Wednesday, February 06, 2013


This is a big, rambling, super personal, hopefully one-time post on infertility, from the point of view of someone who managed to conceive quite quickly with a very simple fertility treatment. If you do not suffer from infertility, or (think) you do not know anyone who does, or if you just don’t want to hear about someone who conceived quickly with the right medication, feel entirely free to skip this post! There is actually a tie-in with lactose, though. And I’ll be back soon with another recipe.

I was educated in the French schooling system. Not only do I feel like I got a great education all around, but unlike in many Southern American curriculums, when came time for sex ed (STD prevention, birth control, emergency contraception and pregnancy interruption), we glossed over abstinence and learned everything about all the actually useful stuff, including the importance of going double Dutch*. Which is to say that I’ve always been very careful. So I naturally assumed that when I stopped taking all those precautions, I’d just get pregnant immediately. Or at least within several months. But that’s not how it happened.

(*The Engineer informs me he’s never heard of this expression before, which is not to be confused with going Dutch on a dinner date. I didn’t make it up, though: according to its Wikipedia disambiguation page, “double Dutch” refers to “using multiple forms of contraceptives simultaneously, usually one by the female, and one by the male.” This is standard practice in the Netherlands, hence the name.)

You see, when you decide to not get pregnant, you’re in control; ergo, getting pregnant is a choice, something that happens because you made (or didn’t make) certain decisions. This then gives you the illusion that you can also choose to get pregnant, by controlling it in a similar way. But that’s just it, an illusion, even for many couples who are perfectly fertile. When I thought of famous TV couples to represent the Engineer and me, I liked picturing Marshall and Lily, but it turns out we are more like Chandler and Monica. I’m not sure why that’s surprising, really, considering that I’ve always been more Monica than Lily!

There are always people who ask couples when they’re planning on having kids. This usually starts immediately after the wedding (sometimes right after the ceremony on the day of the wedding). And the longer you go without producing an heir, the more people will ask. Sometimes it’s just good-natured ribbing by people who mean well, and sometimes it’s actually parents and/or in-laws anxious to become grandparents and who, often quite knowingly, put pressure on the couple. At first, the Engineer and I didn’t really mind, because we just weren’t ready to have kids and didn’t mind saying so. Then it became more delicate, because we were indeed trying to have a baby, but weren’t willing to shout it from the rooftops. (And had I been pregnant, we wouldn’t have wanted to say anything before the second trimester anyway, so the constant inquisition would have led to a few months of flat-out lying.) It really became bothersome, though, when we realized that we were having fertility problems but, again, weren’t ready to share that information. And some people just keep prying and asking and pressuring and getting all up in our business and being completely oblivious to our cues that this was not a topic we wished to discuss. It seemed that no amount of “Don’t worry, when we have something to announce, we’ll announce it” would satisfy them. Was our family afraid that we would have a child in Texas in secret and never bring said child with us to Canada? Sometimes it came from people we don’t see often, so they might have honestly thought they were the first to ask us this, ever. This happened at my sister’s wedding, for example, where three different relatives asked when we would have kids already, and a family friend simply assumed I was pregnant, probably because I wasn’t drinking wine (I never do, but he doesn’t know me well enough to know that) and I was wearing an empire-waist dress (I just like the style, dude). So that third phase was the really tough part, at least for me.**

(** I am not saying this to be in any way hurtful to the relatives involved. It’s simply my side of the experience and how it felt from my point of view. I tend to be a private person and I share the information I wish to share; when I don’t give any news on a particular topic, it’s either because there are no news or because the news are private. After talking with some of my fertile friends and reading accounts of infertility from other women, I realize that they have experienced the same thing and resented the intrusion on their personal life as much as I did. That’s why I chose to share this, because I know others can relate and because it is almost always part of being infertile.)

It’s not that I wanted to be in the infertility closet for the rest of my life. As of recently, I’m halfway out: my immediate family and close friends know, but my extended family and acquaintances don’t, which is the way I want to keep it. (Coming out often really has to do with how much questioning the couple is willing to deal with, how much explaining they want to do, how much pressure they can take… But there’s pressure either way, pressure to have kids or pressure to explain what they are going through. I hope that with this post, any explaining will be out of the way for us! Here’s an account of a woman who came out because she felt it suited her personality best, although both she and the commenters can see both sides of the issue, as well as one where the woman is mostly in the closet still.) But some people respect your privacy and some people just don’t see the same socially accepted personal boundaries we do. For the latter, my experience has been that if you give them an inch, they take a mile. If you so much as open the door on your personal life and give them a piece of information, they think they’ve been granted permission to ask even more personal questions, more often. Case in point: before her first pregnancy, my friend Natasha (not her real name) was very open about the fact that she and her husband would be trying after a certain date, that she was off birth control, etc. As a result, everyone kept asking her if she was pregnant yet, several times a week, including right on her Facebook wall for the world to see! It was painful for her to have to say “No” for four months, then to have to lie and say “No” for another three months. For the next two pregnancies, she kept the trying part under wraps until she was ready to make an announcement, and apart from her parents, no one bugged her. As for me, I knew that if I said we were trying and weren’t having any luck, we’d get a deluge of “What’s wrong?” and “Are you going to see a doctor?” and “What did the doctor say?” and so on from some people. And if I had said we’d be trying fertility treatments, then it would have been “When did you ovulate?” and “Did it work?” for weeks, probably for multiple cycles. I refused to put myself in that position.

That two-week wait between ovulation and expected day of period is just killer at first, too. I referred to it as Schrodinger’s uterus, because there may or may not be an embryo in there, but you have to wait to find out. The slightest little twinge can be twisted into proof of a pregnancy (bloating, cramps, sensitive breasts, dizziness, frequent urination, hunger, fatigue, etc.). And the truth is, I’ve felt all that when I wasn’t pregnant. Here’s a funny post with ten ideas to make it through that two-week wait. I always took precautions as if I were pregnant during that time (no sushi, no wine sauce, no raw eggs, etc.), and the Engineer and I cheered ourselves up with a sushi dinner when I got my period. Eventually, though, sushi wasn’t enough to cheer me up. I did get to the point where I had stopped hoping it would happen naturally, so those two weeks eventually became like any other weeks. (When I finally did get pregnant, I had cramps that, until taking the test, I had attributed to perhaps eating something with lactose, even though I could tell it wasn’t really coming from my digestive tract. I’m telling you, I really wasn’t expecting it anymore. The cramps only made sense after I saw the second line on the pregnancy test!)

Of course, you’re free to try natural fertility supplements or fertility-boosting foods (see here, here or here for examples) early in the process, but let’s face it, if you have a physiological problem, it’s probably not going to help at all. My best recommendation today to a couple in their twenties or early thirties would be to seek the help of a fertility specialist if you haven’t been able to conceive after one year (if you are older, seek help sooner). But if you have any kind of fertility problem, or even if you don’t and it takes you 6 months to conceive naturally instead of the 1 or 2 it took your best friends, it will be in your face all the time. Friends and family around you get pregnant (even some who weren’t trying), characters in your TV shows get pregnant, pregnant women and babies and adorable baby clothes start popping up everywhere, and teen moms stare at you from the tabloid covers in the checkout lane at the grocery store. I even have a friend who first started trying to get pregnant at the same time I did, and she’s due with her second child in less than two months – at that rate, I was afraid her kids would end up babysitting mine! And the women around you who complain that they “can’t” get pregnant reveal they’ve only been trying for a few months, so it’ll take all your restraint not to high-five them. In the face.

I found it difficult to come across good infertility blogs when I was looking for online support. They’re definitely out there (start with the top 50), but many of them either turned into mommy blogs (encouraging, sure, but not what I wanted to read about at the time) or got depressing (like one poor woman contemplating her 21st IVF cycle, since the first 20 did not work, and she had to pay for all of it out of pocket – so she had it way worse than me, but it’s also not what I wanted to hear right then). My advice would be to look through the archives of various blogs and find what you need from each timeline. Redbook magazine also has a great series featuring videos of real women talking about their infertility, which can bring some comfort to those who feel alone or isolated. (Statistically, though, something like 1 in 8 couples will deal with infertility, so it’s really a pretty common problem. According to Time magazine, 5 million babies have been born using assisted-reproduction technologies since the first test-tube baby in 1978.) Some people may find Quips and Tips for Couples Dealing with Infertility useful. I also sympathized with Kate Hawkins’ tale of trying to conceive. And while we’re trying to get a few laughs, here’s a list of 50 things not to say to your wife if she’s suffering from infertility, as well as a feature I enjoyed on the blog Conceive This: Yahoo Answers, Not So Much (see another edition here or here). And here’s also an infertility board on Pinterest that had me in stitches!

As for those of you who have never dealt with infertility, if you want to know what to avoid saying, read this and this. Some of my favorites? “Getting pregnant is the fun part” – well then obviously, you’ve never really had to try to get pregnant. Another is “I know exactly how you feel. It took us three whole months to get pregnant!” Um, shut up. Or suggesting charting ovulation, having frequent sex, just relaxing… You don’t think we’ve tried that already? (Just one more reason we didn’t announce we were trying; I didn’t have to deal with misguided advice like that on a regular basis.) And don’t ever ask people if they’re pregnant, or whether there’s something physically wrong with them if they’re not, that’s usually just rude.

Long story short, we tried for almost two years before we ended up getting a correct diagnosis from a fertility clinic: I have polycystic ovarian syndrome, a.k.a. PCOS (here are links to its definition on Wikipedia and PubMed Health, depending on your reading preferences). In a nutshell, it means that my ovaries are producing eggs, but are not releasing them – I am not ovulating. I did not see this coming because a) I do not fit the textbook symptoms, and b) I used pee-on-a-stick ovulation tests for most of those two years and got positive results (it turns out that they are not reliable in women with PCOS because of the hormone they test, and I might have realized something was wrong sooner had I tested my sweat, saliva or temperature instead of the LH hormone in my urine). PCOS is actually such a common problem that there’s even a reality show about it (gotta love America). So technically, I am not infertile, “only” sub-fertile, though I might decide I prefer the term fertility-challenged in the future.

I had to take clomiphene (Clomid by its street name), which was of course prescribed by my fertility doctor. Clomid triggers ovulation. Couples who are prescribed this medication are obviously trying to conceive. Interestingly, though, the drug came with warnings saying that it should not be taken by women trying to become pregnant… So, why do you think I’m taking it in the first place? Do people actually take clomiphene just for fun? And clomiphene, by the way, contains lactose. So, yeah. I was so worried about the possible side effects from the active ingredients of what is probably the most prescribed fertility drug that it didn’t even occur to me to check the other ingredients. My nurse did have the good idea of telling me to take the clomiphene before bed, though, so that I would sleep through most of the side effects. I still dealt with a few things, but I’m aware it could have been much worse. And in the end, the Engineer and I got really lucky, because the clomiphene worked immediately. It could have taken much longer to work, it could have been ineffective, we could have ended up doing IUI or IVF or adopting, but our infertility was “resolved” quickly, and for that we are very grateful. This could have been emotionally and financially a whole lot harder – not to mention physically, in the case of IVF.

(I’m still going to share some links on international adoption that I really liked, in case it helps someone else: an article written by a woman born in Korea and adopted as a child by American parents, titled What No One Told Me About Adoption, and another one written by a mother then in the process of adopting two children from Ethiopia, called How To Adopt In 9 “Easy-Peasy” Stages. And if you have 16 minutes, here’s a very interesting account of what happened at FAO Schwartz when a new baby doll came out and the store sold out of white dolls – did parents choose Latino dolls, Asian ones or African-American ones instead? The result is pretty disturbing, but the story is told in a very entertaining way, and I think that it reflects much of society’s views on international adoptions.)

(Plus two articles about dealing with the cost of IVF, one from Newsweek and one from Time. And while we’re at it, if anyone is still reading, here are two posts I liked on So Close: IVF Barbie to differentiate the attitudes of various women who undergo this procedure, and How to be good friends with an infertile, if your friends don’t know how to act around you now that you’ve come out.)

Anyway, I hope this post might bring comfort to someone else, which is why I decided to publish it (that, and it was a good occasion to vent). I’ve made it into the second trimester, and I can’t even tell you how awesome it is to now go to a regular obstetrician’s office and have ultrasounds where I get to keep my pants on!


Katie said...

Hey, PCOS-related infertility! Me, too!

I'm glad that you posted this; even though I've generally regarded my own infertility as none of the general public's business, it's something I talk about a lot more now whenever it's relevant (since, now that I have a son, the edge is off, so to speak, and I think that it's just something that people don't think of as happening to actual, normal people that they know). So, I love that you might be helping someone to understand that infertility isn't the exclusive domain of, say, sad baby-crazy old women who we see in the tabloids.

So congratulations on the pregnancy! I can't help but think that all of the extra waiting that I had to do for Theo has made me just a little more patient and appreciative than I'd otherwise be, and, as you point out, it makes standard OB visits seem incredibly hands-off. ("You don't need a blood sample? Or for me to come back tomorrow? Sweet!") Enjoy!

Amélie said...

Thanks! Yes, it does feel a bit like an elephant pregnancy, because it's been in the works for so long, but we're really lucky that it wasn't any harder. I pretty much stopped complaining of the first-trimester discomfort after hearing about Kate Middleton's HG, and I thought, "Yeah, what I'm feeling is really not so bad after all." But I'm definitely not taking this for granted!

It is weird sometimes how hands-off some OB visits are! We had one this week, where I gave a urine sample, we listened to the heartbeat, and the doc was all like, "Alright, see you next time."

I'm happy this post could help others; that's really why I finally decided to publish it, even though it does make me step out of the closet even further. I figure that since most of my readers don't know me personally, though, I don't mind if they know I have PCOS. Even I didn't realize how often it happens until I found out I had it!