It Only Takes One

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.

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!

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!

Words Of Wisdom

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.

Doubt

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.

Laughing at (In)Fertility

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.