The silver infertility Nutribullet

It’s National Infertility Awareness Week 2013.  I couldn’t sleep over the weekend and ended up flipping channels, finally landing on an infomercial for the Nutribullet.  I stopped because I was intrigued by the similarities between the Nutribullet and the Magic Bullet; both have identical designs and systems, and I already own a Magic Bullet.  I use it to make smoothies all the time.  What makes the Nutribullet’s smoothies all that much better than the Magic Bullet?

Fortunately, Nutribullet had the answer to my questions.  Through a high-powered motor, the Nutribullet shreds everything in it’s path down to the cellular level so that it’s easier for your gut to digest, thereby allowing you to absorb more nutrients and solving many of your health worries.  Apparently the Nutribullet is designed for nothing else but making green smoothies that include every vegetable and fruit in the produce aisle but still taste delicious and always look green.  Both dubious claims.  I get that we have teeth so we can chew to better digest our foods, so why not let a machine do the chewing for you and drink your vitamins?

A few minutes in to my viewing, the commercial listed all the ailments Nutriblasts (their name for their smoothies) cure: fibromyalgia, acid reflux, aging, cholesterol, high blood pressure, and oh yeah, infertility.  What?!  It popped up once during the time I watched the commercial, and none of their testimonials included someone who miraculously had a baby after drinking a Nutriblast.  And the whole experience angered me, to use a topic as personal as infertility as an emotional plea for you to buy a product but then never show me any evidence.  Not even a short testimonial.  And all of us who have struggled to have children know that it’s not as easy as drinking a mug full of green slush.  I wish.

At the heart of the Nutribullet’s purpose is getting people to eat/drink more vegetables.  I’m all for that.  A healthy diet is just one way that we can all work toward better health.  And of course, filling your belly with whole fruits and vegetables is going to help you reduce your cholesterol and blood pressure, lose weight, improve your vitality.  Nutrition for infertility, however, is a little more involved than throwing carrots into a blender. 

I once went to a “Nutrition for Fertility” workshop and spent two hours eating wheatgrass and hemp pesto on gluten-free crackers and learning the foods with yin and yang to balance out whatever my qi had going on with it that made me infertile.  Books that tell you to throw wheatgerm into your cereal every morning, or drink green tea.  And don’t forget to go organic so you don’t have to worry about the pesticides.  Suddenly shredding your meals down to the cellular level doesn’t sound so far-fetched anymore.

I understand the person who has tried everything with no end result, looking for just the right thing to do the trick.  I know that frustration and that pain.  That desperation led me to set a timer to wake up at the same time every day, take my temperature, give up coffee, stay off soy, mess with my hormones with high doses of clomid…  Was it only a matter of time before I tried the Nutribullet, or at least tried making veggie smoothies in my own blender?  Looking back on it now, I’m more insulted by the makers of Nutribullet that they would banter infertility about like a disease to be cured.  There are some lucky people for whom infertility can be “cured,” through surgeries, hormones, lifestyle changes, procedures, ARTs.  There are some lucky people, like me, whose infertility was struck down by luck once in a blue moon.  But even from one infertilite to the next, the solutions, if there are any, are hard to come by and even more unique.  So go ahead and try the Nutribullet – I really don’t see the harm if it fits into your fertility plan – but don’t put all of your eggs into that basket.

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Why so silent, good monsieur?

We’ve reached the end of National Infertility Awareness Week, and though the week will end, the good work that’s been started through this awareness campaign can’t end.  Here’s why.

Infertility in our society is a disease never discussed in public, and rarely detailed in private.  We probably all know a family or couple with infertility, and have wondered at some point, “Why didn’t they ever have kids?  Why did they adopt?”  I know I have – and still do, although with a far more sensitive curiosity than before I realized I might be one of those wondered-about people.

Is there a shame in infertility that I just haven’t internalized yet?  I get that it’s embarrassing – you hardly ever want to share medical details anyway, nevermind one as personal as having to do with your reproductive bits.  But I’m not ashamed that I’m an infertilite.  And part of the reasons why I started this blog was to get people talking about it, to raise their awareness, and to put some good thoughts out into the world for all the other people experiencing infertility.  Heck, if I was ashamed would I have posted a picture of my uterus for the world to see?

The reason I ask this question is because you almost never actually find out why other people are infertile.  For instance, I saw a posting on Twitter the other day about a teacher who was fired from her job for getting IVF treatment (it was a Catholic school, and IVF is against Catholic doctrine).  The teacher was described as “suffer[ing] from a diagnosed medical condition which causes infertility.”  (Read the ABC News article here)  Ooooohhhkaaaaayy….   I mean, not that it’s any of my business, really – but what a missed opportunity for someone to shed light on the realities of infertility, especially from an “everywoman.”  Tell us you have blocked or malformed tubes.  Tell us your body has a thyroid problem leading to off-balance hormones.  Tell us anything, something – because most cases of infertility are caused by “medical conditions.”  Infertility is a disease.

It’s one thing for celebrities to be open about it (Giuliana and Bill Rancic, for example) – they make a living off it and employ publicity managers who guide every move they make.  But it’s quite another – and quite more powerful – for an ordinary person to speak openly and honestly about their experience.  And there just might be thousands of people out there who hear, “I have a uterus didelphys,” and stand up and say, “Me too!  Phew!  I thought I was the only one…”

I guess I can only really speak for myself about this, because everyone’s case is different and everyone has a different threshold for public scrutiny.  And I’ve never been in the national media for my infertility.  I don’t wear a t-shirt that says “I have a unicorn in my uterus,” though I find that hilarious.  I don’t necessarily want everyone to know that much detail about my life, because it isn’t their business.  But should I run away from that truth, or meet it head-on come what may?  If I talk about it, even just a little bit, to friends, family, and strangers alike – maybe I will make it a safer, supportive space for others to share their experiences.

That’s something you don’t have to wonder about.

Exercising while TTC: A monthly plan

While I was in the middle of my clomiphene citrate treatment, resulting in some unsightly and unwanted weight gain, I decided to finally get back into a regular exercise routine – partially to help prevent more weight gain, partially to help me get my sanity back.  Exercise has long helped me alleviate symptoms of depression and anxiety, as well as help cure the occasional bout of insomnia.  During treatment, I would spend the two weeks after ovulation petrified of doing any exercise, thinking I might “shake things loose” or that I might rupture an over-stimulating ovary (as a result of the clomiphene).  After all, experts like Dr. Alice Domar suggest taking a whole three months off of exercise just to rule it out as a factor in your infertility.  Unless you’re training for a marathon I really don’t think that’s practical advice; did she ever bloat up to the point that even your “fat” pants become uncomfortable?  Right.

That’s where I started to put together my own plan that I thought might help kill two birds with one stone: integrate more body-mind awareness practices as well as take some time to fight flab.  This included making more of an effort to relax through meditation, both using podcasts at night and making the time at work to join in a weekly 20-minute meditation group.  I mixed this with a monthly exercise plan broken into two parts, and it seemed to satisfy both my need for vigorous exercise and my desire to keep my activity light during the critical days.

I should note that I am not an expert in health and fitness, and I have no training in this area whatsoever.  If you are TTC and want to put together an exercise plan, you should probably discuss your own limitations with your doctor.  And always do what’s right for you, so tweak it as needed.

My plan was extremely simple: 2 weeks of vigorous exercise, starting day 1 of my cycle (first day of menstruation) and lasting through about the time for ovulation; at that point, I would switch to yoga for two weeks, until the start of my next cycle.  With this routine I didn’t feel guilty for not exercising and I didn’t feel guilty for exercising.

I really like challenging workouts, so during my 2-week vigorous time I would do circuit training like with Jillian Michaels’ 30 Day Shred (or, really, any of her other videos), or jogging.  For the 2-week restful-exercise time, I would do power yoga or pilates.  I like JM’s Yoga Meltdown video, as well as the MTV Pilates, Pilates Mix, and Power Yoga videos.  I exercised about every other day, or however my schedule allowed for it.  I was doing yoga so much more than I had ever done that I would get excited for sun salutations, waiting to slide into upward dog – a pose I never had much respect for until I became strong and flexible enough to do it correctly and feel an awesome stretch in both my back and my core.  It’s as comforting to me as chocolate…  but I’ll save the “yogasm” talk for another post.  😉

“Everything feels normal” and other lies

OK, I’ll give you that the first stage of grief is denial.  It would not be an unusual reaction to any negative news, therefore, to immediately think, “That can’t be right.”  But when I was blindsided by my UU diagnosis back in September I actually began to have serious doubts about all the other health care practitioners I had ever come into contact with.

Having moved several times, I have been to about 4 or 5 different OB/GYNs or primary care practitioners until that point.  And each one of them during my annual examination would say, “Everything seems normal.”  I distinctly remember one doctor pushing on my pelvis very hard with the butt of her hand, saying, “There’s an ovary…  and there’s an ovary.”  How could so many doctors have gotten it “wrong?”  How could they tell me everything was normal and later discover everything wasn’t?

Of course they were right about my having two ovaries; it still seems doubtful that’s something they can feel from the outside of the body.  I’m sure there really is no practical way to identify if there were two “horns” during a physical examination.  So they weren’t wrong, not at least about that.  But that example just exemplifies the lack of information, awareness, and proactive treatment of infertility in the medical profession.  Infertility is a problem that you don’t look for until there is a problem.  But with a statistic like 1 in 6 couples of reproductive age experiencing infertility, shouldn’t we be advocating for a little more proactive and aggressive diagnoses?  Maybe if I had known at 26 when I got married that I was a UU I might not have waited to try knowing what I know now about my chances of getting pregnant naturally.

I don’t think it’s fair to say that the doctors didn’t know what they were doing when they were giving me their clean bill of health, so to speak.  The x-ray was only first discovered in the late 1800s, and so in the last hundred years how much further have we really come in finding ways to unintrusively examine the body?  Ultrasounds (now in 3D and 4D) and sonography, CT scans, and MRIs – and that’s it.  Genetic research has been around since the 1960s but only in the last twenty years have we “unlocked” the human genome.  Modern medical research is stymied by political agendas, big pharmaceutical company lock-outs, and expensive rigorous testing for approval, a process that could take several years.  I am nearly as old as the first “test-tube baby,” born in 1978.  Reproductive endocrinology is still a fairly young science, and with all the information doctors need to keep track of nowadays it’s no wonder that screening for congenital anomalies and other causes of infertility aren’t exactly on the top list of priorities for doctors.

Even still, it’s hard to have faith in going to anyone but a specialist – if only to save yourself the time of having to run through the details of your own diagnosis and its implications for your treatment.  There’s no denying that.

Don’t ignore the data

  • Mullerian anomalies occur in approximately 2 – 3% of all fertile women; 3% in infertile women.  (Seattle Reproductive Medicine)
  • Unicornuate uterus anomaly seems to occur in 1 of every 4,000 women.  (Wikipedia; yes, I know – I hope this doesn’t discredit me)
  • The term pregnancy rate is 47% in women with unicornuate uterus.  (BabyMed.com)
  • The total fertility rate for women in the US is 2.01 children per woman.  (Wikipedia)
  • Male factor infertility can be a primary source of up to 35% of infertility cases.  (Resolve.org)
  • Up to 50% of cases of infertility respond to treatment (and result in successful pregnancies).  (Resolve.org)
  • Women who have taken fertility medications (such as clomiphene citrate/clomid) have a 3-4% risk of developing ovarian cancer, compared to a 1-2% risk in women who had never taken the medication.  By comparison, the average woman’s chance of developing breast cancer is 12%.  (Georgia Reproductive Specialists)
  • Women who took clomiphene citrate for more than 12 cycles had the highest increase in lifetime risk of developing ovarian cancer; women who achieved pregnancy while taking the hormones did not have as high of an increased risk. (Georgia Reproductive Specialists)
  • There are about 600 reproductive endocrinologists in the US.  (iVillage.com)
  • The first IVF baby was born on July 25, 1978 in the UK.
  • Since 1978, over 45,000 babies have been born in the US with the assistance of IVF; over 70,000 total have been born with some form of assisted reproductive technology.  (Discovery Health)
  • About 2% of the child population in the US are adopted.  (ChildTrendsDataBank)
  • About 3% of American families include adopted children.
  • Adopted children are more likely to be read to every day, told stories to, eat a meal with the family at least six times a week, and participate in organized activities.  (ChildTrendsDataBank)
  • Infertility is a factor in 39% of families choosing to adopt a child from foster care.  (US Dept Health & Human Services)

To learn more about infertility, please visit the Infertility 101 page at Resolve.org.

Click here to learn about National Infertility Awareness Week.

Don’t ignore the gifts you have been given

I believe that everything happens for a reason.  Even if you’re not sure why it’s happening at the moment it’s happening, I believe that there is a reason for it that will be revealed in time.  I have to feel this way, if only to find relief from the things that have been so challenging in my life.  And for some reason, I was chosen to be an infertilite and as I’ve come to discover over the last year, I’m not alone.

According to Resolve.org, infertility affects 1 out of 8 American couples. I started on this journey with the same guilt I imagine many modern educated working women might feel: Did I wait too long?  Would it have been easier if I hadn’t gotten that degree, or focused on establishing a career?  Is this my punishment for “being selfish” and making sure that I would be in a position to offer a child an emotionally and financially stable family life?

You can lose yourself in those arguments, and you can beat yourself up all you want – but it doesn’t change the fact that you are where you are right now not because it’s a punishment, not because you were self-centered, but because you were doing what you thought was best – as any parent would do.  You are meant to be on this journey for some reason too big for you to understand right now. And I know that it’s not easy to accept that fact, to just “let it be,” so my advice to you is to seek solace in the gifts of the life that you do have. Daily, simple gratitude for the small gifts of everyday life, however silly it may seem, helps give meaning to a time during which you might feel your most helpless and unsettled.

I need a daily reminder myself to not get lost in feelings of guilt, depression, and failure.  I remind myself daily that even if it doesn’t seem fair that I carry this burden of a perilously small uterine cavity, one tube, and low ovarian reserve, it is the card that I’ve been dealt and nothing can change that, except for an honest appraisal of my options and acceptance of my choices. In recognition of the strength that it takes millions of people – women and men alike – to cope with, heal, and resolve infertility, here is a list of life lessons that I am grateful to have learned since my infertility diagnosis.  How many of these are also true for you?

  • I celebrate being a better advocate for my health.  Having a rare congenital anomaly as the primary source of my infertility plays a large part in this characteristic. I had to learn a lot about my anatomy, and quickly, to be able to keep up with doctors and explain to new practitioners the procedures I’d already been through. I’ve read a lot of medical studies in peer-reviewed journals about pregnancy outcomes in women with Mullerian anomalies. I’ve researched the pharmacology of fertility drugs trying to understand just what was happening whenever I took them. I’m dying to see what my MRI results looked like. I’m thrilled that my reproductive endocrinologist has an online patient portal where all of my medical documents are kept and that I can read for myself. I’m not thrown or surprised by terms my doctor throws around, and I’m not afraid to ask about them anyway.
  • I celebrate making lifestyle changes for the better. I’m not perfect, but I have increased my whole food intake and eliminated a great deal of processed foods from my diet. The processed foods I might eat (such as soups, stocks, tomato sauces, cereals) are either organic or have very little additives to them.  Over a year’s worth of abstinence from alcohol has made me a seriously cheap date, but I don’t miss it. And I read cosmetic labels as religiously as I do nutrition labels.
  • I celebrate the wonderful family I do have.  Even if it is just my husband and I and a chihuahua who likes to cuddle under your shirt when the temperature is below 75.
  • I celebrate the life I have created for myself.  I’ve paid off my student loans. I have a great career and I work with amazing people. I get to travel for my job and I am always learning something new. I can buy things that I need or want, and I live in a nice town in a home that I put a lot of work into. All things considered, I am truly blessed.

Infertility does not define me but it is an undeniable part of what makes me who I am today. It’s not something we talk about as a society. Older, successful women without children are often portrayed in stories and on television as cold, uncaring, manly, or bitter; did that stereotype develop from the thick skin you need to develop to live in a world that fails to understand the full impact of infertility?  Too often we judge childless couples for not having (or wanting) children rather than consider what they may be going through, and the strength it takes to pretend like everything’s okay.

We are fortunate to live in a nation at a time when more options are open to infertilites than ever before, through better diagnoses techniques, improved medication, a range of amazing reproductive technologies, and wider acceptance of adoptive families. Do I know how my journey is going to end? Absolutely not. But I am certain that whatever path I choose, I will not be the first one to have had to walk down it.

I celebrate that I do not have to be on this path alone.

To learn more about the disease of infertility, go to http://www.resolve.org/infertility101

To learn more about National Infertility Awareness Week, go to http://www.resolve.org/national-infertility-awareness-week/about.html

A visitor of undetermined location

When, on my seventh cycle of clomiphene citrate – and the third round at 100mg doses – my period didn’t arrive when expected on day 28, I didn’t panic.  The previous month it had extended my cycle to day 30, so I didn’t worry.  I took a HPT which was negative and went about my business.  When it didn’t arrive on day 30, I didn’t panic either, thinking it would happen any minute.  But on day 32, when putting on a sports bra to jog was nearly unbearable, I took another HPT – got two lines – then panicked.  I purchased a different brand HPT and took it in the afternoon the next day.  Two lines again – positive.  Having just begun to accept that the natural odds were stacked against me I had to unwind all of my thoughts and start preparing for the next whirlwind of steps.  I called my clinic and was scheduled for my first blood test early Tuesday morning. 

After a six hour wait for the test results, my nurse called with the news exactly at the time she said she would.  “Congratulations!  You are pregnant.  Your hCG level is at 80.  We will have you come back in two days to check your levels to make sure everything is rising.”  W-o-w.  There was no more denying it.  I googled an expected due date (end of November).  Based on my calculations I should have been, technically, about four weeks pregnant.  On the ride home that day I thought twice before sticking a piece of gum in my mouth, wondering if the artificial sweeteners and chemicals in it were safe to ingest.  I thought better of it and put the gum down, despite the Pavlovian need I have to chew gum while driving home. I was determined to give this pregnancy every possible chance to succeed.

In those first few days I had mild cramping, deeper and higher than usual PMS cramping, which started on day 32 and lasted until the day after my first blood test (day 36).  Everyone told me this was normal to experience, and at best it was distracting, at worst mildly irritating.  But in my mind, as long as I felt cramps, something was growing.  So when they topped part of me was relieved (maybe I could finally concentrate on work), but part of me knew something wasn’t right that they had stopped so soon.  I don’t know that I could call it women’s intuition, but I guess I’ll just say my fears were confirmed with Thursday’s test result phone call, which took at least three hours longer to get than Tuesday’s: “Your hCG is rising but it’s rising abnormally.  It’s at 96.  We would expect the number to have doubled by now, somewhere between 150-160.  We need you to come back in two days.”  By now the inside of my elbow was bruised, but at that point I knew and started to prepare myself that things weren’t going to last.  I waited another 48 hours for my third set of results.  The number then was only 123.  This is the point at which they start to prepare you for the worst – that it’s ectopic, meaning in the middle of my only good tube, which has a danger of rupturing the tube and could be fatal.  I panicked, backed off my exercise routine and waited another five days for my next appointment – an ultrasound. 

I didn’t know what to hope for from that appointment.  I hoped that it wasn’t ectopic.  I hoped that it was in a place where there might be a fighting chance.  I hoped I hadn’t done something wrong to cause the word “abnormal” to become the situational descriptor of choice.  But nothing prepared me for the sight on the screen – an empty gray and white cavity (my uterus, which the doctor and nurse had both concurred, “That sure doesn’t look unicornuate from that angle”), and a dark spot barely discernible by even those who stare at these kinds of pictures all day long in the top left corner.  It was like trying to find the big spot on Jupiter, if Jupiter’s atmosphere was entirely as orange as the spot is.  “We think that’s it,” the nurse said.  “It doesn’t look ectopic but we can’t be sure.  We would call this a ‘pregnancy of undetermined location.’  But your levels are still not rising as they should.  If it doesn’t take care of itself naturally, we’re going to have to give you some medication.”  

I went home to tell my husband and to prepare for what I knew would be coming – the reality of this pregnancy being non-viable and the side effects of methyltrexate.  In typical fashion, my husband was optimistic.  “This is good,” he said.  “That’s okay if this doesn’t work out.  What it means is that it’s possible – that it could happen.  This is all right.  This is for the best.”  I wish those feelings came as naturally to me as they do to him.  That’s why I fell in love with him. 

Three days later, the miscarriage started just as it had four years earlier.  I updated the folks on the message boards I belong to, who had been sending positive thoughts and well wishes my way since the start.  And there, one of the women gave me a new meaning that eased my pain and gave me the strength to move on: 

“Maybe somebody out there doesn’t want you to give up.”