Thursday, June 21, 2012

Infertility Etiquette

Though infertility can seem like a lonely row to hoe, I have managed to make some valuable and comforting connections with others who suffer similarly.  We share tips about how to ease the searing pain of intramuscular injections, agonize over ridiculously pale lines on home pregnancy tests, and empathize heartily when a long time friend or sibling turns up pregnant without even trying.  Sadly, many women I talk with have dozens of stories involving being hurt or offended by loved ones in regard to their infertility status.  I like to think that, in most cases, the faux pas was entirely accidental (and largely unnoticed), but we infertiles have a special set of sensitivities that many cannot anticipate.  I think the miscommunications can be broken down into three categories:

1) This is not a time for humor.  I know you're just trying to help and lighten the mood, but it feels deeply offensive and distasteful when you jokingly offer us your own misbehaving kids or tease "You sure you want kids?!"  Many of these women have experienced repeated miscarriages.  And those who haven't often liken the painful years of waiting, the disappointments, the ever widening gap, to a kind of death.  "It's like you're a mother," a friend told me one day, "but someone has locked up your child and won't let you see or meet him.  You walk around feeling like you're incomplete, bereaved, haunted by the baby you can't find."  If you wouldn't joke about someone's child dying, you probably shouldn't joke about their child failing to be born.

2) Don't minimize the problem.  The worst. possible. thing. to say is, "Just relax, and it'll happen." SHUDDER. Other vile variations on the same theme include, "Just adopt, and then you'll get pregnant," and "Lots of women have healthy babies well into their 40s."  Similarly, providing anecdotes of people on TV or someone's brother's aunt's boyfriend's hairdresser who had triplets naturally at 45 or who got pregnant as soon as they stopped treatment....not helpful.  We know our chances.  They're not good chances.  Shaking a lucky rabbit food at us doesn't make math and science go away.  It just tells us you don't get it.  Relaxation and dumb luck are luxuries for the healthy.

3) Don't tune us out.  If someone screws up the nerve to confide in you such an embarrassing, taboo problem, please be a good listener.  It's a big deal to reveal that kind of medical and psychological pain.  Yes, it may make you uncomfortable to hear about sperm or shots or ultrasounds, but think about how we must be feeling, facing all that invasive craziness mostly alone.  This is a good time to put other preferences to the side for a moment and listen with your whole being.  And finally, once you know, be sensitive about bringing it up again.  Yes, many women would be relieved to have a genuine, "How are things?" volleyed their way.   However, a brash text message like, "Hey, pregnant yet?! ;-)" is pretty much salt in the wound of a failed cycle.

If you're reading over this and thinking, "Whups!  I've done one of those," it's okay.  We forgive you.  (Donations are a good way to avoid a karmic shin-kicking, however.)  For those of you who've been awesome all along, and you know who you are, a million thanks.

Tuesday, June 12, 2012

The Birds and the Bees - Test Tube Edition

I have had a lot of questions and quizzical looks when I explain what we're signing up for with In Vitro Fertilization.  I thought I'd take a moment this week to break it down for one and all.

The first step is to make my ovaries go nuts making eggs.  On a natural cycle, several eggs start to develop at once until one finally releases, and the others quickly sit down and shut up.  (In the case of natural fraternal twins, two eggs accidentally release spontaneously, before the "I got this!" message could be sent around.)  In our IVF cycle, I will inject myself daily with drugs to make my ovaries triple this process of development while simultaneously taking another drug that shouts into a bullhorn, "Hunker down! Nobody let go!"  During this time, I'll need to go in for daily ultrasounds to monitor my hardworking ovaries and tweak my drug regimen.  If they don't develop eggs quickly enough, we may not have adequate material to work with in the next step.  If they develop too quickly, I can get a painful and life-threatening problem called Ovarian Hyperstimulation Syndrome.  So easy does it, here!

When my ovaries start to look really beautiful (or insane, depending on your viewpoint), they'll schedule the egg retrieval, and I'll take a "trigger" shot telling my ovaries to leggo my eggos.  The doctor will put me under, then use an ultrasound-guided needle to suck up all the good looking eggs he can find.  If we're all doing a good job, then we might get as many as 30 eggs!  Around the same time, Jake will need to give the clinic a cup of his "special" sperm.  Both eggs and sperm then go to the beauty parlor and get totally prettified for their big date on the petrie dish.

Now, with well-adjusted sperm and eggs, you can usually just introduce these gorgeous kids and let nature take its course.  They're in the prime of their lives, after all, and have never looked better.  However, Jake's sperm is too socially awkward for these subtleties.  They'd sit around all night just looking longingly at my eggs and wishing they were less homely.  So our doctors actually plan to pick up each sperm by the scruff of his neck and stuff him right into each egg.  I know.  So much for cellular foreplay.

After that, we put the newly created embryos in special "grow, baby, grow" juice and cross our fingers.  Within 48 hours, each should have multiplied into 6-8 cell organisms (many won't).  We can implant then, but if many are looking hardy, we'll wait until day 5 when we might have a few blastocysts (80-100 cells).  We'll select the very best of the bunch, and if there are some good runners-up, we'll put those on ice for another time.  The doctors will send our over-achiever up the birth canal and into the uterus where we hope it will find a warm place to burrow and sleep.  I'll probably continue with a few drugs to keep my uterine home nice and comfy for as long as the doctors see fit.  Then the dreaded two week wait.

The rest of the story is undoubtedly familiar to you: tests, celebration, reading, registering, showers, shopping, joy, pain, cuddles, milk, kisses, perfection.

Wednesday, June 6, 2012

Why Not Adopt?

One of the reason many couples fear coming out of the closet with fertility treatments is because the public is somewhat divided on that topic.  An acquaintance of mine who received an IVF scholarship from INCIID was interviewed on NPR, and the online comments from listeners were half supportive, half bitterly critical.  The latter half mostly griped that fertility treatments are the ultimate in upper-class, self-indulgent vanity.  "Why not adopt?!" they cried.  "Why spend tens of thousands of dollars trying to have your own baby when there are tons of babies out there that need good homes?  It's just selfish and short-sighted.  What a waste of money."

In some ways, I agree.  Ever since I was a little girl, I've dreamed of opening my home to little children in need.  I can remember driving around looking at Christmas lights in the opulent Highland Park neighborhood with my family, and as my mother and sister oohed over the beautiful homes, my ascetic 12 year old spirit turned up her nose at the decadence and swore to only own a house that large if I could fill every room with a homeless person.  I can recall listening to educational sermons in church about the value and necessity of foster parenting, especially older children who will soon graduate from the system at eighteen without an ally or mentor to guide them to true independence.  I thought, "Oh man, I hope I can marry a man who will want to foster tons of wayward teens with me."  For a long time, I was so passionate about adoption and foster parenting, I couldn't see any reason to go through all that messy childbirth business.

But then, I fell in love.  And something miraculous and mysterious starting working within me, just as it does nearly every woman at some point in her life.  I felt the deep, spiritual calling to create life with my partner.  I felt my love for him yearning and reaching to extend through new generations.  My admiration for his beauty and wit overflowed until I sought a likeness in his future children.  I wanted to give birth.  I longed to feel life inside me.  I literally dreamed of breastfeeding.  This baby would come from my flesh and his, I would bring it forth into life with my own body, suddenly flowering with all this maternal instinct and drive.  My body was so heightened with desire, we joked that I could sense any baby in a mile radius, without even turning my head.  It wasn't academic anymore.  It was physiological.

As for the money argument, it seems that infertile couples must pay a sort of tax for their reproductive failings.  Though IVF treatment, at around $12-15,000 per try, seems indulgent and ridiculous, consider that the average domestic newborn adoption costs between $25-35,000.  What about China, you ask, where they don't even want their little girls?  An average of $29,000 per child.  (Jake and I don't even qualify for most of those international adoptions because of our medical histories.)  But, at least adoption is guaranteed, right, unlike risky fertility treatments?  Nope, approximately 31% of adoption attempts result in the birth mother changing her mind.  I immensely respect adoptive parents and children, both domestic and foreign.  However, part of that respect is acknowledging that it's no cake walk to adopt a child.

I still plan to adopt and foster.  My passion for helping others that way has not diminished at all.  I just know that I need to try this first.  I want to experience motherhood, with all its varied delights and pains, just as women for millions of years before me have.  When I look into the beautiful faces of my friends' and relatives' children, when I see a flicker of likeness to mommy or daddy, it breaks my heart with the universal beauty and miracle that is "family."  Though our treatments eventually may not work and we'll never experience such miracles first hand, I would hope that our decision to try is understood and respected.