Tag: infertility

Feelings

It Only Takes One

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Before I met Tommy I spent a lot of time dating in hopes of meeting the right man to marry. Mostly blind dates, these were often an obvious mismatch which would end up as stories shared over a bottle of wine with other single friends. We’d laugh, commiserate, and wonder “where all the normal guys had gone?” After awhile I began to tell myself, “Toby, you don’t need to meet a million guys or dates, it only takes one.”
I have often find myself comparing my experiences in the single’s scene to our struggles with fertility. Both take a lot of patience, perseverance, and most importantly a significant measure of luck. Fertility treatments, especially, encourage you to focus on the numbers and statistics: age, hormone levels, follicles, sperm count and quality, ova retrieved and embryos transferred and everyone’s favorite beta levels. At the start of each round ultrasounds, on an almost daily basis, allow you to track the growth and number of eggs, but it is with the retrieval that you know how many can be reached. You then wait patiently for 24 hours to discover how many eggs are fertilized, you wait some more after that-3 or 5 days- to find out the number and quality of mature embryos and if you are lucky, how many will be transferred. Finally, it is a two week wait to find out your Beta level to determine if you are pregnant (and you pray that those levels will continue to increase as they monitor the early stages of the pregnancy).

I find it remarkable that today’s technology  offers many more options to people dealing with infertility, yet my experience has been that at times I was lost in the details and forgot the big picture. It’s difficult not to be disappointed when every ultrasound leading up to an egg retrieval indicates that you have plenty of eggs, but on the big day you learn that very few were retrieved-especially since you know that even fewer will fertilize and mature. All you can do is hold your breath and hope for the best.

Last June we went through a round of IVF that was both extremely difficult and disappointing: the cycle was longer than most because of holidays, I became very ill yet still managed to cut my head open while on bed rest, and for all our efforts we ended up with very few eggs and then embryos. So few that the doctor who performed the retrieval – not my regular doctor because in the public system your procedures are performed by whichever doctor is on duty that day – asked me if I was aware that I had endometriosis (all I could do was wonder if he had bothered to read my file before pumping out my eggs!!). We had 5 eggs, this was not a promising number and I was disappointed. I looked at Tommy and said “It only takes one.” It became our mantra. We repeated it as we waited for the rest of the numbers, assuring one another and ourselves, that all we needed was one fertilized egg to hang around in my uterus for 40 weeks and then we’d have a child. For all the positive thinking, that round did not end with a pregnancy.

I was done, we’d have to try some other route to parenthood. Tommy wanted to give it one final chance and encouraged me to try a new doctor- we had already agreed to try IVF for two years and there was still a bit more time. He reminded me that it only has to work once. So at the beginning of August 2014 we started all over again. I can’t say I was optimistic but I did my best to make it as manageable as possible: I pampered myself at a day spa with a massage, continued with acupuncture and generally did my best to take it easy. Throughout, Tommy and I repeated, “it only takes one.”

As I write this post, cradling my sleeping daughter with one hand, I am still in a bit of disbelief that it worked. One egg and one sperm, became one embryo that was transferred into my uterus, and with plenty of luck, it managed  to stay around for 39 weeks. Even as my belly grew, I was skeptical as to whether it had actually worked;  was there actually a baby on her way? I watched her  grow from a dot on a screen under a laboratory microscope until I held her in my arms moments after her birth. Still, I cannot believe that it had worked. In the end it only took one and this one is ours.

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chillax

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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.

Feelings

Between Dos, Don’ts and Empathy

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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!

Israel

Reassuring Information

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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!

Feelings

Words Of Wisdom

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Early in our relationship it was obvious to me that Tommy and I were on the same page when it comes to the big things; that’s why I married him. Sometimes life gives you those little reminders of what you knew to be true and why you first fell in love.

I’m sure that it comes as no surprise that the two of us spend a lot of time talking about the fertility treatments and our hopes of becoming parents. It’s not the only conversation that we have, but we do talk about it on a fairly regular basis. Today, Tommy and I were having one of those “big picture” conversations and Tommy came to the following conclusion:

“What really matters isn’t what you don’t have, but what you already have and how you feel about it.”

He posted it on Facebook but I wanted to be sure it received a wider audience. This process makes it easy to obsess over details that are often out of our control: Follicle size, number of embryos, quality of embryos, the effect of freezing on embryos, and finally the “big one,” will an embryo decide to stay awhile in my hormone enhanced uterus?

It’s nice to know that we are both able to help each other keep a perspective on what really matters.

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!