Tips and Resources for Dealing with Infertility

You have been trying to conceive for what feels like forever – at least 6 to 12 months – you have been tracking your ovulation, you have lost a few pounds, quit drinking/smoking/toking/coffee and you still aren’t pregnant. Your OB has recommended that it is time to get in touch with a Reproductive Endocrinologist or Fertility Specialist, and you are crushed. You may also feel relieved knowing that you could get some answers soon.

Broadly, infertility is defined as the inability to conceive after one year of trying.

By the Numbers (according to the experts: ASRM, CDC and RESOLVE)

  • 1 in 8 couples have trouble getting and staying pregnant.

  • 1/3 of infertility is attributed to the male partner, 1/3 to the female partner and 1/3 to a combination of both or remains unexplained. 

  • 85%-90% of infertility cases are treated with conventional medical therapies – i.e. medication or surgical intervention.

  • The inability to have a child is considered a disease of the reproductive system that affects 6.7 million women in America.  

 SEEING A SPECIALIST

Most fertility specialists will begin with a detailed intake that will gather you and your partner’s information including medical history, social history and the history of your reproductive health. Additionally, ultrasounds and labs may be ordered for the medical team to get an idea of your baseline and to begin identifying the source of what is going on. I always suggest bringing a list of questions to this first appointment that touch on the concerns you have. Suggestions for things you may want to ask:

  1. What is the process for identifying my diagnosis and how will this diagnosis inform my treatment?

  2. How long do you think the initial workup will take and when do you estimate we will be able to move forward with treatment?

  3. What courses of treatment do you recommend/are most commonly successful in your practice? Additionally, what are my treatment options?

  4. How long do we focus on each treatment and at what point do we move to a new treatment? For example: if we start with IUI how long before we discuss IVF.

  5. Is there anything I can do to improve my chances of becoming and staying pregnant during the course of treatment?

  6. Are there any lifestyle changes you recommend?

 PREPARATION AND SELF-CARE

Infertility brings a landslide of emotions including immense vulnerability, feelings that you have no control and moments of intense sadness. When we think about growing our families we think about future homes, communities, holidays, birthdays and milestones. Experiencing infertility can feel like the biggest threat to those things.  When you take your journey to have a baby from the bedroom to the doctor’s office it’s only natural that floods of emotion will come with you. Stress, sadness, excitement, grief and fear all bundled into one. Here are a few tips on how to provide yourself self-care during this time.

  1. Educate yourself on the medical components of infertility.
    Gathering information and education can help you feel empowered and whittle away at the feelings of powerless that come with the process.  

  2. Identify your support system, both individually and as a couple.
    Finding a therapist that specializes in infertility or a group for families going through infertility treatments will help you build your tribe and a support system that knows exactly what you are going through.  Also, social media outlets have support groups that many women find helpful.

  3. Try your best to focus on the moment.
    Be your own best advocate and don’t get caught up in future worries and anxieties: what if this happens, what if this doesn’t work, what if what if what if.   Do your best to live in the moment and don’t give too much power to the what if’s. 

  4. Feel your feelings.
    You may wake up feeling great one morning and incredibly sad the next. You may feel you don’t recognize yourself, like you have changed forever and wonder if you’ll ever return to the person you were before you started trying to get pregnant. This is ok. Allow yourself the moment to honor however you are feeling and remember that all feelings pass.

  5. Engage in regular check-ins with your partner.
    Infertility is a couples experience. Make sure you keep up your communication, try to make time for fun and be sure to connect in some way. Given the stringent requirements surrounding treatment, sex may be off the table at certain times- practice other ways of sharing intimate moments outside of intercourse.

 THERE ARE PLENTY OF NATIONAL AND LOCAL RESOURCES TO HELP YOU IN YOUR JOURNEY TOWARD PREGNANCY, HERE ARE JUST A FEW:

  • Hasidah
    An organization that builds awareness, develops a network of support resources and provides financial assistance for IVF.  They will be in Denver hosting an event on February 26.

    Pathways to Parenthood – We live in a time when people are marrying later, working more, having fewer children and considering freezing their eggs. How do these influence the choices people make about family building and how people deal with fertilty struggles? Come hear from experts in the field and those who have infertility experiences, ask questions and share. Whether you’re going through this yourself, been through it, curious about it or trying to support a loved one, come learn and share as we explore the issues of modern family building and how to create more support in the Jewish community. For people who are currently facing fertility issues, who have in the past, and for people who want to support them.

  • The American Society for Reproductive Medicine
    ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers.

  • RESOLVE: The National Infertility Association
    RESOLVE, the website of the National Infertility Association, provides free support groups in more than 200 communities; is the leading patient advocacy voice; and serves as the go-to organization for anyone challenged in their family building.

  • National Conference of State Legislatures
    NCSL will help you learn the infertility insurance laws in your state.



Our Preemie Journey

I remember sitting in my prenatal classes as we were discussing birth plans thinking about what that day was going to be like for me and my husband. Anyone who knows me will tell you that I am a planner. I like to be prepared for any and everything and generally expect things to go according to my plans. Knowing this about myself and knowing how little control I was likely to have when it came to my son's birth, I figured my best plan should be "don't have a set plan." That way, I couldn't be disappointed or caught off guard when it didn't go the way I expected. Looking back, this was probably the single best decision I made, and perhaps best possible way I could have prepared for what actually happened.

February 2nd seemed like a pretty normal and uneventful day. I had just hit 32 weeks and my sciatica was finally feeling a bit better. Things were crazy at work, but I was able to sneak away for a quick lunch with an old coworker. That day was one of those "wintery mix" days, where there was a thin layer of slushy ice everywhere. On my way back from lunch, I slipped on the sidewalk and fell straight forward. More shaken up than anything, I was thankful that my arms and coat had braced most of my fall. Nonetheless, being the risk averse person I am, I decided to call my doctor to double check. To be safe, she suggested I stop by the hospital for some routine monitoring--just to make sure nothing had happened.

Thinking nothing of it, I went straight in and let my husband know I'd probably be home just a little later that night. To cut a very long story short, as I was being monitored, my baby's heart had a deceleration (heart rate drop), which was pretty concerning. The doctors and nurses decided to keep me over night, and one day turned into 5 days with long periods of everything being normal to sporadic dips in my baby's heart rate. At first, my doctors told me we needed to wait 24 hours. Then was the idea that I might be on bed rest for a month, before I delivered. Then the thought that they wanted to get me to 35 weeks. Then, just 34. Then the notion that I needed to go ahead and consent for c-section now, because there was a chance that could happen at any time. On February 7th (at 33 weeks), after another heart deceleration, my doctor rushed in to tell me that it no longer made sense to wait--there was someone in the OR at the moment, but in 20 minutes, they were going to deliver my baby, ready or not. I remember shaking as she rubbed my back and calmly walked my husband and I through the procedure. My husband says I was unbelievably calm and strong in that moment, but all I remember is being so scared for my baby that I could barely say a word. What kind of birth or plan I had no longer mattered. Whether my son would survive was the only thing I could think about.

Usually, when you hear someone's birth story, there is a lot of chaos followed by an overwhelming feeling of joy. "When they put my baby on my chest, it was all worth it!" or "When she finally arrived, I was overflowing with love!" As a preemie mom, those are feelings and experiences that I never got to have, and it's hard not to feel robbed or jealous of that. I didn't get to hold my baby on my chest because he was whisked away to the NICU before I could even see him. I didn't feel a sense of relief after he was born because I had to spend an hour in the recovery area without my husband (he followed our son to the NICU) consumed with worry about the baby I still had yet to meet. We didn't get to have a birth announcement that said "mom and baby are doing great!", because the reality was that we were a long way from that.

Because of the dramatic differences between a term and preemie birth, the NICU can be a very isolating experience. While most new moms tell the woes of cluster feeding, NICU moms pray for their baby to develop the ability to eat. As other new moms might worry that their baby is making a weird sound or stops breathing in the middle of the night, NICU moms pray for their babies to be able to breathe without extra oxygen or machines. Not that these "normal" new mom worries are any less valid or real. They are just as hard and just as meaningful. But, they are some of the very first ways as a preemie parent, you come to realize that your experience is very different from that of other parents.

At times, I found it difficult to navigate this space of having a similar, yet drastically different experience. My "mom group" is made up of perhaps the most inspiring and supportive group of women, and I relied on their humor, support, and encouragement tremendously. However, there were times where I still found it hard to connect. Sometimes it was something silly. Like when a number of them started pumping for the first time in preparation for their return to work and were surprised at the inconvenience and the amount of effort that the whole process took. I had exclusively pumped for over a month while my son was in the NICU and felt like a true expert by the time all those questions came up. Other times it was much harder, as I watched their babies met milestones without issues, or the fact that their doctor appointments were just another check on the list, rather than a constant source of anxiety.

At 20 months, I wish I could say that we are past all that now, but there are aspects that still linger. Our son's gross motor skills are still a bit delayed. His preemie lungs make him much more susceptible to things like brochiolitis (4 or 5 times at this point... ugh). And I'm pretty sure his weight will be an issue until we send him to college. 

That said, after quite some time, soul searching, and a little therapy too, I've come to accept that although being a preemie will always be part of our son's birth story, it isn't going to be his whole story. I've stopped qualifying his age when people ask, and I don't feel my heart race when people tell me he is small for his age. I often say that while I would never wish the NICU/preemie experience on my worst enemy, it has given me a perspective that I will always appreciate as a new mom. The developmental milestones are that much more meaningful and the snuggles are even more special. I can only hope that there is another preemie mom out there reading this who can start to feel a little less isolated. Though your experience and concept of normal may be wildly different, you are not alone.

What Have I Done?

I have a clear memory of changing the sheets while I listened to a short story about a couple who had adopted a baby.  When the story ended, I collapsed sobbing on to the bed. I wanted a baby so badly that I physically ached for one. And yet, when I found myself pregnant, a year and a half after my husband and I had started trying, the first emotion I felt was fear.  What had I done?

My pregnancy was not easy.  I threw up constantly - once thirteen times in three hours.  I was put on a “milkshake diet” by my OBGYN because I had lost an alarming amount of weight.  I went to bed at 7 pm and woke up still exhausted 12 hours later. I did not glow.

And then, at 33 weeks and 5 days, my water broke unexpectedly and unexplainably.  My questioning mantra of the last few months remained, but, suddenly, the inflection changed.  What had I done?

I spent two days in the hospital on supervised bed rest - attempting to keep my baby in for as long as possible.  On the third day, 34 weeks exactly, I was induced. Ten hours later, I met my girl. And, then, they took her away.  We had previously decided that my husband would go with her and I watched him follow her incubator to the NICU. Suddenly I was alone with my thoughts for the first time in 72 hours.  And, again, I asked the question that had become my constant companion.

My daughter was a NICU superstar.  She was off her CPAP in 12 hours, off her feeding tube in 3 days, out of her incubator in 5 days, and home in 7 days.  She had moxie and gumption in spades. She came home on oxygen and even that didn’t stop her from thriving. She amazed everyone she met.  And yet I still couldn’t shake my guilt.

There is no medical answer for why my water broke when it did.  One minute, my daughter was safe and the next minute she wasn’t.  My body, for whatever reason, decided that it was time for her to make her arrival. I had failed her. After a particularly rough day, I called my mom and I finally asked out loud the question I couldn’t stop asking in my brain, “What had I done?”  

I cried a lot that day.  To my mom, to my friends, to my husband, and to my daughter while I rocked her to sleep.  The next week, I started therapy. I continued to cry a lot. I got diagnosed with PTSD. But I started talking out loud and I have kept talking out loud.  My internal mantra of doubt become conversations of trust.

I love my daughter.  I love her big, blue eyes.  I love her laugh. I love the way that her whole body shakes with excitement.  I love how her favorite thing to do is kiss herself in the mirror. I love that when she is crying the sure fix is throw her up in the air.  I love her ten fingers. I love her ten toes. I love that when I was pregnant with her I was terrified I had made a mistake. I love that when she was born I was afraid that I had already ruined her.  I love that she wasn’t a mistake. I love that she isn’t ruined.

I love that now when I ask myself what I have done, she is and will forever be my answer.   She is what I have done.