#LetsTalkProFamily #IFAdvocate

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Hey friends! I’m interrupting my personal ramblings to talk to you about some Pro Family Legislation. Yup, it’s that time again for RESOLVE’s Federal Advocacy Day. This Thursday, June 17th, more than 500 volunteers from across the country – all 50 states – will meet with Congress to discuss the following legislative issues:

Access to Infertility Treatment and Care Act: Provides infertility treatment coverage to those who receive their healthcare through government health plans like TRICARE, the VA, or the Federal Employee Health Benefits Program. It also provides access to fertility preservation services for people like cancer patients, who risk infertility because of their medical treatments.

Veteran Families Health Services Act of 2021: Permanently allows veterans access to reproductive medical treatments like IVF and ensure that veterans’ and service members’ spouses and partners are included in eligibility rules.

Veterans Infertility Treatment Act of 2021: Makes infertility care a part of VA healthcare for enrolled veterans with infertility regardless of marital status or service-connection, and removes the ban on donated sperm, eggs or embryos.

Every Child Deserves a Family Act: Bans discrimination against foster and adoptive parents, families of origin, and foster youth, based on sex, sexual orientation, gender identity, marital status and religion.

Adoption Tax Credit Refundability Act of 2021: Encourages adoptions, especially of children with special needs and those from foster care.

Infertility Resolution: Recognizes that infertility is a widespread problem and affirms Congressional commitment to address its causes, diagnoses, treatment, and costs.

PCOS Awareness Month Resolution: Designates September as PCOS Awareness Month and recognizes the need for more education and research on PCOS, which is the leading cause of infertility in the US.

Stephanie Tubbs Jones Uterine Fibroid Research and Education Act of 2021: Increases research funding for uterine fibroids and improves awareness and training.

Medical Research Funding, FY 2022 Appropriations: Requests funding of $1.7B for NICHD, the division of the NIH that conducts reproductive health and infertility research.

If these bills appeal to you, you can help by sending a letter to your representatives HERE. It takes about 30 seconds.

For more information on these bills or infertility legislation in your state, visit: RESOLVE: National Infertility Association

Courage vs. Confidence

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Last week I had the opportunity to speak at a Fertility Rally group support meeting.  Fertility Rally is a wonderful support group/ membership community for anyone who struggles with infertility or chooses to build their family in a non-traditional way. 

After sharing my story and talking about Recurrent Pregnancy Loss Association one of the attendees asked me how I knew it was time for me to move on from trying to conceive.  I answered honestly – that after my sixth miscarriage it was immediately and abundantly clear that I was neither capable of, nor interested in trying again.  My husband and I were experiencing treatment fatigue well before our final IVF transfer.  We were exhausted and had been for a long time.  Before even starting IVF, we began considering other options.  So, for us, it was less a question of whether to move on, but howto move forward.  We chose surrogacy; but that didn’t mean we were happy about it. 

I’ve been hesitant to write much about my surrogacy experience because I’m still in it. However, the conversation last week made me realize that my mixed feelings about surrogacy are worth sharing. 

Let me be clear up front: I adore my gestational carrier.  She has positive energy, a warm heart, and an openness that makes her impossible not to like.  Honestly, she reminds me of my sister.  We have developed a lovely relationship and I am looking forward to going through the birthing process with her. But it took me some time to get this emotional place, and I also still wish I were able to carry my child.

Surrogacy is a long process, and in the beginning, it feels a bit like online dating… if you were forced to choose online dating because you’d tried everything else and couldn’t find a partner. My husband and I answered a bunch of questions about our values and preferences and then put together a profile that could be shared with potential gestational carriers. 

It was damn near impossible for me to write that profile – I finally had to have my mom compose a first draft in order to get started.  It felt like I was being asked to justify why we deserved to be parents, when biology and the universe had determined otherwise.  And I was angry.  I didn’t want to sell our story to someone who I would be paying to have our child.

But, as with so many things, it’s clear now that my anger and disinterest were not really about the profile.  The profile was emblematic of the process, and I wasn’t excited about the process.  After our profile was selected, there were dozens of other steps – a face-to-face match meeting, the contracting process, our gestational carrier’s medical examination, and of course, the embryo transfer.

I was committed to surrogacy, but it felt like a committed resignation.  Recurrent pregnancy loss gave me a supreme lack of confidence.  So even when things went well for our gestational carrier, I didn’t trust it.  I kept waiting for the bad news.  When friends, doctors, or family would ask “aren’t you excited” I’d nod, but I wasn’t.  It was as if my heart refused to get invested. 

My therapist encouraged me to join a support group to talk to other intended parents, so in an atypical demonstration of bravery from my introverted self, I attended a virtual social through our surrogacy agency.  I told the group I was feeling disconnected from the pregnancy and that I was struggling to open up to our gestational carrier.  And then something amazing happened – I learned that I am totally normal!!  Some parents shared that they never felt invested in surrogacy until they were in the hospital holding their baby.  Others said their excitement grew in the second trimester as the baby developed. Some felt involved and connected from the start, but not the majority.

I’ve been listening to a bunch of life coaching podcasts recently and one discussed the difference between confidence and courage.  The coach explained that when we’re doing something new, we need courage, not confidence.  Confidence about our ability to do the new thing grows as we experience success.  If we wait to be confident before starting something, we’ll never start. 

Oddly, this made sense to me in the context of surrogacy (or really any stage of my infertility journey).  If I’d waited to be confident or excited, I’d never have moved forward.  A forward step in my journey meant my prior step hadn’t worked, and any hope that I’d built up was lost.  Taking a next step was only achieved through courage. I had to choose to move forward; I didn’t have to confident it would work. 

For me, anticipation and excitement around surrogacy has grown steadily through the second trimester – helped along by the fact that Covid restrictions have lessened, and my husband and I have been able to attend key appointments with our gestational carrier.  The more milestones we hit, the more confident I am that we’ll be parents.   

There is still a part of me (sometimes a large part) that wishes I were pregnant.  But now there’s also a part that’s grateful I’m not experiencing heartburn, or constipation, or migrates; or that when I’m nervous about parenthood, I can have a glass of wine.  There’s a part of me that thinks it’s kind of cool that I will get to see my baby being born when most mothers don’t. 

So, to that Rally support group member, or to anyone who is sitting in ambiguity or on the cusp of a big decision, I think when you’re ready to move forward, you’ll know.  Don’t wait to be “sure,” don’t wait to be “excited” or “happy,” just move when you’re ready.  All it takes is courage; the other stuff will follow in time.

The Green-Eyed Monster

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I feel the need to start this post by sharing my recent learning that “jealousy” and “envy” are not actually synonyms – they mean different things – and apparently, I’ve been misusing them for years!!  Envy is wanting something someone else has.  It involves only two people.  Jealousy is worry that someone is going to take something you have.  It involves three people.  This post is about envy.

Regardless of my vocabulary ignorance, I was brought up and conditioned to believe that both these emotions fell into the “bad” category.  I mean, haters gonna hate, right?  It was bad to feel envious – it meant you were ungrateful or unsupportive.  It was bad to feel jealous.  It meant you were insecure or untrusting.  But it doesn’t work like that.  Jealousy or envy – just like any other feelings – are neither good nor bad, they just are.  What matters is how you think about the feelings and what actions you take because of those thoughts.     

Women trying to conceive often lament that it feels like everyone around them is getting pregnant when they’re not.  Of course, everyone around them is not actually pregnant, but when you’re hyper-focused on something you tend to pay more attention to that thing and less attention to other things.  (This is actually called “attention bias.”)  And, when your perception is that everyonearound you is pregnant and you’re not, it creates an overwhelming sense of missing out – envy

I experienced frequent and often intense envy throughout my fertility journey.  I tried to put boundaries in place to protect myself (and my friends) from these feelings, but it was often difficult. 

Vicki Tidwell Palmer, author and host of the podcast “Beyond Bitchy: Mastering the Art of Boundaries,” describes boundaries as “the practice of creating physical, intellectual, emotional, and spiritual safety through protecting ourselves and others.”  She explains that “at the extremes of boundaries, we are either boundary-less (too vulnerable) or walled off (invulnerable).”  I admit, I oscillated a bit between these extremes based on the nature of my relationships and my personal context.

For me, pregnant women fell into three groups: strangers, acquaintances, and dear friends. Can you guess for which group it was hardest to establish self-protective boundaries?  Hint: It was not strangers.

Pregnant women on the street bothered me, for sure.  Every time I saw one, I experienced a pang of sadness, a wave of indignation, a slurry of unkind thoughts.  But there were no meta-emotions tied to these reactions.  I didn’t feel bad being envious or angry at these strangers.  They annoyed me, but I’d recite an internal “eff you” and move on.  No relationship boundary needed to be set because no relationship existed.  I was invulnerable to them.

Acquaintances who were unaware of what I was going through (and some who knew but were a bit tone deaf) activated a slightly larger emotional response.  These were friends I followed on Instagram, people on my holiday card list who I didn’t speak to regularly, work colleagues, etc.  When they got pregnant or had a baby, I experienced a greater amount of envy, but it was still relatively easy to ring-fence.  I’d unfollow them on social media, decline invitations, throw out birth announcements (yes, I really did this) or not return phone calls.  This wasn’t always possible.  I remember one time while travelling, my husband and I attended a birthday dinner for an old school friend.  Before dinner I said to him “if she’s pregnant, I’m leaving.”  Wouldn’t you know, she walked in at 8.5 months… and, as a birthday “gift,” her sister-in-law announced that she too was pregnant.  I drank a lot of wine and didn’t say much.  But aside from these occasional annoyances, overall, my relationships in this group weren’t really impacted.

Then there were my good friends.  My dear friends.  The friends who warm my insides like a sip of hot tea.  When they got pregnant it was incredibly hard because I had to decide if – at my life’s current juncture – their friendship created more joy or more hurt.  I didn’t want to feel envious of these friends.  I didn’t want to begrudge their happiness.  Having unkind thoughts about women I loved made me feel horrible.  But these were also the women I shared my life with – the friends I wanted to understand me and likewise relate to.  So, their transition to parenthood ahead of me felt like abandonment.  It was another of the many faces of grief. 

I wish I could say that I found simple ways to navigate the pain, but I didn’t.  Sometimes, I pushed myself beyond what was comfortable with.  There were a couple of baby showers I probably shouldn’t have attended (to the credit of these women, they all gave me permission to decline).  But I chose to be there.  I didn’t want to miss out on their lives.  It would have made me feel even more left out and disconnected.  Other times, I chose to let friendships slowly fade with the intention to reconnect again once my fertility journey had ended.  I just didn’t anticipate that it would take this long.

But boundaries have consequences, and relationships are two-way streets.  I had every right to decline baby shower invitations.  But I had to accept that doing so might hurt feelings – even if it would have been understood.  I could ask my friends not to talk to me about their pregnancies.  But I had to accept that it meant they were shielding me from one of the most momentous events of their lives and, at least in the short term, our friendship might suffer.  I could request to socialize without children.  But I had to understand that it meant some of my friends would decline out of necessity or preference.  I was constantly reassessing and adjusting… No, I can’t talk to her today.  Yes, I’d rather see her, and her kids than not see her at all.  Should I or should I not ask how her pregnancy is going? How much will it hurt if I do? 

Over time, it has gotten easier.  I don’t feel as vulnerable, though I can’t explain why.  I think it is a combination of things.  For some reason it was harder when my friends were pregnant or when their kids were babies. As their children aged, the envy faded a bit.  Also, my own life circumstances changed.  A global pandemic, a relocation, and situations that have happened to people close to me took some of my focus away from family building.  It was all consuming for a long time, but eventually it became tiring to be constantly on guard and always thinking about motherhood.

Additionally, my own fertility challenges have made me appreciate just how difficult it is to have a successful pregnancy as we get older.  As most of my friends now fall into the “advanced maternal age” group, when someone gets pregnant for the first time, my initial reaction is more “atta-girl” than “traitor.” 

Finally, I’m also getting better at recognizing envy for what it is – a normal feeling rather than a personal failing.  It’s ok to feel envious of your friends.  It doesn’t mean you don’t support them.  It’s ok if you need to put boundaries in place to manage your feelings.  Relationships can adjust or be rebuilt.  As my therapist constantly tells me – let go of the meta-feelings (the feelings about your feelings).  They don’t serve you.

When All You Have is A Hammer, Everything Looks Like a Nail

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When my husband and I moved to Seattle we needed to establish care with a new fertility clinic.  We selected our doctor because she is an expert in treating recurrent miscarriage. 

I was stunned when I entered the lobby of the our new clinic.  It’s located on the 10th floor of a medical tower which faces south east, so I walked into a perfect view of Mount Rainier in all her glory.

I have found there to be a marked difference between private fertility clinics and university clinics.  Our doctor in Chicago worked at a University and was a researching clinician.  Her facility was decked out with all the best equipment – hi-def ultrasounds, doppler imaging, etc.  But the rest of the clinic was sparse; it felt understaffed, it wasn’t inviting, and it wasn’t comfortable.  It was functional.  The two private clinics I’ve been to were the opposite.  The waiting rooms were chic with comfy sofas, nice views, free teas, and candies.  They dripped with support staff… and color coordination… and branding. I want to be clear that I received excellent care in both settings, they were simply different.  One clearly prioritized the science, the other the patient experience. 

Anyway, after checking in for my appointment, I remember being led back to a small, shaded office.  I was by myself, because I’d accidentally scheduled the appointment for the same day we were supposed to move into our house.  But, since it takes months to get a first appointment with a new fertility clinic, rescheduling seemed out of the question.  The lights weren’t on because the sun was beating in through the windows, and the blinds were slightly drawn.  When my doctor arrived, she drew them down further, telling me that after seven years in Seattle, she’d turned into a vampire.  I don’t know why this stuck with me, but it did.

I remember thinking she seemed nice.  She was young, but older than I was, which seemed important at the time.  We went through my medical history, each of my losses, my prior test results, and my family building desires.  I told her I was exhausted.  I confessed that I had little hope I’d ever be able to deliver a child and wondered openly if it was time to move on to other options.

To my surprise, she told me there was nothing in my test results to indicate to her that I wouldn’t be able to carry a child and encouraged me to give it more time with a new approach.  She suggested I try IVF.  As we hadn’t tested the tissue from any of my prior pregnancies, she hypothesized that our problem may have been poor egg or sperm quality.  She explained that IVF with genetic prescreening could eliminate those variables and potentially increase our chances of success.  I told her I would think about it.

I think it’s a bit of every patients’ fear that as soon as you enter a fertility clinic, you’ll be prescribed IVF.  I mean, that’s what happened to me.  But, at the time, her logic made sense.   And after trying naturally and getting nowhere, I was willing to give anything a try. 

In retrospect, I have mixed feelings about my decision.  IVF was expensive, hard on my body (both mentally and physically), and ultimately unsuccessful. I’m sure I’d feel differently had it worked.  Since it didn’t, I’m a bit salty.  But that’s the risk one takes when agreeing to a non-standard or experimental course of treatment…

The theory – which has been validated in some data – that IVF with genetic prescreening decreases the risk of miscarriage is based on the fact that most miscarriages are a result of “aneuploidy” (the embryo having the wrong number of chromosomes).  This can be due to poor egg or sperm quality or be a result of random errors during cell division as the embryo forms.  These types of losses are considered “sporadic” and may account for as many as 50-60% of early miscarriages.   By prescreening embryos before implantation, you largely eliminate the aneuploidy risk. 

But here’s the rub, the more miscarriages a person has, the less likely it is that they are a result of sporadic errors.  It’s basic math – its statistically unlikely to get the same roll of the dice over and over again.   If aneuploidy is the cause of someone’s losses, statistically, if they keep trying, eventually, they’ll stay pregnant.  They actually studied this at Stanford.  They compared the live birth rate between couples who’d had unexplained recurrent miscarriages and continued with “low-tech” approaches (trying naturally) versus those who used “high-tech” approaches (IVF).  The life birth rates were similar.  On the flip side, if aneuploidy was not the cause of someone’s losses, IVF probably wouldn’t help anyway.

I don’t know if aneuploidy was the reason for our initial losses. As I said, we never tested. I decided to do IVF because I was pretty hopeless, and it was something new to try that gave me a bit of hope. It was like getting off a jammed highway onto surface roads. It may take longer to get to your final destination, but it’s a more satisfying drive when you feel like you’re making forward progress.

I will write about the full IVF process in more detail later, but we retrieved 27 eggs, of which 22 were mature, 13 were fertilized, 10 grew to the blastocyst stage to be genetically screened, and 7 came back normal. There are many women who would do anything for numbers like these. Some women endure multiple egg retrievals to get one usable embryo. My immediate response to my doctor was “so I guess egg quality wasn’t our problem then.” Please read that as an indication of how desperately I wanted an explanation for my losses, rather than as a complete lack of gratitude. I do appreciate what good news I was receiving, it’s just that the news didn’t bring me any more hope.

My doctor has since told me it was a poignant moment for her as well because it helped her understand the psyche of an RPL patient.  We are small subset of fertility clinic patients.  Mostly fertility doctors are met with excitement at a successful retrieval or a successful transfer.  Not with the RPL patient, or at least, not with this RPL patient. My excitement was tempered.  I would not be fooled. 

For me, IVF proved an unsuccessful exercise.  We got pregnant, but we still miscarried.  Twice.  The only good thing I have to say about it, is that it allowed our surrogacy process to move slightly faster since we already had frozen embryos. It also enabled me to stop trying without shutting the door to pregnancy completely.  My fertility is now frozen in time.  I still have eggs in my basket, and I am grateful for this. 

End Note: I want to caveat this post by saying that I think IVF is a remarkable procedure. For many women, it’s the only way to achieve a successful pregnancy.  But it is not a silver bullet. It’s not the answer for every woman. It was not the answer for me.  

A Meditation on Obedience

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When my mind is feeling busy or overwhelmed, I sometimes pull angel cards for guidance and meditation.  Angel cards are about the size of a quarter Post-It and each has a single word on it, like “gratitude,” or “openness,” or “abundance.”  Before selecting one, I mix all the cards up in a jar, sit quietly, and ask the universe for guidance.  Regardless of whether my selection is a result of divine intervention or utter randomness, the word itself provides me a framework for considering my problem.

Recently, I pulled the angel of “obedience,” and to be honest, at first it really bothered me.  I have a negative association with the word obedience.  To me, obedience means submission – a lack of control and a relinquishment of autonomy.  Dogs are obedient to their masters.  Children are obedient to their parents.  Throughout history woman have been obedient to their husbands.  I don’t want to be obedient.  I want to chart my own course and make my own decisions. 

I couldn’t figure out how to fit my situation into the context of obedience.  I didn’t know who or what I was supposed to be obedient to.  So, I Googled it – the word obedience – and I ended up finding a beautiful Presbyterian sermon about being an obedient servant of God.  The sermon was on the story of Jesus being tested in the wilderness. 

For any non- or lapsed-Christian readers, here’s the re-cap… Jesus went into the desert where he fasted for 40 days and 40 nights.  Then the devil appeared and tempted him three times.  First, the devil told him to use his power as the son of God to turn stones into bread so that he could eat.  But Jesus declined, explaining that faith, not just food is required to sustain us.  Next, the devil taunted him to prove his holiness by throwing himself off the temple roof and forcing Got to save him.  But Jesus responded that true faith does not need to be tested.  Finally, the devil offered him power over all the kingdoms in the world in return for Jesus’s worship.  But Jesus told the devil to be gone and was finally left alone. 

I remembered this story from Sunday school, so it wasn’t the story itself that intrigued me, but how the pastor interpreted it.  The pastor explained that Jesus proved he was an obedient servant of God, but not because of something he did.  Rather, he was obedient because of what he didn’t do.  He didn’t succumb to the temptation of disappointment (not having food), the temptation of doubt (wondering if he would be saved), or the temptation of desire (power over the kingdoms of the world). 

Disappointment, doubt, and desire.  That is what this Christian pastor wrote about, but it struck me as being very Buddhist.  Buddhism teaches the importance of observing our mind and living in the present moment.  From a Buddhist perspective it does no good to wallow in disappointment over things that happened in the past because they have gone.  Neither is it productive to worry about whether you’ll get the things you desire in the future because it is always hypothetical and can never be controlled.  The practice of “zen” is to trust (in other words, don’t doubt) that the present moment will provide everything you need because it’s all that ever is. 

When I started thinking about obedience in these terms, it didn’t feel like losing autonomy, but rather like gaining a sense of security.  Obedience to the now.  Letting go of fear and worry and trusting that I can manage in the current moment. That’s the lesson I decided I needed after my study of the word obedience.  So, for the time being, the angle card of obedience is sitting dutifully by my desk reminding me to stay present.  She’ll stay there until I decide I’m ready for a new lesson and new meditation. 

If my process strikes you as being too “woo-woo” that’s perfectly fine.  We each need to find right tools to quite our minds.  I am a non-linear thinker, so I often struggle to logic my way out of worries or problems when my thoughts go too wide.  I appreciate the imposed structure that angel cards provide. But like everything, there are an infinite number of paths we can take.  Each leads us to the exact same thing. The here and now.

Parenthood – Experts Only

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My husband works at Amazon and one of the things they talk about when making decisions is a concept of one-way versus two-way doors.  The metaphor being that you can’t walk back through a one-way door, so you need to be more certain about those types of decisions.  To me, becoming a parent feels like a one-way door.

I want kids.  I want the experience of being a mother.  I want to build family traditions.  I want to teach my child and watch them grow and develop.  I am almost sure.

I think most people have some amount of apprehension about becoming a parent.  What’s different is that with infertility or recurrent miscarriage, you must repeatedly face this uncertainty and weigh the strength of you desire for parenthood against the time, financial, and emotional costs of continuing to try. 

For the Fertile-Myrtles, there may be nerves when trying to conceive, but once pregnant it’s a “train out of the station, better get on board” situation.  I, on the other hand, returned to that place of nerves again and again, each time wondering whether I wanted kids badly enough to continue to endure the process and pain. 

Sometimes I’m nervous to become a mother because of my mental health issues.  I’m afraid I won’t be able to be present during bouts of depression or that I’ll pass on my mental challenges to my child.  In really dark moments, I wonder if this was the reason the universe caused me to lose my pregnancies in the first place

Other times I worry because my infertility has been part of my identity for so long that I can’t picture life without it.  I’ve become accustomed to my grief.  After I become a parent, I am not sure where it will go, or how it will change, or how I will honor it, or if I will want to.   

And I’m uneasy about how parenthood will change me.  My sister has always been incredibly maternal.  Her preschool reports talk about how she sang to the baby dolls and fed them pretend meals.  In middle and high school, she spent her summers nannying. It’s no surprise she’s a phenomenal mother.  But I also see how much her life has changed by having children.  She gained so much, but she has lost some of herself as well.  I worry about what I’ll lose.  I worry that I’ll miss the freedom of this child-free life. 

My fears often make me feel ashamed.   As if my doubts themselves indicate that I don’t deserve to be a mother.  As if because I have worked so hard to become a parent, I’m only allowed to be excited and thank my lucky stars.   

But these thoughts are unfair, unkind, and untrue.  It is perfectly natural to be nervous about changes in our lives.  We can move towards something and still have doubts about it, and that doesn’t have to mean we don’t want it or aren’t ready for it. 

I love downhill skiing, but I’m only ok at it.  Often when I’m riding up the chair lift, I look at the mountain below me and think, “wow, that looks like an awesome run,” only to arrive at the top, peer over the precipice, and think, “oh my god, I can’t do this.”  In these moments, my mental mantra is to tell myself that the only way down is down.  Sometimes I fall.  There have been times where I’ve gotten in over my head and had to take off my skis and walk a bit.  But other times, I handle the scary runs with great ease.   

Anticipating parenthood is like riding up the chair lift and peering over that precipice.  At the top of the mountain, I have no idea what the run will be like.  But rather than assuming my apprehension is an indicator I’m doing something wrong, I can choose to interpret it as an indicator that I’m doing something big. Even if it means I might even have to take off my skis and walk a bit. 

I Will Say Kristen

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In high school I took a creative writing class and my teacher had us practice writing all different types of poems.  One type was a “name poem” where we had to describe a person poetically by saying what their name reminded us of.  I wrote about the women in my family.  Here is the stanza I wrote about my sister:

I will say Kristen because she reminds me of flapping butterfly wings, and snowmelt streaming with laughter as it carves a spring path through green foliage.   
Kristen is the sun that shines yellow warmth on cold, grey earth.
She is the licorice tea that soothingly coats the back of your through.
And she is the duckling that becomes a swan.

My poetic prowess notwithstanding (ha!), what was clear then that remains true now is how dearly I love my sister.  She is still a comfort to me.  She is still warm and bright.  She still has a joyous spirit.  And even though she’s a grown-up swan, sometimes I still can’t help but want to protect her like a baby duck.  

No one likes a helicopter parent/sister/friend. We must be allowed the space to make our own way.

It’s not entirely my fault, I learned to be a helicopter-sister early.  When my mom brought Kristen home from the hospital, she told me she was my baby and I took that seriously.  Before Kristen was verbal, I used to speak for her, “no, mom, Kristen doesn’t want a banana, she wants apples…” It came from a place of love.  I wanted things to be perfect for her.  I wanted her never to hurt. 

Our relationship has shifted several times over the course of our lives.  As children we were playmates and comrades.  In young adulthood we became friends.  But even in friendship, we retained an older-sister/ younger-sister dynamic.  I was still hitting life stages before she was.  I still had a surplus of knowledge to share.  I still wanted to make sure she avoided that damn banana.  Then she became a mother. 

The day my nephew was born my little sister transformed before my eyes.  She was still my friend, but she was also something new, something I wasn’t.  Our dynamic shifted.  I no longer had advice to offer. Instead, I marveled as she entered a life phase ahead of me.  Instead, I learned from her for a change and wanted to follow in her footsteps.

But, while she grew her family through two more pregnancies, I suffered my six losses, and our relationship readjusted.  In recent years we have lived vastly different experiences.  Sometimes it has been hard to relate to one another.  There have been messy feelings involved.  I didn’t feel like anyone – even my butterfly-licorice-tea-sister – understood my pain. 

Our parents did not have a happy marriage.  We heard a lot of arguing when we were little, and it would make Kristen scared.  She used to crawl into bed with me and I would hug her, and we would both feel better.  It was us against them.  We refused to be divided even if they were. Maybe that’s why now, even as adults, whenever she’s hurting, I want to swoop in and stand next to her in the fire; make her pain my pain, convinced that together we can bear it more easily.  Maybe that’s also why it felt so disorienting to be alone in my own grief. 

Because it no longer works like it used to.  We no longer live in the same house.  We no longer share the same enemies, even if we sometimes fight similar daemons.  We can no longer operate as a team.  I know Kristen grieved with me after my miscarriages.  I think she also grieved for me.  I think she felt indignation and unfairness on my behalf and wished she could have had kids for me in my place.  But she couldn’t stand in the fire with me.  She couldn’t make me a mother.  All she could do hold my hand while I burned.  It’s all any of us can do when someone we love is hurting.

This new phase of our relationship requires better communication.  Since we don’t have an innate understanding of one another’s circumstances we have to listen more.  We validate when we can’t relate.  We talk about feelings rather than solutions.  It’s good. Yet I’m sure we’ll shift again.  If or when I become a mother, Kristen will have the surplus of knowledge. She will have the advice to give, and I will be the baby duck. I’m looking forward to it.

Keeping Track of Happiness

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I found a beautiful but short-lived quiet in the week between Christmas and New Year’s.  I had given myself permission to take the week “off,” so I felt absolutely no pressure or compulsion to make phone calls, check email, post on social media, or be “productive” in any way.  My mornings involved sitting in front of my happy light while drinking coffee and working on the crossword, followed by yoga and then whatever I fancied.  It was a nice way to end the year and I felt excited to wash my hands of 2020 and begin anew. 

Unfortunately, this week hasn’t been going quite as smoothly.  The news continues to be crazy. My dog was hit by a car! (She’s fine, thank God) And I’ve struggled to return to professional routines while maintaining that sense of inner calm I had just days ago.  It’s disappointing. I guess I forgot (again) that just because the year changes, life doesn’t magically readjust.  I started 2021 with all the same demons I carried with me through 2020.  It’s just more frustrating this year because last year was such a suck-fest. 

One of the demons that continues to creep along beside me is chronic mild depression.  This existed long before my miscarriages, and while I’ve done a lot of work on my grief to move through the pain of pregnancy loss, I’m not sure I will ever be fully free of mental illness. 

A lot of people don’t understand depression, and I think it stems from a basic misconception of the word itself.  We think of “depressed” the same way we think of “sad,” and we’ve learned that when people are sad, they are usually sad about something. “What’s wrong?” is the most common question I get from friends and family when I tell them I’m feeling depressed.  And it doesn’t make sense to them when I my answer is that nothing is wrong, feeling depressed is just how I am sometimes.

Depression for me is more about energy.  It’s not a feeling of sadness about something specific, but rather an inability to take pleasure in anything generally.  Usually, this leads to a conversation about all the wonderful things in my life and the importance of practicing gratitude.  But this is another misconception.  Because you can be grateful for all the things in your life and still have low energy.  I often experience enjoyment and gratitude during bought of depression.  It’s just that the feelings seem muted, like I’m watching a movie through a window rather than being in the room.

My husband sent me a TikTok video recently of an inspirational speaker who equated negative thought patters to weeds, explaining that they will take root anywhere and grow with no help whatsoever.  Conversely, positive though patterns, like orchids or roses require the right environment and proper care in order to flourish.  I love this metaphor.  Firstly, because for the life of me I cannot keep my plants alive; but more so because I think we all need to put in the effort to prune our weeds and maintain our mental gardens. 

But if you’ll allow me to take this metaphor a bit further, for those of us who battle depression there’s an extra step, because our soil isn’t accommodating.  We have more work to do for our garden to grow.  That’s just how it is. This is one of the reasons I started making what I call “Happiness Charts.” 

About five years ago, my husband and I were in Maine with his parents, and I remember sitting at the edge of their dock looking out over a smooth, icy lake and snow-capped trees, and noticing how peaceful I felt.  I wanted to figure out how to give myself more moments of peace like that throughout the year, so I began listing all the activities that brought me joy personally as well as those things that made us feel like closer partners. 

The first chart was pretty simple: We wanted to leave the country once a year, escape into nature once a quarter, and do something active together once a month.  And these simple goals worked well for us until we moved to Seattle.  I, in particular, found that regular time in nature wasn’t enough to compensate for how much I missed family and friends back in Chicago.  As a result, we had to think differently about what brought us joy as a couple and as individuals.  We’ve iterated a couple times since then, and this year my husband and I each have a chart of our own, plus one for our relationship. 

Our first chart
2019 chart, personal and relationship combined
My personal 2021 chart

My personal chart this year includes the following: Once a quarter visit my immediate family.  Once a month spend time with girlfriends in Seattle.  Once a week do something active as well as sometime creative.  Our relationship chart includes things like camping, game nights, dinners/date nights, etc. 

It seems silly, but I’ve found this an incredibly helpful process and practice for a few reasons.  Firstly, it forces me to sit down and think about the activities that renew my energy rather than deplete it.  Secondly, it reminds me to actually prioritize engaging in those activities.  Finally, it gives me a visual reminder of all the things I’ve done for myself throughout the year so that when I have down days, I have proof that I didn’t have a down year.  One of the most intrusive thoughts for any depressed person is the one that says it will always be like this and you will never feel better again.  It’s not true, so I encourage you to give yourself something to prove it.

My Fourth Miscarriage

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My Journey
Fingers Crossed for 2021

I’m determined to put our entire journey down on paper.  So, I am forcing myself – mentally kicking and screaming – to tell the story of our fourth miscarriage.  But if the theme of our third loss was compounded grief, due to the concurrent loss of our cat, the theme of our fourth loss would have to be ignored grief. So ignored, in fact, that my husband barely remembers the pregnancy at all. 

Our fourth pregnancy was not necessarily an accident, but it was a surprise.  Our third pregnancy had ended just a few months prior and had been carefully ‘manufactured,’ with regular ultrasounds leading up to ovulation, a trigger shot, and a prescribed conception window.  This pregnancy felt almost natural to me by comparison. 

I didn’t want to tell anybody.  I wanted it to stick, and I was afraid that just speaking the words “I’m pregnant” would somehow jinx it.  As if I were being given a test like Lot’s wife in the Bible – if I vocalized it, I would turn into a pillar of salt.  But I did tell people.  I told my immediate family.  Like I always did.  Like I always would.  My mom was the first. I confessed my condition to her through hysteric sobs.  I say “confessed” because that’s what it felt like.  For the first time, the words “I’m pregnant” were more fearful than hopeful.  I was terrified I would lose the pregnancy and I was ashamed.  Ashamed that I wasn’t excited, and ashamed in anticipation of a loss.

I was supposed to leave for a business trip to Europe the following week, so I called my clinic and they brought me in for a blood test to confirm.  The morning of my departure the clinic called to inform me that my levels low.  They told me the pregnancy would not progress.  My husband was already at work.  I couldn’t even see him to tell him in person before leaving. 

I admit that as I type this I am thinking, “Why didn’t I just cancel the trip?” In retrospect it seems obvious that I was experiencing trauma and that it would have been fully appropriate to call my boss and my supplier and tell them I couldn’t come.  I didn’t.  With a false rationality, I told myself that there was nothing I could do about it (true) and that my cancelling wouldn’t change the outcome (also true).  I know I didn’t want to go through the hassle and embarrassment of explanations, but I also think I didn’t want to admit to myself that I was upset.  Wasn’t it the exact outcome I’d expected?  Wasn’t I mentally prepared?

I boarded the plane and flew to Germany, but I kept taking all my medications.  I specifically remember giving myself shots of blood thinner on the plane.  It was always like this with me.  I was certain I would lose my pregnancies, but then when doctors would actually tell me they weren’t progressing, I was convinced they were wrong.  Maybe the real reason I didn’t cancel the trip was because I didn’t accept that the pregnancy was a loss.  Afterall, I hadn’t started bleeding. Maybe, just maybe, there was a miracle waiting to happen. 

The day after my arrival I had six hours of meetings with our supplier.  The bleeding began before our morning coffee break.  I didn’t say anything, I simply excused myself to the bathroom.  I held it together, but I have no idea if I appeared normal to the team.  I’d bet I did.  I have a remarkable ability to compartmentalize. 

I remember one time finding an enormous cockroach on the wall of my hotel room.  We were about to check out, and my husband had already left to go downstairs and pay our bill.  I hate cockroaches, and I’m certain that had he been in the room, I’d have screamed and made him deal with it.  Instead, I calmly covered it with a glass and walked away.   That night in my hotel I reread The Untethered Soul.  Then I wandered alone through the December Christmas markets in Germany.  I drank spiked hot chocolate, bought boxes of marzipan, and fingered handicrafts.  I didn’t cry.  It was like the cockroach; no one was there to comfort me anyway. 

My husband and I recently listened to Malcom Gladwell’s book, Talking to Strangers.  Gladwell would characterize me as a person who is ‘mismatched’ because my outward appearance belies my inner feelings.  I am an example of why we never truly know what’s going on inside the head of people sitting across the table from us.

The next day was Saturday, and I flew to the UK for another supplier meeting the following Monday. Luckily, one of my childhood friends lived in Cambridge and I spent the weekend with her drinking wine and catching up.  Her company buffered me across the waves of grief, and again, I refused to collapse.  I was engaged and present, if a little emotionally distant. 

Then, the night before my trip home, my sister informed me that my brother-in-law needed emergency surgery.  I shifted into help mode.  Rather than returning to Seattle, I went to Chicago to sit for my niece and nephew.  I am ashamed to admit that while his situation was scary, I provided me relief.  I was grateful to have “acceptable” justification to change my flights and take time off work.  Surgery.  Emergency. Family.  It now strikes now me how ridiculous it was to think I didn’t have this already.

My brother-in-law’s illness also provided me a reason to push aside my grief in support of someone else.  Because I didn’t want to grieve our 4th miscarriage.  I didn’t want to admit that I had a 4th miscarriage.  So, I deflected. I redirected. I avoided.  But like phantom limb syndrome, just because I cut it off, didn’t mean I couldn’t still feel it there, aching.   

I don’t like sitting in in uncomfortable feelings.  I don’t like talking about them either.  I don’t think anyone does.  But we have to find ways to process or the feelings fester.  A lot of what I’ve worked on with my therapist over the years are ways to process grief nonverbally, through journaling, art, visualization, or movement.  Because grief can’t be rationalized.  You can’t talk your way into feeling better.

The Christmas after our fourth miscarriage, my husband and I spent alone in Seattle.  This Christmas will be the same. I feel similarly sad and lonely, although for different reasons. But I am better at recognizing my emotions now, instead of ignoring them. I know I am grieving distance from family, a gap in traditions, and missed memories.  Talking about it doesn’t help, because we all feel this way.  So, I am trying to process other ways.  I am making a concerted effort to create, through art, decorations, crafts, and cooking.  I am using what energy I have to connect, through Zoom, and FaceTime, and phone calls.  And I am giving myself the grace to sit quietly with my coffee, hang out in my low energy, and eat all the holiday sweets I desire.  If I have learned anything, it is that time heals (most things).  The challenges of 2020 will fade.  We will recover.  Of this I am sure.  Happy holidays. 

Time Keeps on Slipping, Slipping, Slipping

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This is actually one of the first ‘comics’ I drew when I decided to start blogging, but up until now, I haven’t been able to find the right words for it.  Or maybe I always had the right words.  They are just angry words, so I didn’t want to share them.  But after reading my recent newsletter from Andrea Syrtash, Founder of Pregnantish, I decided it was time.  

In her letter, Andrea mentions an AirBnB owner, who after hearing what she (Andrea) did for work, remarked that she (the owner) knows so many women having issues with pregnancy and wished that they took better care of their bodies and/or didn’t wait until 48 years old to start trying.  [Loaded sigh.]

Unfortunately, this is a common characterization of the infertility/miscarriage community – older, stressed-out women who waited too long to have kids and are now turning to science to solve their problem.  Sad, but it is their fault. 

We all face this.  About six months ago, I was telling one of my former business school professors about Recurrent Pregnancy Loss Association and the importance of research into miscarriage and infertility because there is so much still unknown and unexplained.   He nodded along, then said it was “unfortunate” how many more people were dealing with infertility these days and posited that perhaps one of the reasons was because women are waiting to have their children until later in life.  This was a smart man.  An educated man.  But a man completely ignorant to the realities of infertility. 

It is true that rates of infertility and miscarriage are correlated with age.  But it is not true that infertility rates themselves are increasing.  A CDC National Health Statistics Report showed that the rate of “impaired fecundity” (difficulties getting pregnant or carrying a pregnancy to term) has remained nearly constant since 2002.  But even if this were not the case, I desperately want to tell this man the following:

  1. Infertility is a multi-factorial, medical condition, please stop assuming age is the cause of our problems.  Many of us started trying for a family at a much younger age than we are now and have been on our fertility journey for a long time.
  2. Male factor infertility is a cause for about a third of couples suffering from infertility, and multiple studies show that sperm count and quality decline with age, so don’t assume the problem is women waiting longer to have children.
  3. Some of us didn’t meet our partner until later in life and weren’t inclined to start trying to conceive before then, so don’t assume we waited because we wanted to.
  4. Some of us did make a deliberate decision to wait until we were older to start building a family, perhaps even knowing there were increased risks, but that doesn’t mean that our frustration, grief, or losses aren’t worthy of attention and compassion.

I am not ignorant of the science.  I understand that statistics are not in our favor.  Numerous medical articles detail the risk of aneuploid embryos (embryos with an abnormal number of chromosomes) by maternal age.  The risk sits around 30% for women under 35, jumps to 60% by age 40, and +85% by age 45.  A woman’s chances of naturally conceiving a chromosomally normal embryo are literally time stamped.  But the belief that infertility or miscarriage is simply a function of age serves to stigmatize and minimize a very real health problem.

A similarly triggering phrase for the trying to conceive community (TTC) is “just relax.”  All of us – and I mean ALL of us – have had someone tell us the story of their friend’s sister’s cousin who tried for years and then magically got pregnant once she quit trying and calmed down.  “It’ll happen when you least expect it, if you’d only just try and relax.” Barf.   

The LAST thing I wanted to hear when I was trying to get pregnant or stay pregnant, when I was feeling broken and traumatized, when I was hopped up on all manner of hormonal cocktails, when I was anxious and uncertain if I would ever be a mother was to relax.

I faced an impossible conundrum.  Yes, of course I wanted to take a break from trying again after every miscarriage, but I also felt a terrible urgency to start up again as quickly as possible lest my chances slip away from me entirely.  I felt older and less capable of success by the month.  So, when an uninformed advice-giver then assumed that my family building struggles are my fault, because I was just stressing about it too much, I kind of wanted to punch them in the nose.  

There are mountains of evidence to show that infertility and miscarriage cause stress, anxiety, and depression.  In fact, a literature review cited in a 2018 article in Dialogues in Clinical Neuroscience showed that 25-60% of infertile individuals experience anxious and depressed psychological symptoms. What is NOT proved is that stress, anxiety, and depression cause infertility and miscarriage.  Certainly, we are all healthier and better able to cope when we manage our mental health.  But this isn’t the cause of our medical, fertility related problems.  Would you tell a cancer patient to “just relax” or that their tumor will go away when they least expect it if only they stopped fighting so hard?  Of course not.  Cancer is disease that needs to be treated medically.  Guess what?  So is infertility.

Next time someone tells you about their struggle to build a family, rather than trying to identify or solve their problem simply try saying this:  “I’m sorry that you have been dealing with that, but I want to thank you for sharing your story with me.  It’s so important for people to talk about the challenges of infertility and miscarriage.  Please let me know what I can do to support you through this process.”