A Minor Nuisance

Bureaucracy, emotions, current events,your body and even the weather may become obstacles when going  through fertility treatments. If only we could anticipate and control all those “things” that come up in life and prevent us from getting the job done. Two years of treatments have taught me that some things are beyond my control and that realization is often a relief.

After both consulting with a new doctor and some deliberation, we decided to move forward with a new round of IVF. Everyone seemed to be telling us the same thing, it just takes time and keep at it. Even Dr. Google’s resource of choice concurred: IVF is effective in dealing infertility related to endometriosis. Still, I wanted to be sure that we had weighed all our options and I had heard good things about the Center for the Treatment of Endometriosis  at Tel Hashomer hospital. If anyone was going to have “the magic answer” it would be them.

Early this morning I left our apartment and thanks to the brilliant programmers at moovit I made it to the hospital complex(though finding the clinic within the hospital complex is an entirely different challenge). As my bus pulled into the hospital’s entrance my phone rang. My appointment had been cancelled; the doctor who I was scheduled to see would be attending the funeral of one of the soldiers who was killed in Gaza.

Given that I had traveled in from Jerusalem, I asked if I could see another doctor,but the secretary confirmed that there was no one else available. I hung up the phone mildly annoyed – another delay would cost us this month. Thank you Hamas. Then I took pause to comprehend the situation. The violence over the past few weeks has killed hundreds of people: civilians and soldiers. Living in Jerusalem, I feel safe and can only pray that we find a way out of this violent and painful moment. I am extremely lucky and incredibly thankful. Life is not lived in a vacuum and so it goes with fertility treatment: they move forward or are called to stop by both the mundane and the exceptional events.

On my way back to Jerusalem I picked up some supplies to donate to soldiers who are risking their lives. In the scheme of things, schlepping to Tel Hashomer and back was only a minor nuisance.

 

Returning to the Routine

This time is different, or at least I am experiencing in a new way. Over the past 13 years I’ve been through a number of cycles of violence between Israel and its neighbors. I don’t spend too much energy debating how it should be handled because I don’t have a good answer. Like most Israelis I do my best to continue with my life and pray that an enduring and peaceful resolution can be reached.

As a resident of Jerusalem, my daily routine continues: I continue to work and socialize almost as usual. Yes, I make sure that I know about safety precautions and the nearest bomb shelters when I am away from my home, but for the most part my life continues. When I hear a siren indicating that rockets have been launched in the direction of Jerusalem, I make my way to the shelter and wait until I can safely return to whatever I had previously been doing. I’m not suggesting that it is easy and certainly not ideal, but I, like many Israelis, continue to continue. People still go out to pubs and events – though a few larger events have been postponed or canceled due to safety concerns – there are still tourists on their summer vacations, and the World Cup is part of daily conversations. There is a real effort placed on maintaining as much of a normal routine as possible.

My routine involves IVF treatments and those continue as before but they may be my biggest challenge in dealing with this outbreak of violence. My Facebook feed is full of comments by parents forced to wake their sleeping children in the middle of the night to bring them to the safety of a bomb shelter. There is a part of me that is grateful to have been spared the fear of parent who finds themselves apart from their child at the sound of a siren. Still, the fear and violence affects my experience in fertility treatments. I fear the day that when I have to rush my child to safety.

Optimism and hope are what push me forward through the hardships of IVF. It pushes me through the stress of the treatments and allows me to see beyond my immediate situation. Unfortunately, it is precisely these two feelings that are most difficult maintain while standing in a bomb shelter. I do hope to bring a child into the world, but I’m concerned about the world that he or she would enter. Optimism is hard to maintain given the daily news cycle. Devoting significant energy to creating life seems trivial amidst the violence.

I return to the IVF clinic accompanied by two prayers: that this IVF cycle will be met with success and that my children will inherit a world where peace is routine.

For My Birthday

People who know me well have probably picked up on two things: I love to celebrate my birthday and I seek meaning in the numbers associated with each year. Both became more pronounced when I realized that anywhere outside the United States my date of birth is written 5/6/78 – I’ve yet to get over how unique that is and it makes me feel pretty cool. I went a bit overboard in the year 2012, on my 34th birthday, I insisted that a toast be made at both 9:00am and 9:00pm, thereby associating and celebrating all the single digits with related to my birthday.

The Hebrew language makes these associations all the more interesting because each Hebrew letter has a numerical value and adding significance to the birthday. Many people know that 18, Chet and Yud,  spell chai meaning life.  I know some of you believe this to be nonsense but I have observed these numbers playing out in my life. Take for example the number 28, its Hebrew letter equivalent is Kaf and Chet,  which form koach (strength); the year after that birthday was difficult and I needed a good amount of strength to push through. My favorite is 32, Lamed and Bet, lev (heart). Tommy and I met when he was 32 and I was 32 when we married. Maybe this is all about self-fulfilling prophecies, but either way I enjoy it.

All this brings me to this year, today, my 36th birthday- 18 is life and so 36 is double life. No, that is not a plea for twins and yes, I do know the risks of playing around with fertility drugs. Usually my birthday celebrations are quite standard: food, cake, wine …. This year, however, we’ll be doing things a bit differently as Tommy and I will spend a good portion of today trying to get pregnant. This is all absent of any romance you might imagine because this process involves: fasting, an IV, anesthesia, a couple of doctors, quite a few nurses, bed rest and mostly patience. It was not the celebration that I  had envisioned, but my body calls the shots on this one.

Tommy and I celebrated a few days early and I may arrange a belated birthday related event- with daily visits to the fertility clinic this past week I have  not found the head space or energy to put it together. For now, I am just focusing on today, this moment and all the hope and potential it holds.

 

*******Note to readers: Normally, my posts describe events that have already transpired and I don’t anticipate that changing moving forward. I felt a need to share colliding of events because they could not be ignored. This is not an invitation to ask if I am pregnant or if it worked. I will let you all know, at some point. For now send good vibes and happy thoughts.

Sharing the Burden

Nothing beats a moment of clarity. We all have them every once in a while: after mulling over different options or scenarios you know with absolute certainty how to proceed. This week I had one of those.

For the past couple of months I have felt ambivalent about this whole process. Last May we put a nice stash of embryos into the freezer and over the year completed 3  transfers. I was even pregnant a couple of times, and then not. I have yet to formulate the words to describe the emotional roller coaster that we have been on.

Suddenly, we found ourselves back to almost square one. However, by this point I was tired, uncertain, skeptical, scared and unmistakably aware of the toll that it was taking. “Keep at it” the doctors say we’ve only done two rounds and have had some “promising” results. Still, inside I was relieved that we would be taking a couple months off. It gave me time to forget,  escape and reclaim my body.

As Passover came to a close I started to dwell on the inevitable, the day I would walk  through the double doors of the fertility clinic and start the process all over again. As much as I knew what I had to do and all that it involved, I could not accept it. My energy reserves were all cashed out and I did not know how I would do the seemingly impossible.

I kept hinting to Tommy, but I was torn because I also knew that we were not ready to stop. I just could not figure out how to begin.

It hit me as I sat in a course given by the university’s psych. services designed to help staff members recognize and respond to mental health issues among students. As I listened to the psychologist speak about identifying the needs of a student in distress, I thought “what do I need?” “how do I move forward?” This time I had the answer: I needed Tommy.

The first step in IVF, and various other fertility treatments, is to track the woman’s cycle up to the point of ovulation. It involves a blood test and ultrasound every few days. It’s pretty straightforward and therefore many women do this stage on their own. It didn’t make sense for both of us to miss work and Tommy’s presence was not required.

Something had changed and Tommy’s presence had become absolutely critical. It was the starting point because I knew that he would have the strength to open those cumbersome double doors and share the burden. The rest was on me, but this he could and would do.

I sent Tommy a text with my realization and the bottom line: “I need you.”

Thirty seconds after I received his response: “No problem.”

Anything You Say….

Discussing fertility or IVF in Hebrew is like playing with fire.

Here’s why:

Hebrew word for ova (plural of ovum)= ביציות beitziot

Hebrew word for both eggs (gobble gobble) and testicles= ביצים beitzim 

And so as I discussed IVF with a group of women this evening I mentioned that  “In my last round of IVF they retrieved 6 testicles.”

So my list of embarrassing moments is just that much longer.

Under My Umbrella

My phone rang as I made my way home from work yesterday. It was Tommy.

Tommy: “Are we still going out tonight?”

It’s cold, wet, and hailing in Jerusalem these days and the only thing that I wanted to do was go home and hang out in fleece pajamas under a warm blanket.

Me: “Um, I think we are going to have to rethink our plans. Can you pick up dinner on your way home? Thanks.”

Like many couples we plan  “date nights” when we go out and do something new together to enjoy each other’s company and break up the routine. Making these evenings happen is an important part of everything that we are going through; they are little escapes from the disappointments.  But most importantly they are reminders of all  that we have in each other. I usually walk away with a half full glass – though if the evening involves a good bottle of wine the glass is definitely empty by the end of it!

Both of us were looking forward to an evening out. The week has not been easy. My body and  its constant changes have left me feeling physically and emotionally out of control – you never know if it’s the hormones affecting you or something else. After our most recent appointment with our doctor, we have been mulling over some big decisions and feel mostly left in a haze of uncertainty. The idea of going out to a nice dinner and just forgetting it all was exactly what we needed.

My commitment to date night aside, the weather put a real damper on things. While you can’t complain about rain in Israel  (we desperately need it these days), I don’t feel obligated to venture out in hail. Date night would have to wait. I made my way home on the bus and the phone rang again.

Tommy: “Where are you? Are you close? It’s pouring outside and I don’t have an umbrella.”

He was standing under a covered walkway between our apartment and the bus stop.

Me: “I’ll be home in ten minutes and yes I have my umbrella. Wait for me and we can walk home together.”

I stepped off the bus and saw Tommy standing in a tiny haven from the storm. In truth I was skeptical that we would be able to share my small umbrella and assumed I would end up soaked. I handed him  the umbrella and we started to walk, he put his arm around me to both coordinate our pace and to maximize the umbrella’s coverage. At a certain point he started to sing. You’re crazy, I thought. Then I joined him. There we were: one umbrella, torrential downpour, and singing. I wished that that moment would never end because I felt complete, wanting for nothing, and happy beyond my wildest dreams. It lasted a mere two minutes but in that brief period, we escaped, together.

chillax

The other day, I went to the IVF clinic for the routine blood test and ultrasound and as I waited for my turn I watched the morning news show on the television. I think everyone in the room was watching because at the time the “hot topic” of Israel’s news cycle was all about the new law related to IVF coverage. Until recently most people believed that women in Israel were entitled to coverage for unlimited rounds of IVF - not entirely accurate as a doctor, and often a board,  always had to determine that the woman was candidate for IVF. Now the popular misconception is that a woman is only entitled to eight rounds of IVF and then she is left with no recourse.

The segment that morning involved an interview with both a woman who gave birth after her 10th round of IVF and a reproductive endocrinologist. The last words of the interview came from the doctor who advised viewers, “do yourselves a favor and have children early.” Thanks, that was helpful because there are absolutely no women who have fertility issues in their 20s!!

Annoyed and frustrated does not adequately describe my reaction to the media’s need to sensationalize this story. So I beg and plead that it stop and will now set the record straight. For starters, the law doesn’t state that a woman is limited to eight cycles of IVF, but rather it qualifies that if a woman does not become clinically pregnant (referring to the appearance of a gestational sac) after eight rounds her case will be evaluated by a committee. Additionally, the law specifies that if no embryos are available for transfer after four cycles, then the case will also be reviewed by a committee – I believe this was previously part of the law. Finally, the law allows women who are passed the age of 42 to begin IVF treatment immediately and not go through the previously required stages of fertility treatments such as IUIs.

Over the past year and a half, we have completed three IUIs (required by the law) and are in the middle of our second round of IVF (a round includes the transfer of frozen embryos). Since the law has always limited the number of cycles that a woman can do in one year, it would take at minimum two years to complete what is now covered under the new law. I know that people spend years trying to have a baby through IVF, but eight cycles would in many cases still cover years of treatment.

I do hope that this law impacts fertility treatments in the country in a positive way by encouraging both doctors and women to take a closer look at their treatment and consider various options. At times I feel like my clinic is a factory and I struggle to receive personalized care. The treatments and approach are standardized and the doctor believes that eventually it will work – there is all the time in the world! As an optimist I want to believe that the new law will encourage doctors to take a closer look at their patients and, when possible, seek more specified treatments.

When we started this process, Tommy and I discussed how long we were willing to try IVF. I knew that it would be taxing – though I had no concept of the extent to which that would be true – and I needed to set a limit. In our situation eight rounds will suffice regardless of whether we have a biological child. I am not suggesting that that approach will work for everyone but it was essential for me. We know that there are multiple paths to parenthood and though each has its obstacles, we will get there one way or another.

While people are welcome to disagree with my take on the new law and its consequences, one thing that is rarely debated is that stress never helps the situation. So I return to my initial point and ask that the media refrain from sensationalizing this story. Anyone who has been through this process knows it is best when approached one day at a time.

Between Dos, Don’ts and Empathy

Weekly phone or Skype conversations with my mother have been a tradition since I moved to Israel.  Sometimes these are great and last hours and other times they go more like this:

Mom: “Hi Toby. What’s new?”

Me: “MOM! That’s such an annoying question!”

Doesn’t she get that I don’t feel like talking about that right now?! She’s walking into a minefield at times and  can’t win, but I do love her for trying. I suspect that over the years she has  mostly learned to interpret my responses and she proceeds with due caution – mostly.

In a recent conversation, we discussed the fertility treatments and I made a slightly sarcastic comment. My mother was about to disagree with or otherwise correct my statement and stopped herself mid-sentence. Instead she said something like:

“You know what? I really have never been through this myself so I can’t really tell you how to feel.”

I was filled with warmth and love. It was all I needed to hear at that moment.

So, what should you say, or rather not say, to me as I share my struggle with infertility? Quite a few lists out there address the dos and don’ts when speaking to a couple or person going through fertility treatments, or any other of the numerous trials we all face in life.

Though these lists can offer someone going through a difficult time the comfort of knowing that others have been there too, I don’t find them  particularly helpful in actually knowing what to say. Why? Because the experience itself cannot be conveyed in a list. My emotions are fluid. Our path to parenthood has turned into a lengthy and trying process. What was painful to hear yesterday is hilarious today and vise-versa. As far as I am concerned, there is no rulebook for relating to me – except maybe this one –  you just have to feel your way through it. Don’t worry, I don’t bite. Often.

Where does this leave you though? In the dark? Maybe. Here is a hat tip to  Naomi Weiss (my self-professed biggest fan) for sharing this:

‘Nuff said!

Both Sides of the Coin

Who doesn’t like a snow day, or two, or three….?I think I’ve done  a good job making the most of mine: slept late, drank hot chocolate, caught up on TV series, made waffles.  I don’t have any real affinity for snow in and of itself. My parents never took me sledding – not a complaint, just a fact- and I have no real love of snowmen. Tommy, my Hungarian husband,  believes that the snow is not fun here, it’s better in Hungary but here it is just a nuisance.

To be sure the Jerusalem municipality did a dismal job of cleaning up the snow and all that came after:

2013-12-16 11.52.34

Though I like these relaxing days for what they are: me days!

Then I go to Facebook and I see the pictures my friends have posted: baking cookies, sledding, building snowman, making memories – all of it with their children and it looks like so much fun, maybe more fun because it is with kids. I can’t help but wonder when it will be my turn to create these moments with my children? I even find myself hoping that this is not a one time event for Jerusalem – though please not in the near future!

I ask Tommy: “Will we take our kids to play in the snow one day?’

“Of course,” he answers, “in Hungary.”

I know that there are two sides to this story. Parents are at their wit’s end trying to figure out what to do with their children going into the fifth day straight of school closures. I’ll wake up at 9:00 am tomorrow morning – an hour that parents of  young children can only dream of – I won’t have to deal with children climbing the walls. Childcare is not a concern for us on those days when Tommy and I need to work and schools are on vacation. We are flexible and free to do what we want when we want to and we enjoy it.

Still, one day I plan to take my kids sledding, perhaps in Hungary.

Reassuring Information

The following is an actual conversation I recently had with a friend, I find it very telling:

      Friend: “So who is your doctor?”

      Me: “Dr…..”

      Friend: “Oh, he got all my friends pregnant!”

Can’t beat a man with a reputation!

Brave?

Since writing this blog’s first post  I have received quite a bit of feedback from my readers. One of the recurring things that I have heard is, “what you are doing is very brave.” Brave? not really, what is particularly brave about it? I am told that most people would want more privacy. Well,  my life is Mostly an open book.

People say that blogging about our infertility is brave because most couples who have to deal with this issue are ashamed or embarrassed. That never made sense to me, embarrassing is:

  1. Running away from the microphone in the middle of your speech at your Bat Mitzvah.
  2. Introducing a colleague, one with whom you have worked for over a year, by the wrong name.
  3. Modeling your underwear to everyone at the bus stop because your skirt falls off as you run to catch the bus.

Infertility does not belong on this list.

I understand people who are concerned with their privacy, but I have discovered many wonderful things in my willingness to share my/our experiences. Last week my mother, one of my avid readers, called me after she had learned more about endometriosis and asked relevant questions about my treatment. This was the first productive conversation that the two of us have had on the subject and for a mother and daughter that can mean a lot. A friend suggested I should no longer refer to myself as  the infertile half of the couple because it can lead to feelings of guilt or inadequacy. After all, she noted, it takes two. There are also those people who have read the blog and shared their own experiences. Knowing that other couples have been through this makes us feel less alone.

More than anything else, by sharing this experience  I am able to gather the strength I need to push through this challenge. The past year has not been easy, but knowing that people out there are rooting us on and hoping for the best makes it a bit easier. So with the support and encouragement of those people who care I become not brave, but strong.

The Disclaimer

Today I had a choice: I could either go to work, or not – guess how this one turned out. I love that the university gives me Yimei B’chira (elective days) allotted to certain holidays on which I can choose whether I want to work or not – too bad I only get three a year! The plan was clearly to sleep in, but at 8:00 am I was wide awake (if you think waking up at 8:00 is by any definition late, I assume that you have children).

As I was lying in bed, wide awake, for no good reason, I of course began to think about possible posts. I more or less already have about 30 posts that I would like to share. These are mostly cute anecdotes, with little bits of information thrown in here and there. The blog is meant to serve four concrete purposes:

  1. Keep people posted in a lighthearted manner
  2. Demonstrate that conversations about infertility are not taboo
  3. Perhaps offer perspective to other people facing the issue
  4. Satisfy my constant urge for an audience

This post was not planned, but it hit me that I must put out the following disclaimer to all: I am the farthest thing from an expert about any of this. You already know that I have no medical certification, but the situation is far worse than that. I don’t read blogs on infertility; without a little help from google, I can’t tell you the phases of a woman’s cycle (and I know that many woman out there can recite it by heart). I didn’t even know about the TWW until someone used the acronym in a conversation – her response to me was “Toby, don’t you read blogs?”

Truth, no, I don’t really like them.

The alarm on my biological clock?

This scene from the movie My Cousin Vinny has stuck with me over the years:

I laughed and understood that Marisa Tomei’s sentiments were those of most women. The accepted narrative being that women are in this big race against time to fulfill their purpose of bearing children. Once you hit your mid-20s, the clock starts ticking. So naturally, one day I too would hear that same dreaded tick-tock.

Lo and behold, that  if the alarm on my biological clock has gone off, I must have hit snooze. To clarify, I am not referring to my body. If being 34 means that I am supposed to feel a time crunch to have children, then I must be young at heart because I feel no pressure. I am not in a race, not against my own body and certainly not against anyone else.

Let me explain, I grew up in the Jewish Modern Orthodox world and imbibed in my childhood was an understanding that I was meant to meet a man, marry and start a family-in that order, please; I spent a lot of time struggling to find my place in this world as a single woman. So I dated,  A LOT.  Blind dates, during which I learned the crucial lesson that you must, must Google people before accepting a date and that one little cup of coffee can actually be a form of torture. I willingly shared the details of “what I was looking for” with every new person who asked – remember I talk a lot. Sure, I had fun too, but  all of this was towards the fulfillment of my destiny. At a certain point the word beshert made me want to vomit.

Then the most dreaded of events suddenly happened, I turned 30- as a single woman- oh the horror! Surprisingly,  I was overcome with a sense of freedom. I could hardly believe that my world did not crumble in front of me, but instead it got so much better! I picked up and moved from Jerusalem to Haifa, started a new job, and added some more friends to the wealth of great people in my life. I felt liberated, and I stopped behaving as though I was waiting for a partner to come around so that my life could begin. I still dated, but I was not afraid to be fulfilled by and grateful for the wonderful people and elements that my life comprised. It was also around this time that I thought about whether I would want to parent a child on my own if I didn’t end up meeting a partner. For me, it was clear that the answer was no;  I would only embark on all the challenges involved in parenthood with a partner. Make no mistake, I still wanted to have kids, but the alternative did not feel like a compromise or some inferior existence; I had visions of the things that I would do independent of who was in my life. Quite simply, I was happy and content.

Enter Tommy, the love of my life. In the blink of an eye we were envisioning our lives together, talking about a family, and I was moving back to Jerusalem (the things you do for love). I knew that most people must have assumed that we would want to have kids immediately. After all, we were in our early 30s, so tick-tock, tick-tock. In fact, we were, and still are, so happy that we wanted to take time just enjoy each other and our new shared life without all the common “joys” that go along with pregnancy, preparing for a child, and then having an infant. The rest of our lives was, and remains, ahead of us and we chose to cherish the moment. We knew that if infertility was an issue that we would face then so be it, but we would not allow our lives and every decision to be dictated by that possibility.

I have yet to hear the clock, but I do have a condition known as endometriosis; I had it ten years ago and I refuse to consider that I could or should have done anything differently to change my situation. Tommy, on other hand, could have asked me out years ago when our paths crossed for 30 seconds in 2005! Here’s a reality check, both men and women hear the clock ticking away when it comes to their lives. I refuse to spend precious moments obsessing over those things that are missing in my life, because let’s face it, there will always be something. Instead, we make the best efforts to move forward towards all of our goals, but we are sure to enjoy all the wonderful things that we have together. No regrets.

Afterall, tick-tock.