Feedback to Time Magazine

As a doctoral-level psychologist and a women personally diagnosed with infertility, your article made me cringe on several accounts and is horrendously offensive to both the infertility and the mental health communities.

Let's begin with the title, specifically the word "crazy." This is not an accurate term used to describe any type of mental illness as recognized by the American Psychological Association or American Psychiatric Association. In reality, this term perpetuates the stigma of mental health that prevents countless numbers of people from seeking and receiving needed treatments. The term is also strongly associated with significant mental health conditions, such as psychosis and dissociative states, which is not what the actual study was focused on.

Additionally, the study did not address the question of "why?" as the title states, but rather looked at a variety factors that may be related to mental illness. The study was strictly correlational, looking at relationships between different variables, and does not, or cannot, claim any causal relationships, including the answer to "why?"

The title is inaccurate and the subtitle, stating that "it's less about the children," depersonalizes the entire experience of infertility. It is as though we could substitute children for promotion and make the same statement, "It's less about the promotion and more about thwarted dreams." No, Belinda, it is all about the children, or lack thereof.

Throughout the article, the language used by the author is insensitive and very reflective of her lack of understanding about the inability to fulfill a basic biological drive that is so interwoven in our society it is inescapable. Women, and men for that manner, do not "let go of the idea of having kids," or "get over that particular life goal." Fertility is not the equivalent of home ownership, getting an advanced degree, or traveling to that one destination on your bucket list. Infertility is a medical disease recognized by the American Society for Reproductive Medicine and the World Health Organization, among others. As you would not ask someone to "get over" the goal of beating cancer or "let go of the idea" of receiving a heart transplant, it is equally unfair to suggest this from the infertility community. Instead, the appropriate term to use would be acceptance. Mental health professionals can be very helpful in the process of accepting that a disease will not be overcome; accepting that the cancer is terminal, that a transplant is no longer an option, or that a couple will not be able to create a biological child. We do not help patients "get over" these major obstacles, but rather come to terms with the current reality.

There is growing research in the psychology literature, that acceptance is an important factor in mental health functioning across a variety of populations. I believe that this is the underscored outcome from the study, but this message is lost in the sea of inaccurate, insensitive, and stigmatizing wording from the author.

I sent this letter to the Times feedback email. I am not normally one to take a stand, but this article hit too many nerves...

Resolve to Know More... Sensitivity

One in eight couples will struggle to create their family. One in eight! This is higher than the prevalence of depression (one in ten) or autism (one in 68) and the same estimated lifetime prevalence as breast cancer. This month was autism awareness - it has been all over the news, Panera Bread is selling special cookies to raise money, and there have been walks and races. Where is our ribbon? Where is our 5K Komen race or 3-day walk benefit in every city?

One vs Two, Revisited

Tomorrow I have my first ultrasound. We will find out if there is one sack or two. One heartbeat or two heartbeats or no heartbeats. One sack and one heartbeat, two sacks and two heartbeats, or two sacks and one heartbeat. Or one or two sacs with one strong heartbeat and one weak heartbeat. Or just one weak heartbeat. Oh, the combinations. This sounds like a math problem. Or a Dr. Seuss book if I could make it rhyme.

In This Together... Not So Much

I confided in our fertility issues with a co-worker back in the fall. She was supportive and about a month later revealed that she was having a "difficult time" trying for her second child. While we're not typically very open with one another, it seemed that there was this moment of mutual understanding and oneness. As if we were now brothers in arms.

She knew when I had my IVF procedure because it interfered with some work stuff that we were working on together. A week later she asked how we were doing and I told her, that we were waiting to see at that point. I asked how she was doing and she said that she was also waiting to see, being relatively vague.

The Big Reveal: Another milestone scarred by infertility

I have been thinking a lot about Brianna's comment to my past post about holding out on telling people. That fact that the lab mistakenly tested a week before we were expecting, and before we told everyone else we were expecting, really did give us a small opportunity to feel like a fertile person who is able to keep pregnancy a secret. For a week.

On Tuesday, I was 14 days post transfer. This was the day I was originally scheduled to test, and the day that everyone else expected it. C and I agree that if it was still good news that we would tell people then. It is, and we did. My results came back at 1055, which was a 34 hour doubling time. Very solid. Possibly in the twin range, but trying to figure this out with Dr. Google is just maddening.

C told his parents and one sister the day before because he was seeing them for lunch. I agreed because he doesn't see them all too often and it would be nice to tell them in person. I told my parents Tuesday night. I called my sisters and my best friend after work the next day.

Essentially, everyone was expecting it. They were all excited, but it felt a little anti-climactic to me. There was no real surprise. Yes, there was questions of "yes" or "no", but everyone was expecting some sort of answer. They all knew when we had the procedure. They all knew when I was hospitalized. They all can do math and it doesn't take a genius to know that a few weeks is enough to know.

I may have liked to make a big reveal. To do something creative. To really surprise people. C mentioned that we could still surprise people on if it's one versus two or still surprise them with a gender reveal. Those are good ideas.

In the meanwhile, the close and important people know. This is real thing. And I am still reminded of the differences in becoming pregnant naturally versus having infertility.

Second Best Day Ever

Yesterday, 10 days post-transfer, I am still pregnant. My HCG rose to 146, "progressing well."

C also passed his nursing final. He was in major jeopardy of failing this class, which would mean that he would be removed from nursing school. This is not his reality. He now has 1.5 semesters before he graduates. The remaining classes are known to be easier. It's downhill from here.

I was fairly nervous at the beginning of the day. What are the odds that we both get good news? That things could go so perfectly right for both of us at the exact same time?

We still haven't told anyone, enjoying our secret, but I am working on making it feel more real. On Thursday, I went into a baby superstore. It's relatively new in town and I drive by it on my way home from work every day. I've always wanted to check it out, but didn't want to jinx myself or get upset over what I could not have. So this was my first move. The effect was not what I was going for.

Holy crap is that place overwhelming! It was pure baby overload. I found myself thinking over an over, "how ridiculous!" Special jugs of "purified baby water." Infant bath robes. A baby towel warmer. Special cups to pour water over your baby's head to wash their head, because regular cups will not do. Specialized tupperware to store homemade baby food, again because regular Tupperware is not sufficient without a baby themed name and imprint. Floor to ceiling bibs, towels, and diapers. Over a sixteen feet tall wall of childproofing equipment. Rows and rows of what-felt-like over a hundred strollers, all of which looked nearly identical.

I think I need to ease into this a little more. It will be a while before I venture back into that store.

In the meanwhile, I have change my thinking from "having a positive Beta" to "being pregnant." I began looking at some websites. I began getting twinges of excitement.

Best. Day. Ever.

Yesterday started off rocky. It was the day of my Grand Rounds presentation. I was speaking to a full auditorium comprised of the entire staff of the Children's hospital. It was also being live-broadcasted across the satellite campuses. I was a little nervous, to say the least.

If you were to ask me immediately following how I'd done, I'd say that I was just glad it was over. I could also have pointed out each of three or four times that I stumbled over my words and said the wrong thing. But my boss, the one who is usually pretty formal and dry, had a huge grin on his face and told me in several different ways how great the talk was. His boss, the head of the entire  Children's hospital came up and congratulated me, shaking my hand. I returned to my office to find an email from the department head of Pediatric Infectious Diseases, cc'd to my boss and the head of the pediatric GI department, praising the talk as the "best grand rounds she's ever attended" and how lucky each of them were to have me working on their team. Each of them then responded, that they were indeed lucky, and that I am asset to the entire hospital. Yeah, I was on cloud nine.

When I got home from work, I received a letter from my health insurance company, explaining that they reviewed my appeal form and have agreed that I am a) not diabetic (Metformin can, in fact, be used for other purposes) and b) and not overweight. This means that I can now get lower healthcare premiums next year, just for wearing a pedometer and maintaining my activity! Totally doable, whether pregnant or not. If they didn't accept the appeal, I would have had to lose weight in order to keep my low premiums, which is just slightly in opposition of my more important goal for the year ;)

In between these two awesome occurrence something else happened. I went to the lab to get my blood drawn. I was one week post-transfer, and they wanted to check my estrogen and progesterone levels. My beta wasn't scheduled until next Tuesday, a full 14 days after the transfer; which I had accepted as a positive, despite the longer wait than I've heard is typical, because it would decrease the changes of finding out about and then being let down by a chemical pregnancy.

Well, the lab made a mistake. It's wasn't the fertility lab, but the general hospital lab in my building. It turns out that the order for the HCG was already in the system. I recognized the error almost immediately. When the lab technician was drawing three vials, instead of two, I briefly considered asking what they were for and clarifying the error. But I kept my mouth shut.

Over lunch, I decided that I couldn't wait any longer and I didn't want to be completely thrown off during the afternoon full of patients. I logged into my medical chart and confirmed. The HCG serum blood test was drawn. The result was 45.5. It was a little challenging to make sense of this because Dr. Google didn't have a ton of information on levels this early in the game, but it seemed pretty legit.

I waited until the nurse call to be sure. She confirmed it. She then said that it's still very early and that my estrogen levels are too low so they're increasing my dose. They want me to come back on Friday for more blood work to recheck all the labs; confirming the HCG results and hopefully an improved estrogen level.

I think I'm still in shock. When my presentation went stellar, I was elated. I could clearly feel the emotion, and it felt awesome. A few minutes after sharing the blood results with C, I opened the letter from the health insurance company and I literally squealed with delight. With this news, there was no squealing, no tears of joy, no 100 lb weight lifted, no elation. It's as though my mantra through this whole thing of being cool, calm, and collected has become a permanent sense of my being. As I type this now, I feel nothing. Not nervous, terrified, elated, or relieved. Not anything. But apparently I am something. I am a healthy kick-ass psychologist...who is pregnant.

I Am More Than Infertility

Dear Everyone,

I have recently discovered that some of you have been avoiding me because of my infertility. Because you “don’t know what to say” or what to ask about. Because you’re not sure how to ask how I’m doing without feeling like you pestering me for information. Perhaps even because I make you feel uncomfortable. I would like to offer up some suggestions.

Next time we talk, you could ask me about the video-recorded presentation I am giving to the entire Children’s Hospital tomorrow or the paper that I am submitting for publication. I could tell you about my yearly performance review coming up and how I’m struggling to identify career goals for the upcoming year. You could ask about my upcoming trip to Philadelphia and give me suggestions on what not to miss. We could talk about C and how stressful his academic course load is this semester. I always have cute and funny stories about our dog and his new feline friend. If all else fails, we could talk about TV shows; I’m really into the Walking Dead, Downton Abbey, Parks and Rec, Daily Show, and Modern Family and I just started watching Orange is the New Black.

The point is, with rare exceptions, I have so much more going on in my life then my struggles with infertility. Yes, it is big and yes, it is stressful. But it does not consume me. Sure, last week when I was hospitalized and then bedridden that was pretty much the only thing going on. But when I’m mobile, I’m my life is full. I am a relatively well-rounded person. Infertility is a part of me, and I wouldn’t mind talking about that as well. It would be nice if you asked how our fertility treatments were going, but if you simply ask, “how are you?” don’t expect to jump right to that part of my life.  

If you want to ask how I am doing with this specific aspect of my life, I won’t get offended or be put-off. If you have questions, I would love to answer them for you. If you’re ignorant, be prepared for me to correct you (no, it is not my intention to carry 8 babies!). If I make you feel uncomfortable because I let it casually slip into conversation (I’m not drinking wine because I’m in treatment), well then this is something I cannot help. If you’re uncomfortable because you know that I am sub-fertile and you know that I doing treatments, this is about you and not me. It doesn’t have to be awkward. It doesn’t have to be uncomfortable. I won’t make it this way if you don’t.

I would love to talk (about anything).

Katie

A Word About My Husband

I am pretty good at picking up on subtle social/emotional changes in people based on the words they choose; their facial expressions; the prosody, speed, and volume in their voice. In fairness, this is a fairly important part of being a psychologist. What I've noticed over the past few months is a distinct change in C's mentality.

In the beginning, we were both excited. He would joke after intercourse that we just made a baby. We would talk a lot about our future child.

I figured out really early on that I wasn't ovulating (thank you OPKs) and began Clomid far before we would have ever been considered infertile by the standard definition of 12 months. Technically, I had only been off birth control for about 6 months and we were only seriously "trying" for 1-2 months.

Six months in, as I was inconstantly responding to the Clomid, and more often not responding, my frustration level was increasing. C, on the other hand, was calm and collected. He told me that, "I assumed it would take several months and we really haven't been trying for that long," ignoring the obvious fact that I wasn't ovulation and wasn't responding to medications.

After nine months of continued frustration, continue lack of response to any oral medication they threw at me, C stopped being overly reassuring. He turned into "the rock," a role so many husband's assume. He would attend appointments and would provide words of encouragement. He was very supportive. But I could tell that he was supporting me, not us. He wasn't allowing the discouragement to affect him, to become emotionally involved himself, likely feeling that he needed to hold it together for me. He was on the outside looking in, and feeling helpless that there was nothing he could to truly comfort me. He was feeling bad for me, not with me.

This continued even through our injectable cycle, when I did respond (beautifully, I might add) and we did have a very real shot at pregnancy. Maybe he still felt the need to be guarded, to not get swept away in the possibilities.

Then things changed. If was after I melted down, we began talking IVF, and ultimately decided to cash in our life savings.

It was gradual at first. A random comment about our future child. Jokes about "creating a baby" during our nightly injection routine. Talking about specific treatment details with some of his friends and family. He would still come to my monitoring appointments, but this time he would take a picture to capture the moment, as if he knew that these moments were ones we would like to look back and remember someday. The talk of our hypothetical child(ren) increased and I could tell that his wall was slowly crumbling. It was solidified the other night that he informed me he wanted to scan in our embryo pictures, "just in case something would happen to the originals."

He was hooked, invested, in this. He's not just excited because I'm excited. He's excited for himself. He's hopeful all on his own. This is no longer about him being a wonderful support for me. This is about us finally being in this together. Together sharing in the joys and excitement. Together sharing in the possible disappointment and let down.

A large part of me is so happy to see this shift, to know that we're in this together and that he's emotionally invested. A smaller part is nervous. If things don't go well, he will suffer double. I know he'll still be very upset for me, but he'll also be very upset for himself. But I suppose this is the potential cost of caring: twice the reward or twice the let-down.

One vs Two: The Great Embryo Debate

I wanted to devote a separate post to our decision on how many embryos to implant. This was a difficult decision that was only further complicated by my stay in the hospital and physical turmoil my body's already been subjected to.

The guidelines indicate for someone my age without any prior history of failed cycles, that 1 or 2 embryos be implanted. The recent push has been for implanting one embryo, especially if it is a high quality blastocyst (i.e. Day 5 transfer). In general, the odds of successful pregnancy increase from 50 to 60% with a second blastocyst, but the odds of twins increases from essentially nothing to 30-40%. Twins can be born healthy and without complications, but the risk for both maternal and infant complications is much higher than with a singleton pregnancy.

Personally, the idea of twins terrifies me. I am well aware of how big of a deal, how dramatic a life change, one baby causes. The idea of doubling this is very overwhelming to me. Not that it wouldn’t be possible. It’s just overwhelming. Carrying two babies to term. Breastfeeding two babies. Two different sleep schedules. Two toddlers toilet training. Yikes!

C is actually a big fan of having twins. He says that it would be "cool" to have two, and then points out the more practical reasoning of being assured that our child will automatically have a sibling without necessarily going through this again. He said that it didn't want to see me go through this again and with two there might be less pressure for this. He acknowledged the huge undertaking that twins would entail but said he was confident that we are both on the same page with a lot of things and have a lot of support from both of our parents. His other reasons were primarily financial. 

For me, the bigger factor was related to money and success rates. We are spending a majority of our down payment on this one cycle. For even a 10% improvement in odds, that’s nothing to balk at in the world of infertility. That’s almost the average success of any given Clomid cycle, depending on which statistics you look at.

It angers me to think about all the ways that money has influenced my infertility journey and how different decisions I may have made with insurance coverage. We probably would have a waited a few months before going straight to IVF, trying less intense options first. I would have been more inclined to opt for a single embryo transfer. I wouldn't have been as stressed every time they asked to come back for another monitoring appointment or required us to purchase two different types of triggers, "just in case."

I wish that I could say that I had better, more profound, reasons for choosing to implant two embryos. I wish that it was more meaningful than “maximizing my investment” and the vote of my husband, although his vote was clearly important. I wish that infertility treatment was not considered a luxury and was not an industry driven by money. I wish that we have one, or two, healthy babies when this is all said and done.

Updates on Embryos, Health, and Family

What a boring title. Oh well. This is what you get when attempting to wean off narcotics and return to a normal diet.

My embryos are doing well. The lab has called me daily and reported that initially all fifteen embryos were growing and dividing on track, but that today we are down to thirteen that are still growing. Surpassing my low expectations, this is still fantastic news. We are officially a go for Day 5 transfer, although they will contact me tomorrow with the specifics. I have purposefully had the lab leave messages and not asked any more questions about specifics, because there's nothing to be done about it at this point and any more information might just cause unneeded stress.

My big focus has been to regain my health before transferring back in the embryos. I'm trying to wean myself off the pain medications and return to a regular diet. The hardest past has been the constipation so I've made "have a bowel movement" my number one goal and accomplished that this morning! My abdomen is still very sore and somewhat crampy, sort of reminding me how I felt after my appendectomy. I still walk hunched over, but I am at least able to mobilize myself without assistance so that's a huge step forward.

The other excitement around here has had everything to with my sisters. Technically, it's about me as well, but I am refusing to get involved and let it affect me. I have bigger things to focus on now and sister drama is not in my plan of remaining calm and relaxed.

Remember how I explained that my one sister is also going through infertility and copes with it in a very different way than me, and often has managed to step on my toes while doing so? Well mostly since this post, I've just accepted this about her and kept my distance when I couldn't handle her, and focused on my own well-being. One of the biggest differences about our coping style is that she is much more open (AKA attention-seeking) than I am. Well, she decided that she needed to make a huge announcement about her infertility struggles on Face.book to let the world know what she was going through. Fine. To each is own and I know that other people have done this and found it helpful. I personally do not feel the need. I do not hide my struggles but I am also not one to openly announce them. While I did appreciate how this could make it awkward at times with people knowing about her but not about me (e.g. when our relatives comment to me about "poor AE" at family functions), I also appreciated that she should not let me impact what she needs to do to cope. She gave me some advance notice, which was nice. Otherwise, it's no big deal.

Until the big announcement came on the exact day of my oocyte retrieval procedure. Of all the 365 days in a year, this otherwise random Thursday was the day she felt the need to draw the world into her struggles. I noted to my other sister how it was impeccable timing, and likely reflects AE's lovely tendency to be self-absorbed, but otherwise I was in a lot of pain and on drugs and didn't let it bother me much beyond this.

Well the other sister, E, was not on drugs or in pain. She decided to voice her concerns to AE about how this was very un-empathetic and inappropriate timing. AE responded that E was insensitive to her infertility needs and that everyone only ever cares me. Yelling and crying ensued. The two are currently not speaking to each other and somehow the last few days have revolved around AE's hurt feelings. Personally, I'm a little amazed at how she manages to make it about her, every time, intentionally or not.

Mostly, I don't care. I'm remaining calm. I'm letting outside stressors bounce off my protective tranquility bubble and focusing only on my health and well-being. However, I am a little curious about where others might stand on this issue, as it does bring up some interesting controversies.

Have you or do you feel the need to make a public announcement about your fertility struggles? Do you think the timing of this should be influenced by what other's are going through or should it just be based on what works best for you? At what point does your own self-care infringe on others?

IVF Monitoring Appointment #5: Cleared for Retrieval

My last monitoring appointment was yesterday. My estroidal only raised to 3500ish, which is great, but they still decided to go the Lupron trigger route. The follicles grew a little, but to be honest it wasn't a significantly noticeable difference. I now have 20 follicles between 10mm to 24mm. This sounds like a lot, but I know that some of them won't be mature and others might be "past-mature." I'm working on not having unrealistic expectations and setting myself up for disappointment.

I've taken the trigger shots. I've cancelled all my patients and cleared my schedule at work. I've showered and have my outfit picked out. I had a large dinner to prepare for being NPO after midnight. I've told everyone I wanted to tell that tomorrow is part one of the big day(s).

My very first therapy client as a graduate student was a young mother who had a little lower-then-average intelligence. She would have numerous worries related to her children's safety, especially when they were out of her sight at school or with their father, despite any evidence to suggest that there was any need to be concerned. She would get herself very worked up over this and had difficult focusing on other activities. We talked a lot of the purpose of anxiety, how it motivates us to take action. When we're anxious about a test, we study harder. When we're anxious about the snowy roads, we drive slower. But when there is nothing to do, when we have no control about a situation, the anxiety serves no purpose. It is wasted. This woman and I developed a mantra, "There is no point in worrying about something that you cannot control". Maybe it was that this woman was a little slower and needed a lot of repetition. Maybe it was because she was my very first client and therefore our appointments were much more salient. Whatever the reason, this mantra also became engrained in me.

There is no point in worrying about something I cannot control. This is where I am now. It's out of my hands.

Because we strive to maintain our immature sense of humor.

Intimacy with IVF

In some rather interesting ways, our relationship has not only gotten stronger, but also more intimate as we've moved on to more intense infertility treatments.

We've always had a strong relationship. We worked out most of the glitches in the first 6 months of our marriage/first time ever living in the same city since we began dating. That was fun... Now we communicate well and express our opinions without upsetting the other, most of the time. We spend much more of our time together laughing and enjoying each others' company than arguing. Yes, I would say that we entered the infertility realm as a strong couple. And for us, things have only gotten better.

First of all, I've actually taken to enjoying our nightly injection ritual. Every night, C and I share in an uninterrupted moment where we are working on the same goal. He treats my abdomen in a tender and even intimate fashion and I feel very close and connected to him at these moments. After all, I am trusting him with a needle filled with hundreds of dollars of medications that he jabs into a very sensitive part of my body. I've also realized how nice it has been for him to be the sole person responsible for giving me my injections, making him a very active and necessary person in this process that otherwise treats the males largely as bystanders.

Another key benefit to IVF that I've noticed is that sex is no longer stressful. There is no pressure and specific formula. We can just enjoy ourselves and each other. We don't have to force it based on a calendar or what color my urine turns a stick. We initiate it when we feel like it. And when one of us does initiate sex, the other one isn't wondering about ulterior motives in the back of their head. I forgot how enjoyable stress-free sex can be.

The entire process up to this point has forced us to have more difficult conversations, share in more secrets, and come up with more agreements than I would imagine most other couples at this point their marriage. And if practice makes perfect, we've gotten a lot of practice at navigating tough situations as a team. Sometimes I notice how some of our friends interact as couples, how disconnected or hierarchical they appear, and I smile inside with the same pride that I imagine parents feel knowing their child is succeeding and happy.

Whenever I think about the silver lining, my relationship with C is always the first thing that comes to mind. This is probably the most sappy I will ever be, so happy Valentine's Day, and I now need to vomit.

P.S.A.: Don’t Mess with a Lady Injecting Herself with Mega Amounts of Hormones

I have been making a very conscious effort to remain calm and find my inner zen state. I am focusing on my breathing and on being mindful. I’m trying not to sweat the small stuff, or even the big stuff. I am trusting in the universe. Of all the non-medical adjuncts to infertility treatment, I personally believe that stress reduction will be the most impactful for me.

Yet sometimes it seems like the universe is working against me. My job has been extra stressful lately. I’ve had a lot of requests to take on extra patients, although I don’t have the time, and the expectation is that I “make it work”. My annual performance review is coming up and I have to prepare for that. I need to submit a paper before an approaching deadline. My clinical outcomes were due last week, which required a full extra Saturday of work to complete. I have an upcoming Grand Rounds presentation that I must prepare for. My emails explode each day and it’s nearly impossible to keep up. Patients are stressed out and parents call me in distress.

The biggest frustration at the moment is from our billing department. The expectation is the all charts are closed and billed within 48 hours, although sometimes I’ve heard 24 and my boss has told us he doesn’t really care as long as it’s within a week. Writing notes are the bane of my existence. I hate it. When I’m stressed and had a rough patient day and feel physically shitty (cue infertility drug effects), my chart notes are the first thing that I slack on. The billing department  has taken to sending daily emails to “remind” us of our outstanding notes (as in incomplete, not exceptionally brilliant and well written), which are then CC’d to five other people including my supervisor, administrator, and several other peoples that I don’t even know what they look like! Then, sometimes, these people decide that I need the email forwarded to me again, just to rub it in.

Usually I just ignore these emails. My boss has assured me that he doesn’t care because I always get the notes done in a timely fashion, just not quite as timely as the billing department would like. But coming up on my performance review, it still doesn’t look good. When I open my email on my phone as I’m sitting in the waiting room of the fertility office and see these emails, I can’t help but get annoyed. Plus, the whole principal of the this action gets under my skin. What a horrible way to motivate people! They don’t ever send positive emails, praising me for taking on additional patients, for working 13 hours in a day, and for closing the charts that I do get done on top of this. The system is entirely based on negative reinforcement and, frankly, is horrible for moral.

Plus, I’m jacked on hormones.

Today I decided to change my tactic. I am no longer ignoring the emails. I am now sending emails of my own, a mocking reply if you will. Their emails typically go something like this:

Good morning Dr. Psychologist,

The following charts are open….(bullet pointed list of patients). 

Please complete your documentation and billing. Remember that we are not able to bill for the service until the chart is closed. 

Thank you,

Ms. Billing Person

My nightly emails will be sent out to each of the 5+ people that have been receiving the negative news about me, and will say something along these lines:

Good evening Ms. Billing Person,

The following are charts that have all been completed and billed along with the other services that I provided for today that were not billable… (Bullet pointed list of all patients that I saw or communicated via email/phone...today this amounted to over 9 hours of patient contact). 

I am aware that not all charts are complete, as many of these charts require additional scoring or other follow-up, but I assure you that I am working on these charts and am aware that they cannot billed and I cannot get credit for the hours that I’ve spent with these families until this is complete. 

Thank you, 

Dr. Katie

Yes, I am aware this is passive aggressive. Here are my goal(s): either a) force them to acknowledge or at least be aware of the positives that I do (i.e. reply to the email with positive reinforcement vs negative) or b) annoy the crap out of them so that they see how irritating it is and tell me that nightly emails are not necessary, which I can then reply that daily emails in the morning are equally unnecessary. At the very least, having nightly emails of all the work that I have accomplished each day will make me feel better.

I’m about to force some behavior change here, people. Watch out! And if it all blows up horribly, you bet that I will be blaming the fertility meds and going for pity. Because infertility has to at least be good for a Mulligan every now and again.

IVF Baseline: Signs and Coincidences

I find it interesting how we find "signs" in those things we want to believe and call it a coincidence if it doesn't support our desires. If it's a sign, we are somehow supposed to have greater knowledge that we're making the right decision and that the universe is looking out for us. Coincidences are random and this makes us feel uncomfortable. Unless, of course, the sign is negative, suggesting our decision is wrong and that we should turn back immediately. We'll just call that a coincidence as to not induce panic.

A very large snow storm moved through our area last night. We were all given warning and schools began announcing their closings before the first flake descended. I didn't pay much mind to this, just planning to leave a few minutes early. Growing up in the "snow belt" has made me immune dramatizing winter weather.

I made it halfway down our winding driveway, on the way to my baseline appointment. I was only very slightly nervous that my cysts would not have dissipated or that my estrogen levels would be too high. Apparently just nervous enough to walk out without remembering to bring my work shoes to change into, rather than wearing clunky snow boots the entire day. In an effort to save time, I began backing down the driveway to return for the shoes. This resulted in me veering slightly off the pavement, over the stick sticking up 5 feet to warn me where the driveway ends, and getting stuck in the frozen grass and snow piles. My dad heard the tires spinning and I also woke up C to participate in the fun. Because pushing my car out of a snow drift in his pajamas and snow boots is exactly what he was hoping to wake up to.

After this adventure, I was counting on making up lost time in the normally 30 minute commute to the doctor's office. This, however, was not the case. The freeway was packed with cars that refused to move faster than 10 miles per hour. I could do nothing but crawl along, eventually making it to the doctors' about 75 minutes later. My only saving grace was that I called into work to find that my morning patient had cancelled due to the weather so no one was specifically waiting for me.

The appointment went well. Lots of little follicles. No cysts. Low estrogen levels. Good to officially stop the birth control pills, hopefully inducing a period, and begin stimulation medications on Saturday. As I sit now, nuzzled under the blankets, warm in the house and protected from the harsh weather outside, I take solace in this coincidence.

Quantifying Pregnancy Status Update Reactions

On a scale of -10 to +10, where 0 is neutral and the other numbers are self explanatory range from the most positive to the most negative, I will now quantify my reactions to various fertility status updates**: 

+10:  My very own positive pregnancy test (this is an assumption, of course, as I've never actually experienced this).  

+9:  A positive pregnancy announcement of a fellow IFer who got pregnant from IVF. This brings me joy for them and hope for me. 

+8

+7

+6: A positive pregnancy announcement of any other IFer. Joy for them alone.

+5  

+4

+3:  The first baby announcement of a friend. I am happy that they do not have to go through what we are going through. Mild jealousy. 

+2

+1

0:  The random first baby announcement of a Face.book "friend". Great job at being fertile and avoiding this misery. I don't really care. 

-1

-2:  Celebrity pregnancy announcements. Why do people care so much that it has to plastered all over the front pages of magazines that you can't avoid but seeing when you just need to pop into the grocer to by some milk and bananas? No baby is that important, unless you're religious and then I'll give you Jesus Christ, but even he didn't get this amount of publicity. 

-3

-4

-5:  Second, third, or fourth pregnancy announcements and further status updates on Face.book or otherwise. I get it - you're fertile. Get over it already and stop rubbing it in. 

-6

-7

-8:  Hearing pregnant women complain about their pregnancy or parents complain about raising children, especially when said complaints are given directly to me (vs stated generally over the FB). I have pretty good empathy skills, but I can't begin to understand these woes.

-9

-10:   The news of a failed IVF, chemical pregnancy, or miscarriage from a fellow IFer. This brings me such sorrow for them and also sheer terror for myself. 


**Subject to change upon further deliberation, emotional state, or my own fertility status updates. How would you rank the following?

Too Cold, Too Hot, Just Right

As I tell others about our plans, I am struck by their reactions.

I have now disclosed to my best friend, my parents, my youngest sister, and a few other close friends of our plans to begin IVF in just a few short days. My sister (not the one with the rivalry) responded in a very nonchalant, casual manner. I found this unsurprising from her, who can't get excited or emotional about anything, and slightly off-putting. This was not a casual decision. This is fraught with emotion.

Teaching Myself

After teaching a relaxation exercise to a highly wound tween and explaining the effects of anxiety on her physiological responses to her parents, her father asked me a question. "As someone who teaches relaxation every day, are you a really relaxed person?" Ha! My answer had something to do with being able to relate and empathize with these kids.

In reality, I can only assume that reinforcing positive coping strategies on a daily basis in my work has been helpful for me personally. Who knows how stressed I would be otherwise. Sometimes I catch my thoughts taking over and heading straight into panic mode, but I can usually stop this before it gets out of control.

What if my procedure tomorrow is as painful and horrible as the HSG? What if they find something that counter indicates IVF? What if my random bleeding is suggestive of cancer? What if C's sperm quality somehow changed dramatically in the last 9 months? 

I take a deep breath and remind myself that it will all be ok. Things are rarely as bad as I fear they will be. The meeting with my boss last week was very helpful, not worth the anxiety it caused ahead of time. The "period" last week lasted only a day and my doctor didn't seem concerned (although I'd still like more of an explanation for this). Both doctors assured me that the hysteroscopy is nothing compared with the HSG. There has been no other signs that the testing won't be completely normal. If anything, C has only gotten healthier and there is no reason that he would have a significant change. Tomorrow will likely bring only positive news and more a solidified plan towards beginning our IVF journey.

My hospital has a "meditation chapel" for families of all faiths to find solace. I have been utilizing this room myself lately. After I am done with my work, when most everyone else is gone and the hospital is quiet, I will sit and think and pray. With this practice, I have developed a calming sense of acceptance. This will all work out. We will be ok. I will be a mother. Someday.

Sibling Rivalry

I've written and re-written this post in my head for months now. My hesitancy to delve into this topic reflects the raw emotions, guilt, and ambivalence I feel.

I have two younger sisters, one four years younger than I am and then another 3 years younger than her. I have always been closer to AE, the middle-sister, likely because we were much closer in age. We're not particularly similar. She was always more social, more into fashion and popularity, and much better at cooking and baking and crafting. I was the book-smart introvert who always bragged that I didn't need to learn to cook because I would make enough money to pay someone else do it for me (ha!). My other sister and I would often joke that she was the favorite, as she was pretty good at getting attention,  being dramatic, and getting what she wanted from our parents. I was never that savvy.

Despite our differences, we both played soccer and both were in girl scouts. We both tried to get good grades in school and we both started dating about the same time (not the same age, but the same time). AE had this tendency to do everything I did six months after I did it, despite her being four years younger. There was often this underlying competition that would bubble up when someone made the more competitive soccer team, or had a new boyfriend, or got engaged.

AE got engaged within four months of C and I getting married. She announced that she and her future husband were trying to conceive three months before her wedding, while C and I were just beginning to discuss the idea. She made it very clear that she wanted to be the first sister to have a baby, that being the middle child never allows her to be the first at anything. I was more than happy to allow her this win, naively assuming she had a 6+ month head start.

Nine months later, I'd been off birth control for several months to "regulate my cycles" and was realizing that this was not happening. AE was extremely upset each month when she would get her period. I saw my GYN who ran some tests, determined I wasn't ovulating, diagnosed me with PCOS, and recommended beginning Clomid. She thought this was a great idea and promptly made an appointment with her GYN, beginning Clomid about a month after me. And so it began.

Every month we'd be going through the similar treatments and comparing notes. Not that there are better or worse cases of infertility, but I would get frustrated when month after month I was non-responsive to the medications and she was. However, despite ovulating each month, she was still not getting pregnant. After a few months of Clomid, my GYN recommended moving on to RE and of course my sister followed suit the next month. Her RE was a little more aggressive than ours and while she was beginning IUIs, we were still struggling to find a medication regimen that would actually get my eggs to grow and ovulate.

She would call me frequently, upset that she only produced one egg, or that she ovulated earlier than expected and it wrecked her plans, or convinced that she wasn't pregnant within 7 days from ovulation. She would forget to ask how I was doing. She would put her foot in her mouth by complaining about her insurance deductible (that covers infertility) despite knowing that I have no coverage. I would listen patiently and provide empathy and support, like the big sister and psychologist that I was. But when we got off the phone, I would be upset and furious.

The breaking point was in November when I got the results that I wasn't responding to my last shot at oral medications. Since then, our relationship has changed, likely for good. We stopped talking at all for a while but have recently been calling each other more. Our sharing is more guarded, or at least it is for me. If she doesn't know what is going on with me, then I can't get upset when she says insensitive things because I can assume its out of ignorance. Needless to say, she does not yet know about our decision to move on to IVF.

My hesitancy towards sharing this is primarily because of the feeling as though I am betraying the AF community, or at least a fellow IFer. When people first find out that my sister is struggling with infertility at the same time, they express assumed gratitude that I have an automatic support system. As if we should be able to have an inherent understanding of what the other is emoting. Us IFers, we're all in this together, right?

I've just recently come to terms with the fact that just because we're suffering from the same disease does not mean that we cope with it in the same ways. None of us do. Honestly, there have been some blogs that I've stopped reading because their coping strategies and attitude towards IF annoyed me. But I can't stop "following" my sister. We just must accept that everyone copes and manages it in their own way, what works best for them. Just because we have one unifying similarity does not automatically make us the perfect supports for one another. To expect this would be synonymous to expecting people to grieve in the same ways and on the same timeline or to expect that someone in the middle of their own grief would be a great support for someone else at the same time.  Increased understanding should not be undervalued, but this alone does not make for improved support.

Sharing is Caring

In our decision to choose which hospital system to move forward with for IVF, one of the options C and I considered was an egg sharing program. This program was offered by UH, along with >50% reduction in the total cost to me. The deal is that I would go through the IVF protocol as planned, but in coordination with another person, and then share half of my eggs. I had to share half, unless there was an odd number and then I get the extra. The program was designed as completely anonymous.

C and I considered this option for a few reasons. First, I've been told repeatedly that I have "too many" eggs and that I am expected to respond really well to super-ovulation for IVF. If I have 20+ eggs and end up with 10+ eggs, that should still be plenty for both a fresh and frozen cycle for me, right? This was my argument. The second reason is the obvious financial benefit. Money is unfortunately a serious factor in our reproductive decisions these days. The third main reason is my mom. I mentioned previously that my mom was a surrogate, almost 14 years ago now. I have a half sister and I was able to see, first hand, the wonderful gift that my mother was able to give to such a deserving couple. To be able to do something similar myself would be such a blessing and I would be honored. 

We/I ultimately decided not to go this route. On the more selfish level, the anxiety about giving away half of my options at a child was significant. What if I only have a few eggs and then lose half of them and don't have enough leftover for myself? What if she got pregnant with my eggs and I didn't? My mom was a surrogate after her own family was complete, not trying to accomplish both goals simultaneously. Additionally, neither C nor I felt comfortable with the anonymity aspect. C's primary concern was What if we have two children of the opposite sex and they meet each other one day and fall in love and never realize that they're actually siblings? As silly as this is, I couldn't argue. Science suggests that we fall in love with people are similar to us, and who is more similar than a sibling? My concern was a little more realistic, but less gross. With my half sister, we see or hear from her every year or so. I know generally how she's doing and what's she up to in her life. She knows that she has ties to a second family, but I know she doesn't think of us like that and that's a good thing. She can know her medical history if she wants and she can know her ancestry if she's interested. We don't have to look at every strange 14-year-old on the street and wonder if we might be related. I wouldn't want a strong relationship necessarily, although I would be open to this, but I also do not want anonymity and I don't believe that is in the best interest of the child. 

I told C that I didn't feel comfortable with the program at this time. I think he was relieved because he was trying to let me make my own decision about this (they are my eggs after all). But I did tell him, that after we have our baby, assuming my eggs are really as plentiful as everyone says, I do want to donate my eggs. I do want to give back and pay it forward. But I want to do it on my own terms and not at the same time that I am so pressured to build my own family. I feel good about this decision.