Author: FutileorFertile

Feelings

Doubt

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In many ways the process messes with your head. I have always been a person who knows when I am right, and when I am right, I am just right. No argument – I’ll let Tommy attest to that.

Today, I found myself facing a moment of doubt. I woke up and followed my routine which includes taking my daily dose of hormones (no shots, yet) plus a super strong pill of folic acid – they give you a stronger dose when you are going through fertility treatments. It was right after swallowing that I was overcome with doubt. Had I just taken the wrong pill? The wrong dosage? Had I ruined our chances for this month? One step in the wrong direction could throw my body off and then  we would have to wait another month!

My concerns stemmed from a conversation I had had with a nurse yesterday; she called to make sure that I understood the new instructions sent through their electronic system. It’s a great system: in the morning I go to the clinic for a blood test and ultrasound and a few hours later I receive a message, through the computerized system, with updated instructions from my Doctor. I read the instructions and pushed a bottom to confirm that, yes,  I understood. It was fairly straightforward and nothing out of the ordinary.

Then she called. Admittedly I was only half listening, she wanted to be sure that I read the instructions carefully. She reviewed the dosage and asked if I had questions. Nope, none. 

Until this morning, why would she call if it was all so obvious? I’m an old pro at this so I must have missed something! I panicked, but also ran to recheck the instructions.

It was a brief moment of doubt, but rest assured, I’m still right.

Feelings

Laughing at (In)Fertility

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I was quite young when I first  became aware of women who had struggled with infertility. It doesn’t matter that I had little understanding of the intricacies involved or that I, V and F were no more than letters in a recently mastered alphabet.  Back then, my  Hebrew teacher emphasized Sarah’s laugh in response to the suggestion that she would finally give birth to a child and that her laughter was a sign of disbelief.  Over the years I discovered that Sarah was not the only Biblical character who faced infertility and that there were numerous responses: surrogacy, competition, depression, despair and prayer.  Today, as I deal with my own infertility I can relate to each of these reactions, but Sarah’s laughter is the one with which I can most identify and find it to be surprisingly prevalent.

My own laughter probably arises from a sense of doubt and this is likely a defense mechanism. If I remain skeptical that treatments might actually succeed it is easier to accept it when they don’t. No matter how far technology can assist, in the end we are counting on a miracle – divine or otherwise. It is this sliver of doubt that keeps me going. Sarah keeps most of her doubt inside, questioning whether after all these years she would finally experience joy. I’m fortunate enough to have the luxury and freedom to express my feelings.  All too often women dealing with infertility hide their feelings for any number of reasons. Maybe they are afraid that other’s will misunderstand or judge their feelings, or maybe the process is too difficult. My expressions of hope, doubt, happiness and sorrow are all part of the experience and giving them voice has become a source of comfort.

Sarah was not alone in her laughter, Abraham also laughed when he learned that he would father another child- though his laughter never receives the same attention as the story is retold.  Early in the text, he wondered if he could actually have a child at the age of 100 with a wife who was 90-years-old. They did not laugh together, but I like to think that the similarity in their reactions reminds us that a couple facing infertility must do so together. It is true that regardless of the cause, the burden of fertility treatments fall mostly on the woman. Nonetheless, both members of the couple are on an emotional roller coaster. Plenty of resources have been developed aimed at women who are dealing with the emotions that accompany infertility, but far fewer exist for men. My husband and I have found it helpful to remember that  this is a shared experience and trial. Through it all we have shared both tears and laughter.

For the most part, I find that society laughs off infertility. Most people learn about it only once they directly feel its affects. While in our adolescence we are taught all about birth control – an important message- often, we fail to encourage young women to understand their bodies and recognize abnormalities that might prevent later complications.  Instead, we promote a culture that tells women to worry about the ever-ticking biological clock long before it is actually a problem. Finally, in cases where a woman, or couple, does face infertility, treatments are often prohibitively expensive. I am always grateful that Israel covers IVF as part of its national insurance and am fairly certain that it would not have been an option for us were we living elsewhere.

Examples of women, Biblical and otherwise, who overcame their struggles with infertility allow me to remain hopeful. I believe that, like Sarah, when given the news of my own pregnancy, I too, will laugh.

Israel

Closed For The Holidays

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There are a few things about living in Israel that never get old: the buzz of  Jerusalem on  a Friday morning, buses that flash the message “Shanah Tova” or “Chag Sameach,” The Rosh Hashanah and Passover bonuses that I receive at my job; I love living in a country with a Jewish culture.  Admittedly, I maintain a strict observance of all Thanksgiving related practice – minus the football- and there is still a warm place in my heart for the movie theater on Christmas Eve, but there is nothing like Israel during the holidays.

Israelis begin their preparations for the fall holidays at some point in mid-August, it’s about that time  when they begin to throw around the phrase “Achrei HaChagim,” (after the holidays). Anyone who has spent a significant amount of time in the country understands the implication of this phrase: everything gets put on hold until after the holidays, no exceptions. There are particular rules for this “season” and learning to accept rather than fight the trend will make for a much happier holiday season. To name a few:  don’t even think about trying to start a new job (you are much better off taking a vacation), assume that all government offices will be closed for two-thirds of this period, never start any type of home repair that will take more than a day’s work by any contractor – if you do, you will have only yourself to blame. In short, whatever it is that you figured was oh so pressing that it couldn’t wait, will have to wait until after the holidays.  Over the years I have been on both the giving and receiving end of this phrase, it’s all part of the culture that I love.

Last year, right before Rosh Hashana,  l learned that fertility clinics in Jerusalem, and possibly other parts of the country, basically shut down for the entire month Tishrei. A nurse told me in passing and I didn’t give it much thought; we were still in the beginning stages of the fertility treatments- tests and IUIs. I was prescribed drugs that stimulated the  development and release of multiple eggs and told  that if  I were  to ovulate over a holiday, then we should try the old-fashioned way. The stimulants at least  increased the chances of conception. At the time I thought to myself, by next year we’ll be pregnant so there was no need to worry (I was so naive!)

Yet in the blink of an eye a year passed and we were well into the IVF process ready for another  transfer of frozen embryos, but that would only happen “Achrei HaChagim.” When you think about it, it does make sense, IVF is an extremely time-sensitive process and there are too many days when the clinic would be closed. It is easier to slow things down to a full stop and give everyone, staff included, a break. Yes, we could have looked for a private clinic or another option that may have been open, but in the end we decided to take a break and wait. It wasn’t ideal, but also was not horrible to escape the process and enjoy the holidays; our embryos remained  safe and sound in the freezer.

Israel is back in full swing and we have returned to our regularly scheduled fertility treatments.

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Something From Tommy (Guest Post by my Husband)

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I’d like to write about infertility from my perspective.
It is not up to us when it will work, or if it will. My approach is coming from the model in the Torah.
Sarah was very old when she finally became pregnant and when she was told that she was going to conceive she did not believe it. She had already given up and that is when it happened. It was miracle. For us, when we get pregnant, it will feel no less miraculous.
Later, we learn that Rachel suffered a painfully long time before finally getting pregnant with her first child Yosef.
The Bible even notes that Rachel cried out to Jacob “make me pregnant or I will die!” These words came out of her mouth because she was very very sad. I think that I am able to understand and sympathize with how she felt, particularly when I remember Toby’s eyes after an unsuccessful attempt.
Both of our foremothers became pregnant only when “the Lord opened her womb,” not before. This is my belief and the answer to the question of when it will happen. It is not in our control and we have to accept that.
We just have to be patient and calm, continue this struggle and gain strength from the stories of our foremothers and forefathers. We have to believe that, God willing, it will happen for us too.
I love my wife and I support her through this very tiring and challenging process, she is a very strong and brave woman.
Most of the process and tests fall on Toby and I am aware that I can’t possibly understand the depth of the hardships she faces with each cycle. Simply, I don’t know how it feels to be injected with hormones, to be checked by doctors all the time and so on.
I don’t experience the process in the same way, but I understand the disappointment when it does not bear fruits.
In some ways I am removed from the process, but I am always with my wife.

We, together, will continue this process, and God willing, we will fulfill our dream and become a family soon!

Feelings

Looking Back and Moving Forward

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I know what you have all been thinking: I hope that Toby posts something for Rosh Hashana! It took me awhile to figure out what to write because it seems all too obvious, when I think about the coming year I hope to have a baby. This wish has the number-one spot on my short list. Sure, I’ll throw a few prayers out there for world peace, but this year I am allowing myself to be a little selfish and focus on what I want!

Someone once told me that couples who are dealing with infertility often have a difficult time around the holidays and especially with the new year. I’m not sure. Throughout the year a  hormonal surge can be relied upon to add  an emotion to any point in time- Tommy has learned to say, “Tobyka, it is not you, it’s the hormones!” In general, my most difficult moments usually have little to do with communal events, holidays or life-cycle celebrations. Instead, the hardest times are usually deeply personal and private and mostly involve disappointments.

If the Jewish new year was only about looking forward, a person could focus exclusively on his or her aspirations for the future and the yearly repetition of an unanswered prayer would make for an arduous holiday season. Fortunately, reflecting on the year that is concluding is an integral aspect of  Rosh Hashana  and Yom Kippur. 

Looking back on this year, I can only conclude that it was a good year full of blessings (both open and hidden). This year I have learned and grown so much: I amazed myself in the sheer number of people I have touched by sharing our story through this blog, I approached challenges with an internal strength I never knew was there, I discovered that members of my family were there to support us in very tangible and helpful ways, and I received an AMAZING recipe for homemade ice cream – ice cream just makes everything better! Tommy lost his job but found a career, strengthened his Jewish practice and knowledge, and used his subtle and still incredible sense of humor to create amazing moments. Approaching this year’s challenges together has strengthened our relationship and taught us both the meaning of partnership – in those moments when I want to collapse in my disappointment, he is my rock. Looking forward, I can only hope for much of the same.

There are numerous Hebrew greetings/blessings for Rosh Hashana and these days I find myself drawn to one in particular: Shana Tova U’Puriah ( a good and fertile year). AMEN! 

Feelings

Other People’s Pregnancies

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We all heard about it months ago: Kate and William are expecting! We were notified when she went into labor and waited with bated breath to find out if the royal family would welcome a new princess or prince – I believe that is his official title. I’m not gonna lie; I’m jealous. She has a great body, beautiful clothes, never a bad hair day and for all that she only has to put up with the constant scrutiny of the public eye. On second thought, no thank you, I’ll take my life instead – frizzy hair and all.

Then it hits me, the royal couple were married after us. We have been trying to conceive for about a year and a half and have had a year filled with IUIs, two rounds of IVF, a chemical pregnancy, and finally OHSS (ovarian hyperstimulation syndrome). So the question that begs an answer is how do I react to the royal couple’s news, and more importantly that of my family and friends who are pregnant or parents?

Truth is, it depends. My biggest fear when I first began to share our struggle with infertility was that people would respond by treating me differently; that they would hide their pregnancies from me. I didn’t want to be overcome with jealousy upon seeing a friend’s belly begin to show. How would I feel when my sister called to tell me that she was expecting again, or far worse, when she avoided telling me? I worried that infertility would slip into all aspects of my life including my relationship with others.

Eventually, the day arrived and my sister told me she was expecting her second child. In that moment, I was overcome with joy at the thought of my adorable nephew as a big brother. Then I realized that she is due right around the time when I would have given birth if the chemical pregnancy had turned out otherwise. I actually felt relieved because it would have been difficult for my mother to be in two countries at once!

That’s when I stopped myself and thought, “Toby, how do you feel about this?!” I allowed myself to feel both happy for my sister and disappointed at my own situation. Mixed emotions are one of my favorite things in life.

There are those evenings when Tommy and I come home from a night out with friends who have children and wonder when it will finally be our turn. Those are the moments when I am most grateful to be going through this with him as my partner. We both know that there are multiple paths to parenthood and we will get there one way or another.

Every person who deals with this does so differently; there is no one way to approach all the emotions that accompany infertility, but in my experience it is helpful to speak with other women and couples who have been through or are currently involved in treatments. Their support and empathy helps me to overcome what can be an otherwise lonely and isolating experience and offers me an outlet to deal with various emotions.

A few days after my sister told me she was pregnant I received another phone call, this time from my 93-year-old grandmother. More than 50 years ago she, too, struggled to get pregnant.

“Tobaleh, I’m calling to see how you are doing, are you OK?  I want you to know that I love you!”

“Bubbie,” I said, “I love you too, and yes I think I will be just fine.”

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Read my post on Kveller

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http://www.kveller.com/blog/parenting/infertility-at-the-bris/

Disease

Sometimes it’s nothing to do with infertility

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It was August 30th 2011, Tommy and I were still in the newly-wed phase of our marriage as evidenced by my willingness to both order and deliver his dinner when he worked late. Nearly two years later, things have changed ever so slightly: no more delivery and all dirty dishes are his domain. The only problem with the dinner for two was that I couldn’t eat a bite.  Though I had been fine all day, that evening I felt strange and decided that Tommy would be dining alone. So I went home, crawled into bed and hoped to feel better in the morning. I was not so lucky; at 2:00 am I awoke to feelings of stomach pain, still I wasn’t sure that it was serious, so I decided to wake up Tommy and allowed him to join the debate – that went over really well. “Toby,  do you want to go the TEREM?!” (the emergency clinic). He was exhausted  and I don’t remember him offering to accompany me.  In any case, I didn’t really want to go out in the middle of the night so I rolled over and went back to sleep… eventually.

That morning I probably should have gone to the doctor before heading to work. However, I prefer to go the route of ignoring it and seeing if it just disappears; it’s kind of the opposite of hypochondria. I was not always like this, as a child I used the tiniest possible ailment to enjoy a day off from school- my parents lovingly nicknamed me “Sarah Heartburn.” Nowadays, I wait for a clear symptom before I accept that something is actually wrong. More importantly, I was three days into a new job and really did not want to be sick so I willed myself to feel okay.

Then, at about noon, I sneezed and felt a horrible stabbing pain on my right side. I jumped out of my chair and yelled “ouch” -nobody heard as I have my own office. Okay, I decided (with some coaching from a few g-chat friends) I should go to the doctor- after work, of course.

After a brief exam where she put pressure on my side to see if it hurt  and it did, the doctor told me to go the emergency room ASAP. She thought it was either and appendicitis or an ovarian torsion, either way I needed to go to the hospital.

Tommy and I headed to the hospital at 6:00 pm and there began six hours of debate between the gynecologists and the general surgeons. Basically, they needed to rule out a torsion to determine that it was appendicitis. As we waited between tests we called a family friend who is a doctor to get his opinion; he thought it was neither because I was far too talkative to be in pain! Do you even know me?! I managed to convince myself that it couldn’t be anything because if it was really serious, they would obviously be able to diagnose it with relative ease. At about midnight they sent me for a CT to rule out a torsion. I was convinced that I would soon be heading home.

Nope. About an hour later the surgical resident came to speak to us and appendicitis it was. He did his best to demonstrate compassion and empathy, but he was a little too excited at the prospect of being able to perform a surgery – if I hadn’t already known this from all the Grey’s Anatomy I have watched, it became blatantly obvious when he bragged to his colleagues as he accompanied to surgery! “How do you know?”I asked. Actions speak louder than words and in response he places pressure on my right side, “OUCH!” Really, I can’t say enough about bedside manner. Tommy called our doctor friend who said, “don’t worry any idiot can perform an appendectomy.”

I went into surgery with so many things on my mind: I gave all of my personal belongings to a nurse who helped me get ready for the surgery while Tommy signed a bunch of papers and I hoped that he would actually receive them; the next day I was meant to have been in charge or a really important project at work or not; I was nervous about the operation and possible infection; mostly, I was in pain.

The next thing I knew I was in the recovery room. Tommy’s was the first face I saw and I remember feeling love and relief. I would be Okay. My new colleagues sent flowers. I, however, was still not convinced that I had actually had appendicitis; maybe it was  just pain from a cyst. I consulted with my family doctor who requested the pathology report. Turns out that sometimes it is just appendicitis.

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Priorities

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My birthday is one of my favorite times of the year. I start planning the celebrations a month in advance  and I have no qualms with multiple events: a party at work, dinner with Tommy and a get together with friends. The festivities begin on my birthday according to the Hebrew calendar and come to an official close with the arrival of a card from my parents – they tend to mail it on June 5th, so about a week later I receive a small final birthday shout-out.  Some people just want to let their birthdays pass because they would rather not focus on the fact that they are getting older or they fear that the “best years” are behind them. This has never been my approach. Yes, I do get annoyed when Tommy, while towering over me, identifies a new grey hair on my head. At the same time, I see no reason to shy away from having my friends and family celebrate my existence.

I decided that brunch with a small group of friends would be part of this year’s festivities. The brunch was called for last Friday morning at 10:30 am – I readily admit that brunch is synonymous with Sunday, but in Israel we take what we can get. I should have slept in and enjoyed a relaxing morning, but instead a routine blood test and ultrasound came crashing down on my  plans. Unfortunately, it is sometimes impossible to have more than a day’s notice in advance of these tests.

In Israel, IVF clinics are located in hospitals and many of the clinics are closed on Fridays or Saturdays – the hormones  that women take leading up to procedures ensure that the timing does not become problematic. Our clinic happens to be open on Fridays  for tests and certain procedures. The clinic’s busiest days are  Sundays and Thursdays – right after and before the weekend – and I have easily spent 3 hours waiting for tests on either of those days. Fridays tend to be a bit lighter since the clinic closes by 1:00 pm and there are far fewer patients. Of course fewer patients means significantly less staff; though I am usually able to finish in an hour’s time on a Friday morning.

Reluctantly, I set my alarm for 6:00 am, the plan was to arrive when the clinic opens at 7:00 and be out there by 8:00. Apparently,  great minds think alike and 30 other women had the exact same plan! I found myself staring at the clock and waiting for my number to be called. By 9:15 my blood tests were done and I was waiting for the ultrasound; there were only three women ahead of me and I figured I would be done  in about 30 minutes. It only takes 15 minutes to get to the restaurant, so I was fine.

All of the sudden,  ultrasound technician came out of the room, and headed to another part of the clinic. She was needed in the room where they were performing embryo transfers. Since there was only one technician working that day, those of us who were waiting for an ultrasound would have to be patient. I knew that there were at least three couples who had arrived for transfers that morning (it’s easy to identify them because they go to a separate part of the clinic). Having been through the process myself, I estimated that she would not return for about half an hour. On any other day I would have waited but I had a birthday to celebrate.

It could have been a real dilemma. Sure, I could have called a friend and explained the situation and everyone would have waited, but I knew that I had other options.  Prior to a frozen embryo transfer doctors need an ultrasound to determine the best time to begin hormone treatments. However, through a friend, I learned that with a frozen embryo it is possible to have a natural cycle and not take any hormones leading up to the transfer. I went to speak to a nurse about delaying the ultrasound and she told me that if I left I would have to return on Sunday morning. She also warned me that by then it might be too late to start taking hormones  – both options were still possible when I came back on Sunday.

If nothing else, fertility treatments will teach you to be flexible when it comes to plans. It is natural to perceive the appointments, tests, shots and procedures as trumping almost every other commitment. It is undoubtedly  full of challenges  but does not have to become an all encompassing ordeal. I could easily lose myself in this intricate and emotional process but I have discovered that I am best at navigating my way through by remaining conscious of my priorities.  Last week my birthday brunch topped the list and I think that’s about right.

Israel

Battling Bureaucracy

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It is a fact of life and unavoidable; at one point or another we all encounter bureaucracy. If the DMV is the worst of it, consider yourself lucky! Israel thrives on bureaucracy and Israelis spend significant amounts of time and energy negotiating their way through oceans of paperwork and endless lines at numerous offices – welcome to Israel. Over the years, I have developed a few strategies for dealing with this reality. It all begins with acceptance, don’t fight the  bureaucracy, instead focus on your goal of getting whatever you need. With a little persistence, you can almost always get what you want or need from the system.  Second, the fax machine is your friend and can spare you hours on hold or waiting at an office. Finally, be sure to bring something along  to keep you busy as you wait. When I arrived in this country ten years ago, I had only the newspaper and some mediocre games on my phone to keep me entertained in a long line; today my smart phone offers me infinite opportunities to mindlessly pass the time.

Strategies aside, I never expected to encounter bureaucracy while trying to conceive. I had always just assumed that it would involve a bit of fun and the need to pee on a stick (POAS).  Eventually,  I learned that it might not be quite that simple for us,  but instead of bureaucracy, my associations with fertility treatments included tests, injections, examinations and stirrups.  Therefore, allow me to set the record straight, there are many forms and documents that must be submitted, signed and approved. The bureaucratic elements of fertility treatments are particularly difficult to maneuver because often both emotions and hormones are running high. I have dealt with lost folders and numerous tests that have simply disappeared or were not recorded; all of this can be resolved, but is nonetheless frustrating.

Tommy and I were introduced to the web of  medical bureaucracy well before we began fertility treatments. About two years ago,  I had been told that my cysts could become cancerous and needed to be removed as soon as possible. The doctor wrote an order that I be hospitalized and informed me that I could simply call a hospital and schedule the surgery (he was not a surgeon).  He was correct and though Tommy insisted on vetting the doctor who would perform the surgery, the process was easy. Probably too easy.

The final step was to obtain a form from my insurance company confirming that they would pay for the procedure. It is a standard form and, in most cases, easily obtained. I faxed a copy of the doctor’s order to the insurance company’s administrative office – it  seemed to be a redundancy as the order was already in my electronic file and had been ordered by the company’s employee. The insurance company informed me that they could not provide me with their commitment to pay without a written order from the hospital. That seemed reasonable so I contacted the hospital. Only they told me  that they could not provide the information because they did not order the surgery!

A game of ping-pong began only I was not having much fun. After endless phone calls that led nowhere, I decided to show up at the hospital and find someone to resolve the problem. I spoke with the same nurse who already insisted over the phone that it was impossible to provide the information. She assured me that the insurance company was mistaken and had an animated phone conversation with them regarding the situation. She begrudgingly signed the form and the insurance company committed to pay.

My persistence had paid off and proved that I was unstoppable, but the twist would come two days before the scheduled surgery. I went to the hospital for a series of tests and to meet with the surgeon. I had a new set of blood tests and another ultrasound and handed it over to the surgeon.  He reviewed the file and made it clear that he disagreed with the diagnosis. The cysts were most definitely not cancerous, they were endometrioma and they were not especially big. Since we had yet to try and conceive, there was no reason to remove the cysts. The surgeon told me that he would not have approved this surgery and it is unfortunate that he was not asked to approve the surgery – touche!  He wrote a very direct letter to my physician explaining that there was no reason to suspect cancer (my doctor conceded that he was right). Last but not least, he told Tommy and I to get busy; that prescription was easily approved.