Tag Archives: infertility

Talking about Family Planning with Students

Last week the senior faculty member in my department hosted his annual 4th of July barbecue for our department — all the faculty, their families, and all the students who are here doing research for the summer were invited.  It was quite a crew (for a liberal arts college), with 30 or more people hanging out in his backyard, munching hot dogs and (veggie) burgers, and splashing in the pool.  It was a beautiful day with some really great people, and I love that my department is such a welcoming and family-friendly place (this is one of several regular events throughout the year at which partners and children are explicitly encouraged to attend).

I was sitting on the grass with my son on my lap.  He was contemplatively munching on a veggie burger.  We were surrounded by students.  They were commenting on how much he’s grown since the last time they saw him, how long his hair is (it’s in these amazing platinum-blond ringlets right now since we haven’t cut it yet), asking what new things he can do, etc.  Then, one student busted out with “Are you going to have more kids?”

I gave my stock response: “We’ll see!”

Another (perceptive) student said: “It sounds like maybe you say that a lot.”

I laughed and said, “You’re right!  A lot of people are curious.  Almost as much now as when my husband and I first got married and we got lots of questions about when we were going to have kids.”

Another student said, “It’s kind of a personal question, isn’t it?”

I said, “Yes, it’s personal.”

The student who asked in the first place apologized.  I told her I didn’t mind, that I was also very curious about things like that when I was her age.

It was a brief twinge of discomfort in an otherwise lovely day.  I kept turning it over in my head.  I almost wanted to tell them why it was personal — to tell them about the daughter we lost before our son was born, or the fact that I’ve been pregnant three times with only my son to show for it, but I didn’t want to spoil the festive mood.  On the other hand, I feel that we generally do our young people a disservice by being so closed-mouthed about the realities of pregnancy loss and infertility.  I teach my students lots of things, and sometimes they learn from me whether I want them to or not — I know that the students have been keenly interested in my life since I revealed that I was pregnant with S (the students were also keenly interested when I was pregnant with his big sister, although that generation has all graduated by now).  I also know that for all the young women, I am the sole example they have of a female professor in our field, which can feel like a heavy responsibility.  I want them to be encouraged by my example, not daunted.  But I also want to prepare them for challenges they are likely to face.  There were about 8 students sitting with me on the grass during this conversation — odds are that several of them will experience miscarriage sometime in their lives, and probably one of them will experience infertility.  Is it better to prepare them, or to let them find out for themselves?  I made a choice in the moment, a choice that felt right to me at the time, but I could imagine having handled it a different way.

For now, I educated them that asking questions about fertility plans is personal.  I’ll save the conversation about pregnancy loss for another time.

Slow-Motion Miscarriage

I really wanted medical management of my miscarriage, i.e., to take medication to speed it along.  I wound up not having that option, since my indicators last week were not great, but also not totally inconsistent with a healthy pregnancy.  Since my doctors weren’t sure, they didn’t want to intervene with medication or surgery (a decision I certainly understand and agree with), which meant that I wound up undergoing a slow-motion miscarriage as, over the course of the week, I slowly went from spotting to bleeding to passing tissue and knew that it was over.  An ultrasound this morning confirmed that my body passed the tissue on its own (even though I am still bleeding), so I have officially miscarried.  Gravida 3, para 1.

The strange thing about going through a slow-motion miscarriage is that you can’t just curl up at home with a pint of Ben & Jerry’s and wait for it to pass.  I mean, I guess you could (perks of the flexibility of an academic job?), but mine has gone on for at least a week, and that would require more pints of Ben & Jerry’s than I am really comfortable consuming.  So, as a result, I wound up doing a lot of things that I never imagined I might do while having a miscarriage:

  • Having a miscarriage during research meetings with my students and postdoc
  • Having a miscarriage while talking with my department chair
  • Having a miscarriage while writing an invited major review article on recent advances in my field
  • Having a miscarriage while sitting on the grass and listening to a student folk music concert with my toddler
  • Having a miscarriage at my department’s end-of-year party
  • Having a miscarriage while baking cookies and playing board games with my old college roommate, visiting from New York City
  • Having a miscarriage during an ice cream fundraiser for my son’s daycare

I mean, on the one hand, if you have to have a slow-motion miscarriage, many of these things are quite pleasant ways to pass an otherwise depressing time.  On the other hand, I’ve felt weirdly disconnected from my life this week, and it’s bizarre to be engaged in some other activity and then have the intrusive thought “wow, isn’t it weird that I’m doing this while having a miscarriage?”  It also feels strange, and somehow dishonest, to interact with other people when they have no idea that you’re having a miscarriage during the interaction — but not quite enough that I really felt like telling them about it (I did tell the two close friends who happened to call this week, and my visiting college roommate).

It’s also frustrating because my son seems to be old enough now that people feel comfortable asking me if we’re planning to have another baby.  Twice this week alone, I got the question, and not from people that I’m particularly close to.  I wanted to yell at them that I was having a miscarriage, and they really shouldn’t ask questions about people’s reproductive plans (or at least point them to this amusing flow chart).  Instead, I just gave my stock answer of “we’ll see!”

One thing I found both disturbing and reassuring this week was a recent study on 2nd and 3rd trimester loss that was published in 2016.  I wasn’t aware of it until this week, since it wasn’t published yet when I was scouring the literature after we lost our daughter in September 2014.  I thought it was such a great study that I emailed the author to thank her for doing the work, particularly since there seems to be so little research on 2nd trimester loss.  You can read the full article here, but these are the two main takeaways for me:

  • Second and third trimester pregnancy losses are strongly correlated, indicating similar etiologies.  Once you have had a 2nd or 3rd trimester loss (including before 20 weeks), you are about an order of magnitude more likely than a typical woman to have another one.  The overall probability is about 4%, with recurrence more likely if the cause of your first loss was placental or maternal, and less likely if the cause was fetal or unexplained.  (This was the disturbing part — my first loss was placental/maternal, which puts me in the higher risk category of ~8% recurrence.  I sort of knew that already, but this was the first time I’d seen the probabilities broken down in that way.)
  • First trimester miscarriage is not correlated with 2nd or 3rd trimester loss, including recurrent 2nd or 3rd trimester loss.  Roughly a quarter of previous pregnancies ended in first-trimester loss for all the women in the study, regardless of the number of previous 2nd or 3rd trimester losses, which is not significantly higher than the general population.  (This was the reassuring part — it makes it more likely that my current miscarriage was just run-of-the-mill bad luck.)

So, anyway, here I am, just waiting again.  Waiting for the bleeding to taper off, waiting for my cycles to reestablish themselves, waiting to see if we can get pregnant on our own again.  The OBGYN had me make a follow-up appointment for August, mostly as a chance to check in and come up with a plan if necessary.  She half-suggested that I could go for an infertility evaluation at the local big state hospital system if I wanted, but since I’m already being followed by an RE at the other major hospital system in the state I figured it wasn’t necessary, at least not yet.  As I discussed with her, while it’s great that we spontaneously conceived (and so quickly!), it does make it hard to know how long to wait before going back to the RE again.  I did put in a note through the electronic messaging system to my RE to update her about this pregnancy and ask if she had any suggestions moving forward, and her one suggestion was: stop breastfeeding.  I’m not quite ready to do that yet, and it seems pointless to go back to her before I am.  So I guess the plan is to wait a few months, see what my cycles are up to, and then reevaluate.  I think I’m OK with that plan for now.

A Plan

Yesterday I visited my reproductive endocrinologist (RE) for the first time in almost two years(!), and now we officially have A Plan.

I’d originally intended to wait a little longer, but last week I had my annual OBGYN appointment, and of course the fact that we were already trying to conceive came up during my visit.  I mentioned that it was hard to know how long to try on our own before going back to the RE, especially since we don’t know whether things are the same or worse than they were at my abnormal HSG right before we conceived our son two years ago.  I also mentioned that the HSG seems to be helpful, or at least lucky, for us since both times I’ve gotten pregnant before it’s been the cycle after an HSG.  She encouraged me to go back to the RE and talk to her about getting another HSG sooner rather than later — as she said, it won’t hurt (too much), it will give us more information, and it might help!

So after that appointment I called the RE’s office, and they had a cancellation this week so they were able to get me in right away.  Yesterday I made the trek back down (it’s about a half-hour drive — in the smallish college town where I live there are no REs so we have to go to one of the large state hospital systems).  It felt so odd walking into that building again, realizing that I hadn’t been there for two years!  And since it’s National Infertility Awareness Week, they had cupcakes in the waiting room — hey, sucks to be infertile, but here, have a cupcake!  Actually, I thought it was very sweet — they were clearly homemade, and I wondered who among the office staff took the time to bake cupcakes for all their patients.

The RE was very sweet, and excited for us, and positive about our chances of conceiving again.  As expected, she gave me a talk about cutting back on breastfeeding before we start getting serious about intervention.  But she didn’t take as hard a line as I was expecting — she said that once a day was probably OK.  She would have been happy to put in the order for the HSG right away, but she pointed out that to maximize the fertility benefit it might make sense to wait until I’ve cut back on breastfeeding.  I was cool with waiting a few months — as I’ve mentioned, we’re really not desperate to get pregnant immediately.  I’ve been thinking a lot lately about trying to at least wean off of daytime pumping, since I dislike it so much and I’m not convinced that at this age there’s really any benefit to breastfeeding four times a day as opposed to two.

So, here’s the plan: I’ll slowly (super-slowly, since I’m so prone to clogged ducts!) wean off of pumping during the day over the next ~month, but continue to nurse morning and evening, plus maybe a little extra on weekends or sick days if S asks for it.  I have the order for the HSG whenever I’m ready, which I’m thinking will be around July or so — if he’s still nursing then, I’ll see how I feel about cutting back to one session (probably bedtime, since he’s often impatient with the morning session anyway — too excited to start his day!).

So that means that we’ll keep trying on our own for a few months, then probably do the HSG and my bloodwork mid-summer, then try on our own for a few more months while my husband gets his testing re-done, and then if nothing has happened by mid to late fall, we’ll be ready to escalate.  The timeline I discussed with the RE is that we’d like to be pregnant within about a year, but it’s OK if it’s not immediate, so we’re content to try this for a while.  She’s optimistic about our chances for a spontaneous conception.  I’m happy with the plan, my husband is happy with the plan, and it just feels good to HAVE a plan and know what to expect.

So, we’ll see what happens.  I’m feeling more positive these days about trying again.  And little S is a huge light in my life, making me appreciate so concretely every day how fortunate we are to have him, even as we look towards a hopeful future of perhaps, someday, a family of four here on Earth.

Dragging My Feet on Trying Again

I’m curious whether any of you have ever felt this way.  Before we were pregnant with our daughter, and then again after her death, I was laser-focused on getting pregnant as quickly as possible.  I was temping, I was charting, I was using OPKs, I was doing everything I could to time things properly and maximize chances of conception.  This time around feels… different.

I want another living baby, very much.  Therefore, I want to be pregnant again.  And rationally, I realize it makes sense to start trying now.  It has never been easy for us to get pregnant, and it probably won’t be this time either.  I’m 34, so Advanced Maternal Age is staring me in the face.  If we want another kid, there’s no time like the present, clearly.

But… our son is still so little.  Our breastfeeding relationship is still going strong.  He’s only just started reliably sleeping through the night.  I’m enjoying the mommy-daddy-baby triad and am not eager to upset it with another little one, even though it’s absolutely what we want for all three of us in the longer run.  Starting over with a newborn sounds exhausting.  Being pregnant again sounds exhausting.  Heck, even getting pregnant again sounds exhausting — getting pregnant with my son was an exhausting and heartbreaking almost-2-year-long haul, counting everything we went through with my daughter.   That’s part of what makes me eager to get started sooner rather than later, but it’s also a big part of what’s making me reluctant.  I just can’t imagine going through it all again.

So, I’ve been dragging my feet a bit.  Just last night my husband asked… isn’t this the week?  And I was surprised to realize that it was, and I just hadn’t really been on top of keeping track.  But he’s keeping track, apparently!

Are we really ready to get back on this roller coaster?  I know that another living baby in our family will be more than worth it in the long run.  But it’s been a LONG run to get to where we are now with our son, and it’s daunting to think about going through it all again.  There’s also my tenure clock lurking in the back of my mind.  If all goes as planned, I’ll submit my materials about a year and a half from now.  Another baby between now and then would practically require me to push back that clock.  But since it’s probably going to take us a while, it still makes sense to start now so that ideally our pregnancy will be timed (ha!) so that my due date would be shortly after I submit my materials.  So there’s the gamble about trying to time it so that it’s soon… but not too soon.  But I also fully subscribe to the mantra that there is no good time for a baby, and that the potential pitfalls of waiting too long are far more dire than the pitfalls of moving back my tenure clock a bit… or even than not getting tenure at all.

Maybe it’ll be easier this time.  Maybe we’ll surprise ourselves and get pregnant quickly without intervention (unlikely, but possible).  Maybe I won’t lose another pregnancy.  Maybe the Lovenox will just inject itself every day.  Maybe we’ll get a magical easy newborn (ha).  Right now, it just looks like a lot to handle, and I’m tired (but not newborn tired, thankfully!), and I want to enjoy my son, whom I love to the very depths of my soul and with whom I never feel like I get to spend enough time.  I’m sure this ambivalence is normal.  But I’d love to hear any thoughts about how to get past it.

In other news, S continues to delight.  He’s walking and climbing all over the place these days, and starting to communicate.  No clear words yet, but definitely several expressive gestures that he uses in different contexts (I won’t call them “signs” because they’re not the official ones that I’ve been using with him, but he has clearly developed his own signs — instead of “all done,” for example, he’ll grab the front of his high chair tray with two hands, and just this morning he also did it when he wanted to get out of his jumparoo.  It was very clearly the same communicative gesture in a different context, and it was so cool to see that he is actually putting together the pieces for communicating with other humans!).  He’s big into blocks and wheels and gets delighted whenever he manages to balance a thing on top of another thing.  He’s very snuggly and pretty social and loves to hang out with our friends and family members, or walk outside and just look at the world and touch the bushes and trees.  I simply can’t get enough of him these days!  Having another little one to watch grow up has to be just as great… right?

Breastfeeding and Trying Again

OK, here’s the thing… we are three weeks away from my son’s first birthday.  There are many amazing things to reflect on at the end of this first year.  I am acutely feeling the parenting cliches: on the one hand, it feels like only yesterday that I was holding my wide-eyed newborn son in my arms, and on the other hand, it feels like he’s been with us forever, and I can hardly remember my life without him.  There are many more things I hope to write about as his first birthday approaches and passes, but another thing I’ve started thinking about as his first birthday approaches is our strategy for conceiving the  living sibling we hope that he will one day have.

Surprisingly for me, my thoughts on trying to conceive our third child are all tangled up with my feelings about breastfeeding my son.

Conception and pregnancy have never been easy for us.  It took 2.5 years from the time we started trying to conceive to the birth of our son.  There were two pregnancies along the way, including the loss of our daughter in the middle of the second trimester.  Both pregnancies involved consultation and testing with a reproductive endocrinologist, and the second time around the RE had recommended moving onto IVF due to tubal factor infertility, which we were in the process of preparing to do when I became spontaneously pregnant with my son.  I am not expecting conception or pregnancy to be easy the next time around either.  Tubal factor infertility (in my case, due to the infection and scarring that occurred after the loss of our daughter) does not tend to get better with time, and it might have gotten worse since the birth of our son.  It is likely, though not definite (we might get lucky again!), that IVF is in our future.

What does all of this have to do with breastfeeding?  For one thing, breastfeeding influences menstrual cycles.  My period returned when my son was 10 months old, but it’s been irregular.  While I’m breastfeeding, it may remain irregular, but I won’t know whether the irregularities are due to breastfeeding or some other hormonal imbalance.  Muddying the waters, I had wildly irregular periods for 11 months before conceiving our daughter, and then clockwork regular periods for 8 months before conceiving our son.  We’d like to try for a while on our own before going back to the RE, but it’s trickier while my periods are irregular.  There are also some data indicating that breastfeeding might impede implantation and reduce the likelihood of pregnancy.  Finally, most REs make a blanket recommendation that you should cease breastfeeding before starting fertility treatments, although it’s not clear how evidence-based that recommendation is.

Many women think of it as a tension between their living child and their hoped-for child: do I prioritize the breastfeeding relationship with the child I have and love, or do I wean in order to maximize the probability of conceiving the child I hope to have?  I suspect there’s a middle-of-the-road option I might be comfortable with, but I’m not yet sure what that looks like.  My breastfeeding relationship with my son is still going strong as his first birthday approaches, but he doesn’t seem to be as attached to breastfeeding as some of my friends’ children.  He doesn’t really ask to breastfeed very often, and he’ll often refuse when I offer because he’s much more interested in seeing what’s going on in the world around him and doesn’t want to take any time out to nurse.  So a bit of mama-led weaning might be well received.  At the same time, I love our breastfeeding relationship and am not sure I’m ready to encourage its end, plus I know that my son derives comfort from it, especially when he is sick or tired.

So, what does our plan going forward look like?  When he was first born I thought “We’ll start trying when he’s a year old, and go back to the RE at six months.”  Now, with no end to breastfeeding in sight (and, honestly, with sex still kinda uncomfortable thanks to the breastfeeding hormones), I’ve started to think “Maybe we’ll start trying when he’s 18 months and go back to the RE when he’s 2.”  I don’t want to wait too long, because I’m not expecting the road to be easy, and I’m not getting any younger.  I’m turning 34 next week, and staring Advanced Maternal Age squarely in the face.  I know that timing can make a huge amount of difference in IVF cycles, and that waiting to even go back to the RE until I’m already 35 (when my son turns 2) might be risky, especially since we’d love to keep the option of a third living child open if we are lucky enough.   I feel sad contemplating the end of our breastfeeding relationship.  But the experience of having our son in our lives has only made our desire for another living child stronger, and my husband and I don’t want to wait too long.

Not My First Mother’s Day

I’m sure that anyone reading my blog is highly attuned to the fact that Mother’s Day is this Sunday.  Already, well-meaning people have started gushing about how this is my first Mother’s Day as a mother.

It’s not.

This Mother’s Day is very bittersweet.  My feelings are still quite fresh from last Mother’s Day, which was 8 long months after our daughter’s death and just a few weeks before we found out that I was pregnant with Soren.  My feelings are also still fresh from two Mother’s Days ago, when we were just about to start infertility treatment, again just a few weeks before we found out that I was pregnant with our daughter.  Those two painful Mother’s Days are very much in my mind as I also reflect on the joy that it has been to be Soren’s mother for the last 2.5 months — finally, mother to the living child that I dreamed of for so long.

This Mother’s Day, I send love and strength to the invisible mothers.  The mothers who have experienced miscarriage, stillbirth, and infant death.  The women who are mothers in their hearts as they toil through infertility tests and treatment.  I also send love and strength to the women who lost their own mothers far too soon, especially the women who will never experience the loving sandwich of having a living mother while also being a mother to a living child.  It’s a beautiful and wonderful time of life, and something that I will never, ever take for granted.

While this isn’t my first Mother’s Day, it’s by far my best Mother’s Day.  I am surrounded by love, and my love surrounds my newborn son.

What I have to look forward to

This week has been a vacation week for local schools, the university, and university-affiliated daycare.  As a result, faculty parents are bringing their kids to campus with them — the kids are playing with each other, the parents are looking frazzled, but everyone is generally running around and having a good time between semesters while the grown-ups try to get a little work done.

Several times this week, as I’ve wandered the halls 7.5 months pregnant, I’ve gotten comments from frazzled parents along the lines of, “See, this is what you have to look forward to” — usually while their kids are screaming, hitting each other, or otherwise misbehaving.  Another variation includes, “Just be grateful yours is still on the inside — they’re so much harder once they’re out.”

I have to admit that in my hyper-emotional highly pregnant state, some of these comments have brought me to the brink of tears.  Pregnancy, especially late pregnancy, isn’t easy for anyone, but it’s particularly emotionally fraught when it’s a pregnancy after infertility/loss.  Here’s what goes through my head when I hear these comments:

  • What if I’m making a mistake, and nearly three years of dealing with infertility and pregnancy loss on our way to a living baby is only going to make me miserable?
  • How am I going to deal with highly physical boys like these?  Why did my daughter have to die?
  • God, I hope I have this to look forward to and that my baby doesn’t die again.  Don’t you know how lucky you are to have two or three living children to annoy you? 

In my saner moments when I’m able to sit down and think things through rationally, I realize that this is all silly.  I know that none of these parents would, for a moment, give their kids back.  I know that they love their kids with their whole heart, that even when it’s tough they value the time they get to spend with their kids.  So why are they making these hurtful comments, the ones that make their kids sound like monsters, in my very pregnant direction?

Of course, there are all sorts of moments that they might have chosen to highlight instead, where those very same words would give me strength and hope instead of insecurity.

When they’re snuggling together — “See, this is what you have to look forward to.”

When those sticky little hands give them a hug, a little mouth gives them a kiss, and a little voice says I love you, Mommy — “See, this is what you have to look forward to.”

When their heart bursts with pride to see their child being kind and generous to someone else — “See, this is what you have to look forward to.”

I recognize that it’s part of an entire genre of things that people love to say to freak out pregnant women: “Sleep now, because you’ll never get any sleep again after he’s born!”  “Boys are such a handful — say goodbye to your clean house!”  “You’ll never know what hit you.”  And then add 1,000 horror stories about labor and delivery.  These things are normal.  They’re mostly just good-natured teasing.  I know that I’m extra-sensitive, especially right now.  But wouldn’t it be nice if people could make the positive versions of these comments instead?

I know it’ll be hard to have a baby.  I know that I don’t know how hard it’ll be.  But I also know that most of my parent-friends feel that despite the difficulties, parenthood is one of the best decisions they’ve made.  It’s something my husband and I very deeply want to experience.  We are so looking forward to welcoming this new little life into the world, and to all the good and bad experiences that come with being parents.  As January begins and my February due date looms ever closer, I’m trying to look past the negative comments, and focus on what I truly have to look forward to.  To think about looking into my son’s eyes for the first time, to think about holding his little body safe and snuggled into mine.  To think about watching him grow and change and learn and discover all the beautiful and amazing things the world has to offer.  That, along with a million other little things, is what I have to look forward to.