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.
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.
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.
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!
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.
At the end of April it will be a year since we first met with a fertility specialist. This year, like any other, has had its ups and downs. I can’t claim that trying to conceive has been all fun and games, but this year has not been exclusively about us trying to get pregnant. At times though, it did feel as though our lives revolved around one all-encompassing goal. We learned that that approach would not work for us and could potentially lead to difficult series of disappointments. We seem to have stumbled on the perfect remedy, travel therapy.
There is nothing like a brief respite from all things relating to infertility: no doctors, no daily blood tests, no ultrasounds, no injections, and most certainly no talk of trying to get pregnant. Most of the time this can be achieved by simply deciding to take a month or two off. However, I have discovered that the cause is furthered by hopping on a plane and escaping it all. It is just my luck that the option has presented itself a few times this year.
Two weeks before Passover we learned that our first round of IVF did not take. I don’t think that I really expected it to be successful (a future post will deal with the full 5 days for which I was pregnant). The whole process left me drained and I needed to regroup before starting again.
Tommy’s parents and grandparents suggested that we come to Budapest for the holiday. I could smell the aroma of my mother-in-law’s culinary talents and my head filled with images of us riding bikes through Margaret Island along the Danube. It did not take long for us to accept the invitation. While the 6 inches of snow has kept us far from the Danube, there is no doubt that the trip has served its purpose.
Like most vacations it also proved to hold a bit of the unexpected. Tommy’s parents and grandparents appreciated the spirit that we brought to the Seder (I am rarely complemented on my singing).The absence of children could not be ignored when I recited the four questions. At the end of the evening, Tommy’s 90 year old grandfather commented that it had been a very long time since he had been to such a vivacious Seder. It seems that the combination of the Holocaust and Communism drained Hungary of its Jewish energy and vibrancy. That evening, Tommy (with the help of his talented wife) returned his grandfather to his own heritage. It was a powerful moment in which I realized the potential that I have to teach a future child, but also to learn and grow from the next generation.
At some point during the course of the fertility treatments I began to focus on the process and distanced myself from its purpose. That evening, watching Tommy with his parents and grandparents, I reconnected with our hopes to one day have a similar experience with our own children and grandchildren.
Not one ounce of my time or energy was wasted on the cysts between the months July and December 2010. Instead, Tommy and I spent most of our time preparing for the wedding. When the big day arrived we were ready to cherish the moment. We had a wonderful time and as the celebrations concluded we headed to Budapest so I could acquaint myself with Tommy’s hometown and his extended family. I fell in love with Tommy’s relatives, the beautiful city of Budapest and its culinary delights. My Hungarian improved ever so slightly to the point that I was fully capable of commenting on the weather, nagyon hideg.
With the arrival of the new year, I decided it was best to reconnect with the doctor who had given me a second opinion. I did not want to return empty handed, so I made sure that I went for the ultrasound (which could only be scheduled for the insane hour of 7:00 am) and the blood test. The ultrasound confirms the type of cysts and their sizes. The blood test would measure the amount of CA 125 in my blood and if I never again have to hear about this protein it will be too soon.
The doctor’s office was conveniently located near some nice restaurants, so I scheduled that the appointment for a Thursday evening and figured that Tommy and I deserved a nice dinner after a long week of work. That particular work week turned out to be quite short as far as I was concerned. I was laid off on Monday and while I was not all that disappointed about the prospect of having a few months off, I can’t pretend that it didn’t sting. In Israel, being laid off (or fired) is a process that involves multiple meetings over a number of days. By the end of that week all I could think of was going home and opening a bottle of wine. This Dr.’s appointment was the only thing between me and a merlot.
I sat across from the doctor who told me it was a good thing that I came in because he would have called me with disturbing news after reviewing my blood tests – this guy had an unparalleled bedside manner. He printed out an order for me to be hospitalized and directed me to have the cysts removed immediately. Apparently, my CA 125 indicated that they could become cancerous. My face must have gone white and he oh so comfortingly explained that he was not saying that I had cancer, at least not yet – grand slam for that bedside manner! I asked him if this would hurt my chances of being able to have a baby and he told me cancer was a far more serious problem. Thanks!
I walked out in shock, I was completely unprepared for this news. What the hell was going on? I felt as though nearly every aspect of my life was crumbling to the ground. I could handle loosing my job and I knew that Tommy and would face infertility together, but the threat of cancer was too much.
I dialed Tommy’s cell and of course, it went straight to voice mail. So I redialed about a million times but his phone must have been off. Tears started streaming down my face and I walked and walked and walked and hit redial every 30 seconds. This was not the first time that I had wandered through the streets of Jerusalem crying, there is a guy out there who once drove me to tears but it was nothing that a few doses of scotch couldn’t fix. This time I was lost, the familiar Jerusalem streets were suddenly a maze and I could not figure out how to get home.
Finally, Tommy answered his phone
“Tobyka, I ‘m sorry my battery died, what’s wrong?’
I couldn’t even talk, so I got into a cab and told Tommy to meet me outside. The cab pulled up and there he was waiting for me. I knew that I was not in this alone. That whatever was ahead, he would be there – ideally with a fully charged cellphone.
We decided to take Dr. Google’s advice and we looked up CA 125 and discovered that endometriosis is one of a number of conditions that can cause an elevated CA 125. We spent the rest of the night on the phone with various friends in the medical field and agreed the cysts should be removed, but I did go to sleep in a much calmer state of mind – I finally got my wine.
Today was going to be a great day. It is the International Day for Working Women. The university gives me about 3 hours off and I had plans that included a nice lunch and maybe some errands.
My plan was to go to the fertility clinic to have the regular blood and ultrasound that are standard for all fertility treatment and then go to work for an hour or two. The blood went fine and I patiently awaited my turn for the ultrasound.
One hour later, the technician tells me that her ultrasound is not able to see everything necessary and I will need an additional test. She calls the department to get me an appointment and the secretary informs her that I have a long wait ahead of me. That is not a good sign anywhere but in Israel when they are so upfront about it you should multiply your expected wait time by a factor if ten! So much for a few hours off, good thing I have a smartphone to keep me entertained!
So it goes:
Toby plans, God laughs! Or at least someone does.
If anyone ever needs to know, it is no problem going through airport security with a syringe and needle. I have now done it in both Israel and Italy. The Frio is keeping the medicine nice and cool.
Now I get to relax and enjoy my vacation.
Futile or Fertile 