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