Thursday 18 February 2016

Talking about fertility again, part 1

For the past two years I've know that at some point I would be talking about fertility again. I've never stopped thinking about it, other than perhaps the anxiety-ridden weeks of early pregnancy, and labour, and the first month of AJ's life.  During those particular points in time there was no room in my mind for thoughts about future fertility / sub-fertility / infertility. But most of the time, there's a dialogue about it in the back of my mind, and anything that happens in my life, or that I read in the news, or on another blog, or in a conversation, or __________ (fill in the blank) becomes part of the commentary.

Of course, there have been plenty of reasons to silence or ignore this commentary for the past couple of years. And I have. But in the last few months it's become harder to ignore, and finally I'm relieved to put the questions and the thought process out there. One way or another, we have to move forward. So here goes.

It all comes down to a couple of questions, basically: How important is a second child to our family, and what are we willing to do to bring that child into our family?

Mr. Turtle and I both agree that we would like a second child. We seem to be doing alright with the child we have, and in our innocent visions pre-IF diagnosis we always thought we'd have two or even three.  At the same time, we can both envision a happy family with one child, i.e. A.J. After all, we are a happy family now! It does not feel like a great burden to simply go on being a happy family. Of course, for me, stopping at once child means accepting that I will never be pregnant again, never give birth, hold a newborn, breastfeed, etc. etc. This is hard to do. I could write a half dozen blog entries about why, but I'll just leave it at that for now.

So, we want to try for a second child. We offer our will and wish against.............whatever in nature opposes it.  But what exactly are we willing to try?

Our ideal scenario: We get pregnant again without intervention. It happened once, after all. Or at least, I got pregnant after a failed intervention. I'm not sure that's quite the same as you know, natural-naturey-naturally-O, but I doubt we can exactly replicate the conditions of that conception (shudder).

The challenges here? Mainly premature ovarian failure. POF.

Here's the dirt. We've been sexually active more or less regularly for about a year.  Factor in parenting a young child, a parade of infectious illnesses, death in the family stress, work stress, graduate school stress, etc. etc. and it's certainly not been optimal conditions all the time. But still, we show up for our dates of reproductive roulette.

My period returned last April. My cycle lengths since then: 30, 23, 21, 44, 20, 21, 24, 25, 67 (I almost lost track with that one!), 19, 21.

I ended up going to see my doctor during the really long cycle because it was unusual even by my standards. Except my doctor was on holidays, and the one that saw me looked about 22 years old. Sigh. But actually he was able to call female reproductive parts by their full names without smirking, and that's better than I've sometimes experienced. We went over my reproductive history, including several letters from The Fertility Clinic. When we (mainly I) was undergoing testing in 2013, Dr. Cotter kept my family doctor informed by sending him letters describing the results. I had never seen these letters as Dr. Cotter would meet with us in person. She wasn't one to mince words, but somehow the letters seemed even harsher than the meetings I remember. My POF is "severe." There is little to no chance of unassisted conception. And so on. It felt very cold.

The conclusion of Not-My-Doctor was that my very irregular cycles are consistent with the POF diagnosis, and that I can expect more of the same, followed by early menopause. He did not think more testing was necessary, but I said I would prefer to be pro-active about my health. So he requisitioned a few blood tests, an ultrasound to look at the ovaries and fibroids, and, on second thought, a bone density scan since low estrogen can lead to osteoporosis. I go for the ultrasound/x-ray tomorrow, and the plan is to schedule another meeting to discuss the results with my real doctor (Dr. Gnomish on the blog).

I'm expecting that the bloodwork and ultrasound will show similar results to my 2013 tests, and can only hope that things have not gotten much worse, but it wouldn't surprise me to learn they have. I'm not too concerned about the bone density scan, because I don't have symptoms of low estrogen. But we'll see. I also discussed the long-term health implications of POF with Not-My-Doctor. The main concern with early menopause is low bone density. Hormone replacement therapy addresses this issue, but also causes infertility. Not just almost-infertility, but complete infertility. Hormone replacement also leads to a slight increase in the chance of uterine cancer, although that can be addressed by the proper balance of hormones. It slightly decreases the chance of breast cancer. It also can improve "lifestyle" by regulating the irregular or heavy periods associated with POF.

Unless these tests show something really unexpected, I am not interested in pursuing hormone replacement therapy, and I don't think I'd even consider it until I'm completely in menopause. But still, it's part of the discussion.

So, in summary, it's not a very optimistic picture, and then add to that Mr. Turtle's sperm problems.  On the other hand, we have a cuddly, adorable, and very real counter-argument in the shape of AJ. Should that give us hope? I don't know.

Back in 2014, Dr. Cotter told us that we should pursue donor egg IVF, that anything else was a waste of time. And if we go back to The Fertility Clinic, I don't expect to hear any different. It would be nice if there was a reproductive specialist who could analyze how I fell pregnant in the first place, and come up with some personalized treatment to help that happen again, but I doubt it. I have no reason to believe Dr. Cotter was dishonest with us, but The Fertility Clinic is a business and they will steer people toward whatever process is a money-earner and will hopefully look good on their statistics.  There's no money in or research into people who become pregnant after a failed IVF cycle.  I don't think so anyway.

That leaves, most likely, DEIVF. We were on track to do DEIVF in 2014, and we were completely OK with it then. Obviously since we didn't end up doing it we didn't fully process all the emotions. But we didn't have any ethical issues with DEIVF. And I think DEIVF is an amazing option for many families.

Now, however, with AJ in the picture, things are a bit more complicated. Since this entry is already getting long, however, I think I'll save that discussion for another entry. For now a big fat novel is calling me.

Jump to Part 2 of this contemplation

16 comments:

  1. Way to leave us hanging... Which novel? Haha. I too have been only thinking and not actually wanting to talk about fertility challenges. It is chock-full of emotion and unknown. I seem to know so many people that had "lightening strike" after being told it would only happen with assistance. But you are right and there isn't any money in researching why or how this happens. I don't have any answers, just know that I'm listening as you navigate these stormy waters and at some point might join in. Not sure when that will be, finally going to pelvic floor therapy and it could be viewed as the beginning of the process.
    Ps. I'm currently reading The Red Tent again 10 years after the first reading. Not so sure reading about all the births is such a good idea when I'm feeling so unnerved about trying to conceive again.

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    1. Thanks for the comment and support! Yes, it is so full of emotion and unknown; I wish I could avoid it but until we make some sort of decision we're in a holding pattern and truthfully that just makes me more obsessed, so I have to jump one way or another. I hope pelvic floor therapy helps! I do believe in taking good care of your health; I have had negative experiences from ignoring things I shouldn't have. Thanks for the book recommendation...or is that warning? haha. I am reading Dragonfly in Amber by Diana Gabaldon. Or rather re-reading. I didn't want to start any new books trying to follow an unfamiliar plot and characters sounded like too much of a commitment lol. I've only been reading familiar fiction and non-fiction. DinA is a very rich and interesting book (#2 of the time-travelling historical series). Also has some traumatic pieces, including sub-fertility and a still birth (but I'm past that part now and feeling easier). Although I'm dreading the dramatization of it in the upcoming TV series. Anyway, good to know there are fellow travelers out there on the road and to be reminded that good books are a welcome distraction!

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  2. ha yes, don't live us hanging!!! Keep us updated!

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    1. Ha, I guess these thoughts have been rattling around in my head so long I forget everybody doesn't already know about them. Thanks for reading, will write more soon.

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  3. As a DEIVF mom I can totally see the complications that would come from already having a biological child. I have the same thoughts, but in reverse (ie. what if we got pregnant naturally? HAH. But seriously, would that be bad for Q's self worth down the line?). Hopefully people won't badger you too much with "So when are you having another??"

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    1. I can see your perspective too, and it's difficult to say what it would be like because families built via donor gametes are quite a new thing; there isn't a lot if conventional wisdom to guide and I don't know if anyone has tried to research family dynamics. I guess the closest equivalent might be stepfamilies but that is not quite the same, because the history and relationships are different.

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  4. I remember the stress over having a second child or not. Like you, we felt that we would be happy as a family of 3 too. What helped bring peace for me was determining how many treatments we were willing to undergo before starting anything. We decided on one IVF cycle and if that failed, to keep trying naturally until Sawyer was 2, at which point I would have wanted to implement a longer term or permanent birth control option because I couldn't picture myself living with that stress for much longer.
    Our story of course is very different but we did run into the same negativity from the clinic and I am honestly wondering if their prognosis is even realistic for most people. I personally know 2 other women who were told they needed IVF and still got pregnant. These aren't the "my aunt's neighbour's cousin's daughter who lives in Boston" but people going through our fertility clinic. I was also told I had a chance of almost zero to get pregnant naturally despite us being "unexplained" and young at the time. I did get pregnant naturally, had a miscarriage but I DID get pregnant. And then with IVF, both times they told us our embryos didn't look good and too small a number had survived to day 3 so they weren't hopeful. Well you know what our outcome was so that has left me thinking that they do a lot of guessing and don't really know the answers either.
    So... maybe your chances are better than you would think going by their prognosis?

    I hope you will get the best possible answers out of the new tests and that you will soon be on a course towards that second baby.

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    1. Good advice and thanks for your comments about RFP. I wasn't aware that what we experienced might not be uncommon (I wouldn't go so far as to call it common). Maybe it's a matter of promising less than they can deliver, or maybe like you say there's more guesswork involved than the (highly paid) experts care to admit. I also firmly believe in setting a limit on treatments, or at least (as Melissa Ford advises) a point at which you review and re-assess.

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  5. This is something I've been thinking about too (A LOT). I would like a second one (if I were younger a third) BUT there are lots of little annoying complications and no decisions have been made over here yet. It's funny (not really) how infertility always sits there, sometimes in the background and sometimes up close. I still read any news articles with infertility in the headline that come across my path.

    Hopefully you will get a second lightning strike sans all the circumstances of last time. I think there are just so many factors surrounding fertility that the docs can never quite get it perfect- but wouldn't it be great if they could explain to you exactly how your miracle happened so you could repeat it? I often wonder why my pregnancy with Bubs stuck when the others didn't.

    And potential future second child aside, I am so looking forward to menopause. I can't wait to say goodbye to Aunt Flo. If I could (after potential future second child) I would have the docs remove ovaries, tubes, and evil uterus. Unfortunately I don't think they do that on an elective basis.

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    1. I agree that infertility permeates life. It's connected to so many meaning of life questions and powerful biological urges; I guess it's inevitable. One thing I really enjoyed about early motherhood was that I was able to let it go (mostly) for a while, but I always know that wouldn't be permanent since there are still unanswered questions. I too hope that with the end of fertility however it happens there will be some closure. I don't want to be 45 and wondering if I'm pregnant or not, I'm sure of that. Yes, so many complications! Thanks for the support and hoping you get some peace and clarity too.

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  6. I hope that your doctor's appointment and bloodwork is favorable -- It is really interesting to me that no one looks at what happens when someone gets pregnant on their own after a failed cycle. I have a friend who is in her 3rd trimester now with her own "surprise" pregnancy after several failures and miscarriages, and she was told nothing but DE IVF would get her pregnant. No one could explain it. It sounds so cynical to say that clinics always go for the biggest moneymaker, but I have to agree to an extent that yeah, that can be true. I hope that you can come to a decision in peace. It must be tricky contemplating DE IVF now that you have AJ, this little piece of the two of you... that would complicate feelings on the matter for sure. I don't have sage advice, just commiseration that it stinks that infertility can have such a profound effect on everything from tracking cycles to thinking about the size of your family and how to get there (or be at peace with where you are). So complex, no matter which way the chips fall. I hope you get information and encouragement to pursue whichever path is best for you and your family. Good luck!

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    1. Thanks. Yes, there's a lot to process whatever direction we take, as well as a healthy appreciation of everything that is not in our control. I am not looking forward to any kind of fertility intervention, but I don't know if we are ready to close the door on that either. So it's weird.

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  7. I know this is an older post, but I have been out of the blogging world for ages and I've just been catching up on reading some of your recent entries. I don't know what exactly brought me back here except I have been having those baby thoughts again more and more recently. I just wanted to say I can so relate to all the things you wrote about being happy as a family of 3 but also feeling the desire for another.

    Last fall, shortly after our little guy's first birthday, we got a huge surprise when we found out we were expecting a June baby. We were thrilled, and I thought maybe I was one of the lucky ones for whom having one child "cured" my infertility. Long story short, it was a brief joy ride that ended in another miscarriage. In my emotional state, I decided to send off the "products of conception" for testing, I guess looking for some closure. It's a decision I now regret as we didn't get any answers and are still dealing with outrageous billing issues. But after that initial rush to do something proactive, I found myself holding back. My doctor offered me an RPL panel and some other tests, which I declined. That decision, at least, I feel very good about in retrospect.

    We are so very happy with our boy, happier than I ever imagined I could be. Every day truly feels like a gift. And yet…there's always the and yet. Seeing another mom at the park with a toddler and pregnant belly always stings. When I think about possibly never experiencing another birth or breastfeeding again, it really hurts. Is it the same kind of panic and grief I felt at the thought of possibly never having a child at all? Not by a long shot. But there is still a longing. In my heart, I still believe there will be another surprise with a happy ending for us. I suppose in spite of the two losses and other difficulties, becoming a mother has made me a more hopeful and positive person in general. But if that's not in the cards, I still have a really great hand. It's an interesting spot to be in waiting/hoping for baby # 2 because there are strong similarities to my experience before having my son, but at the same time it's an entirely different world. Then, our attitude was "whatever it takes"--we were all in. Now, there are very strict limits on what we're willing to wager emotionally, financially, physically. The stakes are lower in that we're already happy, but also higher in that there's now more to lose, if that makes sense. I just realized I used a lot of gambling metaphors there, ha. (I actually really hate gambling, won't even play poker with pennies--I don't like the stress!) Anyway, sorry for the incredibly long comment. Just wanted to say I can very much relate to your feelings. I'm so glad you've kept up your blog, I loved reading the updates :)

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    1. ANNIE!!!!!!!!!!!!!!!!!! (((huge sweep-you-off-your-feet-internet-hugs))) This comment made my day. I am so sorry to hear about your loss. Hope and joy is dearly paid for by you and others in this community, and it is so harsh to have it dashed again. (((MORE HUGS))) How nice it would be to be "cured." (Even if the cure only lasted for one more pregnancy). It is perhaps an especially seductive thought for those who happened to conceive unassisted. I can identify with so much you say here: "t's an interesting spot to be in waiting/hoping for baby # 2 because there are strong similarities to my experience before having my son, but at the same time it's an entirely different world. Then, our attitude was "whatever it takes"--we were all in. Now, there are very strict limits on what we're willing to wager emotionally, financially, physically. The stakes are lower in that we're already happy, but also higher in that there's now more to lose, if that makes sense." Yes, yes, yes. I have no answers, but come back and write as much as you want anytime. SO GLAD little H continues to light up your lives. I'm sure he is too adorable now.

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  8. I ended up having unassisted twins after going around and around with fertility treatments and doctor appointments. It was a terribly long process and my husband and I were giving up hope. It's so incredibly hard on a marriage to keep that process going. We had finally stopped all treatments when I got pregnant with my beautiful twin boys. Keep the hope!

    Margie Day @ Reproductive Wellness

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    1. What a wonderful story! Thank you for sharing.😀

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