Stories & Decision Making

My husband recently started his doctorate. He's spent the past year or more reading articles on decision-making and visualization. Not visualization like imagery, but rather the visual display of information. A few days ago, he emailed me about an article that he was reading, that reminded him of Fertility Stories. (We do actually see each other too, it's just that he was at the university which is about 60 miles south of here.)

The article - "SUPPORTING INFORMED CONSUMER HEALTH CARE DECISIONS: Data Presentation Approaches that Facilitate the Use of Information in Choice" by Judith H. Hibbard and Ellen Peters (Annu. Rev. Public Health 2003. 24:413–33) discusses the information patients need when dealing with health care systems, in order to allow them to make informed decisions.

Interestingly, they found that, people who were provided with information in the form of a story were both able to better understand the situation and make better decisions as a result of this understanding.

So... if you're dealing with infertility - on to the stories :-) Enjoy.

That Rotten Two Week Wait... Rambling

Like it's not bad enough that you didn't conceive last month, you have to wait two long, long, everlasting weeks until you find out if this month you succeeded... Two weeks, if you're one of the lucky ones who has a fairly regular period or if you're going through fertility treatments and already know how many ultrasounds, blood tests & clinic visits it usually takes before you ovulate.

As soon as the 2ww begins, you're soooooooo in tune with your body. It's like everything's under a magnifying glass. Are my breasts sore? You put your hands on them to make sure. Is the smell of (fill in the blank) making me sick? COOL! Didn't I just go to the restroom a few minutes ago... quick lookup... frequent urination? YES! Another sure sign... And then you remember that it's only been about half-a-day since your IUI, IVF or natural attempt... Hey, only 13-1/2 more days to go.

A good thing to do at this time is to take care of yourself as if you are pregnant. Get enough rest, eat healthy foods, take your folic acid. Fantasize about things that make you happy - enjoy it now, who knows what will be at the end of the two weeks?

So you've gotten through the first few days? The next step is the bargaining step. You think to yourself, "I won't test at least until the (fill in the blank-th) day" or "I am waiting for the blood test." And the days eventually go by, they have to. Slowly, but they do... You read up on how long it takes until the sperm meets the egg, how long it takes for the fertilized egg to travel from the fallopian tube to the uterus, how long it takes for implantation. You wonder if implantation bleeding is real or a myth. Is it a good sign or a bad sign (whether you have it or not)? Once 7 or 8 days have passed, you realize implantation really could have occurred.

The magnifying glass now acquires a high-powered-lamp and a super-sonic microphone system to go along with it. I crave pickles. And chocolate ice cream. And I am so tired. All the time. My breasts are sore. They must be sore. And my jeans don't fit the way they did yesterday. Or... maybe this is all in my head...

By day 10, the bargaining usually begins again, along with the thoughts, "If I test now, it's still probably too early... that means I can test now & it's still not final... So, if it's negative, I still have a chance..." Some women break down about here. Some last another few days and some make it through the whole two weeks.

Toward the very end, it gets a little easier. By then you've pretty much decided if you are or aren't pregnant and taking the test means you're actually ready to know for sure. My guess is that every woman, even if she's "sure" she's pregnant, is at least a little worried that the test will be negative... and that will end the fantasy.

In this, the age of impatience, many of the searches for Fertility Stories have to do with pregnancy symptoms. Cramping after IUI; not nauseous pregnant; if my breasts are sore am I pregnant; faint pink line pregnancy; no symptoms pregnancy; IVF implantation bleeding... if you think about it, it makes sense. A letter that used to take a week is now an email that takes 10 seconds. News that you waited until 5:00pm to hear is on the Internet instantly. You can check your bank account to make sure your check was deposited even if you only think about it at 2:15am and if you need your addressed changed on something, you send a fax so they can change it right away... so why does it have to take 2 whole weeks to find out if you're pregnant???

This is where this blog entry actually ends... If you want to read on, feel free.

[Sept 24 - See our new book giveaway.]


My experience

I (see my story here) went through this (the rotten two week wait) oh... about 50 times, I'd say (maybe more). Each time I'd think it couldn't be so bad to wait two weeks & each time discovered anew that two weeks can be an eternity. With the first pregnancy (from IVF), my breasts were so tender by the 9th day that I couldn't sleep on my stomach. It was back in the olden days when they made you wait 20 days - by day 19, I felt so awful that I called the nurse and told her I thought I was coming down with the flu. She asked me what I was feeling and sent me for a blood test. It came back late that night. My beta was 2500.

With the second pregnancy (IVF - frozen embryo transfer), I had bleeding before the 14 days were up, so I had my sister run and get me a home pregnancy test on day 12. It was positive. I assumed the bleeding was a sign that it wasn't going to succeed & I was shocked on day 14 to find that my beta was 599 (I was to later discover that I was expecting twins). In both cases, I have to admit that I felt "something" that was getting stronger and stronger.

My 3rd IVF pregnancy didn't start well (and didn't end well). My beta was 29 & there was a huge hematoma (blood clot) in the uterus. I miscarried sometime around the 13th week (after several weeks of bleeding heavily on & off).

Ironically, my 2ww was much shorter than expected with my last pregnancy - I was in my first cycle after delivering my daughter, exclusively breastfeeding, and I thought the chance of pregnancy was fairly low. I had what I thought were either pre-menstrual cramps or ovulation, so I took an ovulation test (I sell discount kits out of my home) and it was positive, so I guessed I was finally ovulating... A week later, I was feeling tired and just generally different. Without thinking, I took a pregnancy test upstairs, put my baby in her crib (she was all of 4-1/2 months) and took the test, which was immediately positive (no waiting a minute, no faint pink line). I was in shock. So was my husband, when I was finally able to tell him about half-an-hour later. I decided to kill my business selling ovulation kits & pregnancy tests if the test was wrong. The next day, I took a test made by a different company (I get free samples too...) and it was positive even before I put it down on the counter... It turned out that I was 6 weeks pregnant. (I didn't kill the business :-))

Nomi was born March 25, 2006. Yirmi joined our family on March 8, 2008.

Stolen Stories

For a long time I've been wondering why Fertility Stories barely comes up in Google searches. Today I finally found the answer. Someone stole 8 stories from Fertility Stories (including my personal story - hullo?!?) and put them up on a competing site.

The way Google works is that it doesn't like duplicate content, so it only lists one. Seeing as this plagiarizer put the stories on a large, well-known site (as a subsite - it's not one of the biggies who did this), Fertility Stories got knocked off of Google's list. Lovely, huh? So I wrote an abuse report to the site and sent a message to Google about it & hopefully I won't have to call my lawyer in because they'll take down the site within 24 hours. Hopefully.

I can't say that I never looked for stories. I did. I looked for ones that had the names of the authors, I contacted them and I asked for their permission to use the stories. There's not one story on the site that was published without it... In my fantasy, women who wrote last year or even a few months ago will write to update their stories and tell us their good news. It happens here and there (some of the stories have little updates at the end), but not as often as I'd like...

Anyway, fighting this thing drained a lot of my energy & the battle isn't over until the site goes down. So that's my story for today. I really put a lot of work into this site and into answering tens of questions a day. Copyright infringement is really ugly.

Babies in the Waiting Room

Forums. They're all over the place and they're a great way to be able to share intimate details of one's life without actually revealing anything about who you are. Once in a while, I like to read messages and offer some hope for those who need it.

I read a message from a woman who had poor quality embryos and I told her about my FET (frozen embryo transfer) cycle that I did just to be able to move on to a "real" (fresh) cycle... and about my twins who are now 9-1/2 years old from that cycle. A woman with a small hematoma (blood clot) wrote to ask if there's any hope for her pregnancy and I wrote back that I had both cases - a large hematoma that eventually caused a miscarriage & a small hematoma that disappeared sometime around my 9th week of pregnancy. Usually, I only answer when no one else has...

Different forums have different rules. The ones in the US tend to be the strictest, where you have to write "pg ment" or "m/c ment" (pregnancy or miscarriage mentioned) in your title. Of course there's also "kids ment" and others. You can't put your successes in your signature line because you'll be hurting other, less fortunate, people's feelings. And there's the inevitable - "I can't believe that someone brought her 2-year-old to the fertility clinic" and all the women who jump up to say how horrible it is. Over the years (and I've been reading infertility forums on the internet for 10 years now) this has come up in almost every forum I've read.

It took me over 3 years to conceive my first child. Not a very short time, especially since I was under 21 when I started trying. My friends were all older, all having babies, and believe me, I was soooo sick of being invited to their baby parties that after a while I only went to those of really close friends. But when I was in the waiting room and a woman came in with her baby, it made me happy. It gave me hope. Hey, I could be like her someday. I could have a baby too... and even try for another! I would attempt to start a conversation to get some encouraging information. "Was your baby born through IVF?", "How many cycles before you succeeded?"

My second cycle was successful and I delivered a healthy baby girl at the end of 42 weeks (I had to be induced). I was 24-1/2 and I refused to let anyone call her an only child. She was my first child. After she was born, I went back for treatment as soon as I could, to try to get pregnant again. I didn't take her with me, but only because it wasn't convenient (I dropped her off at her nursery school and then drove to the fertility clinic).

Seeing some of the less tolerant messages makes me wonder what an ideal situation would look like. Would they (the writers) really like to see the world on hold until they're successful? Would their life be happier if their friends didn't flaunt their pregnancies, if their little sister didn't have her 3rd child (usually it's an unplanned child or the sister's not married). And in general, would a childfree world really be more convenient? Um... oops... that is... until they have their child...

For those of you who are going through infertility - enjoy seeing other people with children. When your child is born s/he will be the most special and precious person in the world to you. You'll want everyone to see how wonderful, unique and beautiful your baby is. You'll take him or her (or them :-)) for a walk in the park, to the pet store, and to the playground just for fun, not to make anyone feel jealous... People who walk around with their children are not being insensitive. They're living.

Enjoy life now. Smile at little children the same way you'll want people to smile at yours someday. Hopefully someday soon.

Egg Donation

Q - I have an 11-year-old from egg donation and want to discuss with him his beginnings. Have other people done this? How? How was the outcome for the child learning his or her origins? I am getting cold feet now that he is of an age where he will understand, but I still want to tell the truth. We have lost touch with his donor but kept up with her his first few years of his life. I cannot find any literature or advice on this topic. Thanks for your help!

A - I found the following article that might help you:

http://www.theafa.org/faqs/afa_talktoovumdonorchildren.html

If you go ahead with you plans & you're interested in sharing the experience, I would be very interested to hear how it goes.

Response - Thanks for the article. It gives me the confidence to proceed and know it is felt to be the best to disclose egg donation. It is likely the more difficult questions will come later but now at 11 I think he needs to know. Knowing the donor for a while and admiring her helps make it easier.


Q - If a woman is very healthy and 54 years old, is it still possible to have a baby using donor eggs and IVF?

A - It is possible for a healthy 54-year-old woman to carry a baby conceived using donor eggs and IVF. Please see my post on this topic.


Q - I am interested in becoming an egg donor, but I don't know where to begin. Any recommendations?

A - We're not affiliated with any organizations. You may find some helpful information and links on our egg donors page.


Q - Is it common for a sister to donate eggs to another sister who is infertile?

A - I don't know how common it is, but I have read about some such cases. An advantage, of course, is the biological connection. A disadvantage is that it may cause conflict between the sisters.


Q - Can a woman who is taking anti-depressants donate eggs?

A - No. Other contraindications are smoking, drug use, use of anti-anxiety medication, history of mental illness and many other health indications.

Secondary Infertility

Believe it or not, secondary infertility - defined as "difficulty conceiving after already having conceived and carried a normal pregnancy" - is often just as difficult and challenging as primary infertility.

Basically, you have a baby or child, but you can't get pregnant. Since you were able to get pregnant before, people naturally assume that whatever fertility challenge you had in the past is now behind you and that all you need now is to relax and the next baby will come along.

Women or couples who suffered both primary and secondary infertility know that this isn't always so. Think of a woman who has no fallopian tubes or a couple where the husband suffers azoospermia (absence of live spermatozoa in the semen). They're not going to get pregnant by relaxing. The fact that they were able to conceive before doesn't mean it's going to be any easier this time.

Comments like, "but you already have a baby, so it's not such a big deal" aren't really very helpful. When you decide that you really want another baby, it doesn't really matter if it's your first, second, third or even fourth - and maybe even beyond that. When it's not working, it hurts. When it's been difficult before, you're afraid it will be difficult again. You're even worried you'll never have a baby again. If you went through years of infertility in the past and you started trying again now, you wonder how much time is still ahead where you'll be fighting this battle... and infertility drains so much time and energy...

A word of wisdom to those who have friends, co-workers or children suffering secondary infertility: It's not very different from the first time. It's painful, it's scary and unfortunately, it doesn't always have a happy ending.

Quads or double-twins?

This morning I got an email from my father about an incredible story. Two women (life partners), after many failed attempts to conceive, went through the process of IVF using the eggs of one and donor insemination. The resulting embryos were transferred to both women and they both conceived twins(!) and gave birth a week apart. Their babies are considered quadruplets that were carried by two women - they are full genetic siblings. The story that appears in The Marin Independent Journal includes a picture of the women with their children.

It was encouraging to read that the women seem really focused on raising their children and that they've got things as "under control" as possible (they do have 4 babies under a month old in their house).

It's a pretty unique success story. I wish them a lot of luck and a peaceful night here and there!

Surrogacy and Surrogate Mothers

Q - Please could you help? Me and my husband we have been trying for a baby for 6 years but due to me having problems we can not have a child by ourselves. We would very much appreciate it if you would send us some information on how we start going about surrogacy.

Q - Where do I start in the progress of finding a surrogate mother to carry a baby for me as I have had a hysterectomy and am in a new relationship where we would like a child.

Q - I am a mother of a beautiful and very healthy bouncing baby boy. I had an almost perfect pregnancy. I had morning sickness from about 5 weeks till my 16th week of pregnancy but after that it was smooth sailing from there and the delivery went so quickly and smoothly that I would love to have another baby. My partner and I have decided not to have another child for a while but I really do want to be pregnant and give birth to another baby. I have been considering being a surrogate mother since the day I had my son. If you could suggest where to start in researching being a surrogate mother I would be forever greatful.

A - Fertility Stories is not associated with any agency. There are a few links on our surrogacy and links pages.


Q - I'm just wondering if you could please help us with a question I have?? It's can you explain the advantages and problems of surrogacy. Explain the long term effects of such an arrangment on the offspring and the legal parents.

A - I think the information on this page: http://www.fertilitystories.com/surrogacy.htm should answer most of your questions.

In brief -- the big advantage of surrogacy is that it allows a couple who otherwise could not carry a baby to have a biological child of their own (gestational surrogacy). The problems with surrogacy are connected to the fact that an outsider is involved with your child -- there are a variety of possible conflicts, e.g., she drinks while she's pregnant; she needs to be on bedrest but decides that it's OK for her to go ice skating, etc... or more subtle problems that can arise during such a stressful & emotional time.

A baby born using your egg & sperm is your biological child & the surrogate mother has no effect on the baby's genetics.

Surrogacy should always be done using legal, binding contracts & then, when the baby is born, you are listed as the birth parents of the baby, so there are no long-term effects.


Q - I would like to know if I have another woman have my child, will the child have my blood or the blood of the surrogate?

A - If another woman carries your child, using your egg, the child will be completely yours genetically, exactly as if you had carried it.

Sperm Donation

Q - My friend wants me to carry her baby and we would be using a sperm donar. I would really appreciate it if could send us some information on procedures, cost, doctors, and payment plans, any information would help!!! Thank You!

A - We're not affiliated with any medical center or sperm bank that provides these services. The procedure used is referred to as IUI or Intrauterine Insemination. You can read more about sperm donation on our sperm donor page.

Your friend might also be interested in the book Helping the Stork : The Choices and Challenges of Donor Insemination.


Q - I was interested in perhaps becoming a sperm donor. Can you tell me the procedure for becoming a sperm donor?

A - Read more about sperm donation on our sperm donor page. The HFEA (UK) also has an interesting publication - What You Need to Know About Donating Sperm, Eggs or Embryos

Fertell - A New Product in the Infertility Scene

I think they're on to something. Fertell just released a new combo home fertility test kit for men and women. For now, at least, it's only being sold in the UK - in 600 "Boots" stores.

The men's test is the first home test that shows whether the sperm motility is within the "normally expected levels needed to reach and fertilise the egg". Up until now, the most popular home sperm test you could buy was the FertilMarq Male Fertility Sperm Test ($36.95 & free shipping), but what FertilMarq can tell you is just whether the sperm concentration is above or below 20 million sperm cells per ml. It doesn't tell you anything about the motility.

The women's test is an FSH test, which is a good indication of ovarian reserve (i.e., whether the eggs produced are likely to be of good, fertile quality or not). This type of test isn't new - Estroven Menopause Monitor Kit - 2 tests ($18.10 + shipping).

The new test, Fertell, is packaged together (a test for the man and a test for the woman) and runs 80 Pounds Sterling - that's a little over $140. Kind of steep if you ask me, especially since there's only one test for the woman & we can pretty easily establish that those aren't that expensive. Then again, most things sold in the UK aren't cheap.

I find the men's test fascinating. I wonder if it will bring around the revolution that they expect - more men will test at home to know if there's a problem. Is the reason that men aren't going to the lab because they're embarassed to carry the sample in (from my experience they usually just palm this off to the woman anyway) or because they're afraid of the results? Maybe it's a combination of the two and the Fertell sperm test will make it just a little bit easier for reluctant men to test themselves.

I do wonder what you do with the results? I guess you go to your fertility specialist (assuming the results are bad) and say, "My Fertell came out lousy." or something like that and then he sends you for a lab test. If it comes out good & you end up pursuing fertility treatments anyway, you'll end up having to give a sample somewhere down the line.

I'm glad to see that there's continued work to make the life of those struggling with the first steps of trying to conceive easier. I hope that it will save a lot of couples a lot of time and heartache. They say it can save you up to a year. That's exactly right. If the test is poor, you can go ahead and make an appointment without ever trying to conceive. That does sound cool, at least in retrospect.

Too bad it's such an intimate item, otherwise it might quickly become a popular wedding present.

Not what infertility treatment is all about...

I read this article (Clinics prepare for 'lifestyle' fertility treatment) in The Guardian. It talks about offering egg freezing and sperm freezing for people who are delaying childbearing as a life choice -- they specifically mention women who will choose to conceive after the age of 50(!).

My first response was to write my mom who I can always count on to agree with me about such matters. I just sent the link and the phrase my oldest daughter coined when she was about 5 (though she used it about someone who'd double-parked badly) - "that is SO 'come on'".

My mom and I both had babies in our 20's and 30's. She gave birth to my oldest brother just before turning 22. I had my first baby (by IVF, after almost 4-1/2 years of marriage) at 24-1/2. My mom had her last baby at 32-1/2. She felt old. I felt old when I gave birth to my youngest daughter last year, at 35. The old I felt wasn't related to my body or the way I look at life. It was the thought that at my daughter's high school graduation I'd be 53. That by the time she has children I could easily be in my 60's. Hardly a young grandmother...

Obviously I believe in fertility treatments for people who are trying to conceive, but I think there's a point at which it's not in the best interest of the baby who is going to be born. Once you've got the eggs of a woman who's now in her 50's thawed, who's going to stop her from transferring 2 or 3 embryos. Imagine a woman at 54 with triplets... You might say, "COOL!" or that it's her choice, but think about the poor kids explaining to the kids in their nursery school that it isn't Grandma dropping them off, or in elementary school with a father who's starting to experience the signs of old age. By the time they graduate college, they might be looking into old age homes for their parents...

I'm 36 and my parents are still young. That's pretty cool. I hope they'll stick around to see my grandchildren and hopefully dance at their weddings. For now, they've got a great social life. They travel. They enjoy their 20 grandchildren (and are expecting another...) and I can call them up whenever I have questions or if I need to comment on the newscaster's bad haircut.

There are choices we need to make in life and if having a family is high on our list of priorities, we should get started before it's too late. I know it doesn't always work and that sometimes things take years, but to delay starting your family until you're over 50 really seems to be pushing it.