I pretty much remember the moment a switch went off in my head from being young, selfish, and newly-married to I want a baby. I remember at first, my husband and I definitely did not see eye-to-eye and therefore had a few fights about the subject. But it was a feeling like no other. I knew I wanted it and I wanted to get myself ready for it. Here's the funny thing: I had seven years of being my own advocate, fighting my own fight, for a health issue basically no one knew about. I never thought I would need to do the same thing for fertility.
I made the appointment with Dr. Echenberg, ready to talk about what was next. He did his usual check. I had my symptoms somewhat under control, but was still having some issues. I sat up and he told me he thought it was time to consider getting a Vestibulectomy. He said I had done what I could, and I have improved greatly, but this was kind of the last step. And if I wanted to get pregnant, this would be a very important prerequisite. BUT, there was more. Before having the surgery, it was necessary for me to get a prudential nerve block and Botox injections basically as preparation for the surgery.
So what did this mean for me? This meant that I could not even think about getting pregnant for 9 months. I needed to book the prudential nerve block, wait three months and get the Botox injections, wait three months and get the surgery, then wait to heal.
It was hard to hear. It was a huge let down (for me - my husband was a little relieved). But like everything else having to do with my Chronic Pelvic Pain, I listened, I wallowed, I accepted, I moved on and got ready to take the necessary steps.
I think I thought because I was given this huge disappointment, because I was told I could not start trying for at least 9 months, I thought the conceiving part would be easy. I mean, my mom got pregnant easily. That's what they tell you. "Oh, your mom got pregnant fast, so will you!" Who the fuck started this revelation and can I converse with he or she. This thought process, in a way, got my hopes up. I reasoned with myself: "Lior, it sucks you need to do this. But it is what it is. You'll go through the motions and in the end, it's better for Jonathan, and then you'll get pregnant right away when the time comes. You'll be fine. You're owed this one." I was owed this? Oy, Lior. How naïve you are.
So, I had the surgery (a story in a different post). I had about 22 weeks of physical therapy to heal. I went to see my OB (3 months after my surgery) to fill her in but also as a preconception checkup. I wanted to know what I needed to do to start trying. I wanted to be ready because as soon as PT was over, that was it, the unprotected sex was going to happen. Looking back at this appointment, I'm disappointed at how little I really learned. Not to bad mouth the doctor, because honestly I don't think it was her fault, I think it's the health system's fault. But more on that later. For now, just know, I went to the doctor and she basically told me, get off birth control, track your ovulation using the Clearblue Ovulation kits (start taking them daily 10 days after the first day of your period) and let us know when you are pregnant!
Again, looking back, I am just in awe..
So after that appointment, 9 weeks later, Covid-19 happened. Jonathan and I were finally getting on the same page. I healed, we got our sex life back from after the surgery, and it was time. And then we were struck with some scary news. Jonathan, being in the cruise industry and me, being in the hospitality industry had to face the fact that we were not sure what could happen. Could he lose his job? Would I have no work? We just bought a house, we have a mortgage. So we made the adult decision to put off trying for until we knew if Jonathan would make it through the layoffs.
About a month into Covid, I made another OB appointment because I was off birth control and at that point did not get my period for 72 days. Her response was "It's Covid-19. Everyone is stressed out and anxious, it is throwing everyone's menstruation out of whack. I am going to prescribe you some Progesterone to induce your period." Oy. Again, I don't blame the doctor (or try not to), I blame the overall healthcare system and how doctors are made to approach certain situations.
At the end of May, we knew Jonathan was keeping his job. And we, as a couple, used the Covid months at home to make sure Jonathan was ready for this next step. So, it was time. I was taking Progesterone so I could better track my cycle (since I was so irregular-- Hello, red flag!) and I was excited to say the least.
I was so on top of my basal temperature plus my cervical mucus AND using OPKs daily (which is NOT cheap). It was about 3 months in where I was like What the fuck is going on? I am supposed to be pregnant. My mom got pregnant on her like first try. Plus, I dealt with my vagina problems already!
It was also around this time that two of my friends became pregnant. One friend had been trying a year and a half, the other for about 10 months. Having my own vagina problems for eight years, I have become pretty open in regards to talking about them, so what makes fertility any different? So I called them. I wanted to know their tips, tricks, and secret recipe. I wanted, obviously, to be pregnant.
As you may have guessed. There was no secret formula. But I am so glad I called. I asked them if thought it was too soon for me to get checked out. I know it had only been a couple of months, so should I really worry? Their answer? "IT'S NOT TOO SOON!" In fact, they wished they went sooner. See, if you look up fertility you will quickly find that the internet (and healthcare professionals) consider the norm for couples to get pregnant within six months to a year of trying. But here is the problem. That's great and fine if you don't have PCOS or Enodometriosis or the MFH Genetic mutation or if your husbands sperm if fine. You could be trying for a year without realizing you don't ovulate. You could be trying for a year and your husbands sperm can't make it though the fallopian tubes.
Millennials are the instant gratification generation. We are "accustomed to having questions answered quickly, acting on that knowledge immediately and receiving feedback on demand." But what about fertility? The science is there. The testing is available. So why is it that when we tell our doctor we are ready to start trying for a baby (TTC) most of what is said is: Get off birth control, Buy OPKs, monitor your cycle, have sex every other day. And the problem is, why would we think it is any more complicated that that? MTV capitalized on an entire show called 16 and pregnant. Movies, shows, you name it, people get pregnant because they "missed one day of taking their birth control pill" or on Friends when Ross realizes condoms are not 100% effective and gets Rachel pregnant, using a condom, while drinking wine, while being 30 years old, from a one night stand. So why would we think that getting pregnant is any more difficult than having unprotected sex a bunch?
I remember two weeks after I lost my virginity. I was 18. My period was irregular pretty much all throughout highschool (uh, hello red flag for PCOS anyone?). But for whatever reason, this time felt different. I remember taking my best friend to Walgreens to buy a pregnancy test. But, of course, being the hypochondriac that I am, I did not believe the negative results. So I made her take me to a free clinic to get a blood test drawn. It was negative. I look back and I can't help but laugh. The odds of getting pregnant when you are trying to get pregnant is 15%-25%. "Even if you have [unprotected] sex on the right day of the month, there’s still only a 20 percent chance of conceiving [from that session].”(Maureen Whelihan, M.D.)
I made an appointment at the IVF office (These offices are just called IVF, but they actually test all fertility related items) that my OB recommended (more on IVF offices later). Roughly a month later I was diagnosed with anovulatory PCOS. I was TTC to no avail. I was not ovulating. Even if I did, my follicles were weak and shitty. But at least I knew now. I was 5 months in. And trust me that is better than some. Friends of mine were not diagnosed for a year. I count myself lucky, trust me.
I was luckier than some because I had a team of experts on my side (3 good friends, same age as me, who went through or were still going through fertility issues). These women probably saved me 6 months. And now I want to pay it forward.
Women, take control of your reproductive reality. Educate yourself on your body. You can absolutely be one of the lucky women who get pregnant on their first, second, or third try. But knowledge is power and I want you to ask yourself "Why not?" What is the harm in knowing? If I want to get pregnant right now, can you try to understand the emotional hell it is to try for a year and still not be pregnant? It starts to become a mental health issue at this point. Ask any woman (who's pregnancy did not come instantly). Ask her about those months she thought she was doing everything right only to find out the doctor missed something. Ask her what it felt like every single time she got her period. Ask her what it feels like to be on Letrozole month after month. In a time where mental health is taking priority in so many places (workplace, family, and social media) why has it not caught up in fertility?
One of my favorite parts of reading "The Trying Game", by Amy Klein, was reading about what she refers to as "TUSHY"*.
T- Testing fallopian tubes
U- Ultrasound of uterus
S- Semen analysis
H- Hormone Testing
Y- Your genetic profile
The book talks about this idea of "promoting diagnosis before treatment. Ensure all systems are go--before you get your car on the racetrack." As a Jewish woman, I remember being taught that the most important test to take before trying to get pregnant is the Tay-Sachs Test. At most, the only other one I knew about was semen analysis, but this was because TV/Movies used those tests as a premise for humor or a serious couple moment like when Trey needs to get his sperm tested on sex and the city or again, on Friends when Chandler needs to test his sperm and his ex, Janice, shows up. And, again, those tests only come after the couple is trying for a while to no avail, and decides to get checked. And it's always this serious, man-hood moment for the guys to get a simple sperm test. What if we change that? What if testing comes before we even start trying?
When you want to become a pilot, The Federal Aviation Administration (FAA) requires you to take a comprehensive vision test by an Aviation Medical Examiner. You would take this test to make sure your vision meets the requirement to fly a plane, and if not you would need to take the necessary steps to correct it. So why is it so crazy to think that when you want to become pregnant, there are certain tests you must pass to do it on your own? It seems to me to be a no brainer that when you are ready to get pregnant a health care provider should at least present you with this option. You could try for months, take these steps, and see how it goes. Or, if you would like, you could take these five somewhat easy tests and know right off the bat if you are going to have any particular need for hormones, supplements, diet changes, etc..
TTC causes depression, anxiety, and exhaustion. I want to find a middle ground between people coming into pregnancy hopeful and scared shitless. There is a difference between trying for 6 months knowing all the results of the above tests (and knowing they are "healthy" results) and trying for 6 months without having this knowledge (and essentially wasting 6 months while feeling sad, exhausted, and stress because you could not have gotten pregnant). If you get these tests done upon your preconception appointment, and find out you have PCOS, your doctor can immediately put you on medication to help you ovulate, making the time you try to have sex worthwhile. And I say this because, despite the movies, trying for a baby is not glamorous. Having sex at a specific time, for a specific amount, in a specific way every month is not at all fabulous. It honestly takes the fun out of sex and makes it feel like a requirement instead of a sexy, romantic moment. I also say this because, again, TTC can break you down, week by week, making you feel broken and like your body can't do what it's meant to do; making you feel inadequate.
Fertility teaches me a new kind of strength. It continuously teaches me patience. Above all, it teaches me to ask for what I need, whether it be space, time to grieve, or moments of turning my brain off. When your life is dictated by your cycle and fertility you feel you have no control of anything else in your life. You feel like your own schedule is not your own. It belongs to your uterus and your ovaries. Every doctor appointment, every trigger shot, every pill, and every blood test is needed at a specific time of day, specific day of the week, and specific day in your cycle. Fertility has the ability to consume your life. I want you to know that it's okay to ask for what you want or what you need. It's okay to question doctors and ask them why. It's okay to talk to friends about this, if that is what you need (no, it won't jinx you). It's okay to ask for testing, and if your doctor tells you it's not necessary and you should wait, then you have the right to find someone else. It's okay to be scared and still be hopeful at the same time. It's okay to be happy for someone else, but still sad and jealous for yourself. Have faith, but be smart, because the only person who is going to fight for you, is you.
* "The Trying Game", by Amy Klein -- Page 28 (Woman, know thyself) -- referencing Dr. Aimee