Aggressive Approach

I have been going to my OB-GYN for almost ten years now.  So have my girlfriends.

I know it’s weird, that a goodly number of my girlfriends and I have the same OB-GYN, but I see it this way: I don’t go to a restaurant without fully researching it and checking out the reviews. My approach to the person who annually inspects my inner and outer parts for problems probably shouldn’t be less methodical. And so it was that upon the advice of some of the women who have been my friends since I was 14 that I started making annual appointments with the woman who, yesterday, gave me a tight, yet somehow compassionate, grimace when I told her that my husband and I have been trying to have a baby since June.

One of the biggest reasons I chose my doctor was that, well, she was/is a she and she was/is young. I found comfort in knowing that whatever I was going through, chances are, she was, too, and I didn’t have to be inhibited by any problems I might be having, or at least worry about scorn. My friends confirmed this. Plus, she took the time to actually get to know you, to talk with you. In my early 20s, when I was still smoking, egads, an average of a pack-and-a-half a day, she didn’t scold me as much as she did educate me. She remains happy and proud to this day that I don’t smoke anymore, especially since she still has the notes from that one time I came in and people in the examination room over could hear my lungs gasping for air. These days, she’s in a larger, fancier practice, but she’s no less attentive.

“Weeellll, you’re getting to that time…”

That time, in fertility speak, is the year mark, the point for women under 35 where you start to bring in the big guns, should that be your choice.

“I know, I know…”

She stood up straight, and calmly began to rattle off a series of questions pertaining to my cycle, all of which I could answer with precision since I now pay attention to such things, and a few admonishments about temperature taking and cervical mucus monitoring.

“That stuff will just drive you crazy,” she says. “It drives everyone crazy.”

I told her that I wasn’t even sure if I am ovulating, and, she surmised, with my Hashimoto’s it’s entirely possible that I’m not. There are tests, some that are invasive, catheter-involving tests that require me to take several Advil beforehand, that will help to determine if my aforementioned parts are in working order. Several are tests I’ve never even heard of, though what they’re testing for I certainly have.

I tell her that in December we gave ourselves permission to stop trying so hard, and we just let this current cycle walk on by. We talk about stress, and how I’m inclined to believe that the massive amounts of stress I’ve been feeling have contributed to not only the extra 15 pounds of emotional eating on my body, but also our inability to get pregnant.

“I work for, well, until Friday I’ll be working for…”

I tell the doctor that I’ve quit my job, and accepted an offer made to me by a  fantastic company here in Chicago, one that, as has been assured to me by many, is family focused, and places an emphasis on the work/life balance. I start next Monday, I’m taking a week off in between to eat a lot of vegetables and do a lot of yoga. And read. And sleep. And hang out with the dogs at my sister’s house while the kitchen remodel chugs along.

“Stress really can play a role,” she says.

My boobs are fine, as is the rest of me. I get dressed and she comes back with a prescription for two blood tests and a worksheet that breaks down exactly what we’re supposed to do, come Day One of my next cycle. It’s difficult, apparently, to get in for one of these tests. Others are very time-sensitive so there’s no fooling around. I keep wondering if I should start acupuncture and switch to a vegan diet. I don’t know why this has come into my brain, other than I like to give Eastern Medicine a fighting chance. Just the same, we’re simply talking about tests that will probably, she says, reveal that we have unexplained infertility.

“But at your age, we have to be a little aggressive,” she says. At my age. I’ll be 34 in April. It’s not that I don’t think she’s right, it’s just that, well, I am of an age where I am of at your age conversation. Over the hill before I even got up it.

“You’re every fertility doctor’s dream, though,” she says. I’m healthy, and except for the thyroid, in good shape. I guess this means I’m the sort who they can easily get pregnant, without much additional fanfare. There is, of course, my husband’s parts to think about, but in terms of the breeding ground that is my body, I’m just the kind of candidate that only serves to boost a doctor’s success rate.

My doctor talks about the different styles of the fertility doctors she’s recommending, who is more hands-on, who is not. All of them “get you pregnant,” which I don’t think will ever not be a string of words I don’t find oddly itchy. After that, I come back to her, she says, smiling.

I exhale. I don’t think I noticed I wasn’t breathing. Not very yoga of me to do. Clearly I’m a slow learner.

I thank her, I am glad for information. I am always glad for information. I like knowing stuff. It feels comforting to have a plan, and we all know how much I love those. I put my tights and dress back on, zip up my boots and head to the front of the office, head swarming with all of this. I get the numbers and cards for the fertility doctors.

I really don’t know what the fuck I’m doing.

Admittedly I feel side-swiped. It wasn’t my doctor, she of the kind, earnest, frank demeanor. She didn’t give me anything I wasn’t looking for, but it’s at least obvious that I wasn’t ready for what she gave me. I wasn’t planning on leaving there with more than a few helpful tips and a request to come back this summer. I suppose if you’re my age, and healthy, and doing everything they tell you to do, the prescription is not helpful tips but a run-down of what’s next, if you want that.

And here is the truth: I do. I would like to know what’s going on. But let’s be honest. Once you open that box, you don’t get to shut it. I’m still unclear as to whether or not I’m ready to handle what comes out.

On Saturday, we volunteered to watch our nephew, Elliot, so his parents could enjoy an evening out. For reasons that are unclear, Elliot would eat and then promptly pass out on my chest. That was the routine, he accepted nothing less. And for people who want a baby, nothing is probably as intoxicating and ego-boosting as a three-month-old refusing to be soothed by anything but you and your sheer existence. We both fell asleep at one point, resting in the chair, after me wanting to watch Goodfellas for the umpteenth time, and Scott admonishing my choice because of “the yelling,” only to come to an quiet impasse after finding Chris Rock on Comedy Central. I kissed his soft head, over and over, until his parents came home, and we walked out into the cold, into our car.

This, I thought, might have to be enough, as we made our way back to Chicago, to our dog, to our home.

20 Responses to Aggressive Approach
  1. Jennifer
    January 13, 2010 | 10:10 am

    Oh this is such painful deja vu for me. It’s overwhelming, hard to really believe and accept and just not fun. I started 13 months ago with an HSG. While I was going through the testing, the bloodwork, the ultrasounds, three cycles of clomid, and a cycle of injectables it felt like hell. It negatively impacted my marriage, my bank account (and I have awesome insurance), and my emotional and physical health. I turn 34 on Sunday and I’m due June 25th. Now it doesn’t seem all that bad. And it’s nothing compared to the stories I’ve heard from other people. Have lots of hope. There are many of us out there who were just waiting to be success stories. Good luck.

  2. Mr. Smith
    January 13, 2010 | 11:00 am

    “My boobs are fine, as is the rest of me. ”

    TRUTH.

  3. Felicia
    January 13, 2010 | 12:30 pm

    Erin, I know more than I would ever care to about the heartbreak of infertility (myself included, although I can get pregnant, but my body does not do a good job at holding on to the babies). If you ever want to read a few of my friends’ blogs…

    http://ivfonthedl.wordpress.com/
    http://seekingsibling.wordpress.com/

    My heart truly goes out to you as you struggle with this and all the decisions it entails.

  4. Kathy
    January 13, 2010 | 4:22 pm

    I’ve been through this and although it took awhile, we have two mostly sweet kids to show for it. I know you don’t know me, but feel free to drop a line if you have any questions. I think I’ve done it all in terms of testing and procedures and drugs and general crankiness with the whole process.

  5. Julene
    January 14, 2010 | 10:31 am

    It’ll happen. In whatever form it has to.

  6. linda
    January 14, 2010 | 1:31 pm

    Sounds like you have an amazing doctor. There’s a lot of opportunities out there to help with fertility but it takes time, patience and a good sense of humor. Just keep your spirits up. I am in my second year of IF treatments and have a hunch that ’10 will be my year. I also wish you the best in your new career.

  7. Cathy
    January 14, 2010 | 1:50 pm

    I couldn’t figure out how this random blog linked back to mine, but now I see Felicia’s comment and figured it out.

    Anyway, as a 33 year old trying for #2 with zero success, I’d say don’t wait. Your doctor might be a great OB/GYN, but in general they don’t know much about GETTING you pg.

    My RE (fertility doc) put it to me this way. Biologically 20 year olds are really meant to have babies. Society might say that’s too young, but by the time we’re settled and in our 30s, we’re really OLD in terms of getting PG.

    There is a simple blood test that can be done on day 3 of your cycle (CD3 bloodwork. Very impt that it’s on CD3) that tells you a LOT about the quality and quantity of your eggs. I’d do that before the HSG (the test where they shoot dye into your ute to see if there are blockages.)

    Charting can tell you whether your ovulating and tell you a lot about your body. If it makes you crazy, there are ways to reduce the stress (like not charting once ovulation is confirmed.) It will, however, give you a lot of info. I don’t think it’s total BS.

    Hashimoto’s can have pretty big fertility implications (I’m guessing as there are some girls with it on my fertility board.) What a RE might see as ok thyroid levels are not what another doctor might take as ok.

    Anyway, I know I’m butting in here, but just wanted to sympathize and encourage you to not mess around. I really kick myself for waiting as long as I did after my 1st baby to try for #2.

  8. Tamar
    January 14, 2010 | 6:21 pm

    Just popping in to say I’m thinking of you and wishing you the best in your journey to parenthood. Congratulations on the new job!

  9. Laura
    January 14, 2010 | 8:27 pm

    Ugh – so sorry you have to go through this.

  10. Jen
    January 14, 2010 | 9:35 pm

    I just got done reading this post and as I took in that last sentence, “This, I thought, might have to be enough…”, I teared up, I can’t lie. I just turned 34 three weeks ago. I got divorced 9 months ago. And the one thing I know? I want to be a mom. And that feeling you talked about of being over the hill before getting the chance to climb it? I feel that more strongly now than ever. While I joke with my best friends that they’ll get to come to the sperm bank with me to pick out a baby daddy if I don’t have a real candidate for the job in a couple years, in the back of my head I wonder if it’ll even matter – I’ve known I’ve had PCOS since I was 28. I also knew for the last 6 years I didn’t want a child with my ex so it was a non-issue. Now it might be an issue. And I too, think that this might have to be enough. For you, I sincerely hope that this doesn’t have to be enough. For me too.

  11. Amy
    January 15, 2010 | 12:26 am

    Sorry, haven’t been reading long enough to know if your husband has had his sperm tested. Might be a great first step as it is the least invasive of all procedures.

    All the best to you both in 2010.

  12. a reader
    January 15, 2010 | 5:23 pm

    Having gone through infertility, I know how overwhelming all of the info, all of the tests, can be. I have a pretty good doctor but there were times I left her office crying and MAD.

    One thing that really helped me through my years trying to get pregnant were so-called “infertility blogs”. Not that you are infertile, but reading these blogs helped me to better understand all of the possible tests, procedures, outcomes. I love the blogroll at Stirrup Queens and Sperm Palace Jesters.

    Oh, and if charting might drive you crazy, but if you still want to see if you’re ovulating, try a Clearblue Easy Digital Fertility Monitor. The monitor and sticks are a lot of money at the outset, but it makes it much easier to keep track of everything.

    Is your endocrinologist in on these convos? I know some friends who have been able to get pregnant, but had issues staying pregnant, with thyroid issues…just putting it out there.

    My thoughts/prayers/positive thinking are with you.

  13. Melissa
    January 16, 2010 | 9:46 am

    Yes, your last line killed me as well. I can’t even begin to imagine how you are feeling but when I read things where people open their hearts, I can start to understand more. Thank you for this. My best friend from HS (we are in our early 40s) just had a baby via IVF last year and is going for No. 2 this year. I never really got what she went through but you are helping me. I wish you all the best.

  14. Joanne
    January 16, 2010 | 10:29 am

    I will be thinking of you, and hoping and praying for the best.

  15. Jessamyn
    January 16, 2010 | 5:11 pm

    I love you. If you ever want to talk, about any of this, or about anything else, you let me know, ok?

  16. maureen
    January 16, 2010 | 9:36 pm

    I am wishing and hoping for you and your husband. I know you’ll be great parents. Don’t let the mechanics of making family get in the way of the end game which is becoming parents. I am thinking good thoughts for you as you embark on this next challenge in your life. You’ve always been the smart funny girl blog I’ve turned to when I’ve been stuck in my own body image and weight loss dramas. You’ve helped me with your thoughtful words and inspiration.
    I know this all sounds very sappy but it’s true. Be well.

  17. Hannah Beth
    January 18, 2010 | 2:42 pm

    Most of my friends and co-workers in Atlanta all went to the same ob/gyn, and there were several who saw other doctors in the same practice. I don’t think that’s weird. I think it’s smart!

    I will say that it makes me cringe when doctors look down on charting; as if educating yourself about your cycles is a bad thing. But your doctor is certainly not the first to do it. A lot of them think it’s ridiculous, but maybe that’s because there are so many people out there who do it wrong. I mean, I also don’t understand how someone can misread an HPT, but according to the stats, 25% of women do. (And there’s a TV show to prove it.) So maybe those doctors just look down on THOSE women charting.

    But I never found it overwhelming or crazy making. It’s more crazy making to NOT know what is going on, month to month. But that’s me. I’m excited that I get to start charting again!

    Good luck, friend. Thank you for sharing your road.

  18. Eliza
    January 19, 2010 | 5:00 pm

    Blowing you a big fat kiss. See you soon.

  19. Kat
    January 22, 2010 | 3:36 pm

    Everyone has given you great advice. I think your doctor is a little shortsighted in not recommending that you chart. Perhaps she’s worried that *you* will obsess since you’re a self-professed type A. But you also said, “I am always glad for information. I like knowing stuff.” Charting can give you great insight. And a good endocrinologist or fertility doctor won’t poo-poo it. They’ll still do their blood tests but then you’ll have two sources of information that will give you insights.

    Here’s the site for Taking Charge of your Fertility, a great book: http://www.tcoyf.com/

    For me, I found out that my cycles change slightly here and there. Sometimes I ovulate on Day 12. Sometimes, if I’m sick or stressed, I don’t at all. There’s nothing wrong with me, I just seem to be sensitive to external forces. But had I not charted, it would have taken me a lot longer to get Clara.

    I don’t know if you’ve ever been tested for Celiac disease (an autoimmune disease that makes you intolerant to gluten) but it often runs along with Hashimoto’s. Celiac, or any level of gluten intolerance, is really common, they’re finding now. It’s an easy blood test to see if you are, though there are many false negatives. Gone unchecked Celiacs can impact fertility and gestation. Anyway, just another piece to look at.

    You will get the opportunity to parent. Know that. Just take things one step at a time.

  20. Erin
    January 23, 2010 | 10:46 am

    That wasn’t what she said, actually. Her only point was that for some people – like me, who has been charting for months – the results can be a bit wonky and not as precise as needed. So if your results aren’t as “they” tell you to, not to worry since there are other methods.

    Also, I’m guessing you’re a new reader since I’ve been tested for everything under the sun, including Celiac disease. :)

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