The infertilite marriage and divorce

When I got married, one of my vows was “to accept children lovingly” into my life.  I saw that on paper and cringed.  I was 26 and I didn’t want kids.  I thought kids trapped you, wrecked your body, sucked your bank account, turned your life into one full of mom-jeans and sensible flats, tripping over Tonka trucks and Legos and other endlessly messy toys strewn about.  When I repeated that vow on my wedding day six years ago, a voice inside me screamed, “Eeek!  No, I don’t!  No, I don’t!

A year later my niece arrived and she only reinforced my beliefs about children.  She was exhausting to babysit.  She never stopped crying.  She didn’t sleep anywhere but in your bed.  She played with loud toys that she left everywhere.  I didn’t see the joy in parenting.  That and I felt completely incompetent as a woman around her, unable to read her cues or understand her needs.  I never really babysat anyone before – a hazard of being among the youngest in the extended family – so I didn’t even really know how to change a diaper.

Meanwhile, my husband started saying weird things, like, “Wouldn’t it be fun to have four squirts?”  He was loving my niece and I was jealous he was so good with her (he being the oldest had a lot of experience raising kids).  But mostly we had these conversations playfully, to the point where we’d start categorizing activities as “things we couldn’t do with squirts.”  And every year we were married, he came down on his number of squirts.  And every year, I started moving more in his direction, particularly as both of our careers stabilized (though nothing is really stable in this economy).  Kids didn’t seem like a sentence anymore.  And I reached a point in my life when I found myself asking, “There’s got to be something more.”  I sensed a gap in my life that I knew would not be filled by experiences or things.  And that’s when we started trying to conceive.

That was three years ago, three years into our marriage and seven years into our relationship.  My husband and I are now wrapping our minds around the fact we’ve been together for ten years… but we’re also watching friends’ and families’ marriages fall apart.  And falling apart in part because of the baby question.

The average U.S. first marriage lasts 8 years, and the second lasts 10 years.  So our friends who married in their early to mid-20s are starting to divorce.  In two of the most recent cases I know about, babies and infertility are chief among the sticking points.  In one couple, the wife’s sisters and mother have all been diagnosed with ovarian cancer and have experienced heart-wrenching and life-threatening complications in the last two years.  No doubt the fear of having your opportunity to have children kicks your biological clock into high gear…  but her husband didn’t reciprocate the feeling.  Another couple discovered some minor complications while trying to conceive, and as a result the husband wants to talk about their options for growing their family and the wife doesn’t want to deal with it.  Both couples are now separated, and guess what?  They were both married for eight years.

When I tell people this story they ask, “Wouldn’t they have talked about kids before getting married?”  Sure, that’s what you’re supposed to do.  You’re supposed to talk about your finances and spending habits, your expectations for living together, your hesitations about each others’ families, your values, your ideas about having a family (or not).  But even if you did that, sometimes circumstances change your mind.  You lose your job, you travel abroad, your family moves away, you develop an allergy to cats, you find out you’re an infertilite.  And sometimes a couple can recover from that fundamental change and sometimes they can’t.

Being an infertilite alone is hard work enough.  When you are with a partner, it will challenge the foundation of your relationship.  You will have many long tearful conversations.  You will both feel pulled in so many different directions, and sometimes those directions are polar opposites.  You both deal with the stigma and with the difficult conversations with the outside world.  Focus on the love you share for each other to help you dig in.  Be honest.  Listen unconditionally.  Withhold your judgment.  Get a professional to help you communicate if that’s what you need.  We’ve all been there.  You are not alone.

Advertisements

The infertilite in the childbirth class, part 2

As part of the sharing portion of the childbirthing class, after the first of several potty breaks, the instructor asked us if we knew where the baby’s head is.  Most people knew from their ultrasounds that the baby’s head was down.  Except for mine, of course.  My little one’s noggin has been jammed up against my ribs for weeks.  It is a distinctively hard and round mass underneath the skin; when pressed on either by fingertips or by ultrasound, it hurts me it’s so hard.  Because he’s breech, he punches and kicks me all below the belt.  I haven’t had any little feet stuck in my ribs.  Just jabs to my bladder and headbutts when I slouch too much.

So when the instructor heard I had a baby in breech position, she cheerfully added, “Oh you have plenty of time.  He’ll turn.  We’ll talk about ways to flip your baby in another class.”  So when we walked in to class number two, and the instructor had a sheet of paper out at the check-in table labeled “What questions do you have?” I wrote, “How to turn a breech baby.”  And during the first potty break, the instructor proceeded to demonstrate ways to turn your baby.

1. The Gorilla Walk.  With legs wide, bend at the waist and walk on all fours, keeping knees and arms straight, lumbering from side to side.

2. Follow the Light, Little One.  Shine a flashlight at the bottom of your belly, as babies are drawn to shiny things.

3. Talk to the Hand (or Foot, or Shoulder).  Have your partner (or iPod!) talk to your baby from the bottom of your belly, as babies are drawn to the noise.

4. This Should Be Yoga Butt It’s Not.  While kneeling, lean forward onto your elbows and keep your butt up in the air.  Stay like that for 5 to 10 minutes a few times a day (and not after eating).

5. Show Some Moxie.  Get acupuncture, the kind with the burning sticks (moxibustion), and make sure they know you’re trying to flip the baby.

6. Get Hot and Cold.  Put something cold on top of your belly (like a cold can of soda or cold wet washcloth), and make sure you keep your lower belly warm at the same time.  I have to admit the little one goes nuts when I have something really cold (like cold water, ice cream), I think because he gets brain freeze from his noggin sharing space with my stomach.  Not that it’s helped him move anywhere.

I’m the only one in the room taking notes with this, as I’m about the only one in the room with a breech baby.  The instructor does a great job of not making me feel singled out, and the other women seem to be paying attention.  And then the instructor goes on to say that, “Don’t worry.  Over 97% of babies will be head down by the time labor comes around.”  With that, the conversation ends, and with that I turn to my husband and say, “Except I’m already in the 1% with a weird uterus, so what are the chances I’ll be in that 97%?”  I’m guessing slim to none.

The next day I asked my OB what he thought about my chances of the baby flipping, and of exercises to help the baby.  “Honestly,” he said with his lips drawn a little to the side, “with the reduced space in your uterus he’s probably not going to turn on his own.  And many of the ways we would advise you to flip the baby [including the medical procedure] are contraindicated in women like you.”  Oh, okay.  Good to know.  It’s not easy to even bend over to put pants on, nevermind walking around on all fours.

There are some websites out there with lots of do-it-yourself suggestions for flipping the baby.  But I’m not going to list them here, since the internet is the internet, and if you’re a gal with a UU or MU like me it’s probably not wise to try it unless your doctor approves.  We’ll just have to hang in there, use visualization techniques, and keep asking the baby to kindly move down, please.

Choosing a fertility clinic/doctor

I am fortunate enough to live in a metropolitan area where I actually had a choice in reproductive endocrinologist offices.  I realize not everyone has that kind of choice and that I am very lucky to have had the opportunity to seek assistance from both for different reasons.  But when it came down to choosing which one to stick with for my treatment, after some investigations it became pretty clear.

There are two clinics each within 25-30 minutes of my home, and the only ones available for a 50 mile radius.  Fertility Clinic A has been in the area for 25 years, has one doctor and two physician assistants.  Fertility Clinic B has been in the area for maybe 15 years and is one of three locations in the state.  Clinic B also has a spa associated with it that includes services such as acupuncture, yoga and other exercise programs, massage, nail care, waxing – basically the works.  My friend B. actually used Clinic B because of their suite of services and their locations, which allowed her to travel to her home and still receive the same level of care with familiar faces.  Clinic B was my first introduction to fertility clinics by way of B., who wanted to sign up for yoga classes together.

Now, if you are lucky enough to have a choice in clinics or doctors, you can always start the decision making process by looking up the statistics on the Society for Artificial Reproductive Technology’s website, which publishes IVF success rates for every clinic in the country.  But numbers don’t always tell the whole story.  Some clinics might turn you away if they deem you too high risk, which might offset their numbers.  And personally I like percentages rather than wholesale figures.  For instance, Clinic B’s SART report shows over 1500 attempted IVF cycles in 2010 while Clinic A had about 200 IVF cycles reported in that same timeframe.  No doubt a lot of this is attributed to the largess of Clinic B, with three locations and at least one or two doctors at each.  Maybe the smaller number of Clinic A would make people feel nervous – do they have enough experience to really help me (even though they’ve been around for 25 years)?  So consider the percentages: of Clinic A’s 75 IVF cycles in women less than 35 years of age, 53% resulted in a pregnancy.  Clinic B had a whopping 652 IVF cycles for women younger than 35, but only a 36% pregnancy success rate.  There’s much more detailed information on the SART website about these numbers, so be sure to check it out.  Unfortunately, the numbers only detail IVF procedure success, not other therapies such as IUI or medicinal treatments.  It still left me with a little bit of uncertainty as to who to pick.

I decided to try some of the alternative medicine and spa services available through Clinic B, which by the way is a spa open to the public.  I signed up for a month of yoga for fertility classes last summer, took a free fertility nutrition workshop, and enrolled in a “ladies’ night” event where you could sample 4 different mini-spa services in one night.  The yoga was probably what you’d expect a yoga for fertility class to be – easy, relaxing, not very strenuous at all and probably couldn’t count as bona fide exercise.  The nutrition workshop was kind of interesting but a little too on the hippy-side for my taste (the instructor brought hemp pesto to try with almond flour crackers as an example of one of her recipes), and she kind of started by saying that while we could base our nutrition on the Chinese medicinal tables and our own idea of our symptoms, the better way is to meet with an acupuncturist to get an accurate idea of issues with your chi.  I get it, it was a free class, you’d probably expect them to sell you on something.  But it was the ladies’ night’s atmosphere that led me to really shy away from the place.  I paid $60 for what I thought was going to be 2 hours of services, and because of the disorganization turned into 3 hours.  The first part was meditation, where about 20 of us (there were about 60 women total) sat with a therapist who led us through guided meditation.  But then she asked us to share “Who came to meet you in the garden?”  I felt extremely uncomfortable sharing my personal experiences.  Next up was a chair massage, which I would do again with the same masseuse in a heartbeat, and was the most genuine part of the whole experience.  Then it was time for acupuncture – that was really the reason why I went, to see what it was all about.  The acupuncturist asked, “Any pain? What are you working on today?”  “Well, I’ve been trying to get pregnant…”  And after telling him an abbreviated story, he essentially said, “Clomid doesn’t work, acupuncture does, I’ll get you some handouts and my card.”  Having just started the clomid that left me with little hope and wasn’t the reaction I expected from someone who presumably gets his business from the clinic downstairs.  The night ended with a mini-facial (“I would recommend you make an appointment for the cranberry scrub”), a paraffin hand wax and “makeover” which was really just getting matched with a Jane Iredale (all natural) foundation and lipstick.

If you ever have the opportunity to sample services, even peripheral services like these that might be offered by your clinic, or a support group – go ahead and give them a shot before making your final decision.

While Clinic A has none of these fancy offerings, I was afraid of going to Clinic B and having them sell me on the services as part of my treatment plan.  The spa at Clinic B was already trying to sell me tons of products (they really looked at me funny when I didn’t buy anything in the gift shop); what would their medical staff be like?  I know B. saw an acupuncturist regularly, and at $60 a rip I felt like it would be a financial drain (“the more often you go, the better it works”).

It turns out there were a few more philosophical and humbling differences between the two clinics as well.  Clinic B’s entire building smells good.  It smells like the spa, like sugar and flowers and fruit and all kinds of other yumminess.  The clinic’s waiting room has 12 inch travertine floor tiles (money!), a fireplace, leather couches and recliners, dim lighting, bookshelves and DVD racks (all available for purchase), and a K-cup machine for you to make a nice beverage.  Clinic A has tile floors and carpeting, two separate waiting areas (one for the lab and one for your appointments), innocuous magazines to read and tvs tuned to news stations, bright and sunny lighting, and a single-serve coffee maker (not a K-cup) available to use.  One significant difference – Clinic A has a fragrance-free philosophy.  As fragrances are the #1 cause of VOCs (volatile organic compounds – not good for anyone, especially infertilites and fetuses), no one in their office wears perfume or lotions with fragrance and they ask their patients to do the same.  There are no scented candles or air fresheners or nice smelling scrubs in the bathrooms, as there are in Clinic B.  For me that was a signal that this place was about business more than appearances, and helped make me feel confident in making that choice.

Sure, there’s lots to be said for patient-doctor relationships too – you just have to feel that it’s right for you, that you’re in good hands.  But I also urge you, if you have the capability to choose, to consider reading between the lines of the entire business model before committing yourself, your partner, and your future family to a clinic.

Freaky Friday and the minor miracle

At my week 10 appointment I officially “graduated” from the fertility clinic to my OB/GYN group.  My PA performed the ultrasound and let me watch the baby the entire time she took measurements.  I was shocked at the amount of movement going on in there that I couldn’t feel at all.  Little kicks and little waves, already trying to push its way out of the narrow spaces.  Then the other shock – hearing the heartbeat for the very first time.  I would be lying if I said it wasn’t freaky, hearing the big “BUMP bump.  BUMP bump.”  (that’s you, the doctor said) then a little “whish-whish-whish-whish-whish-whish” after she moved the transmitter a little to the left.  FREAKY.

Oh, but that wasn’t even the freakiest news of the day.  In her final measurements, the PA located and measured the follicle from which the egg had erupted.  “I saw this last time but I wanted to make double sure.  You ovulated from your right side.”  Meaning, from the ovary that doesn’t have a fallopian tube or half-a-uterus to connect to.  Meaning, that little egg had to criss-cross my abdomen to even get sucked in by the other fallopian tube, then it had to get fertilized, and then it had to be healthy enough to even stick.  And the chances of that happening in a unicornuate infertilite is like slim to none (technically less than 5%).  Maybe running 12 miles a week helped move things along?  J

Oh, but wait – the story gets much better.  There is kind of a superstition in my family that when one person dies, someone gets pregnant.  It’s just how it goes, and how it’s always worked ever since I could remember.  In late January my husband’s grandmother passed away and I really didn’t think much of it, because after all she was an in-law and probably didn’t count in my family rule.  But then I got pregnant and miscarried right afterwards.  Oh, but then I got pregnant again.  “Do you realize,” my husband said to me last week, “That you’ve been pregnant every possible time that you could have been since she died?  How do you feel about the name Agatha?”

He likes telling that story to his aunts and uncles, especially now as we are finally cleaning out her house and dividing her belongings.  I think it helps him have some kind of ownership of an experience that is largely out of his control, even if it’s not entirely true.  And thanks, Grandma Agatha, for your divine intervention, but your name still isn’t on the list.

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.