began, "I asked her to do a vaginal ultrasound to count my follicles."

"So...?" I responded.

Hana giggled. "I was on my lunch break and just dropped my pants so this woman could see what was up there."

"Yes. I know how these things go," I replied, realizing that to her, this was the equivalent of a banker borrowing some cash from the bank.

"She said there were a lot of follicles!"

The Antral Follicle Count is done through vaginal ultrasound and basically counts the number of follicles, which is where each egg is housed, at their resting stage early in the menstrual cycle. The higher the number, the better. More follicles means more eggs means higher IVF success rate because there is more to work with. This is my biggest problem. An average count for someone my age is between 16-30 follicles. I started with 6 and got up to 9 with acupuncture. 

"How many is a lot?" I asked.

"I don't know, we had to rush. Didn't have time to do a full count but she said it looked like there were many in each ovary. We should be fine," Hana said. Clearly feeling like she just got away with stealing candy, enjoying the few very specific perks of working in a hospital.

She was excited. I was relieved. I think since I've fallen head first into this nightmare, my sister has been worried that maybe there was some genetic issue that would affect her too. I think she's be afraid that maybe she wouldn't be able to help me, and I know she really wants to. 

Her blood tests should be coming in soon, and now we know that she has follicles. At least with her body, each piece of information we are getting so far seem to be moving us towards our goal rather than farther away from it. 

Join the Movement: HOW AM I MAKING A DIFFERENCE IN WAYS LARGE AND SMALL IN THE LIVES OF PEOPLE WITH INFERTILITY?

I decided to launch this blog during National Infertility week because I wanted to find a way to make a difference in the lives of people who struggle with infertility. For the past almost 3 years now, my husband, Noah, and I have been exiled into this world of infertility against our will, and we’ve had to figure out how to survive with nothing but a shopping bag full of hormone shots and a calendar of doctors appointments. 

Noah is a television producer. I am a Licensed Clinical Social Worker. With his film skills and my strong belief in advocacy, we started documenting our process in April 2012, a year after we started “trying.” We shot the first doctor’s appointment with a Reproductive Endocrinoloist in Los Angeles, and continued to shoot every appointment, hormone induced argument, and trip to the pharmacy right through to our failed IVF cycle. We have also been interviewing other couples, who I think of as “survivors,” who have had to be creative in building their families. Our intention is to one day share our journey to parenthood, because even though we don’t yet know how we are going to create our family, we know that we will one day be parents. I have also been writing about our experiences, but the only person thus far who has read anything I’ve written is my dad. And my dad is not currently struggling with infertility, so my words are of absolutely no help to him. They actual just upset him because he is a helpless parent watching his daughter struggle. But he is a writer who has always encouraged me to write. So now I am taking the next step and learning how to use the internet so that I can share my writing with others who feel alone and isolated on a little life raft in the terribly choppy waters of infertility. 

The archive and video posts will tell you where we’ve been. The current postings will tell you where we’re going. Our adventures in Infertility-land started in 2011.

2011 was the year we tried to start a family.

2012 was the year we failed to start a family. 

2013 is TBD.

We officially got the diagnosis of “explained infertility” when I got an HSG X-RAY that looked like this,

showing only one wonky fallopian tube. Then I had a laparoscopic surgery that looked like this,

which reveled two wonky fallopian tubes as the doc couldn’t pass ink through either tube. With seemingly no functioning fallopian tubes, we moved straight to IVF, where I learned that I also have Diminished Ovarian Reserve (DOR), and even though I ate this for breakfast and dinner for ten days straight,

my few follicles hardly responded. On retrieval day the RE got 3 good quality eggs, all of which fertilized, none of which divided properly. We closed shop in early December before transfer day $16,000 poorer. 

This year, so far we’ve attended several meetings about adoption. We’ve discussed donor eggs and I’ve been learning to let go of my own biology and embrace the possibility of having a child with less neurosis and nice legs. I’ve had another HSG because I’ve become a fan of having French Tipped balloons shoved up my privates, which surprisingly revealed TWO OPEN FALLOPIAN TUBES and with that, the possibility to try IUI (Intrauterine insemination), which is much less expensive and less invasive than IVF.  I went back on a steady diet of post-menopausal nuns pee injected straight to the belly, which led to one dominant follicle. Only one. But it only takes one—or so I hear. I did the dirty with a turkey baster full of my husband’s best swimmers and now we wait.

Wait. Wait. Wait. 

In the three years that we’ve been waiting for this to happen for us, I’ve successfully shared our challenges with everyone I know, thus encouraging friends, family and co-workers to check their eggs and start the baby making process as early as possible. The result has been the birth of 48 (and counting) babies to said friends, family and co-workers. Though I may not have helped infertile couples, I’ve become quite the fertility charm for others, helping everyone else hit that developmental milestone of parenthood while Noah and I watch from afar. As an LCSW, I’ve tried to start a support group, but I’m in a strange position because I’m both a peer and a professional. I know once I find an end to this journey and a beginning to our family my career will lead me to help others cope. Because I know firsthand that this is not an easy ride.

So in the mean time, as we wait, I can offer my words. I hope to bring some sense of connection and moments of laughter as well as helpful resources and coping tools. I hope to become a part of the online community of support and advocacy. Infertility shouldn’t be an island. With over 7 million people struggling to conceive there’s no reason to feel so alone. 

                        Thanks to RESOLVE.ORG for being such a great resource. Check out

• http://www.resolve.org/infertility101  (Basic understanding of the disease of infertility.)
• http://www.resolve.org/national-infertility-awareness-week/about.html (About NIAW)

www.resolve.org/niaw

IVF CYCLE 1: SHOTS AND PATCHES AND PILLS, OH MY

On a Saturday morning in November, the week before Thanksgiving, we got our chance. A shopping bag filled to the top with $3,737.50 of medication was delivered to Dr. N’s office, and Nurse Danielle laid everything out.  There were syringes and alcohol swabs and things that needed to be refrigerated and things that needed to be shoved up my privates and patches and oral medication and baby aspirin for after the transfer and valium for the day of. There was one little prescription bottle of antibiotics that Noah will have to take the day he gives his sperm sample; everything else was for me. Nurse Danielle carefully went over each step on our very extensive calendar.

            The first shot is Menopur. It comes in powdered form in little vials and we have to use the syringe to mix three vials with sodium chloride, change the gigantic needle to a smaller, friendlier one, and then Noah shoots the stuff into my stomach.  At our “injection lesson” I could tell he was nervous.  There were a lot of steps and he wasn’t sure if I’d have a reflex reaction of punching him in the face. Nurse Danielle instructed him to pinch my belly fat, which he did the way a mama tiger would carry her cubs by the neck, and then he stuck the needle in.  My eyes were closed the whole time so I’m not sure what happened.  It hurt and my tummy was sore after, but Noah was very proud of himself. We’ve both felt so helpless, but now he could do something to be helpful. 

            The next shot was the Follistim Pen.  This was kind of complicated too, but Noah loved it. It was like a little action figure doll from his childhood that had removable parts—like a transformer that went from robot-man to airplane. He removed some parts and attached the thin vial of liquid into the Pen, like he would an ink cartridge in a regular pen.  Then he put it back together and set the dial for the amount he wanted to dispense, and then he stuck it in my leg and pushed the medication in.  The injection itself didn’t hurt, but it stung for a few minutes after.  Part of me was waiting for the hormones to kick in, and to feel rage or extreme irritability as soon as the shot went in, but I didn’t feel anything. I kept asking if a beard was sprouting as I imagined one of the shots to my leg would result in a Chia Pet-like goatee within seconds. 

            We will go back to the doctor to have my follicles monitored and to introduce new medications. Looking at our schedule for the next 10 days is overwhelming, so we just have to take it one day at a time.

IVF BOOTCAMP (WITH GILLI, THE INCREDIBLE ACUPUNCTURIST)

Dr. N sent me to Gilli for 2-3 months before we were to attempt an IVF cycle.  I don’t know if it was because he could see I was completely freaked out that in the time span of two months we’d gone from “don’t worry, let’s just do some little tests” to “welcome to the world of IVF,” or if he had confidence that Gilli would whip me into mental, physical and emotional shape.

Gilli is an Israeli acupuncture doctor and herbalist who specializes in fertility and women’s health issues. I had seen several acupuncturists before her, but none of them remotely compared. Gilli is a thin, curly-haired mother of three (boys!) with a calming presence and a direct approach. She tells it like it is and doesn’t really see the point in complaining.

Noah and I arrived at her office bright and early on a Monday morning.  She gave me all kinds of forms to fill out, checked my tongue and my pulse and diagnosed me with a variety of imbalances including a kidney yang deficiency, a cold uterus, and some blood flow blockage. In Chinese medicine, the kidney system is connected to the reproductive system and it is affected by anxiety and stress. The remedy was to eat only warm foods (no salads, sushi or frozen yogurt), cut out sugar, caffeine, dairy, refined carbs and anything else delicious. And to drink Gilli’s special fertility tea three times a day, which tasted like there should be an earthworm at the bottom of each cup. And to take specific vitamins including coenzyme Q10, fish oil, vitamin C, and a prenatal. And to rub a burning incense stick that contained an herb called moxa over my lower tummy for twenty minutes a day. I was prescribed a meditation CD and instructions to chill out. 

Taking care of my imbalanced kidneys and cold uterus became a full time job, and eventually a total obsession.  I channeled all my energies into being well, which was perhaps better than Googling “common causes of cancelled IVF rounds.” But being obsessed still meant being unbalanced. Being resentful that I had to do all these things still meant I had not fully accepted that this is our path. Being doubtful still meant I didn’t believe this all was going to work. 

But how could I completely believe? Having six follicles essentially meant by the time they take them all out and see which ones are of decent size, maybe there are four to work with. Then your mix those four with sperm and maybe two or three take. Then you wait until they start splitting and are lucky to get one Junior Mint to put back in.  All that effort, the hormone shots, the thousands of dollars for being lucky to get one? Yeah. I had doubt, resentment, and fear. 

Gilli agreed that six follicles was not a good number.  

“We want to go ten-seven-three,” she said, while putting needles in my stomach and hooking the few over my ovaries to what looked like a small car battery to provide electro-stimulation.

“Ten-seven-three? OK.” That sounded better than six-three-one. 

Gilli seemed confident.  That’s why I was there. To stimulate my ovaries and get more follicles. So I would do my part and she would do hers. If she told me to eat rat poop I probably would have done it. At that point, I needed a team of believers and doers. 

The first week with Gilli went great! My mom and my aunt Mari came over to cook all kinds of Japanese veggies—kabotcha (pumpkin), seaweed, burdock roots and carrots—it was delish and I felt healthy. I ate whole organic cooked food only and only had a mild sugar/caffeine withdrawl headache. 

Week two was fine. I stopped craving sweets and ate lots of farmer’s market veggies. The tea was more bearable and I committed to reading a book called “Way of the Fertile Soul” without cynicism. I spent half my days cooking and taking yoga class and felt grateful that I had this time to focus on myself. I lost a few pounds and was sleeping better.

By week three I lost it. I was so bored with my diet, so angry that I had to do this, so fed up with the meditation CD.  PEOPLE ON CRACK GET PREGNANT! This seemed insane.  I was deprived and obsessive and so resentful that this is how I spent my days, cooking azuki beans and brussel sprouts. I wanted to contribute to the world in a more meaningful way. I wanted to feel like it was okay to go out to dinner with other people without being one of those, “is there cheese on that?” people.  I wanted a fucking cupcake! 

Luckily we were headed North to Seattle for the weekend for my brother-in-laws wedding where there were ample cupcakes, of which I had my fair share. It felt so freeing to splurge on scones and, dare I admit, a cup of coffee! The caffeinated kind! Four days of non-restricted eating was the most thrilling thing to happen to me for months. But when I got home, Gilli knew.

She read my pulse, hesitated, and looked me in the eye.

“What?” I asked. “Can you…tell something?”

She exhaled loudly and said, “Your pulse is faint. You haven’t been eating quality food.”

How did she know!! Are a half a dozen cupcakes standing in the way between me and my Petri-dish baby? I guess I have to get back on the wagon, just for a little while. 

DOUBLE EXPLAINED INFERTILITY (D.O.R?! WTF?!)

The third appointment with Dr. N included an vaginal ultrasound to count my follicles and series of smiley or frowny faces that Dr. N drew on a piece of paper.

My FSH level: 4.8 mIU/mL.  Smiley face.

My Inhibin B level, which helps determine egg quality: 79 pg/mL. Smiley face.

My Anti-Mullerian Hormone, which helps give an estimate of the remaining egg supply: .31 ng/mL.  Frowny face.

My Antral Follicle Count, the number of follicles seen during the ultrasound: 6. Frowny Face.

Having two Alaska Airline Visa cards, one American Express, one Virgin America Visa, and one Discover card: Smiley face.

So the big deal about my tubes being unexplainably blocked no longer seemed to be the issue.  The bigger problem was my egg reserve.  With such a low follicle count there is a high probability that I will respond poorly to the stimulation drugs and a higher rate of IVF cycle cancellation. Seriously?

Dr. N explained the process, but what I heard was out of 6 follicles we may retrieve 5. Out of those 5, 3 may be of decent size. Of those 2, 1 will actually be able to meet the sperm and divide properly. But then that one will deflate and turn into jiz foam that the doctor will dump on my head and a bell will ring and everyone in his office will yell, “You Lose!” But I am dramatic and pessimistic.

What Noah heard was that we still have a chance.

What Dr. N then recommended is that I take two-three months to try some alternative medicine solutions, like acupuncture, to get my body and mind right. Then we have to move quickly. My reserves are running out.

I figured I would give myself three days to be angry and doubtful.  Three days to inundate myself with Internet “research” that just reiterates how minimal my chances are, and then I have to refocus.  I have to see the glass half full.  I have to believe and imagine that this will work. I have to have faith and hope.  Maybe this is my life lesson.  Maybe finding optimism is really what this is all about. So I can create a home for a baby who may go on to do great things because of his/her positive attitude and determination.  I’m determined but defeated. 

And this is only day two. So I can question and obsess and be negative and hopeless and angry for another day and a half.  So here goes:

Why is this happening? Why is this so easy for some people? Why is my body broken? Am I going to start carrying a cat in a onesie around in a baby bjourn? The Internet says a normal total antral follicle count is between 15-30. And that a count less than 6 indicates a poor prognosis. FUCK FUCK FUCK!

There’s more where that came from but I need to move on. Operation optimism is in full effect. But how? My logical brain, my rational self can see my numbers and understand the science behind my actual odds. But the tiny drop of spirituality that lives deep inside my soul knows how badly I want a baby.  It knows that there is a psychological component to all of this.  There is power in hope and healing in positive energy.  This situation has given me no choice but to learn to cultivate some of this optimism that is buried deep within my cynical, charcoal heart. 

In order to actually do this, I need a plan. I have two plus months of IVF prep to increase my shitty egg situation through calming my body and tricking my mind into believing I’m an optimist.  No wait, that sounds like a pessimist in sheep’s clothing.  I have to create a two month mental and physical training program to help me battle any doubtful or negative thoughts and learn to become a more open and hopeful person.  That sounds better. I wish I could just buy optimism on the Internet. Maybe in a tincture. 

It’s not totally true that I am a negative person. I’m selling myself short. Being a psychotherapist, I HAVE to have hope.  Hope that my client’s can get better, that life is worth living. And I do. I just have a tendency to forecast the worst possible situation. 

So I need to start utilizing some of the cognitive-behavioral strategies I teach to my clients. The worst thing that happens is IVF doesn’t work. We will have lost time and money, and I’ll probably have a few bruises on my belly, and we’ll be back to square one in our attempt at figuring out how we’re going to build our family. 

The best case scenario is that I learn to relax. I learn to cultivate hope and acceptance of what is. I learn to love myself and my imperfect insides and I have faith that somehow the universe and my Doctor and my husband and my huevos  will band together to make me a baby.