Baby-Making

Number 1 Step to Getting Pregnant: Breathing

I nearly tweeted this (until I ran it by a friend for a snark-check):
From the Old & Bitter Dept, excerpt from a woman's story: she conceived 'after two days short of a year of trying'. Sympathy Stretch much?

After considering my friend's mildly-amused-but-still-slightly-pained facial expression, for some crazy reason, I thought it would be a better blogpost than tweet. I suppose it's better to take a snarky viewpoint and turn it into a teaching moment.

But here's my point -- TTC'ers, please don't buy into the hysteria about how long it should take you to get pregnant. Easier said than done, I know, but really -- there are so many women out there who never gave a second thought toward becoming a mom until she started to panic about her BBT charts or the months passing her by...

I know that it doesn't help soothe the savage cycle a bit when fertility websites often spin the stances of respected institutions like the American Society for Reproductive Medicine. In the name of making their content more attractive and readable, patient-focused sites will sometimes simplify the complex. That's how we wind up moving from this --

"Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse." (ASRM)

to this

"Considering that both the man and woman are healthy and ready for baby making, it still takes a normally healthy couple up to a year to get pregnant." (BabyHopes)

and even this, from a physician's Q&A site
"If you and your partner have been trying for more than a year without success, it is a sign that there may be a problem." (Ask Dr Amy)

The time it takes to conceive is a hugely sexy quandary. Why, there's even something called the Time to Conceive study at the University of North Carolina (and it's not the first such research, by any means, but what a catchy title!)

Here's the deal: our bodies -- even those of us who seem to function "like clockwork" -- are not made up of simple mechanisms. The whole reproduction thing is pretty haphazard for mammals (just ask any embryologist) and there are myriad variables at play.

So to whittle down to any one factor, like 'time', and its impact on the big picture of conception... is over-simplifying things. True, we need such watered-down versions of biological complexities just to wrap our heads and hearts around scientific realities that challenge us. But in the end, after the puzzle pieces get boiled down to a junior high level pulp (did you know that's the reading perspective that most websites are aiming at?) -- misinformation abounds and TTC Hysteria thrives.

The kernel of truth: statistics are subject to interpretation.
Here's one to consider, before you lose your mind with worry over that approaching one-year TTC mark: generally, with all variables optimally in place, women in their 20's have a 20 percent chance of getting pregnant during each cycle. Women in their 30's, again with all else perfect, move that percent marker down to 15 per cycle.

So, the woman I almost tweeted about (who conceived in her early 30's) was actually doing just fine to get pregnant when she did -- and chances are the stress she felt to beat that calendar wasn't helpful in the least.

Some more reasonable perspectives are out there. It's usually not a whopping difference in data, but a tiny variation in word choice. It may make for less friendly reading, but it can mean the difference between proceeding with confidence versus panic:

Average Time to Conceive on LoveToKnow.com


Infertility on knol.google.com, written by urologist Craig Niederberger & repro med specialist Brad Van Voorhis


Human Fecundity & Fertility Studies at the National Institutes of Health

It's Been a Long Time, and I Still Remember the Babies

It's been a long time since I wrote about my miscarriages. Isn't it telling that I use a medical term to refer to those four losses that spanned nearly three years and forever colored my life? I could have said that it's been awhile since I've spoken of my lost babies.

October 15th is officially Pregnancy Loss Remembrance Day. We are all invited to burn a candle at 7 PM, wherever we are, to create a wave of light around the world.

As many who've met me can attest, I appear jaded. A little bitter at times. Sometimes, a raging madwoman. Thick skinned. As my own precious child says with a laugh, "Meanie Mommy."

Still, it takes very little to crack me open in regards to the four babies that I purposefully struggled to conceive, only to lose, one pregnancy at a time, from 1996 to 1998.

This video -- even given my usual bristling about references to angels and Heaven -- did it for me today. The song is sweet, though not my style. The words are what's important in this piece by Casey Shay Press. Read the words. There are millions of people who experience this common pain alone. Today is a day when being alone isn't necessary.

I will never cease to be amazed at how those babies changed me and my life forever. Still, as they became.

To IVF or Not to IVF? A Perpetual Question

Dr. Sami David has written a book (Making Babies: A proven 3-month program for maximum fertility) and is taking his message -- that there's too much IVF going on here -- on the road. 

He appeared today on CBS' The Early Show and interviews can be found elsewhere on the Internet.

Ten years ago, I interviewed Nancy Intrator, co-author with Dr. Hugh Melnick of The Pregnancy Prescription: An essential guide to understanding and overcoming infertility. Their message, the polar opposite of Dr. David's, was that IVF is the best work-around for most forms of infertility. Specifically, Melnick's opinion (fully explained on the website of Advanced Fertility Services, his private clinic in New York City) is that time and money are often wasted by the diagnostic process when it comes to infertility. IVF allows patients and physicians to cut to the chase.

To the contrary, says David, who also practices in NYC. Getting to the root cause of infertility and curing or diminishing it is the best means of confronting conception challenges. For some, that means no IVF will be necessary while others may never get pregnant without it.

My own opinion vacillates. I tend toward a "less meds, more nature" mindset, but when push comes to shove, my pragmatism is the winner. 'Never say never' comes closest to my firm stance. There are far too many variations on the theme of infertility and its treatment for any one perspective to always be right for everyone.

Fathers-to-Be Speak Their Minds

It's just a fact: men don't use support groups or services in the same way or frequency as women. When situations in their lives warrant assistance from others, many men choose to hunker down and deal with things alone. It's no different regarding the situations that come with infertility.

Even though the Internet has opened up an entire world of support for women who are experiencing infertility, men are still mostly hesitant to express themselves in online communities. So, [in 2000] we posted a special invitation to the men in our community (we know they are out there) to share with us what the infertility journey has been like for them.

Here are some of the responses we received:

From Brock...

I'm always "riding" Sheree about the time she spends on the computer, but we would never get through this without the help she gets from her cyber friends. As some of you know, our biggest problem is ME. The "boys" don't swim.

Through two failed IUIs and one no-luck IVF, you all have been there for her [us]. I myself am a very emotional guy and want so much to be a dad. I'm an only child of two wonderful parents. Next to my great wife, my dad is my best friend and I want to experience that relationship from the "dad" side so bad, it hurts.

All you women and other men should know that us guys feel the pains also -- when one of my friends talks about playing ball with their kids, or bring the kids to the golf course, I get so envious. When you hear about someone expecting, men too think 'why can't that happen for us?' When the first IUI failed, I cried at my machine in a factory full of men, and they understood because they are Dads and know the joy that we so much want to feel.

Has anyone heard Tim Mcgraw's song "Why do they say grown men don't cry"? Well, let me tell you, when he sings about his daughter saying "Daddy, I love you," this very large grown man cries every single time.

Thanks again for being there for Sheree, and I'll keep you all in my prayers.

"Big Daddy wanna be" Brock

From Tom...

Well, to start out, I am 35 yrs old and me and Kel will be married nine wonderful years in September, with the exception of not being able to have children. We have been trying for eight years now, and I have been checked and all is ok with me, but wife was diagnosed with PCOS.

It has been a rough road and seems like it's just getting longer!!! I love my wife more than life itself and if I can help her in any way, I will do my best!! I think I am a supportive guy cuz I have so much love.

I am glad my wife found this site -- she thought she was all alone and she feels like a faliure at times and gets very down. She had been seeing her OB doctor for a few years and he just didn't have many answers for her, so he referred her to an infertility specialist and thank god for him. He is a saint -- he gave us some answers.

Wife didn't ovulate, and this doctor has gotten us to that point, but wife had some problems and we had to put fertility on hold. Well it's been six months since then and now wife is ready to go back and try again!!

I pray every night for us and for all the other special people who are trying to concieve!! You know, the one thing that hurts me the most is... wife babysits for four children and has been watching them since they were very small -- it breaks my heart because she would make a wonderful mother, but I will never give up, because I know one day it will happen!!

Good Luck to all of you out there trying to concieve....Never Give Up!!

Last, from one of our Forum regulars, Chuck, who has a way with words as he speaks his heart and mind...

After browsing some of the posts here, I'm going to feel silly bringing this up, but it has become a real problem for me. I have great difficulty producing a sperm sample "on demand" in a public place at a pre-appointed time. The process absolutely paralyzes me with fear.

I guess I just can't seem to overcome the embarrassment, or anxiety, of producing a sperm sample on cue in a public place, after passing through a waiting room full of people who know damn well what I'm there to do, while a bunch of techs stand by waiting for the results.

It doesn't seem that anyone really wants to talk about this, (or I'm the only one with this problem..), as I could find very little reference to this subject while searching the web.

I was at least partly afraid that it just wouldn't work before the first time, considering my emotional state. I know that it is at least "possible" now, having succeeded once, but it is still a painful prospect for me to go back and do it again. (and it may be necessary to go again, and again, and again, I know. That's why I need to get over this, or I'll wind up in the looney bin...)

I'm just wondering if anyone else had dealt with this, what you may have done to overcome it, or what I might do to make the process less painful. Thanks for reading my ranting....

The above is an excerpt from one of Chuck's posts in a thread that quickly became a frequently-visited discussion. Since then, many other threads have included others' thoughts on the issues of men undergoing the infertility diagnosis and treatment journey.

Several conversations down the road, Chuck and I (and many others) agree that such sensitive topics are easiest (though not necessarily best) left alone by men. The male psyche includes a lot of self-image based on both sexual prowess and ability to reproduce, both things brought markedly to the surface for men seeking infertility assistance. Talking about one's fears and concerns, even with complete anonymity, may quite simply be in and of itself too scary for many men.

Perhaps if they knew how much women crave hearing what men think, perhaps then more guys would chime in on conversations online. There may be the occasional gender-based misunderstanding, but for the most part, women visitors to Internet communities such as ours are intrigued at the least and reassured at most whenever a man reveals the inevitable -- that he is, as others are, deeply affected by the infertility experience.

{The above was originally published in 2000, quoting members of the About.com Infertility community as sources.}

Depressed Men Damned If They Do or Don't

Oh, great. Adding more fodder to the eternal question "Should I focus on getting pregnant or would I be better off just trying to avoid a big depressive slump?" is the recently published study by
New York-Presbyterian Hospital/Weill Cornell Medical Center in Fertility & Sterility.

That's a very real question for a lot of anxious people. I mean, having a tough time getting pregnant produces its own brand of misery. Just think of the double-whammy for folks who are already trying to treat depression, TTC aside.

A few years back, the FDA told women about the increased birth defects risk from taking the SSRI paroxetine (that's Paxil, to you and me) during pregnancy. There've been other worrisome reports that cause women with depression to slide off their meds for the sake of conception. The new report is a first to link paroxetine to male infertility at a genetic level.

We already knew that guys on Paxil have a hard time -- well, staying that way, anyway -- which can make baby-making a truly aggravating experience. But now we're learning that even when you work around that detail (and this study did indeed have confirming evidence of the Paxil-ED connection,) paroxetine makes something else happen: it slows sperm down to the point that they sort of corrode, DNA-wise.

The relatively small study (35 subjects) had otherwise big numbers: DNA fragmentation went from less than 10 percent to 50 percent while taking the drug. More than a third experienced significant erectile function changes and almost half had ejaculatory difficulty.

The good news: both sexual function and DNA fragmentation return after one month of laying off the paroxetine.

How to Have Baby-Making Sex

If getting pregnant hasn't been so easy for you, maybe you're not doing "it" right. Maximize your chances. Straight-forward stuff, no quips. Some of these tips are under the category of "It Can't Hurt to Try"...

Here's how:

1. Stop using hormonal contraception or have IUD removed at least 3 months prior to conception attempts.
2. Make sure you have intercourse during the woman's most fertile time.
3. Men should refrain from unproductive ejaculation for 48 hours prior to the woman's fertile time.
4. If possible, schedule your conception attempts for the morning, as sperm concentration may be higher then.
5. It is best to avoid artificial lubrication, but if it's necessary, use only water-based ones. Water-based are the same lubricants that are marketed as condom-safe.
6. Avoid douching at any time.
7. Use sexual positions that encourage the natural tilt of the vagina toward the uterine opening (cervix) and that assist gravity, for example, missionary or doggy style positions, or lying on one's side.
8. Avoid cunnilingus (oral sex given to the female) during conception attempts.
9. Avoid anal sex during conception attempts.
10. Avoid underwater sex and hot tubs in general during conception attempts.
11. Avoid sex toys during conception attempts.
12. After ejaculation, the man should remain inside the woman for several minutes and withdraw carefully.
13. After ejaculation, the woman should remain lying down for twenty minutes or more, and may also elevate hips and legs with a wall or pillows.

Tips:

1. Include satisfying foreplay to keep things interesting and assist with lubrication.
2. Allow time in your lives for spontaneous, non-productive sexual relations during less fertile times.
3. Seek relationship counseling through your doctor's office if sexual dysfunction of any kind becomes a factor.

In the Middle of My Story: Infertility & Miscarriage Journal

In what seems like another life, I had my own baby-making struggles, and sometime in the mid to late 90's (BB - before blogs), I published my journal online. Written in hindsight up to a point, I paused in the middle to birth a boy who is now 10 years old. Then, at the request of my readers, I put up my epilogue. This is the introduction to that epilogue.

From there, you can also access the trials & tribs prior, as well as my pregnancy journal. Be forewarned: these are relatively roughly written (as in, hardly a smidge of editorial polish) and not exactly what I consider my better work. But if you're inclined toward others' stories, here is mine.

I gratefully forget about my infertility/miscarriage story often, but it's also intrinsic to me now. I can't think of a single facet of my happily complicated life that isn't touched by the experiences I lived from 1994 through 1999. Every now and then, I am reminded by others that my story is still there and welcome.

The present location of these journal pieces is FertilityCommunity, a place assembled by some nice folks several years ago. It was originally written for About.com when I worked as their infertility guide.

ART Twins May Have Higher Risks Than Naturally-Conceived

Parents-to-be should be made aware (but not alarmed) -- an Australian retrospective study concludes twins who result from ART (as opposed to unassisted conception) are at greater risk for health outcomes such as preterm birth, low birth weight, and death.

The researchers looked at all twins born in Western Australia from 1994 to 2000. The double difference in risk rates is specific to "spontaneously conceived twins of unlike sex" -- when compared against all spontaneously conceived twins, including identicals, the risks were similar.

The question of 'why' is the mystery. Michele Hansen of Perth's Telethon Institute for Child Health Research, study author, proposes that the things that are causing the parents' infertility and/or components of the ART procedure may be to blame. She also notes that the hyper-vigilance of new, formerly-infertile parents may contribute to increased incidence of hospitalizations in the baby's earliest years.

Fertility Treatment Twins More at Risk for Hospitalizations - Forbes.com

What She Said: Being An Older Mom

In her op/ed, New mothers and menopause, Roberta Martone Pavia brings up a topic that not many Mama Wannabe's in their 40's (and even some in their late 30's) will want to hear: Being an 'older' mom provokes a special kind of hormonally-induced madness.

If you're in your 40's and heading to monthly or weekly exams at an OB, chances are good that you conceived with the help of a fertility specialist. It's also likely that nobody in that specialist's office uttered a single negative comment, not even a funny one, about what may lie at the end of your hopeful path. That's okay. Nobody expects baby-making docs to talk about potential negative consequences of their work. After all, the benefits of parenthood really do outweigh the rest. Really.

But -- for all you latecomers or those who've been struggling at this family-building stuff for years longer than many, take heed. Yes, having a baby is a beautiful thing, and when you really, really want one, nothing beats it for a supreme life event. And it's also hard as heck if your pregnancy party starts with a body that's naturally ready to shift into hot flashes, insomnia, and other hormonal overdrive effects.

Be sure you have a cadre of understanding loved ones around you.

Secondary Infertility: Dear Body, What's with the sudden attitude?

On a NYT column (Motherlode, by Lisa Belkin) that may at times be painful to read if you're spinning helplessly in infertility's vortex, guest blogger Kelcey Kintner reveals the conflicting emotions and stigma that come with secondary infertility.

Belly Envy