Tag Archives: IVF

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.

A Minor Nuisance

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

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

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

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

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

 

Sharing the Burden

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

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

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

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

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

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

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

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

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

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

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.

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!

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!

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.

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.

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.

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.”