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.

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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.

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.  😉

MRI = Satellite radio and yoga mudra

I ventured into yet another hospital today to complete my MRI exam and fulfill some bloodwork. I arrived a little bit early but was taken right away into the main radiology area. I waited no longer than 10 minutes anywhere before meeting with someone; in fact, it felt like instant service. I’d never been to this hospital before but it’s not known to be one of the area’s best; rather, it leads a quiet, forgotten existence tucked away behind a highway. But not being able to get through half a Simple & Delicious magazine before meeting with the radiology technician? This place doesn’t seem that bad.

First I went to complete my MRI. The fertility clinic had scheduled the appointment and told me it was for 10am; yesterday the hospital called and told me it was 10:30am. So I arrived for 10am, because hey, I have the time and I’d rather be settled in and waiting than anxiously driving to the place. I expected to wait a little before my appointment, but no, they took me right away. Between a painless registration and two friendly nurses walking me down to the MRI, I was surprised how fast they were taking me back. What service! Then I met with the MRI technician, who needed some clarification about why I was having the procedure. I don’t know if that’s hospital standard procedure, but this is where my months of research into having a potential unicornuate uterus (there’s that darn hope again!) came in handy. “I’m here to have my uterus scanned and my kidneys scanned.” “Why do they need your kidneys?” “Because I was diagnosed with a unicornuate uterus” – blank stare from technician (male) – “which means I have half a uterus, and usually people with my condition also have one kidney.” “Have you had any problems until now that would make them suspect you have only one kidney?” “No.” “Oh.” The insinuation being that if it hasn’t been bothering me, why check it out? But I was not going to have to go through all of this not to find out if I had one kidney or not. Haven’t I waited long enough?

The MRI was not as frightening as many people make it out to be. I’m not claustrophobic but it is a rather small machine, so I can see why the worry. I wore two hospital gowns and socks, and they offered me a blanket but the room was warm enough. I had headphones on with satellite radio pumped into them (on a station of my choosing). The technician propped a wedge pillow under my knees. A fan blew fresh air over me; my head and feet were both sticking out of the machine. The sun filtered in from the high windows, lighting up the room and warming up my toes. The noise of the machine would give me slight pulsating sensations in my body, almost like a massage. While most people hear “don’t move” and panic, I dug into my yoga mudra practice and relaxed. Just be. Just lay here and do nothing. Just breathe…

It probably took between 30-40 minutes to do both scans, but with the music and the technician telling me every few minutes “This one’s only 4 minutes long,” the time went by quickly.  After the MRI, I felt extremely relaxed (probably from all that slow, deep breathing). I went down the hallway to the laboratory area and again, within 10 minutes I was helped. And this is where I had the most, shall we say, interesting reaction to my declaration of a unicornuate uterus…