All the good things and the bad things that may be…

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It is impossible to fully address the topic of infertility without talking about sex.  But if I have sometimes been ashamed to discuss my fertility challenges, I have been absolutely loath to bring up its impact on my sex life.  Sharing this aspect of myself feels like inviting spectators into my bedroom to examine the sheets.  Yet it cannot be ignored.  Miscarriage and infertility had a material impact on my sex life. I don’t believe I’m unique in this experience, and I also believe that one of the most effective ways to heal from it is to talk about it.  So, here we go, let’s talk about sex.

There are many reasons to engage in sex.  Some people chase pleasure, some like to experiment, others seek out fantasy – a way to escape themselves.  Mostly, I crave closeness.  I’m a hopeless romantic.  It’s why I read poetry, watch sappy movies, and listen to love songs.  I want the butterflies.  I pursue passion.

I remember the exact moment I realized I was in love with my husband.  I was on the Bryan Center walkway on Duke’s campus headed back to my dorm room when the feeling washed over me – a spark started in my heart and sent tingling waves of emotion through my nervous system and I knew. 

Falling in love was easy when I was 19.  Peering over the precipice of adulthood, I knew it was not a trip I wanted to take alone.  Every conversation and every interaction I had with my husband felt vital to my future.  Intimacy was as essential as breathing.  I wanted to blend into him until we were of one mind and one body, or as Kahlil Gibran says, “to melt and be like a running brook that sings its melody to the night.” 

With time and maturity I disentangled from him and became my own individual within our relationship, and the focus of sex changed from conjoinment to connection.  That’s why it felt exciting and appropriate to embark on a journey of family planning.  It gave our love a purpose – the opportunity to create something.  And when we got pregnant, I felt like our love transmuted into something sacred inside of me.  That is, until my body betrayed me.

Miscarriage was traumatizing.  There was the physical pain – obviously – but there was also the psychological feeling that my body had been violated and that I was no longer in control of my person.  The resulting impact on my relationship was significant.  Good sex and true intimacy require vulnerability.  In order to give your body to another person, you must first let go of it yourself.  Yet after my losses, I was unable to do so.  Love and desire felt unsafe; instead of creating life, they’d invited death.  I was afraid that sex could only ever bring me to a place of sadness and pain. Compounded on that, there was one year in the middle of our losses when we couldn’t get pregnant at all.  Twelve months of trying and tracking and testing; and every month the waiting, the hoping, and ultimately, the disappointment. 

Miscarriage was hard on our marriage because we didn’t know how to talk about it, and we pulled away from each other instead of grieving together.  But our year of failed conception was something different entirely.  Disappointment dominated rather than feelings of sadness.  Sadness was exhausting and overpowering; but it was accessible.  Sadness could invite others to hold it.  Disappointment was harder to share; it was personal and bitter and brutal. 

Overt time, fear and failure defiled my sexuality.  Sex went from being an act of intimacy to a dreaded chore.  “Planned intercourse” around my ovulation felt prescribed and transactional instead of spontaneous and special – even the term was emotionless and clinical.  What should have been languorous and fun became efficient and goal oriented.  My husband struggled to understand how I could suddenly perform when I was ovulating, but otherwise needed to be in the mood. I struggled to comprehend why he could be in the mood anytime except when there was pressure on him to perform.  Many fights ensued.  Multiple nights were spent crying in separate rooms.  Then, of course, we moved on to IVF and no longer needed to have sex at all in order to get pregnant…

This was not how I had pictured my life or my relationship. We loved each other very much, but I think it’s important to admit that staying married was not a foregone conclusion. Infertility can break a relationship. A dysfunctional sex life can shatter intimacy. Some couples don’t survive this. My husband and I have been married for 11 years.  For half of those we’ve been trying to start a family.  Concerted effort and couples therapy enabled us to pull our sex life back from the brink and unshackle it from the weight of procreation, but we are still working to find the way back to one another.

There are moments when I feel hopeless in our efforts; times when I yearn to recover the innocence and abandon I felt when I was 19, though I know it is impossible. But in these moments, I’m reminded of one of the bible passages sung at our wedding: Song of Solomon chapter 8 verse 6, “Many waters cannot quench love, neither can floods drown it. For love is as strong as death.”  

Infertility and miscarriage washed over us like a flood, breaking our levees and soaking us in sorrow. But our love hasn’t been drown; so we rebuild. Brick by brick we are reconstructing our palace of emotional and physical connectedness.  Although our relationship has changed, once again “we’ll celebrate, we’ll sing, we’ll make great music.” (Song of Solomon 1:4)

Fertility is a (half)Marathon

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When I’m being melodramatic, I like to say that my sister saved my life.  In actuality, I think she saved my sanity.  I’m quite certain I would have gone into a deep depression after my second miscarriage had it not been for my sister. 

My second loss was a psychological turning point for me.  My first loss, while devastating, was possible to rationalize.  It was common, a likely genetic aberration, no cause for concern.  The second loss, however, seemed ominous.  Our experience no longer felt ordinary.  It felt wrong.  

My sister was living in LA at the time with her husband and my nephew, who had just turned one.  We were in Chicago.  Wisely, in October, about a month after the loss, my husband forced me cross-country for a weekend of emotional fortification, family and fall festivities. 

We did, in fact, carve pumpkins – really awesome ones that were shaped and painted to look like Elmo and Cookie Monster.  I believe they melted in the LA heat long before Halloween.  More importantly, the visit launched me into a physical and mental endeavor that ferried me through my pain. 

In an effort to lose her baby weight, my sister had decided to train for a half marathon.  During my visit, she dragged me along on one of her training runs.  It was only three miles, but I barely made it.  I remember being an entire block behind as she finished the run, yet she patiently waited for me as I hobbled the last length.  I was impressed, inspired and just low enough to allow her to convince me I should train with her for the full race. 

Let me be very, very clear that I am NOT a runner and never imagined I would run 13.1 miles.  At the start, I’m not even sure I believed I would make it to the end. The longest I’d ever run up until that point was a 10k Turkey Trot, and I distinctly remember hearing a spectator say, “oh, this must be the walking group” as I jogged slowly by.   But somewhere in the middle of the training, the race shifted from something I was doing solely to support my sister to a goal I HAD to achieve at a point in my life when I really needed a win. 

I know some of my readers are runners, and to you it may seem like I’m overhyping the experience, but for me the struggle was real.  We all have something (or many things) in life we wish we could achieve but believe we’re incapable of.  Our “big goal.”  Our albatross.  We want to run a marathon (or an iron man), write a novel, own a home, find true love, start a business, or… grow a family. 

My miscarriages made me feel like a failure.  I felt impatient for a family and completely out of control.  But running 13.1 miles was a goal big enough to counterbalance the weight of my grief.  It gave me back a sense of accomplishment and reminded me I had unknown strengths and faculties.

The training hurt my body.  I honestly almost ran in a shirt that read “everything hurts and I’m dying” because that’s how I felt a lot.  But the lesson I learned was that big achievements don’t come easy and that I shouldn’t expect them to.  Accomplishing something big takes time.  I am not a patient person.  Like Veruca Salt, I want everything now.  But that is not the way running works.  It is slow progress.   I have such an appreciation for the time it took to train, because it made me recognize that I can do big things, they just won’t happen all at once.  The important thing is to keep moving forward and making incremental progress – one foot in front of the other.

For months, my sister and I trained alone together from separate parts of the country.  We mapped our runs and shared our routes.  We encouraged one another and held each other accountable, and in February of 2016 we finished the race.  I was overwhelmingly proud of myself.  I finally understood that “a done something is better than a perfect nothing.”  Up until then, I had often let fear of failure or judgement stop me from doing things.  My perfectionism was debilitating and often lead to shame and unnecessary guilt.  But I never expected to break any records with the half-marathon.  I wasn’t trying to be perfect; I was just trying to finish.  Sometimes, the bravest and most perfect thing we can do is to begin and then begin again.   

My fertility journey reminds me a lot of my training for the half marathon.  It has been an imperfect mess.  It has been physically and emotionally taxing.  It has required commitment and perseverance.  It has seemed never ending.  But the goal is clear, and in the end, all I can do is run my own race. 

Et tu, Brute?

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Hello again.  It’s been several weeks since I posted.  There are some very simple explanations for this, as well as reasons which are harder to articulate. 

My July was spent with family.  First in Chicago, visiting my mom, my sister, my niece and nephews, both my grandparents, and some extended family; then driving cross-country to Seattle with my dad.  In our current socio-political environment personal travel is viewed with a lot of judgement.  While I definitely fall into a less rigid segment of quarantiners, it was a tough decision choosing to go home.  I wondered constantly if I was being irresponsible or putting lives and loved ones at risk.  In the end, my family agreed to let our love trump our fear.  So, after months of nothing but pictures, phone calls, and FaceTime, I finally got to give hugs, share meals, and spend time with those people who fill up my soul and remind me who I am and where I come from. 

I celebrated my nephew’s 6th birthday, painted his face to look like a fox, and shared his cake, littered with fun-fetti and complete with blue icing.  I sat with my mom on the first anniversary of my Grammie’s passing.  I read the Sunday lesson with my Papa and ate dinner with my Nana.  I comforted my dad after he put his cat to sleep and stayed up until the wee hours of the morning talking with my sister.  I was THERE. I was PRESENT.  I was HOME.

A lot of people live near their loved ones and have been able to do this all along despite the pandemic.  I don’t, and it has unquestionably affected my mental health.  My family feeds my spirit in a way that no one else can.  When I am with my niece and nephews, I feel grounded in the current moment and can think of nothing else.  When I spend time with my sister, I feel seen in a way that even my husband cannot achieve.  My mom gives the best hugs in the world – I could live inside her hugs.  My dad and I share such similar energy and dispositions that we could as easily talk for hours as sit in comfortable silence.  There were moments at home when I felt so overcome with emotion, I thought I might burst, as if the love I felt was too much for my body to hold inside.  And leaving broke my heart.  I will not endure 6 months away again. 

The night before my departure, as I was putting my oldest nephew to sleep, he asked why he gets to see his grandparents so frequently, but not me.  I explained that his grandparents live close by, while I live far away and have to take a plane to see him.  I said because of Covid, people have not been able to take planes as frequently as the they used to.  Then he told me a week of visiting was not long enough, and we both cried, and I was filled with rage and frustration at this virus for its continued disruption of my life, as well as a deep, deep sadness for everything it has taken from me.

My trip home is the simple explanation for why I haven’t posted.  I simply didn’t want to take time away from my family to write.  Here’s the more difficult one: this week was supposed to be the embryo transfer into our surrogate, or gestational carrier (GC).  But like so many of my family building plans, things have not proceeded according to schedule.   For health reasons of her own, last week our GC had to pull out of the agreement.  The only good news is that the embryo itself had not been thawed and remains safe and frozen here in Seattle.

So much of what I’ve blogged about until this point is in the past, so I’ve had time to process my feelings.  I’ve been able to look at my reactions with distance and compassion and find words or metaphors to describe the experiences.  But my surrogacy journey is happening now.  My mind is occupied with it, and it’s not always easy to determine how I feel about it.  Excited and hopeful?  Yes.  But also detached and cautious.   And now, sad, and disappointed.

With recurrent miscarriage, you learn to mistrust hope and temper excitement.  There are many steps between deciding to use a gestational carrier and an eventual delivery, so I’d been careful not to let my enthusiasm go too far.  I didn’t want to be disappointed again.  However, my attempts at emotional preservation were completely futile.  Despite my better judgement, I was getting excited.  Surrogacy didn’t rely on my misbehaving uterus – already the odds seemed in my favor.  So, in equal parts pragmatism and optimism, I drove a car full of hand-me-down baby supplies back from Chicago with my dad.  I talked openly and freely about the surrogacy process, our GC, and our transfer.  I even pre-wrote a blog post about the transfer (this one, which I obviously edited…) As hard as it was to engage in a process which I’m inherently separate from, I was hopeful it would all work out. 

And yet, when my fertility clinic called me to let me know the transfer was cancelled, my first thought was, “Of course it is. Why would I have expected anything else?”  I nearly started laughing. 

Then I got overwhelmingly angry.  Not at my GC, who was dealing with her diagnosis, but with God, and Fate, and the Universe in general.  “Seriously,” I thought, “am I just not supposed to be a mother?!”

That said, this loss – and it is a loss – feels different from my miscarriages.  Although there was nothing I could have done differently during my pregnancies, I still felt guilty and culpable after every loss.  I don’t with this.  Our cancelled transfer is plain old bad luck.  I am not responsible.  Interestingly, to my husband, the differences we not so pronounced.  He felt equally upset about our own losses, as the loss of this opportunity. He reminded me that there is a great deal of space between being “fine” and being “devastated” and that I still needed to practice self-compassion and self-care. 

So, after the news the last week I did the following:  First, I made myself a pan of brownies and ate it all myself.  Second, I repainted my bathroom cabinets.  Whenever I experience loss and feel out of control, I develop an urgent need (compulsion?) to make forward progress in another area of my life.  This time it was home remodeling.  Third, I binged on some TV and movie favorites – re-watched Fleabag and made repeat viewings of Call Me By Your Name.  Lastly, I drank Champagne.  I had been saving the bubbles to toast a successful transfer on Thursday.  Instead, I toasted myself, my husband, our marriage, and our continued perseverance.  We haven’t found our pot of gold at the end of the rainbow yet, but we’re still looking for it.

My Third Miscarriage

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Note: 35 is the age after which your pregnancies are automatically considered “high risk”

I don’t spend a lot of time thinking of or talking about my third miscarriage.  There were so many things going on in my life at that point that the loss was gobbled up by other events.  But while the miscarriage itself isn’t crystalized in my memory; it represents a turning point in my life and my infertility journey.  It irrevocably fractured my resolve and changed the nature of my grief. 

My first job after university was as a Teach for America corps member in Houston.  During my first-year, one of my students came to class with a kitten inside her jacket.  It happened that I was leaving early that day, so I took the kitten with me intent on giving it back to her once I spoke to her parents and confirmed they were alright with her keeping the animal.  However, destiny determined she should be mine.  I named her Pepper and she was my first fur baby – a tiny, tenacious, grey ball of fluff.   She liked me best of all the humans, and there were times I might have chosen her over humans in my life.  She was one of my comforts during sadness.  

After our second loss, we tried to get pregnant again for a year with no success (more on that in a later post), so we made the decision to see a specialist.  The same doctor had been independently recommended to me from two friends, which I took as a sign, so it was her with whom I made my first appointment.  However, I have learned after the fact that we started the medical phase of our journey rather atypically. 

The doctor we saw was quietly intelligent, active in research and education, but specialized in reproductive immunology – a field not well accepted withing reproductive medicine where most doctors focus on reproductive endocrinology.  That our immune system plays a role in fertility and pregnancy is well recognized; however, evidence that immune therapies improve pregnancy outcomes is mixed.  Thus, usually patients arrive at reproductive immunology when all traditional treatments have failed them, not as a first stop. 

Regardless, she took us through the standard infertility workup – a battery of blood tests and physical examinations – as well has her own investigative protocol, and diagnosed me with a myriad of clinical and sub-clinical conditions that potentially contributed to our infertility and losses.  Then she started me on a LOT of medicine.  I began taking four different prescriptions, multiple supplements, and daily injections. 

Ever the over achiever, I adhered to her regimen to the extreme. She told me to limit my carbs, so I stopped eating refined sugar all together. She explained we were trying to reduce my inflammation levels, so I cut out dairy and gluten and began taking turmeric and milk thistle and other things that Dr. Google proclaimed to be anti-inflammatory. I proactively stopped consuming caffeine. I began a daily yoga regimen. I viewed my body as a problem that could be solved. I was convinced that being the perfect patient would result in a perfect pregnancy. And after one surgery and six months of treatments with her we were finally ready to do our first “natural cycle.” (I still find it hilarious that what we were doing was considered “natural.” We were told to have sex at a prescribed time after taking prescribed medications – there was nothing “natural” about it.)

Our prescribed time happened to be while my husband was supposed to be out of town. We were in the process of moving from Chicago to Seattle, and he had planned a two-week, cross-country road trip before starting his new job. We could have waited another month to try, but during fertility treatments, a month feels like an eternity. Every day it felt like I was closer and closer to the 35-year-old cliff when I would become medically “high-risk,” all my eggs would dry up, and I would never be a mother. So, much to my husband’s disappointment, I forced him to truncate his trip and bring me along. I’m pretty sure we got pregnant in a hotel somewhere in North Dakota. I didn’t care. I could manage his displeasure. It would all be worth it when we had our child. The positive pregnancy test only served to reinforce my conviction.

A month later, two things brought from my high horse to my knees:

  1. My mom called to tell me that Pepper had stopped eating.  (We had left our cats with my mom while we stayed in corporate housing and looked for a permanent place in Seattle).
  2. I started spotting. 

I flew back to Chicago on a Monday afternoon to see my doctor and the vet. 

The week commenced hopefully.  I reduced my blood thinners and stopped spotting.  Pepper showed no signs of infection and her liver panel came back clean.  But in the days that followed she still wouldn’t eat.  The vet treated her empirically with antibiotics while I hand fed her baby food and pumpkin puree, but nothing helped.  On top of that, my Thursday blood test indicated a probable miscarriage.  I told my husband he needed to fly back as well. 

On Friday, I had an appointment with our doctor which he attended.  The ultrasound confirmed a miscarriage.  On Saturday, Pepper lost the use of her hind legs, and we took her to an emergency vet where she was put to sleep. 

I can’t think of these two events separately because they are so intertwined.  Nor can I say which hurt worse because all I felt was deep aching and emptiness.  In the days that followed I remember regularly rubbing my chest in a misguided effort to massage the pain in my heart.

I completely broke.  I had done everything my doctor told me to the letter, but the outcome was the same.  Moreover, I felt horribly responsible for Pepper’s death.  I berated myself for not having recognized her reduced appetite, for not taking her to the vet early enough, and for not giving her enough attention over her final few weeks.  I felt I had failed her and failed myself.

It’s hard to tell which feelings and which reactions resulted from which loss.  But the result was a complete abandonment of rationality and self-control.  I went from conscientiously dieting in order to control my blood sugar and inflammation to what I can only describe as rage eating.  I aggressively binged.  I ate chocolate and sugar and cheese and salt.  I ate to the point where I felt sick and then kept eating.  I felt so betrayed by my body, so angry at God, and so exhausted from months of self-discipline, that I took back control forcibly, if unhealthily.  I was a rubber band stretched too far, and I snapped back.

I also obsessed over my cat.  I wrote lists of things I loved about her, made slide shows of her pictures, and had her image printed on a large pillow.  I think I did some of these things because I found it easier to grieve the loss of Pepper than my pregnancy.  She had lived, after all.   I could do all the “normal” activities.  I could memorialize her remains.  I could talk about my memories.  I could transition from having her to not having her.  I have never been able to do that with my miscarriages although many women do.  Some women have memorials for their lost pregnancies, or paint pictures of their “angel babies,” or save ultrasound images, or purchase baby shoes and teddy bears to help formalize the loss and move on from it.  Those actions never felt authentic to me, and maybe that’s why I struggled so much.  Pain is like poison; we need to suck it out of the wound, or it will fester. 

I wish I could go back in time and give myself a hug.  The sentiments in the above paragraphs are meant to represent how I felt at the time. But I think it’s vitally important for me (and my readers) to recognize some of my false narratives: 

  • I was single-minded in my efforts to get pregnant to the detriment of my marriage, mental health, and personal schedules. My priorities were clear, but my life was unbalanced.
  • I tried to overcome infertility by rigorously controlling everything I put into my body, but it simply does not work that way.
  • I felt weak for failing to maintain my self-control after the miscarriage; but sugary, fatty foods release dopamine, which is a brain chemical that makes us feel better. I was deeply sad and just trying to feel better.
  • I thought I was responsible for Pepper’s death (who most likely died of lymphoma), when there was nothing I could have done to prevent her from getting sick. And even if I had known of the cancer earlier, I’m not certain treatment would have been the right option.
  • I disenfranchised my own grief, by minimizing it and refusing to memorialize my pregnancy losses. But in doing so, unintentionally prolonged my recovery.

I must learn to be kinder to myself. We must all learn to be kinder to ourselves. There’s a Garfunkel and Oates song I find absolutely hysterical called 29/31 in which the same woman sings about her life perspective from two years apart. The 29-year-old is filled with hope for her future, while the 31-year-old thinks her life is over. The rosy view of the 29-year old is how I felt when we first started trying to conceive, while the fatalistic view of the 31-year-old is absolutely how I felt each passing month of fertility treatments. But I wish the song had an epilogue. Because the 31-year-old woman’s perspective will shift again, and again, and again. So, while it’s laughable how much our world view can change in such a short time, it’s also critical to remember this current view will not last.

Why Doesn’t She Just…?

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This week I’ve been thinking a lot about personal choice.  Specifically, the incongruousness between emotions and principles that cause us to make unexpected choices.  

Many of us spend far too much time in our head worrying about the future – imagining all the possible situations we might find ourselves in and how we would respond.  This gives us the illusion of control.  We feel prepared.  There’s a quote by French philosopher Michel de Montaigne which has always hit me close to home: My life has been full of terrible misfortunes, most of which never happened.

Still, we ruminate on potential catastrophes.  We judge other people’s behavior. How could she stay with her cheating husband? Why didn’t he do more to manage his son’s addiction? How could she terminate her pregnancy? Why don’t they just adopt? It seems so simple in our heads.  If those were our circumstances, we know exactly how we’d behave.  We would never put up with that.  We would never allow this to happen.  We are sure.

But in my experience, when faced with a challenging situation, even one I’d previously imagined, the choices I ended up making were unanticipated.  The moment was never quite as I pictured it.  At the point of choosing, my feelings conflicted with my ideologies in ways I didn’t consider.  It was harder than I thought.  And I surprised myself.

There have been three major decisions I’ve made so far on my journey to motherhood that I would not have expected.  The first was our decision to keep trying rather than adopt.  Before my losses, adoption seemed like such an easy solution.  “They can’t have kids?  No problem, they can adopt.” There were kids without parents, and parents without kids <boom> family.  

If we had pursued adoption, I would probably by a parent by now.  But my husband only wants one kid (he thinks… we’ll see…) and it proved harder than I thought to let go of my desire to have my own baby.  I wanted to carry my child.  I wanted to feel her kick inside my belly.  Even though I know pregnancy is not parenthood, it was an experience I craved.  So, I continued to try, possibly past the point of sanity, certainly past the point I assumed I would. 

The second was our decision about what to do with our unused embryos – our “frosties” as they are sometimes called.  There are four common options: (1) destroy them; (2) donate them to other couples; (3) donate them to science, or; (4) do a “compassionate transfer” where they transfer the embryo to you at a point in your cycle when implantation would be unlikely.  Our clinic doesn’t offer option four, but I wouldn’t have chosen it anyway.  To me it seems like an intentional miscarriage and I’ve had quite enough of that. 

When first faced with this decision, I had an immediate and visceral reaction against the idea of donating our embryos to other couples.  Again, I was surprised.  It felt selfish not to donate them; I understood and empathized with other couples suffering infertility and wanted to do anything I could to help them try to conceive.  But emotionally, I couldn’t imagine another couple raising “my child” when I couldn’t.  If my embryos grew into humans, I needed to know them.

The third decision that surprised me was our choice to pursue surrogacy.  The first time I remember hearing about gestational surrogacy was when Sarah Jessica Parker and Matthew Broderick used a gestational carrier to have their twins.  Candidly, I remember thinking, “Fantastic, now rich people don’t even have to get fat to have kids.” Oh, how terribly ignorant I was.  What sweet, sweet lies I told myself.  I wondered why people went to such trouble to have their own children.  I mean, why didn’t they just adopt? Ha!

Then my husband and I found ourselves at 36, with six failed pregnancies, five remaining frosties (3 male, 2 female), and a misbehaving uterus.  Our options were to keep trying ourselves, choose to live without children, adopt, or use a gestational carrier. We chose surrogacy.

Sometimes I feel ashamed that we chose not to adopt.  I’m clearly defective – it’s not as if my DNA is going to benefit the gene pool.  But part of what excites me about parenthood is the continuation of my family tree.  I want to see myself and my husband combined into a tiny human.  I want to identify traits that have been passed down from our parents and grandparents. And that’s okay.  Would I make a different choice if we didn’t have the embryos?  Probably.

That’s why it’s dangerous to judge others’ choices or rigidly adhere to our expectations for the future – because context matters when we make decisions.  Even the bible tells us this:  For we know in part and we prophesy in part… When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became an adult, I put the ways of childhood behind me.  Our perspectives and priorities change as we age and as our life events evolve. There’s another quote in the bible: Judge not, or you too will be judged. 

Men Are From Mars

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With Father’s Day this weekend, I wanted to take the opportunity to talk about my other half.  The partner to my Misbehaving Uterus: the Sad Sack, the Bad Balls, the Naughty Nuts (thanks, KK for your clever naming, I wouldn’t have gotten here on my own!)

The male experience of miscarriage is so often overlooked.  It’s always the woman’s account that’s reported on in the news.  It’s the woman who receives the majority of our concern and all of our postpartum care.  There are plenty of reasons for this, not the least of which is a societal expectation that men should be stoic and unemotive, but the reality is that men grieve too, it just looks different. 

In the immediate aftermath of my losses my husband, like me, was deeply sad.  We held each other.  We cried.  But while I continued to wallow for days following each loss, he was able to recover his equilibrium, and so assumed the role of my caretaker.  He cooked our meals.  He brought me tea and water.  He let me watch whatever I wanted on Netflix without any complaints. I sense that he did this, in part, because being useful and of service allowed him to focus his attention away from his darker, sadder emotions. 

Regardless, from a relationship standpoint, these times fostered closeness and connection.  We were experiencing acute grief, but we were together, and we were relying on each other.  I was being cared for, as I needed; and he was given a purpose, as he needed.  In the months following our losses, those feelings of unity and shared experience were harder to maintain. 

It was easier for my husband to return to his “everyday life” than it was for me.  He was able to supplant his pain with a fervor and focus on work which I couldn’t muster.  Books will tell you that men recover more quickly from the pain of miscarriage.  I think this is because for men, the loss is strictly emotional.  Miscarriage happens inside a woman’s body, so the physical pain on top of the emotional pain, the feeling of violation and personal failure is impossible for a man to understand.  My pain endured, while my husband seemed to recover.  As a result, I began to emotionally pull away.  I felt abandoned and alone in my sadness. 

Simultaneously, my husband began shielding himself as well.  He felt guilty in his recovery. Aware that I was still grieving; he didn’t ask for what he needed because he didn’t want to overburden me.  And on those occasions when he did reach out with need, I was unable to meet him because my tank was already empty.  It was an extremely challenging time for our marriage.  We each felt so vulnerable that neither of us was able to ask for what we needed to feel close again.  We were both still hurting, it just looked different.   

I asked my husband if Father’s Day was met with the same jealousy and sorrow as Mother’s Day is for me, but he said no.  Yes, he wants to be a father.  Yes, he sometimes has moments of envy.  But the harder part for him has been watching me go through miscarriages and treatments.  He said it was like watching me be repeatedly abused without having the ability to stop it. 

The definition of “paternal” is showing kindness and care associated with a father; being protective, vigilant, or concerned.  Paternalism is also the mores for great men in American society.   My husband is certainly not representative of all men, but infertility challenged his male convention.  My miscarriages made him feel powerless and impotent when he longed to be virile and strong.

Through couples’ therapy and continuous work on communication, we’ve been able to take down some of the walls that miscarriage created.  We understand one another better, though our work is not done.  And despite our challenges and the different ways we grieved, I would not have survived pregnancy loss without him.  So, to my husband, and to all the would-be-fathers this weekend, thank you.  Father’s Day may eventually be yours too, but the craft of the father does not necessarily require children. Thank you for your attentiveness, your security, and your care on this journey. 

Striving for Empathy

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It’s hard not to be overwhelmed by the current state of our nation.  I’ve been trying to process my own feelings all week. I do not consider myself an appropriate authority to discuss race relations, and I didn’t start this blog to discuss current events.  But I can talk about grief.  I understand grief.  And I think that George Floyd’s death and the resulting protests are emblematic of the profound grief being experienced by many Americans. 

We tend to think of grief as a five-step linear process: denial, anger, bargaining, depression, acceptance.  That was the original grief model described in the 1960’s by Swiss psychiatrist Kubler-Ross after working with multiple terminally ill patients.  However, as our understanding of loss has evolved, new models have been introduced.  The most helpful I’ve seen is the “kaleidoscope of grief” which lists eight common feelings/thoughts that come and go in no particular order in the months following a loss.  These eight feelings are: 

  • Deep sadness, because you find the situation unacceptable, but can’t change it
  • Loneliness and longing for what you have lost
  • Trying to escape the pain by doing anything for relief
  • Getting on with your life and putting the past behind you
  • Accepting the situation and feeling like you will be alright
  • Questioning your sanity and seeking reassurance
  • Trying to make sense of the loss by blaming yourself (guilt) or someone else (anger)
  • Shock and denial in order to protect yourself from the impact of the loss

Since early March the world has been adjusting to a new social reality.  Hundreds of thousands of families have lost loved ones; and those of us who have not, have still dealt with the loss of our “before lives.”  We lost our sense of control and safety.  We’ve been isolated from loved ones and missed important life events.  We’ve lost jobs and incomes.  And we’re losing hope that things will ever be the same again. 

For me, and maybe for many of you, it’s easy for me to diagnose many of my quarantine actions using this kaleidoscope of grief.  I’ve been very lonely and missing my family; I’ve tried to escape through hours of Netflix; I’ve sought reassurance from many people that my quarantine actions were “appropriate”; I’ve blamed elected officials; and I’ve tried to downplay the virus and ignore its impact.  Because I can see my own behaviors through the lens of loss, I can also find the compassion for my fellow Americans who are reacting differently.  Our world has changed, and we each walk our own path to acceptance.

It has been harder for me, and maybe for some of my readers, to find the same compassion for the rioters.  Like many white Americans, I was deeply saddened by George Floyd’s death and understood the protests.  But I could not rationalize the violence until it was framed for me in the context of grief.

I assume many of my readers have experienced or know someone who experienced pregnancy loss or infertility.  If so, you understand the waves of emotions that crash over you after each failed pregnancy or each unsuccessful cycle of trying to conceive.  You understand the immense frustration that builds watching other people – no more deserving than you – build a family when you can’t.  You understand the utter desperation from feeling like you’re doing everything right but are unable to achieve your goals.  You understand the anger and rage that follows the insensitive, ignorant comments from people who have no experience with your pain.  There are times when you want to lie in bed all day and cry.  There are times when you want to run around screaming at the top of your lungs.  And there are times when you want people to see you – really see you – and recognize the depth of your agony, even if they can’t do anything about it.

But we move past infertility.  Even though our feelings of loss may never completely go away, in one way or another we all stop trying to conceive.  But you don’t ever stop being black.  So, I can understand how the recurrent experience of injustice and inequity would sometimes become too much to bear.  I imagine it must be the ultimate loss to realize that the system doesn’t work in your favor.  In that situation, I might get angry and want to break shit too. 

This Little Light of Mine

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Several years ago, in the lobby of my therapist’s office, I saw a magazine with a cover story talking about women “having it all” (or something similar).  This may have been in the wake of Sheryl Sandberg’s “Lean In,” or it may have been after Hillary Clinton won the democratic nomination for president, but whichever incredibly successful woman inspired the magazine article, it seriously pissed me off.  I remember taking a picture of the cover and starting my session off in a terrible rant about the unrealistic expectations placed on women.  I’m guessing the article (I didn’t read it) talked about home life and work life and not having to choose.  Much has been written about this and I don’t want to rehash the debate other than to say that I read “Lean In,” and while I thoroughly enjoyed it and discussed it with many colleagues, both male and female, I agree with what Michelle Obama said during the Brooklyn stop of her “Becoming” tour – that leaning in doesn’t always work – we can’t have it all, at least not at the same time. 

In the throes of recurrent miscarriage, I couldn’t lean in at work and at home.  It proved impossible to maintain my pre-miscarriage level of commitment to my job.  I had too many balls in the air and not enough time to manage my feelings. My efforts to juggle everything at once ended with me in total burnout, curled in the fetal position in my shower, sobbing. 

I have always expected big things from myself, and I have usually been successful in achieving them.  Therefore, I expected to be able to overcome my infertility by simply applying the same focus and tenacity I used to tackle problems at work; and I expected to do it without sacrificing my professional dedication or compromising my career progression.  But often unconsciously, and occasionally unexpectedly, my career ended up taking a backseat to family planning.  Sometimes it was for little things like needing leave early or come in late due to doctors’ appointments.  Other times it was for big things like missing key strategic meetings with affiliates because their office was in a Zika zone. 

These choices were completely understandable.  The problem was that I didn’t feel comfortable sharing why I was making them.  I was ashamed of my miscarriages and terrified of showing signs of grief in the workplace.  My work persona was strong and confident – a responsible, engaged, go-getter – and I was afraid my colleagues and management would view me differently if they glimpsed any vulnerability.  So, I put on a mask of stoicism and pushed through.  The weekend after my first D&C I got on a plane to Japan for a two-week business trip.  In the hours after I learned my 4th pregnancy was not progressing, I flew to Germany to see a supplier.  And the morning I started bleeding during my 5th pregnancy, I drove from Chicago to Milwaukee to lead a half-day business meeting.

In retrospect, it’s almost laughable that I didn’t anticipate an eventual collapse. But I was so focused on maintaining control, I didn’t couldn’t heed my own warning signals.

After the half-day meeting in Milwaukee, I went into my supervisor’s office intending to tell him, very calmly, what I was dealing with.  Instead, I burst into hysterical, uncontrolled sobbing.  He was dumbfounded and probably frightened.  I was mortified.  One of the best ways to avoid burnout is to turn to other people to ask for help.  Had I been more willing to share the news of my current pregnancy and history with him earlier, he would have understood my reaction and probably given me the option of not attending the meeting in the first place.  By staying silent, I never gave my employer or supervisors the opportunity to give me the support I needed. 

Burnout is “a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.”  This article explains it well.  It’s hard for me to determine whether work stress or miscarriage grief contributed more, but in the end, it doesn’t really matter.  My miscarriages made me feel like a failure, and suspicions of insufficiency crept into my work.  My role was demanding, and my fertility treatments were overwhelming, so I was emotionally and physically drained and lacked energy to engage in activities that might have filled me back up.  My deep sadness over not having a child made it difficult for me to find meaning in my job. Top it off with perfectionist tendencies and facing the stark reality that I was not in control, and it was a recipe for disaster.

If I could go back in time and talk to my former self, I would ask her to slow down and give herself the space to feel.  The suffragist Elizabeth Cady Stanton said, “The woman is uniformly sacrificed to the wife and mother.” I sacrificed myself trying to become a mother.  I became an unmotivated, dispassionate, depressed version of myself that I neither liked nor recognized.   

My husband and I stopped trying to build our family naturally last March.  This released some of the day to day pressure of treatments, but my feelings of inadequacy and hopelessness were too deeply rooted, and in November of last year I resigned.  It was undoubtedly one of the hardest decisions I’ve ever made in my life.  It felt like jumping out of a plane without a parachute.  I felt like failure and a quitter.  I feared I would go broke.  I worried I’d never get rehired.  But when I finally did it, my body exhaled.  I held so many things so tightly for so long.  When I let go, it was as if I jumped into the Frou Frou song of the same name: “It’s so amazing here.  It’s alright.  ‘Cause there’s beauty in the breakdown.” The release lives in my memory and my muscles.  Even as I type this, I can feel my breathing slow, and my shoulders drop. 

It’s been six months, and I’m slowly recovering.  The first month, I didn’t do much of anything.  It was December; I decorated the house and watched Christmas specials on Netflix.  In January I went home to visit my family.   In February I started this blog, which has been a cathartic exercise that’s helped me process my feelings, spark humor, and practice creativity.  In March, I formally launched Recurrent Pregnancy Loss Association, a nonprofit organization dedicated to eliminating recurrent pregnancy loss through the advancement of research into causes and treatments; to providing support and resources to those affected; and to increasing awareness of the impact of miscarriage and fertility challenges on women and families.  This month I started to draw again – something I used to do endlessly as a kid.  I got out pencils and watercolor paints and created something for just myself, just for the fun of it.

During these months “off,” I’ve remembered that I have passion and capabilities.  But I’ve also observed that my productivity naturally comes in fits and starts, so I prefer flexibility to rigid schedules.  I’ve recognized that that being properly rested makes me an entirely different person, and now I prioritize sleep.  I’ve noticed how much being outdoors rejuvenates me, and make sure to get outside with my dog each day.  I’m slowly coming back to myself.  By letting all my balls drop, I was able to choose which ones to pick back up – my personal relationships and my mental and physical health, for example. I may never return to full-time work in my previous field, and I probably will never restart infertility treatments; but I’m trying to ensure that the choice is deliberate. I still have more self-work to do, but for the first time in a while, I finally feel like I have the energy to do it. 

[I recognize that not everybody is able to leave their job; and I wouldn’t have chosen the circumstances surrounding my departure.  So, I feel compelled to mention that it might have been possible for me to stop my burnout from getting as bad as it did.  I was not practicing self-care – I wasn’t exercising, or getting enough sleep, or sharing my feelings with a supportive community of friends or colleagues.  I didn’t ask for help early enough and I also didn’t take advantage of paid sick leave or benefits like FLMA to manage my health. I encourage others to do as I say, not as I do.] 

#IRepresent #IFAdvocate #Access2Care

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My husband and I recently bought our first house (!!!) at age 37 – roughly seven years after I began wanting to own a home.  I wanted to be able to paint my walls whatever color I chose.  I wanted to purchase furniture that fit my space instead of making the furniture I owned work in the space I lived.  I wanted to think about light fixtures and bathroom tiles and countertops and even landscaping.  I’ve wanted this moment for a long time.  But I have also wanted a baby… and when you can’t have one, wanting a baby becomes an expensive endeavor.

Children are expensive no matter what. According to the US Department of Agriculture, the average cost of raising a child from birth through age 17 is $230,000 dollars.   Thinking about my own childhood and my private college tuition, I know I was much more expensive than that.  I knew being parents would cost money.  I just didn’t think it would cost so much to become parents.

Over the past five years my husband and I have paid more than $15,000 out of pocket on fertility treatments (not including mental healthcare) – and that was with really good insurance coverage.  A single round of in vitro fertilization (IVF) can cost $15,000 uncovered.  Surrogacy – which are doing through an agency in the US – will cost us roughly $100,000.  None of it will be covered.  Had we chosen adoption, the cost for a private agency adoption in the US is around $45,000.

I am not saying this not to complain.  I do feel unfortunate to have endured multiple miscarriages and years of fertility treatments.  But ironically, my ability to do so demonstrates how privileged I have been in this process.  My husband and I are financially secure.  We have good insurance.  We could make the choice to pursue IVF and now surrogacy.  Many other families are not as fortunate. 

According to the CDC roughly 12% of women (1 in 8) have difficulty getting or staying pregnant.  That’s about 6 million people.  Yet only 17 states – less than half – have fertility insurance coverage laws, and only one in five employers provide infertility treatment benefits to their employees (source: RESOLVE, the National Infertility Association).

Like so many things, discussions about family planning and assisted reproductive technologies (ART) touch on issues of equity. Access to fertility treatments favor the wealthy.  Adults making more than $75,000 annually are more likely to know someone who has used fertility treatments than adults making less money.  The same is true for adults with college and postdoc degrees compared to adults with a high school education or less.  (source: Pew Research Center)

Is this because women with more education wait longer to have children?  No.  A 2011 study in “Fertility and Sterility” (the premier journal for obstetricians, gynecologists and reproductive specialists) found that when controlling for age, demographics and fertility characteristics, women with higher household income and higher education levels were more likely to pursue fertility treatments and had higher odds of achieving pregnancy. 

For this and many other reasons, I’m participating in RESOLVE’s Annual Advocacy Day on Wednesday, May 20.  I will be talking to members of Congress about issues like access to infertility treatments, adoption affordability, and NIH funding for infertility research.  You can read about this year’s specific issues and if you’re interested, you can help by doing any or all of the following:

  • Send a letter to your representatives.  It only takes 45 seconds to fill out this letter form and have your voice heard.
  • Advocate on social media.  RESOLVE has put together sample tweets to create at Twitter storm on May 20. 
  • Sign up to advocate in person.  You can register through May 15.  The meetings will all take place virtually, so no travel is required. 
  • Tell your friends and family

Growing up, my mother would tell me her grandmother used to say, “if money can fix it, it’s not really a problem.” Her point was that money couldn’t buy the things that really matter in life. And in my great-grandmother’s defense, in her day assisted reproduction wasn’t an option; she would have considered infertility a problem that money couldn’t fix.  But that’s not the situation today.  Today, if you struggle to have kids, you might still be able to, but only if you can afford it. 

Always the Bridesmaid

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My sister has three young children who are learning to cohabitate, so our phone conversations are frequently interrupted by upset toddlers with sibling disputes.  She usually starts by responding, “I can hear that you’re experiencing some big emotions.”  I just love this phrasing; it’s so validating.  Don’t we all wish we could still run to mom when we’re overcome with feelings?   

With Mother’s Day this weekend, I’ve been experiencing a lot of “big emotions” and have been searching for a verse to articulate these feelings and provide consolation for the fact that I sometimes envy my friends and struggle to be magnanimous.  But I think I am looking for something that doesn’t exist.  There is no grace in envy, only compassion.  Instead, I have become attached to a Shel Silverstein poem called RAIN: 

I opened my eyes
And looked up at the rain,
And it dripped in my head
And flowed into my brain,
And all I hear as I lie in my bed is the slishity-slosh of the rain in my head

I step very slowly,
I walk very slow,
I can’t do a handstand—
I might overflow,
So pardon the wild crazy thing I just said—
I’m just not the same since there’s rain in my head

Maybe I turned to “Where the Sidewalk Ends” because I am nostalgic for childhood and wish I could hug my own mom this Mother’s Day.  Maybe I’m yearning to be a “dreamer” again because of the weight of adulthood and state of the world.  Whatever the reason, RAIN perfectly describes my head full of feelings! I can just imagine my skull as a giant fishbowl of emotions that jostles around on my shoulders and sometimes splashes the folks standing next to me. 

If you have ever learned a friend got engaged and felt an immediate and unwelcome pang of jealousy in your stomach; if you have ever smiled through brunch conversations about boyfriends while pounding back mimosas; if you have ever declined dinner parties because you didn’t want to be the 5th wheel; or if you have ever spent a Valentine’s Day alone with a pint of ice cream and your cat for comfort, then you know a bit about how Mother’s Day feels when you’ve been trying but failing to grow your family. 

“Always the bridesmaid, never the bride.” The sentiment in this statement is relatable.  Not everyone understands infertility or miscarriage, but our desire for love is ubiquitous – it’s described in books and poetry, portrayed in films, and expressed in songs.  So, when we watch a movie like “27 Dresses,” we can relate.  We know that girl, or we have been that girl, or we are that girl.  That girl who longs for someone she can’t have.  That girl who tries for love but always seems to come up short.  That girl who thought she had found lasting love, but then suddenly lost it. 

So, to all the mothers, take your day this Sunday – you deserve it.  But, if you know someone who has been struggling to have a baby, or someone who has lost a pregnancy this year, reach out to them this week.  Let them know you’re thinking about them. They wanted Sunday too. 

And to my infertile sisters and fellow miscarriage survivors, take it easy on yourself.  Do whatever you need and don’t feel badly about it.  If you need to cry, or wallow in self-pity, do it.  Cry until your eyes are dry and your cheeks are caked with salted streams.  Do you need alone time?  Take it!  Luxuriate in laziness – you have no children to home-school!  Sit in your pajamas all day eating bon-bons and binge-watching televisionIf you need to bitch and complain, find a safe friend and do it. If you don’t have a friend, write it down; let the pain flow out of you in vitriolic free verse.  If you need to physically rage, do it (safely).  Take a baseball bat to your pillow, do a kick-boxing video, or scream at the top of your lungs until your throat burns and your chest heaves.  And, if you need to avoid social media and decline Zoom calls, do that too.  Disconnect.  Detach.  Cut your strings and let your fishbowl head float like a balloon up into the sky.  You can come back down to earth next week.