Sunday, March 14, 2010

The Long and Winding Road

Since our daughter Sidney was born in September 2009, we are so grateful for her and the chance to be parents. 
I’ve wanted to write about this for a long time—over 3 years or so. But because my husband felt our troubles were a private matter then, I respected his wishes and avoided the topic.  But now with his blessing and in the spirit of wanting to give back, I reflect on our ordeal of trying to conceive and stay pregnant...

It’s truly amazing that anyone is ever conceived or born. But when it seems like there are so many “accidental” pregnancies, you might conclude that you could just “wish” yourself pregnant whenever it’s convenient and away you go. According to WebMD, as many as 15% of all couples are infertile or have reduced ability to conceive. Only 1-2% are completely sterile and cannot bear a child, no matter how much medical intervention. They say “half of those couples who seek help can eventually bear a child,” but trying to find the right combination of intervention can be frustrating. Part of it is just trying to figure out where the issue is. Generally 1/3 of infertility is female factor, 1/3 is male factor and 1/3 is unexplained.

It didn’t occur to us in the beginning that getting pregnant would be a problem. We planned to wait a few years after we married and enjoy some time together first. We even put off trying for an extra few months because we were going to Finland in late 2006 and I didn’t want to be in early pregnancy in a place with odd (to me) food. But also around that time, a few of our friends had started to have children and a handful told stories about how much effort it took and how much medical intervention had been required. As our first few months of all-out trying passed with no results, I couldn’t help but wonder if we too might have a problem.
I also felt a little bit of pressure due to my age. This was compounded with the fact that we wanted two children ultimately. As 2006 turned over to 2007, I wanted to step up the effort but was determined to address our lack of results in a 'natural way.' So I began to explore what else was out there and kept Western medical science at arm’s length.

First and foremost, after several months of resisting, I finally bought & read the book Taking Charge of Your Fertility by Toni Weschler. My OB and girlfriends had recommended the book initially and I guess I felt that by getting this book it would “admit” we had a problem. I wish I hadn’t held out for so long. This was the *best* tool to begin understanding what my body was doing/not doing in regards to fertility. By the way ladies, what you think you know about your body from health class is either wrong or a fraction of what you should know. It was a real eye-opener—because women are really only fertile for a 24 hour period each 28-day cycle. (So all that paranoia about getting pregnant before when I didn’t want to…yeah anyway.)  One of the best things about this book is that it teaches you how to chart your daily temperatures (taken orally) and symptoms which help you identify ovulation. To know your cycle length and when you ovulate is crucial to hit 'the window of opportunity.'
So, 24 hours of fertility—that’s it. With charts in hand, I thought we were set.
But with no pregnancy in the first part of 2007, I was at least able to show my alternative medicine providers some data. I had been under the care of a local acupuncturist for a few years already and asked that “fertility” to be included in my treatment. The acupuncturist also added Chinese herbs to the mix which I took with some trepidation but hoped it would produce results.
By mid-2007, still nothing was happening so I decided to look into Naturopathy which “focuses on natural remedies and the body's vital ability to heal and maintain itself.” (Wikipedia) The first naturopath I saw specialized in fertility and used homeopathic tinctures &remedies.  I didn’t feel comfortable running Chinese medicine remedies and homeopathy ones together so I stopped the Chinese herbs. Unfortunately, I never really felt comfortable with that naturopath provider—I felt there was something personality-wise that didn’t fit so I never completely felt comfortable with her. I stopped going to her after half a year.
By this time, Ken also got to join the medical fun times and have an evaluation by a urologist. The results were nothing truly alarming but his sperm count did benefit from taking multi-vitamins and zinc supplements. We noticed immediate improvements after the additions of these things. However, the majority of reproductive science focuses and resides in the woman’s body so even if it had been a male-factor issue, things would have been done to me.
With no signs of pregnancy, in Fall 2007 I signed up for a class/group offered at PNW Fertility called Mind and Body Fertility Program. This was a program developed by folks who studied infertility and recognized how stress impacts the success of conception. It focused on empowering women and their partners undergoing treatment for infertility by teaching relaxation methods, providing a forum to talk about concerns/issues and educating couples on all options leading to parenthood.
By this time, we had also begun doing IUIs (Intra Uterine Insemination) through my OBGYN’s practice. Basically, Ken provided a sample the day before or of ovulation, it went into the centrifuge, they spun up the best swimmers and suspended them in a viscous medium. Upon ovulation day for me, it was injected directly into my uterus, by-passing the often hostile and acidic environment leading into it.
Many of the women in the group had done IVF (in-vitro fertilization) cycles, suffered miscarriages and had been trying for years. The hormone supplements, medication, pain, poking, prodding, lifestyle restriction, 'medicalization' of reproduction and expense, coupled with doubt, fear and feeling like your body has betrayed you, all took a major toll. I admired these ladies’ perseverance and commitment because of all the emotional, physical and financial demands. I was definitely the freshman of the group in terms of what little I’d been through but knew this was a group that would teach me a lot.
The hardest lesson of all became crystal clear: just because you spend thousands of dollars on a cycle and take all the meds and do everything right, it does not guarantee you a viable pregnancy. 
Looking around that room each week and thinking about how badly these women wanted to have a child—knowing how much I wanted a child—made the random and accidental pregnancies happening in our friend group (and even among celebrities!) excruciating. To that trend, Ken said, “Fertility is inversely proportional to preparedness.”
 (Note: None of us in the mind body fertility group got pregnant while we were active in the 10-week program but in the two years since, four out of the seven of us did eventually have healthy babies and another couple adopted.)
In late 2007, I tried one last alternative method called Mayan Abdominal Massage before turning to Western Medicine. This method of massage was a little strange when compared to what one usually envisions as massage. It is “a non-invasive massage technique where the abdominal area is massaged to reposition internal organs correctly". This supposedly improves the reproductive and digestive functions and can help with infertility problems.

For all of 2007, I wanted to try natural approaches because I believed if I found the right 'thing' or combo of things, everything would just fall into place. I like to think that all of these methods in 2007 helped get my body ready for the Western Medicine approach. The most important thing for me was knowing we'd attempted to use more natural interventions and methods.  But at this point, I was ready to try something else. So in December, my OB gave me Clomid (a drug that helps juice the follicle production to make large, and to Ken's horror, sometimes multiple eggs) in addition to doing an IUI. This was my 6th IUI, but the first one with drugs. worked.

In January 2008, I discovered I was pregnant--in the midst of our major kitchen remodel and Ken training for the Portland Marathon. We were so excited and couldn’t manage to contain the secret before the 3-month verification ultrasound. [This should sound alarms right here] Friends & family had been rooting for us for awhile and my birthday party was just prior to that ultrasound so we didn't see any harm to tell everyone who attended my party since I wouldn’t be drinking. People began congratulating us.
A few weeks later, we went in for our milestone 3-month ultrasound. (The one that assures you with a good amount of certainty that a pregnancy is going well.) I seen pictures of healthy ultrasounds at 3 months on the Internet so I knew what a normal one looked like. The minute the tech put the wand on my tummy and the image flickered on the screen, I knew.
There should have been an image that closely resembled a head and a body of a baby but instead there was just a tiny mass at the bottom of the screen. The tech looked at it for a few seconds, pulled the wand off my belly, then excused herself. Immediately the radiologist came in and confirmed what I was dreading. Apparently the pregnancy had been viable a few weeks earlier when we'd seen it on the ultrasound at the OB’s office but in that time interval, the pregnancy had terminated by itself.
Devastated, numb and reeling, we made the blurry-eyed walk from the ultrasound clinic to my OB/GYN’s office a few blocks away. Mercifully, this happened during their lunch break so the waiting room was empty instead of being crammed full of swollen-bellied pregnant ladies—a club I learned I had just lost my membership to.
Despite the fact the pregnancy had not been viable for a few weeks, my body wasn’t expelling it. The Dr. said I could (a) wait to see what the body would do, (b) take some pills and go home to pass it with a great deal of cramping and mess or (c) have an outpatient surgical procedure called a 'D&C' which would remove all tissue of the miscarriage. It required heavy sedation and therefore if they we were to do the procedure that day, I could not eat. All the choices were terrible but I chose the last one because I couldn’t bear to “see it” and I wanted this ordeal over as fast as possible.
Even though I was there under the worst of circumstances, everyone at the hospital day surgery center was very nice, things went smoothly and when the anesthesiologist asked me how deeply sedated I wanted to be, I told him, “Whatever gets me able to eat again the fastest.” (At least I still had my priorities.)  That was easily one of the worst days of my life but I got to see what my husband was made of and he was amazing throughout. He made those terrible phone calls to our families, close friends and my work place to tell them what had happened. I could not bear to do any of it, so he did it all.
The doctor later explained the fetus probably had a genetic abnormality so we would not have wanted it to come to fruition. I logically knew that and was grateful, but the event fundamentally rocked me to my core. Naturally, I was eager to try getting pregnant again. ‘Get back up on the horse,’ so to speak. Even as early as the day after the D&C procedure, I got my charts back out and was looking ahead to the next IUI cycle.
[Edit: I forgot to mention this when I first wrote this piece: A week after the D&C, my milk came in (?!?). Initially, it was the most horrifying reminder of what I was trying to get past. I'd not heard of this phenomenon before and it was equally alarming and heart-breaking. There wasn't much liquid but I did have to put tissues in my bra. Finally it stopped after a few days.]
I tried to snuff out my grief by gearing up for our next try. After all, we had been able to get pregnant so it was possible. All we had to do was replicate what worked for us and all I needed was for my cycles to restart. But the weeks went by and nothing. It was as if I was stuck in limbo.

Prior to my own experience when I had heard about people having miscarriages, I couldn’t understand why they got so worked up. It wasn’t even a fully formed baby yet…I thought, just get pregnant again… Yeah, well I realize now, there’s a lot more to it. The loss spawned a flood of introspection and the hormones shredded my composure, causing moments of laughing then crying in the days and months that followed. I was deluding myself when I thought quickly conceiving again would have fixed the pain. With months to ponder, I faced disappointment on that scale I’d never known and I had to do that to move on. I had to know where my limits were in trying to conceive and consider that maybe becoming a parent may look different than what I originally imagined. I even began compiling lists of adoption agencies to have the option...
But by August (5 months after the miscarriage), my cycles finally returned and we resumed what had worked: doing IUI + Clomid cycles through my OBGYN. But after 3 more unsuccessful attempts and the end of 2008 nearing, I decided 3 things for 2009:
  1. We would seek help from the fertility experts at Pacific NW Fertility [CHECK]
  2. I would go to Acupuncture NW, a clinic known for supporting fertility success. [CHECK]
  3. Ken was going to get re-evaluated [DIDN'T GET TO THIS ONE]
OBs are great at taking care of pregnant women and delivering babies but in terms of fertility, it’s not so much the focus of their work. The slightest nuance can make the difference between a pregnancy or not. But in Pacific NW Fertility, we found the right team, treatments and support we needed. Here was our winning strategy:
  • My primary care physician caught a slight thyroid deficiency and supplemented me with a low dose thyroid medication before the end of 2008. We're talking, I was still in the normal range but on the low side.
  • In the first Clomid + IUI round with the fertility clinic running the show, they moved up (earlier) the timing of both the Clomid intake and the egg release shot. They recommended it based on my age and previous experiences.
  • The folks at Acupuncture NW made a comprehensive fertility support plan that transitioned into a pregnancy support plan.
  • I read a book right called The Mind-Body Fertility Connection and it really affected me in a positive way. While it hearkened me back to the work we did in the Mind and Body group, it helped bridge the gap of attitude, outlook and working through emotional baggage that could have been 'hindering' conception on some psychological level. I felt that coming to terms with the miscarriage helped lift a weight off my mind and it opened the door for a positive outcome.
So it was in late January 2009 on vacation in the San Juan Islands, when I took the first test after the first round with the Fertility Clinic and... we got pregnant. The  early weeks of the pregnancy progressed normally but we absolutely waited until that 3 month ultrasound with reasonable assurance from the doctors until we told anybody.

Nine months later, Sidney was born. I was 35 years old.

[Update: We now have a second child with whom we used the exact same strategy and we became pregnant the first attempt that time (continuing Thyroid meds + Clomid + trigger shot + IUI + Acupuncture). I was 38 years old.] 

I notice many more couples needing fertility support to have babies these days. I certainly remember how lost and clueless I initially felt about what to do when things weren't working. From our experience, there was a lot of trial and error but the main thing to remember is that there are many resources available for infertility treatment and support. Don’t ever feel that you have to wait until years have passed or you are at your wits end to consult with someone. And don’t be afraid to make a change if the provider you’re working with (despite their well-meaning) isn’t giving you the help you need.


Melanie said...

The "Taking Charge" book was recently recommended to me - I am even more excited to read it now. Everything about your story confirms the true meaning of miracle of life - so good of you to share.

Amy said...

The "Taking Charge" book should be required reading in biology class. Thanks for sharing your story. I had a ruptured ectopic pregnancy and miscarriage in between kids. Conceiving, loss and pregnancy can be very scary experiences. The more we talk about it, the more can be learned from each other.

Tracy said...

I'm glad you made it out the other side. It's one of those life journeys that changes you at a very basic level.
You guys are awesome parents, and have a little sweetie.