Embryo Testing

So far so good, the first pregnancy test was positive!  They had me check a blood pregnancy test 2 weeks after the egg retrieval.  This makes sense, since normally I tell patients to check a pregnancy test two weeks after ovulation/conception potentially occurred.  This usually ends up being around the time of the missed period in women who have regular cycles.

Since the embryo transfer occurred at Day 5, the wait was only 9 days, so it didn’t feel like eternity to me.  Since I’ve spent most months of the past two years waiting two weeks from ovulation to the pregnancy test/period, 9 days wasn’t so bad.

Next, I will check the hCG level again to make sure it’s rising appropriately.  From there, I’ll have to wait another couple of weeks for my first ultrasound to see if a fetus is present.  And even then, we’ll want to check a little later to make sure it’s still viable.  So there’s still a lot of waiting to do.

I’m aware of all of the possibilities.  There is a possibility that the pregnancy will end in miscarriage again.  With IVF pregnancies, the risks of ectopic pregnancy are much higher.  An ectopic pregnancy means that the embryo implants somewhere outside of the uterus, usually in the fallopian tube.  If not detected early enough, and it keeps growing, the tube could rupture and cause hemorrhage, which would be an emergency, requiring surgery.

In many cases such as this when we know someone is pregnant from early on, we can often detect an ectopic pregnancy early based on the hCG levels rising more slowly than normal.  If detected early, a medication called methotrexate is often used to treat it medically.

Another possibility is twins.  We only transferred one embryo in the hopes of reducing the chances of twins, but sometimes the one embryo decides to split and becomes twins, or rarely more.  I hope this doesn’t occur, since twins are at high risk for complications like preterm delivery.  Also, when twins share the placenta (called monochorionic twins), there’s a higher risk for them to have an unequal distribution of blood supply.  It’s called twin-twin transfusion syndrome, and in some cases could be severe.

For twins that come from two separate eggs and sperm, such as if two embryos were transferred or a woman naturally ovulated two eggs, you’d end up with fraternal twins and wouldn’t have to worry about the twin-twin transfusion syndrome.  You’d still have to worry about risks like preterm delivery, though.  Not to mention the craziness of having two babies instead of one.

We decided not to test the embryos for genetic (chromosomal) disorders, which is why we did what’s called a fresh embryo transfer.  Many people choose to do the testing, which requires freezing the embryo to allow for the testing, and then transferring it into the uterus a little later.  That would have been a frozen embryo transfer.

The testing I’m referring to is called preimplantation genetic screening (PGS).  The test is designed to screen for chromosomal disorders in general, as opposed to looking for a specific disorder.  For people who have a known disorder, it definitely makes sense to test the embryos for that specific disease, and to only implant the unaffected embryos.  This targeted testing is called preimplantation genetic diagnosis (PGD).

Based on my limited knowledge, I don’t think there’s a right or wrong answer when it comes to the decision to test the embryos.  I’m 37 yo, will be 38 soon, so statistically the chances of chromosomal disorders are less than say, for a woman who is 40 yo.  But since I’m over 35, there is still a higher chance than in a younger woman.  One of my friends who had to do countless cycles of IVF before finally having her baby said that they didn’t do the testing of the embryos.  Her doctor mentioned the possibility of false positive results- meaning the results can occasionally show that there is an abnormality when none is present.  Also, she was concerned about the theoretic risks of disrupting an embryo at its early stages to perform the genetic testing.

I think what my friend’s doctor was referring to is the embryo testing that is most commonly performed now, called the blastocyst biopsy.  When the embryo reaches the blastocyst stage at about Day 5, it’s made up of more than 100 cells.  The biopsy takes cells from the outer cell mass which eventually becomes the placenta, as opposed to taking a biopsy from the inner cell mass which will become the baby.  Sometimes the biopsied cells don’t reflect the actual cells of the baby, and therefore you could end up with erroneous results.

My impression is that the errors don’t happen too frequently, which is why many people are commonly having the testing performed.  I have friends and colleagues who have had the testing performed, and their babies turned out just fine.  Not to mention celebrities like Chrissy Teigen have been open about doing IVF.  She mentioned knowing the genders of the embryos before implantation, so they clearly had the testing performed.

The benefit of having the testing done is to greatly reduce the risks of a chromosomally abnormal baby.  Because many chromosomally abnormal embryos/fetuses do not develop beyond a certain stage, this would theoretically reduce the risks of miscarriage.  Also, it would be terrible to later do the genetic screening during the pregnancy, only to find out there is an abnormality.  That would result in the difficult decision for many couples as to whether to terminate the pregnancy.

Our thought was that if there is a chromosomal abnormality, then there’s a decent likelihood that either the embryo wouldn’t develop well enough for transfer, or that there would be a miscarriage.  Our doctor said that in the many years he’s been doing IVF, there have only been a few times that there ends up being an abnormality like Down Syndrome that is detected later in the pregnancy.  When it comes to gender, that doesn’t matter at all to us.

Of course, I’m a little nervous about the prospects of having a miscarriage, or later doing the blood test in the pregnancy and finding out there’s an abnormality.  In case this embryo doesn’t take, we thankfully have a frozen one as backup.  Apparently it is possible to thaw it to test, and then refreeze it.  There would be more of a chance with that scenario to damage the embryo during the process (compared to if we’d decided to do the testing in the first place).  So it may not be worth it.  But if neither embryos take and we have to go through the egg retrieval process again, then it would make sense to consider the PGS from the get go.




My first cycle of IVF

It’s quite the experience going through one’s first cycle of IVF.  For about a week and a half, I had to inject myself twice per day.  There are all kinds of different protocols used depending on the patient, and I’m not familiar with how the fertility doctors choose which protocol.  For mine, I took Follistim in the morning and Menopur in the evening.  The Follistim comes with a pen device.  You change the cartridge and use the pen to dial up the dose you need.


On the surface, it’s more attractive than the usual vials and syringes, but in reality you are trying to maximize use of each cartridge since these medications are so expensive.  So on many days, I’d have to finish one cartridge, then change it out, and give myself a second injection to complete the dose I needed.

The injections I needed to take were all subcutaneous, meaning given in the fatty tissue of the lower abdomen, upper thighs, or back of the arms.  I personally didn’t have a problem giving them to myself, so I used the lower abdomen, changing locations with each injection.

The week before the egg retrieval was scheduled, I went in for ultrasounds every other day.  Prior to each of those ultrasounds, I went to the lab to have my progesterone and estradiol levels checked.  These help determine if the dosing of my medications is appropriate.  With the ultrasounds, my doctor checked to see how many follicles appeared to be developing, and measured their sizes.  As they started to get close, he had me start Ganirelix injections along with my evening Menopur.  The Ganirelix prevented me from ovulating spontaneously.

Once the follicles were just about ready, I injected the hCG two nights before the scheduled egg retrieval.  The hCG is called the trigger injection, as it is timed to trigger ovulation.  So I injected it Tuesday night in preparation for a Thursday morning egg retrieval.  And that was my last injection.

While I’m thankfully not afraid of needles, it is a drag having to inject yourself multiple times daily and go to the lab every other day for blood draws.  I feel bad for the women who have a really hard time with needles.

The day of the retrieval, I went into the area of their office that’s like a mini operating room suite.  Just like if I were going to have surgery, I changed into a gown and they placed an IV.  They gave me antibiotics through the IV prior to the procedure, and then for the procedure itself the IV was used for my sedation.

I have to say, I felt a little nervous being on the patient side, once I got into the procedure room.  They have you lay on the procedure table with your legs in the rests to get you in the position for the procedure.  Then they put a strap over you to keep your arms down by your sides, so you don’t accidentally move them during the procedure.  Looking up at the machines and lights from that position is enough to make anyone feel a little nervous, even though I’ve been in many similar operating rooms before.

Once the sedation got going, I don’t remember anything.  They described it as me being in “twilight,” meaning lighter sedation than general anesthesia.  Nonetheless, I don’t remember anything after that.  From watching the procedure a few times in med school/residency, it entails taking an ultrasound, similar to the vaginal ones used in the office to check the follicles.  The difference is that once the ovary is visualized, there is a needle attached that goes through the vagina, and then sucks out the liquid from each follicle.  Ideally, there should be a single egg in each follicle.

This device is attached to tubing that connects to the microscope, so the eggs go directly there.  An embryologist is right in the next room, looking through that microscope, counting how many eggs are retrieved.

I woke up in the recovery area, and felt really sleepy, like I wanted to take a nap.  They did say some people don’t remember this part, which is why they brought my husband in to review post-procedure instructions with me.  But I do remember things after that.

They made sure I could walk around and use the restroom, and then I was able to leave shortly after that.  Even if I felt better, they advised that my husband drive me around the rest of the day.

I remember in residency, I once worked with an attending physician who told patients about the similarities between the ovaries and the testicles.  There is a condition called ovarian torsion, which sometimes occurs when women have cysts in the ovaries.  The weight from the cysts can cause the ovary to twist, which then causes extreme pain.  If left untreated, the twisting can block the blood supply to the ovary and women can lose that ovary.  If caught soon enough, surgery can be performed to untwist the ovary and save it.

The ovaries and testicles have the same origins embryologically.  They develop into one or the other depending on the gender of the fetus.  I remember the attending saying that this twisting of the ovaries is similar to if you twisted a testicle on a man.  That definitely helped get the point across to the male partners of the patients regarding the severity of the pain the ovarian torsion was causing.

So understandably, sedation is needed for a procedure like this where a needle is poking the ovaries multiple times.  Afterwards, I had the expected cramping of the lower abdomen.  It wasn’t super painful, but definitely uncomfortable.  I considered taking something for the pain, but in the end I didn’t bother.  Heat packs helped.  I’m glad I took the day off after the procedure as well, since it would have been tough getting through a full work day not feeling my best.

Even though I didn’t feel nauseous or vomit after the procedure, which they warned can happen, my stomach felt a little off, even a few days after.  Not sure what that’s from.

The day after the procedure, referred to as Day 1, they told me that 3 eggs fertilized out of the 10 that were retrieved.  The embryo transfers (implanting the embryo into the uterus) are usually performed on Day 5.  However, if the embryo quality isn’t looking that great, they’ll implant on Day 3 to try to give them a better chance.  I guess the thought is that the uterine environment might be a little better than the petri dish.

Since 3 eggs fertilizing out of 10 wasn’t a lot, on Day 1 they told me that I might have to do the transfer early on Day 3.  That was pretty disappointing, after going through all of this.  I was hoping that even if this first embryo doesn’t take, I’d at least have another to freeze and try implanting again later.  If there are frozen embryos, then the transfer alone is a less cumbersome process.  I’m not sure exactly what it entails, but certainly not all of the injections to stimulate my ovaries like with the egg retrieval process.  I imagine it would be much less costly as well.

Thankfully, they called the morning of Day 3 to say that the 3 embryos are looking good so far.  One has 10 cells and the others have 8 cells, so they are dividing appropriately.  So I’m on for Day 5 transfer.  Phew!

In the meantime, now that the egg retrieval is complete, I have to take an estradiol tablet and place a vaginal progesterone suppository 3 times a day.  While this is better than injecting myself, it is still a lot to have to remember medications so often.  Thank goodness for the reminders on my phone.

At the IVF center, they gave us some fun toys- a sperm stress ball and an egg that shakes like a rattle.  Of course WZW is having a ball with them.  I asked him what he thought the sperm was supposed to be used for.  He said, “Um, to take stuff out of my nose?”


So now, I’m waiting for the embryo transfer on Day 5.  From there, they warned us that it will feel like eternity to wait the 2 weeks until the pregnancy test.  Even if it’s positive, I’ll have to keep checking and making sure the levels are rising normally.  And it will also be a number of weeks before confirming the viability of the fetus.  For now, it’s going to be a lot of waiting and hoping for the best.

Preparing for IVF

This month was the last chance for the letrozole medication, and unfortunately it didn’t work, so now I’m preparing for IVF in late November.  Late September was also tough because it’s when I would have been due if I hadn’t had the miscarriage.  When it happened in February, I had come across this article:


Basically, it’s advice to remember when your friend would have been due and to acknowledge it when that time comes.  When I first read the article, I was hoping that I’d be pregnant again by the time the due date came around, in which case I wouldn’t be so bothered by it.  But alas, I’m still not pregnant.  I actually forgot on the exact day, which was September 24.  I was too busy on a Monday with work and such and it didn’t sink in why the date seemed familiar.

But the next day, I remembered and it definitely made me much more emotional going into my work day.  In fact, there were multiple things going on in my life that all came to a head that day, and I actually broke down crying at work.  Thinking about the miscarriage and feeling sad that I’m not pregnant yet wasn’t the only thing, but it definitely contributed.

With this cycle, they started me on birth control pills to suppress ovulation in preparation for the IVF.  I’m still not super familiar with how all of this works, but they gave me a whole schedule for November with ultrasounds and injections.  We’ll go in for a class where they’ll teach us more about the injections, and review a whole packet of consents.  I picked up the medications, which totaled $12,000.  And that’s separate from the fee for the IVF itself.  Thankfully, when all is said and done, my insurance will reimburse a good portion of the IVF costs.  But most people aren’t so lucky and have to pay completely out-of-pocket for IVF.  Or can’t afford it at all.

I found it interesting that in my IVF packet, they included a sheet with an app called FertiCalm.  It’s supposed to help women dealing with infertility, and was designed by two reproductive psychologists.  It has a visually-appealing pretty design, with petals of a flower.  Each petal has a topic (such as fertility treatment or baby functions), and then under that topic there are subtopics on how to cope (cognitive techniques, finding the humor).

For example, one topic is holidays.  Under that, there are subtopics of holiday cards, parties with kids, and religious services.  If you pick holiday cards, there are a bunch of coping techniques.  They range from guided meditation to how to handle insensitive social situations, as well as your own negative thoughts.  So instead of thinking, “I will never be able to send a holiday card with a picture of my baby,” the balanced thought is “Somehow I will find resolution and have a beautiful card to send in the future.”

I’d also previously downloaded the Glow app, mostly to help keep track of my cycles and predict ovulation.  But the app also has a community component to it.  So for those who are interested, there are sections for various topics including infertility.  Of course, there are always pros and cons of social media.  With that said, for women dealing with infertility, miscarriage, etc. it can be comforting to communicate with others going through similar experiences.  That is one benefit of social media and women feeling less alone.


3 years old!


WZW turned 3 years old this month.  It really does fly by, and it’s amazing how much he’s grown and developed since that day he “came out the chute” as my husband likes to say.  Now is a very fun age, since we can understand most of what he says.  It’s funny to hear all of the silly things that come out of his mouth.  Our good friends are expecting their first baby and are keeping the gender a surprise.  So we asked WZW if he wants them to have a boy or a girl.  He said, “Um… a fire fighter!”

There is never a dull moment, as he’s always coming up with new scenarios during his play.  He likes doing things like going on a “bear hunt,” which is something he learned at preschool.  He also still loves trucks, and wanted a fire truck for his birthday.  He will make up an emergency, like a fire or one of his animals fell, so that an emergency vehicle needs to come help.  He is often running around our tiny house, and will bust out with impromptu dance parties.  Life is very entertaining and joyous with a toddler.

We are fortunate enough to live in a place where there is lots of dirt for him to play with outside.  So that is one part of the Paleo lifestyle that I’m glad WZW is able to experience regularly.  Instead of being indoors constantly, he will happily play in the dirt.  He likes to pretend he is a dump truck or excavator and is totally content to be transferring dirt from one location to another.

At 3 years old, he is still cute and fun.  We are grateful that he is a healthy kid, and so far we are very happy with the little boy that he has become.  We feel good about our parenting thus far, but I do know that the challenges right now (like tantrums and refusing to do things) are simple ones.  I wonder what kinds of difficulties lie ahead, as life becomes more complex with school, activities, and friends.  Inevitably as parents, we all do our best based on what we know at the time.  It’s hard to predict what kinds of issues will come up later.

Before WZW was born, one of our friends (who had a teenager of her own), gave us the advice to treat him as if he were our third child.  While of course one cannot do that 100%, looking back I feel that we’ve done the best we could to follow that advice.  We haven’t worried about every little detail, making sure our parenting is perfect.  The little things don’t matter.  For example, based on our crazy schedules during the work week, we don’t have time to bathe him more than twice a week.  And I’ll admit, it’s been a week since he took his last bath/shower.

Everyone has a different parenting style, and we have to be cautious about “parent shaming” on social media and the like.  With that said, my husband and I were horrified recently when we were at a restaurant and saw a table where the father was giving his approximately 1 yo daughter some Coke straight out of the bottle.  Besides the obvious, the other thing that was bothersome about the scenario is that the Coke seemed to be used as a way to calm/comfort the crying child.

As a woman who has issues with emotional eating, I am extra aware to try to avoid the same for WZW.  As a parent of a toddler, especially when I’m at my wits’ end, I have totally been there where he is having a meltdown and I feel the temptation to hand him the phone or give him a treat to make him calm down.  But I remind myself that it would be counterproductive- I would be teaching him that his reward for having a tantrum is screen time or a sweet treat.  Also, I don’t want him to associate food with emotional comfort that leads to future emotional eating.

As for me, it still hasn’t been practical to go back to eating strictly Paleo, but I do what I can.  My husband found a company called Paleo on the Go http://www.paleoonthego.com which delivers frozen Paleo meals.  I had to try it once, so I ordered a variety of their menu items- pot pies, tacos, empanadas, lasagna, and soup.  I was happy with the quality of their meals.  It all tasted pretty good on its own, as opposed to pretty good for being Paleo.

The downside?  The shipping costs to the West Coast are astronomical.  But if you’re in an area where shipping is more affordable (they are based in Florida), then by all means I’d recommend them.

One delivery service that I have been using lately is Thistle. http://www.thistle.co

They deliver freshly made meals and juices.  They aren’t Paleo at all.  Their model is to deliver healthy meals made with a variety of fresh ingredients.  Their meals are gluten and dairy free, and would actually be perfect for those following a plant-based lifestyle.  For those who want, meat can be added to the meals (which is what I do).  Because they aren’t Paleo, their meals do include grains and legumes.  With that said, their meals include a variety of vegetables.

Their lunches are salads, and their dinners are various prepared meals that you throw on a pan to heat up for a few minutes, but otherwise require no preparation.  Because of their ingredients and delivery, the service is somewhat expensive.  Another downside is that the dinners are all somewhat similar, so they get tiring after a while.  But for now, I’ve continued to use Thistle because it is convenient- they deliver to my door, so I don’t need to worry about grocery shopping weekly to pick up salads for lunch like I used to.  Without Thistle, I probably wouldn’t be eating that many veggies, so they help me have a healthier diet.  If only there existed the equivalent of Thistle except with Paleo options.  That would be perfect!

I had to skip the fertility medications in August because of the functional ovarian cyst.  So this month I’m back on the letrozole.  It’s my last chance to conceive with the medications, because with my next cycle I’ll start birth control pills in preparation for IVF in November.

Tick Tock

At the beginning of every cycle, I go into the fertility doctors’ office for an ultrasound to make sure there aren’t any ovarian cysts before starting the medications.  If a cyst is present, then they have me go to the lab to check an estradiol level to see if it’s a functional cyst, meaning a hormonally active one.  This is a pain because I’ve already gone to the lab and had blood drawn to confirm a negative pregnancy test.  So I go back for a second blood draw.

In the past, I’d had a cyst once but the estradiol level was low, so I was able to continue with the medication.  This month, the estradiol level was elevated, so they recommended that I skip the letrozole.  I guess it must be from the hormonal activity of the cyst, but I had abnormal bleeding this month.  After my period was supposed to end, I kept spotting.

Since we went camping, I didn’t do the ovulation test for a couple days, and I think I must have missed the LH surge (positive test) during that time, because my spotting increased to full flow bleeding around that time.  It was like having a second period- joy!  The little twinges of pain on the right side that I’d been having went away, so hopefully that means that the cyst resolved with ovulation.

Since we missed out on using the medications this cycle, I feel like time keeps passing, and yet another month is going by without me conceiving.  My IVF date in late November is quickly approaching.  Also, because I’m scheduled on a particular week, if my own cycle doesn’t match up, then they’ll put me on birth control pills beforehand to get the timing right.  That means that we may not be able to try on our own the month before.

So really, I’m running out of opportunities to conceive on my own and am pretty much waiting for the IVF.  Initially, the scheduled IVF date seemed so far away, so I was hoping we’d get lucky and conceive on the medications prior to that.  Now it looks quite likely that I’ll end up doing the IVF.  Which is fine, because the benefit of IVF is that hopefully we’ll end up with better quality embryos that take, as opposed to ending up with another miscarriage.  But it’s hard not to be impatient either way.  WZW is about to turn 3 yo, and we’re approaching two years of trying to conceive.  The clock keeps ticking…

The Balloon Analogy

This month, we decided to try letrozole, which like Clomid (clomiphene) is another ovulation induction medication.  In other words, it also helps one ovulate more than one egg per cycle.  For someone like me, whose aging eggs aren’t as fertile, it helps to potentially have a few eggs at a time instead of one, to provide more chances of conceiving.  For some women who don’t ovulate regularly on their own, these medications are also useful.

My doctor said that letrozole can be less harsh on the endometrium (uterine lining) and cervical mucus compared to Clomid, so he thought it would be worth a shot.  In other words, Clomid can sometimes thin the uterine lining too much to make it hospitable for implantation of the embryo.  And if the cervical mucus is not right, it can prevent the sperm from making it to the egg.

As I mentioned before, there is a wait time to get in for IVF at my fertility office.  Apparently right now there is even more of a backlog since they are short on embryologists, who are critical in the process.  So they gave me a date in late November.  It’s possible that if something opens up sooner, they’ll be able to move me up.  But that’s what I’ve been given thus far.  I hope it ends up sooner.  And I also hope that I get pregnant on the medications before then.

I have some random parenting advice to share today.  Back when I was pregnant, I started subscribing to Parents magazine because of a promotion, and then they hooked me and I’ve continued to subscribe because I found the issues helpful.  Recently, there was an article about explaining death to children.  The gist was that it’s better to explain it in a concrete way, in an age-appropriate fashion.  Using euphemisms like, “They are in a better place” are not a helpful way for explaining loss to children.

Not too long after reading the article, my friend posted a picture of her toddler, so happy with his balloon.  Her husband commented, “Until it popped.”  It dawned on me that it would be a good analogy for death for children- a balloon popping.  Perhaps there are some situations where there is a small leak and it’s reparable.  But in most cases, the popped balloon is beyond repair.  Thankfully, we haven’t had to explain the loss of a loved one or pet to WZW, but the day will come.  Maybe this will help explain it better to him.

On parenting trick that we heard from a friend that has been really helpful with transitions is counting down.  Since toddlers often have a hard time with switching tasks, like stopping playing to do something else, it helps to give them a little warning.  I tell him, “You’re gonna be done with [whatever activity] in 10 seconds!  10, 9, 8…”  Now I’m constantly counting- “You have 10 seconds to get into the car seat!”  Of course, it doesn’t always work, but it definitely helps.  For us, it’s been a high-yield toddler parenting trick.

Another time-saver I learned from Parents magazine is that for young children, you can forgo the pajamas and put them in their clothes for the next day to sleep in.  That way, it saves the effort of changing them in the morning, which is usually a battle.  I forgot and put him in pajamas last night.  This morning, when WZW got up and the first thing he said was, “I’m ready to change!” I was incredulous.  That NEVER happens.  Only thing with this hack is that if he pees too much and leaks through his overnight diaper, then we have to change his clothes anyway.  Good thing that doesn’t happen too often.



Tired of Being Tired

While my sleep is certainly not as interrupted as it used to be when WZW was less than a year old, it continues to be affected thanks to him.  I think the best time was when he was a year old.  He would sleep for 12 hours a night and take 3+ hour naps during the day.  It was amazing for us parents!  As he got to about 2 years old, his sleep needs diminished and he now sleeps on the order of 10 hours at night and takes 2 hour naps.

During the work week, we are all up before 6 am.  But that also means that on weekends, WZW goes to sleep around the same time and still wakes up super early.  Even if I have an uninterrupted night, I can count on being woken up in the 6 am range, sometimes earlier.  My problem is that I need 8-9 hours to feel truly rested, so it’s hard to get to bed on time.  I usually have a bunch of things I need and want to do after WZW goes to bed.  Even if I go to bed at the reasonable time of 10 pm, getting up around 5:30 am means that I’m still feeling a little groggy.

Also, more recently WZW has been having nightmares and will start crying at night and need to be attended to.  Even though my husband takes care of him most of the time, the interruption seems to affect my sleep.

The result of all of this is that even on weekends, I’m often finding myself still feeling tired.  And having that continue chronically is tough.  Granted, I usually do get some restful nights here and there.  But still, I am tired of being tired all the time.  And then in the back of my mind, I do wonder if that is affecting my fertility.

One of the acupuncturists said that maybe 60% of her clients who are trying to conceive are those who have children already.  I’ve mentioned one friend from residency who has tried cycle after cycle of IVF and is finally well into her pregnancy with baby #2.  But I recently spoke to another friend from residency who is also having trouble conceiving baby #2, and is starting IVF.

Of course, it doesn’t help that we’re all in our late 30s and our fertility is declining.  But part of me wonders if the combination of our modern lives with the inherent stresses from work, combined with the stress and lack of sleep of having a young child, then affects our fertility.

I repeated my labs because it had been a year since I’d last done them, plus they wanted updated ones as I get set up for IVF.  The FSH, which is typically drawn on cycle day 2 or 3, was still stable around 5 and hadn’t changed since last year so that’s reassuring (lower is better).  My AMH, which is a marker of ovarian reserve, last year was 1.64 and now it’s 1.01.  Last year it was in the normal range, and now it’s on the low side (higher is better).  Many women with an AMH below 1 do still conceive with IVF.  I’m not super familiar with these labs since I’m not a fertility specialist, but my understanding is that the labs give us a general sense of the fertility potential.  In other words, is it normal, low, or clearly past the point that IVF would work?  The change in my AMH confirms that my fertility is declining thanks to age.

Part of the reason I made the decision to move to IVF is that at my particular location, the fertility docs have a backlog and it can take a few months to get in for the procedure.  I have my consultation scheduled in a couple of weeks, and from there the actual IVF procedure probably won’t happen for a few months.  So I figure I’ll continue the Clomid until then.  And if I haven’t conceived, then it’s clearly appropriate to go to IVF by that point.

This month, I decided to take a break from even the Clomid since I was tired of all the appointments and such, plus my husband was supposed to be out of town around the time ovulation was anticipated.  I have to say it’s kind of nice not having any ultrasound appointments or taking the medications.  Plus since my insurance coverage for acupuncture has maxed out, I’ve stopped that as well.  So it’s been nice not having my off days be filled with acupuncture and fertility appointments.

The Transition

Happy Mother’s Day to all of the wonderful mothers out there!  My husband outdid himself again, and put together a video montage of WZW learning to say, “I love you, Mama.”  It started late last year when most of what he was saying was still unintelligible, to now where we can understand most of what he’s saying.  It helps that his hair was really short when the video clips started, and you can see the time progression based on how his hair grew back.  I’m lucky to have such a thoughtful husband.

I’m feeling better since my last post.  With that said, the length of time that we’ve been experiencing infertility is wearing on me (and my husband).  Every time I get that negative pregnancy test or get my period, it’s like a big fat:

F on test


And we doctors aren’t used to those. 😉

The finality of it every month is starting to feel devastating, even if it’s for that one day.  Even though I tell myself that it doesn’t always happen right away, and that it’s a good sign that I did conceive recently, it’s impossible for me not to feel a sense of failure with each passing month that I don’t conceive.

I did ask the nurse practitioner in the fertility office how long Clomid causes side effects affecting mood, and she said that she thinks about a week after the course is completed.  I usually take it for 5 days starting within the first few days of my cycle.  That means that how I’ve been feeling at the time of the next period shouldn’t be attributed to the Clomid, according to her.  So I guess it’s just me.

I feel like I’m reaching a transition point this month.  Now that it’s May, we’ve been trying for a year and a half.  We tried IUI twice, then got pregnant on the first cycle of Clomid, which ended in miscarriage.  This is the 2nd cycle of Clomid since then, so my third cycle total.

It’s also been one year since I had my FSH and AMH checked, which are tests to assess fertility.  Last year, things looked fine which is why the REI docs didn’t urge me to go straight to IVF.  But if the tests show declining fertility now, then I’m sure they’d tell me I should go to IVF.  Also, based on the time I’ve spent trying to conceive, I think I’d need to try IVF soon.

Previously, I’d been hesitant to go to IVF because I felt like I should be able to conceive without it based on my labs, and based on having conceived WZW without any problems.  After I did conceive on Clomid, that solidified it.  Plus I’m aware that IVF adds an additional layer of stress.  I got a taste of it with the IUI, but the IVF is more involved- more medications, office visits, undergoing a procedure with the egg retrieval, etc.  I think the nature of it just adds a certain gravity to the process.  My impression is that compared to IUI, it would put me under more pressure and stress, from speaking to friends/colleagues who went through it.  So I was hoping to save myself from that.

But I don’t want to be naive about the fact that my biological clock is ticking away, and that if I wait too long, my fertility will continue to decline.  So long as I do IVF before my fertility declines too much, it would generally result in better chances for us to end up with a viable pregnancy.

One benefit that my friend who did IVF mentioned is that I can have testing performed on the embryos to check for chromosomal disorders.  So rather than taking my chances with nature, especially given my age, and possibly having a baby with Down syndrome or other chromosomal disorder that is diagnosed during the pregnancy, we could start with a normal embryo from the get-go.  She also said I could potentially choose the gender, but I realized that I don’t want a girl that badly.  I’d be perfectly happy with another boy; I just want a healthy baby.

So I’m finally mentally prepared to take the leap and start the process for doing IVF if I don’t conceive this month.


Temporary State of Madness

Infertility is one of those things that you don’t quite understand how difficult it is until you experience it yourself.  I admit, if I had a patient just like me prior to this, I would have thought to myself, “It’s ok, she’ll be fine.  She has a child already, she got pregnant on Clomid so she’ll conceive again, probably without IVF.  She’s 37, so she still has time.”

The reality is that when I get my period, it sends me into a temporary downward spiral.  I got my period again yesterday, and all of a sudden I feel like a failure again.  All of these negative thoughts take over.  I wonder what I’m doing wrong- am I too stressed?  Am I eating too much sugar?  Am I not sleeping enough?  The reality is probably nothing.  I’ve been telling myself that we’re just starting to try again after the miscarriage, so it probably won’t happen right away.  But I can’t help it.  It’s like the quote about grief being incomparable.  Pain and emotional difficulty- no one can tell me what I’m allowed to feel.  Even myself.  I’ve tried to talk myself out of it.

I started to feel angry about everything, and unfortunately my husband bears the brunt of it.  He worked yesterday on a Sunday, and during the day while I was alone with WZW, I started having some light bleeding,  I figured it was my period, so I started feeling sad, but tried to hold it in, and didn’t tell him about the bleeding.  We had already agreed to do the pregnancy test together when he came home based on the timing since ovulation.  But when he came home, he started doing work around the house and such.  So by the time I did the pregnancy test, it was getting late.

When I finally got the negative pregnancy test and had a chance to let my feelings out, I was a mess.  It was 10 o’clock at night when we both needed to go to bed, but I was crying, and angry that we didn’t do the test earlier.  I felt like he knew it would upset me, so he delayed it.  Now it was going to affect my sleep and the following workday.  I just felt like a crazy, emotional, irrational person.

I know it was the right decision for us to move again (this is WZW’s third home in his 2.5 years).  But it’s stressful not feeling settled, and not being able to find things because they are either buried in clutter/boxes or somewhere in storage.  When I’m already feeling bad, then every little inconvenience upsets me.

With puffy eyes, I got myself up early this morning, and got WZW ready so he could head to daycare.  I went into work, early as usual, and started reviewing my charts for the day.  I got through a handful, but I couldn’t keep going.  Being mentally present to take care of 20-something patients all day requires me to be at my 100%.  And instead, I felt daunted by the day ahead, and still wanted to cry.  I didn’t want to set myself up for another breakdown at work, so I decided to cancel and head home.

So now I feel like a failure for missing work.  We doctors feel like we have to go to work unless we’re on death’s door.  But the fact is, my work requires so much mental energy, and requires me to be engaging for all of my patients.  It would be a disservice to them if I tried to get through my workday given how horrible my emotional state is today.  And God forbid I miss something important clinically because I’m not fully with it.  Since I’m the type of person who got through high school without ever getting a detention, I still feel guilty.  Even though it was the right thing to do for me and my patients.

I really want to be pregnant, but thinking about the nausea with the recent pregnancy, I also dread it on some level.  I know that pregnancy is going to have its own discomforts and inconveniences.  I almost feel a sense of resentment towards this child that doesn’t even exist yet.  Don’t worry, I won’t actually feel that way when the baby arrives.  I’m just being honest with all of the negative and crazy thoughts that run through my head when I’m feeling this way.

I am aware that Clomid can cause mood changes.  I don’t know how long they last, and if it’s possible that part of my craziness is due to the Clomid.  I’ll have to ask the fertility office the next time I go in.  I don’t want to be one of those women who blames her emotions on hormones/medications, but I do wonder if that’s why I feel extra unhinged this time around.

My husband asked if I have unresolved feelings about the miscarriage.  Perhaps I do, but I didn’t think I did.  I think that having the negative pregnancy test again is a reminder of failure and loss for me, so it’s upsetting.  It’s hard to go through this over and over again when we’ve been trying for a year and half.

I know that things will get better, and that this is temporary.  I try to remind myself of that, but sometimes I can’t handle things and it gets really difficult.  And that is ok, too.  Thanks for allowing me to vent.

The Shoe Edition

Now that more time has passed, I’ve been feeling better.  Emotionally, what I feel now is disappointment in having this setback, and having to go through everything again.  I feel bad that some women have such a difficult time emotionally.  The author of the Lenny essay that I previously referenced said it best, but essentially she was aware that logically, she shouldn’t feel so deeply affected by her loss, and yet grief is incomparable.  As a doctor and now as a woman who’s been through it, I just feel bad that anyone feels that kind of hurt, and wish they didn’t.

I think it helps that celebrities are being more open and talking about their miscarriages.  And on social media, many regular women are also able to open up about their experiences, which hopefully makes it easier for those going through it to know that they are far from alone.

About two weeks after the miscarriage, my home pregnancy test had become negative, and then not too long after, I got the LH surge on my ovulation kit.  My bleeding got lighter and lighter but never fully stopped, and then about a month after the miscarriage is when I had my first period.  With that cycle, I resumed my appointments at the fertility office and started back on Clomid.  So we’ll see how that goes.  Everything feels like eternity: waiting a couple of weeks from ovulation to see if the pregnancy test is positive.  Knowing that I got pregnant in January, and now the earliest I’d conceive again is April.  I know that in the scheme of things, 3 months+ is not that big of a deal, but it feels like forever when you’re already feeling impatient.

On a lighter note, I decided to write about shoes.  They’re not Paleo and not OB-related, but they’ve been on my mind as I’ve been in the market to buy shoes for WZW as well as myself.  It’s mind-boggling that shoes for toddlers can cost $50 at retail price.  We first received Stride Rite shoes as a gift for WZW and have found them to be of good quality.  We found that out when we bought a cheaper brand, and the tread was shallow to begin with.  In a short time, WZW wore out the soles and we had to get a new pair.

For an active and growing little guy, we want good shoes, but knowing how quickly he goes through them, I can’t bring myself to buy $50 shoes.  He got his current pair at Christmas, a full size larger than he was measuring, and now he’s at that size.  So that means he will need a new pair soon.  I decided to look into other brands, and have heard about Pediped, but those are expensive as well.  I was talking to some moms recently about shoes, and one said that her 5 yo daughter will only wear See Kai Run.  And another brand that came up was Momo Baby.

I decided to Google “best toddler shoes” and found this list:


She mentioned another brand called Tsukihoshi that I’d never heard of before.  I would have liked to try Pediped or See Kai Run, but couldn’t find an affordable pair in my son’s size, so I just ordered a Tsukihoshi pair.  Any other brands I should consider?

As for me, I decided I need some slippers to wear around our house since we have hardwood floors, and I need more support.  Plus despite removing our shoes at the door, my socks inevitably end up dirty.  I’d previously found a pair of comfortable flip flops from Vionic, which are supposed to provide good arch support.  It just dawned on me to check, and they make slippers as well.  Score!  And then of course as I’m looking through their site, I want everything else they carry.  I can only vouch for the style I own, the Tide II Toe Post Sandal.


It has great ratings and I once met a woman who had the same color and style, and she told me it was her second pair.  Now I’m planning on trying other types of shoes that they make.

I’ve worn my Cole Haan Air Tali wedge shoes with a low heel a ton, and had a similar pair previously.  Unfortunately, I bought another pair that had the same low heel height but not the wedge and it wasn’t as comfortable, and I didn’t end up wearing them all that much.  With Cole Haan, definitely wait for sales as they seem to have them frequently.

I’ve also gotten TOMS wedges with a significant heel height that were surprisingly comfortable.  I got a second pair of the same shoes in a different color, but the fabric used was more stiff, and dug into my skin a little.  These days, I have no interest in wearing heels since I have to worry about chasing after a toddler.  Or in some cases, carrying a screaming, kicking one.

One woman said she likes to splurge on Rothy shoes because they’re cute and comfy.  I looked at their site, but none of the shoes have any heel.  For me, since I’m short, I prefer to have a low heel, so I think the Vionic brand might have some better options for me.

These are brands I’ve come across or had personal experience with (no paid advertisements here).  It’s always so satisfying to be able to find a really cute, comfortable pair of shoes that I can wear all the time.  Any other brands/styles you swear by?