Saturday, January 26, 2008

From fertility to infertility ...

The other day a very dear friend of mine asked me if we were considering adoption, she honestly didn't understand why we're continuing to bang out heads against the wall. So I told her ...

"we aren't there yet, there's a lot of steps between here and adoption ... the only thing is we have to face many losses while going down this path ... so really for us it's about endurance to see if we make it all the way down the path"

... and that got me thinking ... I'm going to put together "the stages of infertility" so my friends understand what it's like to be looking down this path ... in hopes that they can understand just a wee bit more about me and the life that I've found myself in.

it's longer than you think ...

1. Avoiding pregnancy - like the plague
Personal mantra: “If I get pregnant now, I’m going to cut off my husband’s doo-da-whack-er; I’ve got a career and a life you know.”

Practices: Religiously take birth control pills for YEARS, read the instructions from time to time in case you miss a pill or two, follow their directions with delicate caution.

2. Not avoiding, not trying

Personal mantra: “Ooooh, oooh, ooh! Let’s make a BABY!”

Practices: You find yourself reaching over to touch your husband’s leg when you’re out with friends, you’re more amorous, you want to cuddle and just be close. You’re just enjoying the bliss of trying to conceive.

3. Trying

Personal mantra: “I can’t believe we’re actually starting to build a family, this is so exciting. Yesterday I was scared that maybe we’re not ready, but today I can’t wait!”

Practices: Have intercourse around cycle day 14 because that's when "most" women are fertile. Try different "positions" and/or elevate the hips after love making. (Where appropriate: tubal ligation and vasectomy reversals). Along with purchasing your first few pregnancy tests, you find yourself buying books pregnancy and diet while trying to conceive … and because you have a “good” feeling about all this, you throw in a book listing ideas for baby names, including ethnic origins and name meanings.

4. Ovulation Detection - Basic

Personal Mantra: “How fun, I get a new toy! So I guess I might not ovulate on cycle day 14? Now THIS will really clarify the issue of ‘when the heck am I ovulating?’”

Practices: Instead of peeing on a pregnancy test each month, you're peeing on an ovulation predictor stick for consecutive days in a row to see when the time is "magic".

5. Ovulation Detection - Advanced

Personal Mantra: “I had no idea my body worked this way. No wonder we haven’t been able to get pregnant. Why don’t they teach us this stuff when we’re in fifth grade?”

Practices: Read "Taking Charge of Your Fertility" from cover to cover multiple times. Learn all about charting. Enlist the help of: BBT/CM/CP, OPK/fertility monitor, and/or fern microscoping. Buy thermometer and subscription to FF to chart. Learn what your cervix is and how to check it with your own fingers without getting grossed out.

6. Natural Fertility Remedies

Personal Mantra: “It’s all starting to make sense and there are many elements to trying to conceive, perhaps my body or hubby’s body just needs just a little bit of assistance.”

Practices: Start to avoid alcohol in the two week wait, avoid caffeine as well. Eat carrots, drink grapefruit juice, or insert egg whites to increase CM. Eat pineapple for implantation. Initiate Endo diet if suspecting Endometriosis. Insist hubby start wearing boxers (or no shorts at all). Allow hubby to sleep naked to help his count. Gently explain to hubby why he can't go in the hot tub any more.

7. Add in more supplements

Personal Mantra: “We’re really not doing all we can to make this baby thing a reality, let’s take it up a notch. There’s nothing really wrong with us, but perhaps we’re not getting a good diet and giving ourselves every chance possible.”

Practices: Decide that alcohol may not be good at any time of your cycle. Find a "better" prenatal, add extra folic acid, start taking omega 3's (6-9's), and/or EPO. Consider Preseed, taking Robitussin, or taking Mucinex to increase CM. Consider Vitex/False Unicorn Root/Raspberry Leaf/B6 to enhance endometrial lining. Consider Fertilaid, FertilTea, or Fertility Blend for overall better fertility.

8. Natural remedies that lean toward technological solutions

Personal Mantra: “I don’t think we really need help yet, besides it’s so expensive and I’m not sure insurance would cover anything. There are some pretty good do-it-yourself options out there. This is just the help we need to become successfully pregnant”

Practices: Stock up on yams or soy products as they mimic Clomid. Purchase Instead Cups to act like a natural IUI. Consider using syringes to act like a natural IUI. Start daily baby aspirin (because maybe you have an undiagnosed clotting issue?) Consider a natural Progesterone cream to extend the luteal phase. Take an at home fertility kit test.

9. Work towards recovering from any miscarriages, stillbirths or infant losses previously experienced.

Personal Mantra: “Miscarriages are common. This is painful, but it happens to a lot of women.”

Practices: Start paying more attention to every detail of your life. Perhaps your shampoo is poisoning your body (and thus any babies you might grow) … increase your vigilance, ALWAYS aking the “right” decision.

10. Educate yourself for the rest of the journey

Personal Mantra: “Ok, this is getting ridiculous, we need some help … now what the heck are those infertility experienced women and doctors talking about?”

Practices: Become your own research assistant and learn to read medical journals, *hoping* to find some new direction or treatment to try. Learn all the acronyms and words nobody else ever wants to know: IUI, IVF, GIFT, ZIFT, FET, HSG, HcG, P4, ANA, MTHFR, PCOS, DOR, POF, FSH, E2, ER, ET, stim, SA, MFI, EP, M/C, PIO, AMA, etc. ... but be careful not to over-learn these acronyms to the point where in real life you start calling your husband "DH" to his face or find yourself telling someone that you're "TTC'ing" - people will start to realize how crazy you really are.

11. Medical intervention I

Personal Mantra: “Ok, it’s time to ask for a little help. These people are professionals, this is what they DO for a living – making people successfully pregnant – we’ll be pregnant before summertime; hmmm… maybe we shouldn’t schedule that big hiking trip, because I’ll be 4 months pregnant by then.”

Practices: Start seeing a Reproductive Endocrinologist (RE). Test those sperm! Make sure husband is taking any needed supplements for sperm issues. Start taking Clomid/Femera Start Metformin as needed. Get ovulation assistance with triggering. Do your first IUI. Start Progesterone suppositories in your luteal phase to provide a little hormonal support. Combine pills, triggering, IUI's and Progesterone for a catch-all solution. Possible thin lining? Start Estrace. Endure the emotional outbreaks and straight up abuse you cause your husband while Clomid is stealing whatever splinter of sanity you have left. Consider going back to a previous step in this slippery slope, in the hopes that something less invasive might actually work.

12. Medical intervention II

Personal Mantra: “That RE sucked we need a fresh start with someone who knows what they’re doing. If we can start cycling in October then I might get to announce my pregnancy at Christmas – I’ve always dreamed of that!”

Practices: Consider seeing a "new" RE who's more cooperative. Run a boat load of blood tests and subject yourself to a painful HSG procedure to make sure your tubes are all clear. Endometrial biopsy as needed. Correct Varicoceles as needed. Learn how to become your own lab tech in order to administer self-injections. Start medications for any issues found during blood tests. Inject yourself with gonadatrophins. Learn how to pronounce gonadatrophins. Attempt: injectibles with well timed intercourse, injectibles with IUI, injectibles with back-to-back IUI's. Conduct a lap as needed. If Endo, receive Lupron medication to induce menopause for 6 months+ in the hopes of reducing endo lesions. Side effects include: hot flashes, night sweats, major mood swings, bone loss and yes, the Endo will return. Consider going back to a previous step in this slippery slope, in the hopes that something less invasive might actually work.

13. Work towards recovering from any miscarriages, stillbirths or infant losses previously experienced.

Personal Mantra: “The doctor says that my two losses have to be a flukes. Although we’ve found some problems, I’ve been on medications for all my issues. The next pregnancy … that will be the healthy one.”

Practices: Avoid getting in the direct line of microwaves. Remove yourself immediately when around smokers. Check to see if you have Mercury in your fillings. Start losing or gaining weight as needed. Increase your diligence and vigilance about your diet – clearly you’re doing something to cause the death of these babies.

14. Consider non-traditional medicine/practices more seriously

Personal Mantra: “This whole process is causing my personal demise. My marriage is suffering, my mental state is suffering, I want a baby but at what expense?”

Practices: yoga, acupuncture, herbs, fertility retreats, fertility support groups, counseling, intensive therapy weekends, begin anti-anxiety and/or anti-depression meds. Deal with feeling very angry towards God. Learn to cope with buying infertility books instead of pregnancy books. If dealing with Endo: Live with the fact that you will always have endo and it may get progressively worse--Stage I(mild)-Stage IV(severe). Learn to deal with the pain.

15. Medical intervention III

Personal Mantra: “I am ready for the big guns. There is no going back now. I’m excited that we’re doing something that has such a great chance for success but I’m scared out of my mind that if this doesn’t work - my world and all I thought my life would be … will come crashing down. Is it possible to be this excited and this scared at the same time?”

Practices: Consider seeing another "new," RE who has a higher SART rating. IVF. GIFT. ZIFT. Hopefully some FET's. Multiple IVF's. Conduct ovarian drilling as needed. Consider going back to a previous step in this slippery slope, in the hopes that something less invasive might actually work.

16. Change perspective on how you will build your family I

Personal Mantra: “I can’t believe we’re here. Nobody ever told you that having a family would be this difficult. Everyone else can do it, why can’t we? What’s wrong with us? This will help us by taking one less variable out of the equation - this has to work.”

Practices: Consider sperm donation, consider egg donation. Consider going back to a previous step in this slippery slope, in the hopes that something less invasive might actually work.

17. Change perspective on how you will build your family II

Personal Mantra: “We will have a baby, damnit.”

Practices: Consider embryo adoption, consider surrogacy. Consider going back to a previous step in this slippery slope, in the hopes that something less invasive might actually work.

18. Work towards recovering from any miscarriages, stillbirths or infant losses previously experienced.

Personal Mantra: “Why me? What did I do to deserve this?”

Practices: Resume drinking, smoking, hot-tubing, etc. Do whatever you want because clearly if everyone else can do these things and keep their babies – then it’s not about what you’re doing or not doing”

19. Change perspective on how you will build your family III

Personal Mantra: “We will be great parents and we can’t have our own children. There are so many children out there that need a home; let’s pray that we don’t get rejected.”

Practices: Consider domestic and/or international adoption, fostering and/or fost-adopt. Do loads of paperwork. Expose yourself to someone who will decide if you are healthy enough to be parents (you’re already feeling pretty insecure on this point). Put your name in a pool and pray that your miracle comes sooner rather than later.

20. Change perspective on how you will build your family IV

Personal Mantra: “If the Lord won’t provide me with a child, I have ways of working around that.”

Practices: Consider stealing other people's children. Ok, so I'm totally kidding, I just wanted to see if you actually read this (please don't show this to your fertile friends - they will certainly be frightened of me! [and perhaps frightened of you! as I would be! ha!])

Ok, the real step twenty ...

20. Letting go

Personal Mantra: “Maybe we can survive without children.”

Practices: child-free living.

If you look close enough at the journey, you can see how it parallels the four stages of grief (as proposed by K├╝bler-Ross) are easily mirrored:
  • Denial: “This can’t be happening to me.”
  • Anger: “Why is this happening? Who is to blame?”
  • Bargaining: “Make this not happen, and in return I will ____.”
  • Depression: “I’m too sad to do anything.” Acceptance: “I’m at peace with what is going to happen/has happened.”

Though sadly, these aren't the hard and fast ways we walk through grief (and this process), grief can be more of a continuum where we find ourselves depressed one day and bargaining the next. The process is overarching if you look at it from beginning to end (step 1 to step 20) but it also is at the micro level, we process through grief with each failed step and we have a hard time completely letting go.

This slippery-slope is not for the faint of heart.

Personally, I'm at step 14. And I can say that at step 14 I'm still hoping and praying that I don't have to endure steps 16-20, I'm not at the point of accepting those steps yet. Would you be? If you have children, can you imagine not having them and having adopted instead? Look at them, right now ... can you live without them? Some people are called to adoption ... maybe someday I will be; but today, I'm not.

(A big thank you to: annieb11, E (aka Dreamer_2007), Shelley, Jenee, Anna, Lara, Cheryl, Ayameow, Amelia, Jess, Jill, Lori, Kellee, Cathy, missg1, pupluv, & Jen for your review and affirmation of this and definitely for your contributions - I hope I made you proud.)


  1. Wow - that is an incredible journey. Not one that I envy. It's interesting that this journey resembles the grief journey, I never thought about it in that context.

    Now that I think about it, any life struggle will resemble those stages. Hmm, interesting food for thought.

    You're in my prayers

  2. I'm at stage 11 and I'm not ready to be at Stage 20 YET.

    As I'm at the infancy stage in dealing with infertility, nobody around me seems to understand what I'm going through. Unfortunately, for me, I feel so alone sometimes cuz it seems that I can only connect with my virtual friends.

    Well said and I look forward to more entries. Keep writing - it keeps my spirits up.

  3. Nice job as always! It is always amazing to see it written out like that.

    I personally am a mix between stages as I have never been pregnant (therefor no losses), and I have had 2 laps, and have had ovarian drilling.

    We are getting ready to move on to IVF when we come up with the money.

    You are a strong and amazing woman, and I am honored to be your friend.

  4. Polly, did you write that? At first I thought you did, but then as I went on, I thought, this must come from an infertility book. If you wrote that, it is incredible. Consider writing a book my friend.

    I saw myself between 8 and 9. I had a laproscopy and that is when they saw the problem of my infertility. And I didn't move on to 9, which I think is a huge transitional point.
    You've been down such a long road. You articulate yourself so well.

    In regards to adoption, I know you aren't there yet and don't need to be because you still have more options to explore. But as a Mom of biological children, I can honestly tell you, if the surgery hadn't worked on me, I would have adopted. Scary, yes. Missing out on pregnancy and childbirth, absolutely. But being a child that was unwanted, there is something about taking home a child that also is unwanted and loving it as your own. If I had more patience, I would still want to adopt. I have NO doubt that God supplies as much love for an adopted child as a biological.

    But know as you go travel on this journey, you are not alone and you are supported the entire way. Praying you never get to 16.
    I hope you do an Angelina Jolie and crank out a couple of your own and then adopt a ton more from every country so that in your old age, you can laugh at the days when there were no children, because you have 10 now!
    That's my dream for you! Is that okay??!
    yours truly

  5. Wow. Just wow. You hit the nail on the head with this post, Polly. I couldn't have said it better myself... in some strange way it is slightly comforting knowing that there are other women who actually understand the journey that IF is taking me through. You certainly do. I think we're at stage 15 right now... ready to bring on the big guns. Hopefully our journey will stop there with success. I am praying the same for you!!!

  6. while I can't say I understand your journey, I love your blog, and as a mother of one with one on the way, I can tell you that IT IS WORTH the journey. There is no love like the love you feel for your truly is a love that cannot be described. I can also tell you that I am not one of those women that simply has to look at my husband and I am pregnant. We had to do the calculations and went through months of "what the heck did we do wrong?" I hate to say that I have been blessed, because that would mean that all of the great infertile couples out there are simply not blessed. I am so very thankful for my daughter and this pregnancy, and I hope you never give up on your dream. And let me tell you, when you get there, there are a million new worries that come along with pregnancy, but I'm sure you would welcome those worries, just as I do, knowing what the gift is at the end.

  7. Well written (even with a sense of humor where most can find none)...can you explain iui and ff and ttc for those of us who have no clue? It sounds like you are letting go a bit already which can be good!

  8. Thanks, Polly, for putting this together!! You nailed it. I guess I am at step 15 and bringing out the big guns with IVF. Steps 16-20 look so hard to me right now, but I guess it is all part of the journey. Maybe 15 looks hard for someone in the earlier stages. I may have to let a couple of IRL friends read this. I really think this could help to bridge that gap. Nice job!!

  9. Polly, I don't know you, but I happened to stumble here. You wrote an amazing post, and I'm sure it will be a benefit to many - to those dealing with infertility, it can be counted a blessing to articulate confusing and painful emotions. And to those who love someone who is having difficulty with fertility - you've given them an avenue by which they may have some understanding, which is invaluable. You mention a desire to get back on track with God. It was on my heart to recommend a book to you. Not about infertility per se, but about hardship, longsuffering. God's faithfulness and mercy. "Polishing God's Monuments" is a fairly new book by Jim Andrews. Its subtitled "Pillars of Hope for Punishing Times". This book is straight theology by a man who knows his stuff and loves the God who loved him first. His message is interwoven with the true to life heartfelt story of his daughter. This book will capture your heart and get you back in touch with a mighty God. As I read your post, this book kept coming to mind. I hope you find the time to read it, and may it be a blessing to you. May God find favor in you, Polly.

  10. Thanks for writing such a great post. I mentioned it to my husband this afternoon when he suggested that we start looking into adoption if we are not pregnant by June. I feel like we are at stage 11, and I was a little startled to say the least. (Practices include Clomid + trigger, acupuncture, and giving up caffeine, adding whole dairy, etc, etc.) I feel like we haven't even started with all the possibilities yet. When we started, I had no idea how painful a miscarriage would be, and I had no idea how painful the whole process would become.

    Thanks for writing and sharing all your experiences, and best of luck to you and your husband as you continue your journey.


  11. You hit the nail on the head. I think that one of the worst parts for me was the feeling of hatred I developed for my own body for its failures. No one but my husband knew how much pain we were in as we tried to keep up a positive attitude for 5 years. After three unsuccessful IUI attempts we had a miracle. Now people keep asking if we want another one. I tell people no because I'm scared to even consider it --- I would not want to get my hopes up and get into that bad place again when I have a DD to take care of and be eternally grateful for.