Things I Wish Fertile People Knew, Part I

So, I am two days away from my scheduled pregnancy blood test (after IUI Cycle #3). Even though I am on progesterone, I feel like my body is getting ready to start my period.  I’m preparing myself for a negative.  Despite this, I’m actually feeling pretty OK, because I know that we have a plan in place going forward if I am not pregnant.  We had a follow-up with the doctor, and decided to go forward with an IVF cycle in August if this last IUI doesn’t work. If I’m not pregnant this month, we are taking July OFF and vacationing to Acadia National Park in Maine. I am so looking forward to a break and an opportunity to focus on Alex and me and the things we love that have nothing to do with fertility, or pregnancy, or children.  Hopefully, this will leave us feeling refreshed and ready to jump into IVF in August.

Despite my positivity in the area of future fertility treatments, I have been fighting some negative feelings that have popped up as a result of an unavoidable reality of an infertile woman’s life: you are almost always surrounded by fertile people, and as much as you love them, that can be hard sometimes. I want to clarify that I think my friends and family are awesome.  More often than not, they have been stellar examples of how relatives and friends SHOULD treat an infertile couple.  My family and friends know better than to question us about “When are you going to have kids?” And even though most friends and coworkers have given birth or become pregnant since I’ve started TTC, they have generally been respectful.   In fact, one of my biggest supporters has been my best friend who gave birth to her daughter one month after I started TTC. Another good friend personally called me to announce her pregnancy (and later the gender), and has made a point of asking me about my journey with infertility even as her pregnancy progresses. Bottom Line: I am very blessed to be surrounded by awesome friends and family, and would not trade them for the world.

That being said, I still experience resentment, jealousy and sadness sometimes.  It could be an innocent comment, a pregnancy announcement, or a well-intentioned question: you never know when infertility angst will rear its ugly head.  Some of this angst is unavoidable.  People SHOULD get pregnant quickly and easily – I’m so incredibly happy that my friends’ bodies are working the way they should. I would not wish infertility on anyone. But, it still doesn’t change the fact that seeing someone attain the one thing you want more than anything in the world can stir up a lot of sadness.

My feelings are my own, and ultimately have nothing to do with someone else’s happiness.  But, sometimes I still wish that people around me had a better understanding of what it is like to experience infertility. “But,” you might ask, “How can you just assume that fertile people don’t understand infertility?”  And, I guess you’d have a point – I’m sure there are people out there who are more knowledgeable or empathetic than I give them credit for. But, the truth is, that before I started trying to conceive,  I was completely ignorant about infertility.  I was the one who believed inaccurate stereotypes or asked rude questions. I took my fertility for granted, and I never once thought that one of the greatest sources of stress in my life would become the inability to become pregnant.

According to the CDC website, almost 11% of Women in the U.S. struggle with infertility. However,  Infertility is still a largely silent and isolating experience – so many women don’t talk about it openly. My own mother experienced infertility and I never knew it until I was 29 years old. So I think it is important to talk about the journey if you feel comfortable. If other people think it’s awkward because talking about infertility is like talking about (gasp) sex….too bad. I don’t really care.  If someone had educated me about infertility earlier in my life, the total count of stupid assumptions and asinine comments made in this world would have been a little lower.

So, without further disclaimers, here is my list of “Things I Wish Fertile People Knew” AKA “Things I Didn’t Know Before I Experienced Infertility Firsthand.”

(1) Infertility happens to people in their 20’s too. I stupidly thought that infertility happened to older people.  IVF? That’s for rich people and celebrities who put off having kids till their late 30’s, right? NOPE.  Infertility happens regardless of age or socioeconomic class. I started trying to conceive when I was 28.  By the time I celebrated my 30th birthday, I was already diagnosed with infertility.  Yes, being diagnosed at a young age is a blessing – statistics and time are on my side. However, sometimes it sucks, because no one ever imagines what you are actually going through.

(2) Some couples diagnosed with infertility can eventually get pregnant naturally. This is a tricky one, because the word “infertility” seems so…harsh.  Infertility is the inability to get pregnant after 1 year of unprotected intercourse. Or, if you are 35 or older, 6 months. (http://www.resolve.org) The diagnosis doesn’t necessarily mean you CAN’T get pregnant on your own, it just means that it is more difficult for you to conceive than the average person.  Which leads us to one of the major struggles after a diagnosis: deciding if, when and how to seek treatment.  In some cases, patients are told from square one that their only chance to conceive is through IVF.  In many others, including ours, the doctors Just. Don’t. Know.  The decision is up to you, and playing the odds game is so damn difficult. For many couples, there is always the lingering possibility that they COULD get pregnant on their own if they just tried one more time.  Dependent on your diagnosis, those chances may be lower than normal or almost non-existent.  I personally find this so difficult, which may be exacerbated by our diagnosis (more on unexplained infertility later).  I’ve found it difficult to justify moving forward with a new treatment, and worried that others might judge us for seeking further medical intervention before trying X amount of months on our own (whatever that magic # may be). If we tried on our own for a few more months, would we get our surprise miracle by the two-year-mark? Or, would we find ourselves back at square one, still childless, with only lost hope and lost time to show for it? The uncertainty of it all is maddening.

(3) Only 15 states in the US require fertility treatment to be covered by insurance.  I am incredibly lucky to live in a state that has mandated coverage for fertility treatment. I had erroneously assumed that if Alex and I didn’t get pregnant on our own, that we would have to pay out of pocket for fertility treatments.  Thankfully, this is not our reality. My insurance plan covers fertility testing and treatment all the way through IVF.  However, the majority of infertile couples in the US are still faced with the harsh reality that they may have to pay for infertility treatments out of pocket. The average cost for a fresh IVF cycle in the US is $12,000. And, what sucks even more, is that there is never a guarantee that a fertility treatment will work. The average success rate for IVF cycles in the U.S. is around 40% for women under 35  (SART National Summary). Some women have to go through multiple rounds of of IVF in order to achieve a successful pregnancy, while others may exhaust their funds or their ability to endure further treatment and never achieve a pregnancy through IVF.  Some women may never be able to afford IVF in the first place. The cost of infertility, both financially and emotionally, can be devastating.

(4) There is no such thing as JUST adopting.  I guess I was a strange kid, because from a young age,  I remember thinking, “There are so many children who need homes, why would you go through fertility treatment if you can just adopt?”  Well, reality’s a bitch, and I had no idea what I was talking about. No one JUST adopts.  Infertility treatments and adoption are two equally valid but entirely different routes to starting a family.  Infertility is a disease; therefore, seeing a reproductive endocrinologist and seeking answers through medical diagnoses and treatments is a logical path for many couples.  Adoption is wonderful and many couples (both fertile AND infertile) start their families this way.  However, adoption and/or fertility treatment is not for everyone. Both options can be prolonged, complex, emotionally difficult journeys with their fair share of financial burdens and ethical considerations.

I am very interested in pursuing adoption and have been researching our options for a few months now. I could spend paragraphs outlining the various adoption options (international, domestic, foster-to-adopt, etc), but  that is material for another post. Starting a family is my top priority – whether that child grows inside of me or finds his/her way to us through adoption makes absolutely no difference to me.  However, here I am, planning my first cycle of IVF.  It turns out that IVF is fully covered by our insurance, whereas a domestic adoption will most likely cost us $20,000-$40,000. There are tax credits and other avenues to make this option more affordable, but it won’t be easy.  So adoption has become our “long-term plan” while we pursue the “short-term plan” of fertility treatments. I certainly don’t see adoption as a “last resort.”  We just need a little more time to get there. So, we have decided to pursue fertility treatments and research the adoption process simultaneously.  If fertility treatments don’t work, we will have already started the adoption process in the meantime.  If fertility treatments do work, we may still continue with adoption for our second child.

I don’t think adoption is any easier or harder than fertility treatments – it is just different. Every couple’s situation is unique, and we shouldn’t be so quick to judge others for the decisions they make to resolve their infertility.  And, one last thing: If adoption is a social responsibility, this responsibility should fall equally on the shoulders of infertile and fertile individuals.   I’ve always been interested in adoption, even before I knew I was infertile. Just because a person can’t conceive doesn’t make them any more cut out to adopt than someone with a fully functioning reproductive system. So, please learn from my mistake and never tell an infertile couple to JUST adopt.

 

IUI Cycle #3

So, IUI #2 was a bust.  Too many mature follices, triggered early to avoid a high risk of multiples, and then period came a day early.  I didn’t think this one would bother me as much, because my hopes were much lower than the first cycle, but it did.

We are in the midst of IUI Cycle #3 now, and on a similar protocol to IUI #1.  We started with 50iu of follistim, I’m assuming to play it safe after I overstimulated on 75iu last cycle.  In my first cycle, I was responding by my CD7 check.  Not this time – same dosage (50iu) and no response whatsoever.  Come on ovaries!  So, my doctor upped the dosage to 75iu again, and I was a little worried that I would produce too many follicles again.  But, I think it worked out in the end. I had a lead follicle at 19mm, then a 16mm and a 13mm on the day of trigger. So, at least one good egg, maybe two.

I’m now on progesterone (endometrin) till July 2nd, when I can take a pregnancy test.  I had to open my big mouth and ask the doctor about my progesterone levels i and luteal phase length during the previous IUI cycles.  The doctor didn’t think it was an issue, but put me on progesterone anyway, just in case. Great job, Jenny – as if you weren’t on enough medications already.

When the nurse called me with my progesterone level today, it was at 19!  My progesterone has been 9.9 during previous cycles.  So, it more than doubled due to the progesterone suppositories.  I had to stop myself from getting excited/hopeful, because, my progesterone level has no bearing on me getting pregnant in the first place – it is supposed to help maintain early pregnancies.  I’ve just never, ever been pregnant, so I’m not holding my breath.  But, let’s face it – I’ll take any excuse to believe that THIS is the cycle.  And, it never is.  Infertility has taught me the importance lowered expectations and defensive pessimism, but at the same time you can never fully kill that hope that maybe, just maybe, this will be your time.