I am adding blogs as fast as my little hands can type. One question my husband raised as we began this project was whether there was truly an “infertility community.” He questioned whether people identified as infertile in the same way that they identify their culture/place of origin/nationality/religion. Do I put it down on forms? No. But, then again, forms outside my ob/gyn’s office rarely ask me about my fertility. But do I think of myself as an Infertile Jewish American? Definitely. It shapes my landscape and mindset just as much as any other cultural marker. It’s not something I’m happy about, but it’s definitely something that has changed who I am and still affects me.

As you can see when I watch television.

I think that people who have never experienced IF watched that episode and wrote it off as a simple story of post-partum depression, preemies, and a crazy IVF mother (who, by the way, talked her husband into having more kids when he was happy with the triplets they already had. So not only was she selfish, petty, and small, but she also was the stereotypical IF woman who bulldozes over all reason because she is a crazy, hormone-striken, baby lusting fool). It fit into the general perception of A.R.T.

But I watched it and cried. Because it reflected all the hard choices that IF parents make. I understood completely why she would want to use 5 embryos while other viewers judged her because I would want to use 5 embryos if finanically I had one shot at IVF. And I understood why she wouldn’t want to do selective reduction because even though it is the intelligent choice and the rational choice, it is also the difficult choice. And when it comes down to it, I am selfish. And I am scared. And I go into too many what ifs which turns me more selfish and scared in our decision-making.

I am obviously taking a television show a bit too much to heart. But I think that’s what I mean by identifying as infertile. In the same way I am affected when I see Jews portrayed as a stereotype on television, I am affected by the flippant way they dealt with infertility on Friends (and Monica/Courtney Cox was going through IVF and miscarriages! How could they not write a better script?). And as comments have already said, I think the general public doesn’t want to hear the real stories–the average stories. They don’t want to hear about so much love and hope coming together to form one child. They want to judge. They have a preconceived idea about A.R.T. and they want it fulfilled. Tell me the good portrayals of IF/A.R.T. and I’ll show you an infertile artist who created them. The new Dixie Chicks song. The… Well, I’m drawing a blank on any other positive outpouring of emotion that reflects the full reality of A.R.T. rather than just the outlying possibilities.

What I am trying to say (in as long-winded a way possible) is that this blog won’t change over time because I will always identify myself as infertile, even after my last child is born or adopted. And I think that’s why we wanted to keep it going as a clearinghouse for information as well as discussion/debate. Because the landscape keeps changing and hopefully each blog that is currently listed in another category will move into the “pregnancy or parenting after IF” category. Other blogs may come and fill the empty spaces (unfortunately), but we wanted this blog to remain the same. It can be your TTC friend that won’t leave you behind and start blogging about pregnancy and beyond. Because other blogs need to do that, but ours doesn’t need to be any place but here. It will still be here after you go through your first pregnancy and then jump back into IF again through secondary infertility (oy vey–if that happens, I have an emormous box of Kleenex that I’ll mail you). Which means you can drop in and out whenever you need to be here. Because that’s the purpose of community–it bonds and defines you while leaving the possibility for growth and change.

We’d love it if you could put a link to our blog on your blog in order to help others find there way here. Stay tuned for our next big project–Operation Heads Up… Details coming soon.

The first time they aired the quintuplet episode on Grey’s Anatomy, I was barred from the television. My husband asked me why I would possibly need to watch a fictional woman’s IF and NICU experience when I had my very own painful IF and NICU experience. Because…that’s what you do when you hear that there’s going to be an infertility story line on television, sweetheart. You watch it. Like a car crash. And I like Grey’s Anatomy. It’s my one hour of escape every week. Though…not much of an escape when they cover infertility…

Last night, they aired the episode again and I watched it. I’m pretty wary of television in general because messy topics (such as infertility) cannot be dealt with on any satisfactory level within one hour. And Grey’s Anatomy didn’t let me down. The replacement for the lost baby—a dog! Because adopting a puppy is the natural equivalent to having a baby.

Every episode of Grey’s Anatomy centers on one idea, with the idea spoon-fed to the viewer via voiceovers by the main character. Last night’s theme was “being alone.” One doctor inadvertently kills a patient, but stays with him because he doesn’t want him to die alone. A doctor is left “alone” to care for a baby. A prisoner—who was in solitary confinement—swallows razor blades in order to come to the hospital and not be alone. A woman feels “alone” without a daughter and does IVF to build her family. Of course, since they’re presenting IVF to the general public, it needs to be an IVF quintuplet case. Because the average IVF case that results in one child or twins is not possibly as exciting. Nor do these average cases play into the non-infertile world’s stereotypes of A.R.T.

The quints are born early. Of course, in an earlier episode, the woman admits that she knew the perils of carrying five children at once, but she couldn’t do selective reduction because she already knew her children. Even in the womb, she knew their personalities. And, of course, in this episode, the woman who confidently defended her decision prior to the birth now feels guilty and confused. Her guilt and confusion are never resolved. We are just left seeing the mother in the throes of depression—the obvious message being that if we are dabbling in A.R.T., we should take the King Solomon approach to parenting.

The King Solomon Approach…oh…the bane of all A.R.T. decision-making. The extreme financial commitment and the desire for outcome coming together in the perfect storm of indecision-induced depression. The story of King Solomon is that one day, two women and a baby were brought before him. The women were arguing over who was the mother to the baby. King Solomon ruled that they should cut the baby in half. That way, each woman would get to have part of the baby. The first mother agreed to this decision, but the second mother thrusted the child at her and said, “no, you keep the whole child. Protect this baby.” King Solomon then awarded the second mother the baby and knew that she was the actual mother because she was willing to give up her baby (and her own chance at motherhood) in order to let him live. A true mother would do anything to protect her child. Even give up motherhood.

But then you come to the questions raised through A.R.T. IVF (and other procedures) is so expensive and you have so much invested in the process—emotionally and physically. Therefore, you want to use more than one egg in order to build more than one chance to get pregnant per cycle. But the risk is that all eggs could take and you would be left carrying quints. Our clinic asked us on our first appointment if we would be willing to do selective reduction. When I answered negatively, they told me I would never be able to use more than three eggs in a cycle—the limit for the clinic. I was fine with that, except that you hear stories of people who transferred seven eggs and only had one implant. And you start worrying about the money and trying to make each chance the BEST possible chance. And the cycle continues.

The woman in the episode is painted as selfish because she didn’t selectively reduce and therefore give the remaining children a better chance at health. The doctors in the episode are seen as the saviours undoing the damage caused by that poor, deranged IVF lady. And it hurts. It really hurts to see the non-infertile world commenting on something that is so emotional to me. I couldn’t do it—I couldn’t do selective reduction. And it’s a very personal decision. I wish I could be the King Solomon mother who would do anything for her children. But I’m selfish. I want to be a mother. And I would continue any pregnancy in order to be a mother. Of course I’m saying this in a bubble—there are my husband’s feelings to consider. There are others who would maybe be able to present the situation in a different light. But from where I sit, I don’t see much that divides me from the IVF lady on television.

My favourite show just inadvertently called me selfish, petty, small.

Big thank you to all of the people who wrote and told me how to create this blogroll. I always have big plans on how I’m going to use the Web, and then I sit down at the computer and realize I have no clue how to do…well…anything other than post to this blog. Thank you also to DH who sat on Bloglines for an hour this afternoon trying to figure it out while I lazed on the sofa. Lazed on the sofa? I mean, did important important important research. With my eyes closed.

Another hope we have for this blog is to make it a clearinghouse for all other blogs in order to connect newbies to those more experienced. I gained so much information on infertility from other people on the Web. I knew the right questions to ask. I knew how to be a better advocate for myself. I knew what was “normal” and what was setting off warning bells.

I have a book on infertility stories that was a fantastic resource. Reading about someone else’s experience with IUI BEFORE I had the procedure let me know what to expect. Again, which questions to ask. And a blog is a living, breathing version of that stagnant book. It’s a space that will be updated as experience continues. There is an opportunity to ask questions.

So I am slowly creating this blogroll. It will take me a while to add all of the blogs I’m already reading. One way you could make it go a lot faster is to email me with a link to your blog so I can click-and-add. You can email information about this blogroll to other IF bloggers. Also, once you’re added, if your category drastically changes (for instance, if you go from the male factor category to the pregnancy/parenting after IF category), please let us know so we can move you. As always, our email address is thetowncriers@gmail.com.

Most people will fit into more than one category. We’ve chosen one for you in order to get you on the list. If you think you fit somewhere better, let me know. Again, it would be best if you emailed me with a link to your blog.

There are lists like this out there, but as we started getting more and more hits, we realized that we could also make this space a clearinghouse for all other blogs. Especially since we’re addressing general thoughts on IF and not just our own personal journey. So if you have a great list that you think could help us put more links on this blog, send that along too.

Wheeew…

I read a lot of infertility blogs.

A lot.

Of Blogs.

There’s a lot of infertility out there. I’ve heard anywhere between 1 in 5 to 1 in 7 Americans. And what is the best way to vent and destress than to start a blog. So there are a lot of infertility blogs out there. I read other blogs too–Amalah, Dooce, Postsecret, Miss Snark…(ahem…)…Celebrity Baby Blog (mutter, mutter). Yes, I have many degrees and I’ve read every Shakespeare play. And I am a lover of People Magazine and Celebrity Baby Blog. And I can admit that. With only a bit of a blush.

Every time I read something I love, I want to send it out to everyone I know. Which is how I came to the idea to do the Friday Blog Roundup and comment publically on a few things I read this week. There is plenty that I read that also moved me, but since space is limited, I must pick-and-choose.

On a side note, I am still trying to figure out how one posts links to other blogs on the side column. Once I get that figured out, I’d love to start a list–a clearinghouse of IF blogs–so if you’d like to be included, let me know.

First off, Dead Bug (http://www.deadbugs.blogspot.com/) had a great post on Monday about Beginning Day, the transfer day for her daughter who she conceived on her second IVF. It’s the thin silver lining of IF–the ability to know the conception date of your child. Would I rather not know the date AND not have had to jab myself in my stomach with sub-cue needles? Sure. But I do love having the family holiday of Conception Day (which will, from now on, be known as Beginning Day–I love that).

Next off, Richard (http://the-end-of-my-line.blogspot.com/) has a fantastic blog overall that discusses donor insemination. We’ve been emailing back and forth. Knew literally NOTHING about the UK’s open-donor policy and it’s after effects until I started reading his blog. There is a huge shortage of sperm donors in the UK due to a new policy that does not allow donors to remain anonymous. Head over there to have your eyes opened about medicine on the other side of the Atlantic.

Carrie (http://lifeinthesoupbowl.blogspot.com/) has tons of information about egg retrieval/transfer from her procedure this week. She has an amazing story about a friendship which goes above and beyond anything between Oprah and Gayle (has Gayle ever donated an egg! Experienced shots for Oprah!). She is in the two-week-wait, so please send tons of good thoughts her way. May she only hear good news this week.

Lastly, Serenity ) is going in for a transfer next week (so channel a bit of the good energy you’re sending to Carrie her way as well). Third time IS a charm. I’ve loved reading about the Ali Domar dance this week–the deep breathing, the mindfulness, the peace. It is so hard. Lying down and NOT thinking about IF is so hard. I tried Domar’s book and it did bring me moments of peace. And moments of peace is better than nothing. If you are extremely stressed, head over to her blog and learn more about Domar’s book. And then go pick up a copy for yourself.

Hope everyone has a wonderful weekend. I’m off to harvest tomatoes from the garden. Make a salsa that will knock you out…

Diagnosis: Premature Ovarian Failure

by Hannah Wept, Sarah Laughed

What Premature Ovarian Failure Means and Its Impact on Fertility
Premature Ovarian Failure (POF) is when ovarian function ceases before age 40. It has previously been referred to as premature menopause, and this cessation of function is not considered a natural, though premature, menopause because it is happening at such an early age. POF can occur as early as the teenage years, although the average age of onset is 27. POF may be caused by a number of factors, from autoimmune disease to surgical intervention; many times, the exact cause is undetermined. While POF is probably one of the least likely diagnoses of infertility, it is estimated that between 1-4% of the female population has POF. For whatever reason, the ovaries cease to function, whether that means a loss of eggs entirely, a dysfunction of the eggs or egg production, or as a result of surgical removal of one or both ovaries. With regard to infertility, a woman carries a statistically small chance (6-8%) that she may become pregnant using her own eggs, but there has been no definitive protocol or treatment to ensure who the 6-8% will be. A woman can be diagnosed with POF and not be able to utilize or conceive with her own eggs at all, but still be in fine health to carry a donor gamete pregnancy to term.

Diagnostic Process
POF can be a particularly tricky diagnosis to obtain, as many other factors can mask the actual problem. The first most obvious symptom of POF is a lack of periods (amenorrhea), as the ovaries are not ovulating and thus, not setting the menstrual cycle into motion. Women using birth control are not necessarily at an increased risk of POF; rather, it is more difficult for women on birth control to know there are any issues with their ovarian function since the birth control replaces and simulates naturally occurring ovarian hormones. Typically, a need for diagnostics occurs when a woman ceases birth control only to find that her periods are not returning. Other symptoms may include those found with naturally occurring menopause later in life: hot flashes, night sweats, insomnia, and/or vaginal dryness. The biggest challenge many women face in trying to obtain a diagnosis is being told that their symptoms are stress-related and may require persistent, informed advocacy on the part of the patient.

Blood work is often the first step, specifically measuring the following hormonal levels: estradiol (estrogen), FSH (follicle stimulating hormone), LH (lutenizing hormone). (A thyroid function workup may also be performed at the same time, depending on your prior thyroid function history.) Very high FSH values (above above 40 mlU/ml) usually indicate POF; most doctors will perform a second round testing these same hormones in one month to confirm that the initial tests were not a fluke. If FSH values remain the same or higher, a diagnosis of POF is usually confirmed at this point. Doctors will then try to determine the cause: autoimmune diseases producing anti-thyroid (Graves’, Hashimoto’s) or anti-adrenal (Addison’s) antibodies often result in creating anti-ovarian antibodies thus inducing POF. Other autoimmune diseases such as lupus and rheumatoid arthritis have also been linked to POF. Blood tests to measure the presence of these antibodies may be performed. Genetic testing (karyotyping) may also be performed to determine if there is a genetic cause to the disease.

Treatment Options
POF carries health risks beyond infertility, as the body is depleted of vital hormones that are normally present until age 40 or the onset of natural menopause. Younger women with POF often begin some kind of hormone replacement therapy (HRT) to supplement the hormones lost, although each woman should discuss and work with their doctor accordingly to determine what type of and if HRT is the safest choice for them. Increasing calcium intake and doing weight-bearing exercises on a regular basis help to prevent osteoporosis, as women with POF are at an increased risk for both osteoporosis and heart disease.

With regard to infertility, ovarian stimulating drugs have little effect on women with POF to encourage their ovaries to produce their own eggs. There is anecdotal evidence (less than 1%) to suggest that some women may be able to stim their ovaries using a round of recombinant FSH injections or even by taking birth control pills for 6 months and then stopping them suddenly. However, these are dicey gambles at best- expensive, emotional failures at worst (with particular regard to pricey Follistim or Gonal-F injections). Women diagnosed with POF are often told to seek the use of donor egg with IVF or to consider family building through adoption. As a diagnosis of POF essentially precludes the possibility being able to conceive one’s own genetic child, women and couples coping with this diagnosis often face extreme grief not unlike the death of a spouse or close loved one. Individual and couples’ counseling can thus be a vital compliment to the diagnostic and treatment process.

Personal Experience
When I was 18, I had my left ovary removed in an emergency surgery for a torsioned ovarian cyst that killed my ovary. I was on birth control pills from that point on, and experienced regular the periods that are associated with taking the pill. My periods suddenly stopped for 7 months when I was 25, but my doctor assured me it was stress and put me on a higher dosage of birth control pills. After stopping birth control pills for a neurological migraine contraindication when I was 26, my periods did not return for 3 months. I went to my doctor, who again told me it was stress, but referred me to the reproductive endocrinologist in their practice for follow up. I was diagnosed with POF at age 26 after two high FSH tests and almost no estrogen. My POF is caused by an autoimmune thyroid disorder (Hashimoto’s). At present, I have not begun HRT as my thyroid function needs to be stabilized before going on HRT (as my thryoid medication will have to be adjusted again once I begin the HRT). I have been informed that my best chances at children will be to pursue donor egg/IVF or adoption, as I have little hope to ever producing my own genetic children. Emotionally, this has been a rollercoaster for my husband and me. I have felt everything from a crisis of faith to panic, despair, and deep grieving. Essentially, I’m grieving for the genetic child of me and my husband that will never exist, and it’s a daily process to navigate emotionally, as every little thing can be its own landmine. For now, I’m working on getting my thyroid stabilized and keeping in general good health to prevent further health complications related to POF, and my husband and I are actively investigating the best options to build our family.