Know When To Hold 'Em

I was recently speaking to a friend who asked me how she should broach the subject of discussing fertility issues with people, which is something that I've thought a lot about since I started writing this blog. Prior to going live and letting basically everyone I know into the most intimate parts of my life I sent an email out to my whole family giving them a summary of what I had been going through, something only my immediate family had been privy to up until that point. I included a link to what I had written so far and offered to answer any questions anybody might have. Of all the emails I sent out, I received back one text message from my cousin offering his support. At first I was hurt and angry; at the time there were a lot of emotions swirling around in my head and I didn't really know where to land. It took me a while to reconcile those emotions and the only way I was able to was by taking a minute to understand where they were coming from.

I come from a semi-private family; and by that I mean they don't want to talk about issues like mine - but they want to know that I'm okay. It's a level of comfort reserved for old-school traditional families - at least mine anyway. The kind of openness it takes to write a blog and tell everyone the experience you had while masturbating into a cup is far beyond the side-conversations prying for information that my family is used to. After I sent out my email to my family, I had expected a bombardment, but what I should have expected is quiet concern, which is what I got, and looking back, meant a whole lot more to me. To my family, it's not your words that show your concern and your love for someone, its your actions - so keeping quiet was their way of respecting my privacy.

What I learned is that if you're looking for support, you need to ask for it. That said, when you're looking for information the principle is the same, but there are a few things that you need to remember.

Everyone is different and so is their journey. There are some people that don't want to talk about their struggle at all, and there are people like myself and K who talk incessantly about our ordeal. This means that when approaching the subject with someone dealing with infertility, you could end up with more than you bargained for, so be concise with your question. For example, if you were to ask me what step we're at in the process, what you're probably meaning to ask is "is she pregnant yet?" but by wanting to be sensitive, you now have an explanation of the actual entire process of IVF on your hands. Why? Because for the most part, in order to understand what step we're in, we likely have to explain the entire process to you which will probably include a list of side discussions required to define certain terms.

There are also many people that have gone through loss, and people that found out they would never even be able to experience that - and every one of those people deals with those situations differently.
So there is a level of sensitivity that you will have to show but if you want to know something - ask. Trust me, if they're not comfortable talking about it, they will tell you that. Keeping that in mind, think about the question before you ask it. Kay had an encounter with a co-worker that consisted of him asking her "Are you ready to deal with your first pregnancy basically being a write-off?" - Kay was confused and asked him what he meant, so he said "You know that most women's first pregnancies result in miscarriage don't you?" I mean, the guy was obviously misinformed, but his message was not the problem. It's the fact that he is asking a woman, who is already having difficulty conceiving, if she is ready to lose her first baby. Dude, the answer is no, and also, no -you idiot. He got off lucky because Kay is not the burst-into-tears-at-work-at-shit-said-by-morons kind of person, but most women, would not have been so understanding.

I think it's also important to mention that unless you're asking for it, it's not your responsibility to navigate the feelings of a person dealing with infertility. Doing so is difficult at that best of times and downright impossible for most others, so in my opinion somebody dealing with infertility shouldn't be making you walk on eggshells around them all the time. If they are, you need to lay your cards on the table and tell them that straight up, but be mindful and supportive when you do it.

How Do You Even "IVF"?

Hi guys! Kay here, get comfortable, you're about to do some learning. Lefty and I have received an overwhelming amount of love and support during our journey to parenthood. So many of our family and friends are so invested in this process, it’s like having our own personal little cheer squad. People also have a lot of questions – after all, IVF isn’t really an everyday topic for a lot of people. This post is going to be a bit of an overview of the process, based on the most frequently asked questions we receive. I do not claim to be an expert, this is just the information I’ve gathered from my research, others going through the process, and some of the staff at the clinic we go to.

IVF refers to the overall $10k process of injecting medications, retrieving eggs, fertilizing them, and growing them in petri dishes for 3-6 days.  FUN FACT: “In Vitro” means “in glass”, so basically, fertilization in a glass petri dish! IVF usually starts with some sort of diagnosis - male infertility, female infertility, or sometimes, unexplained infertility. Of course there are other circumstances such as same-sex couples, or genetic abnormalities, but the idea is the same: we want a baby and we can’t make one the fun way. The doctor overseeing the process is called an “RE” or “Reproductive Endocrinologist”. They make the magic happen.

Photo from: Etsy shop ChiefAndLily

Testing

There is whole bunch of tests anyone contributing any genetic material (read: sperm and eggs) must go through prior to starting fertility treatments. Both/all parties will be tested for an array of Sexually Transmitted Infections, to rule out any “simple” issues caused by something caught during those questionable years in Uni.

Men will undergo:

Semen analysis: (usually several) to assess morphology, concentration, and motility of the little swimmers. If you’re lucky, you can freeze some like we did “just in case” you need it later.

Testing for genetic abnormalities: such as cystic fibrosis, which often causes men to be born without their vas deferens (the little tube that the sperm use to…escape), or XXY syndrome, where a man has an extra copy of the X chromosome which can cause infertility.

Women will undergo:

Blood tests to assess several hormone levels (AMH, FSH): these levels give a good indication of egg quality and reserve (basically, what you’re working with).

Sonohysterogram: a small tube is run through the cervix and saline is injected into the uterus while being viewed on ultrasound to check for any issues with the inside of the uterus, such as fibroids (little tumors made of muscle) or irregular shape of the uterus.

AFC count: this counts your base level follicles (fluid fills “cysts” on the ovaries that contain eggs, usually 1 egg per follicle) on each ovary, to give an indication of how many eggs you can reasonably expect with stimulation.

(There are many more, but I’m only going to talk about what we have gone through, because I have no personal experience with the others.)

Once all the testing is done, and the decision is made to do IVF, you can plan on forking over roughly $10k. Sorry future children, hope you didn’t want to go to college!

Suppression

The woman then goes on some form of suppression (birth control or injectable hormones) to suppress and quiet the ovaries, so that all the follicles can grow at the same rate once they begin stimulation.

Stimulation

Once the woman’s ovaries have been suppressed for 21-35 days, ovarian stimulation begins. Stimulation, or stimming, refers to the daily injection of hormones to promote the growth of multiple follicles/eggs. This phase has to line up with a woman’s natural cycle, so there can be some waiting involved. This includes every-other day (or every day) internal ultrasounds and blood tests to assess hormone levels and follicle size.  

Trigger

Doctors like most follicles to reach 17mm before they “trigger” them to release. The trigger is usually a large dose of HCG (pregnancy hormone) and is injected to promote the maturation of the eggs and the release of the eggs within the follicles. Once triggered, the eggs detach from the inner walls of the follicle and float around inside for about 44 hrs (which would be the upper limit of time).

Retrieval

This step is done by using an ultrasound guided probe to insert a needle through the back wall of the vagina into each ovary to aspirate (suck out) the eggs contained within the follicles, and is usually done exactly 36hrs after trigger. The timing must be precise - too short and the eggs won’t be detached, too long and they will ovulate on their own and be lost.

Egg Fertilization and Embryo Maturation

The eggs are then fertilized and grown in petri dishes for 3-6 days. FUN FACT: Eggs vs Embryos - eggs are just that. Eggs taken from the woman’s ovaries. Embryos are fertilized eggs with the potential to be a baby. The goal is usually to transfer embryos that have reached 5 days of growth, but sometimes they will also let them grow for an additional day, all the way to day-6, to let some slower ones “catch up” (potentially giving you a few more embryos for freeze). The embryologist calls you every day to tell you how your embryos are growing, and a decision is made which and how many embryos to transfer.

Transfer

The number of embryos transferred depends on the woman’s age and how many failed transfers she may have had previously. Once the selection is made, any remaining are usually frozen. The embryo(s) selected will then be placed back in the uterus, and then the finger crossing begins. The difference between a “fresh transfer” and a “frozen transfer” is: a fresh transfer refers to the placement of an embryo back into the woman’s uterus directly after undergoing stimulation, a frozen transfer refers to eggs that have been frozen for later use being placed back into the uterus. About 9 days after a fresh OR frozen transfer, a woman will have her blood drawn to see if the embryo has “stuck”. If so, she is pregnant, yay! Now she waits till she is 12 weeks to make sure the baby is going to “stick”. If not, the couple can wait a few months and try a frozen transfer- if they were lucky enough to have leftover embryos frozen. There is a fee associated with this, but it is substantially less (about $1500). You can do a transfer as many times as you have embryos left. THEN once you run out, you must repeat the whole $10k process again, or look into other options.

TLDR (too long, didn’t read):

-Tests to see why you can’t make babies.

$10k for medication injections to make lots of eggs.

-Eggs taken out and mixed with sperm in petri dish.

-Embryo(s) made and put back into uterus or frozen.

-If the one(s) put back didn’t get you pregnant, try again with frozen.

-If none frozen, $10k again, rinse and repeat.

If you have questions, leave them in the comments below! Lefty and I will do our best to answer them.  We love your feedback, and your continued support!

All the love - Kay.

Puppies and Parenting

In the very first post I mentioned that in 2016 we welcomed the new addition to our family, a chocolate lab named Ruger. While I am sure children will come with their own set of challenges, I'm not convinced they will be more difficult than raising a Lab puppy. Doing so, however, has really provided me with overwhelmingly more questions than answers when it comes to having kids. The minute I say "Lab", people say "yes they're very high energy" as if they understand something about raising a Lab puppy that I somehow don't. As though I should have known what I was getting myself into and because I was so surprised by how much of an asshole this dog could be, it was my own fault - but I'm convinced my experience is unique and those people truly don't understand. Or maybe I'm full of it and this is exactly what every other Lab owner goes through. Maybe this is what raising kids and listening to other people's opinions will be like - I'll think my experience is somehow different than everyone else's and they couldn't possibly understand what I'm going through, when really I should shut up and listen to what they're telling me.

We picked up our new pup when he was seven weeks old. He screamed, and cried, and wailed when we put him to bed for the first week. His cry was heartbreaking and I slept on the floor by his crate for the first two nights just to keep him company. Getting up every two or three hours at night to take him outside to pee was important because allowing him to mess in his crate was both inhumane, and would reinforce that messing in his crate (or in the house) was okay.

By twelve weeks that intelligent-as-hell dog was sitting on command, but was still under the impression that the entire floor was his bathroom. Our lives ran on a 15 to 20 minute schedule: stop cooking dinner, take the dog out, pause the T.V., take the dog out. Forget about the 20 minute schedule, even for 5 minutes, and you were cleaning up urine. Nothing is more infuriating than a puppy who has been taken outside to pee every 20 minutes for weeks, staring you right in the eye, squatting, and peeing on the floor, without ever breaking eye contact.

He developed such a knack for peeing the minute we turned our heads that a lot of the time we didn't even notice he had peed until we stepped in it, which was compounded by the fact that if you didn't catch him in the act, it was too late to correct him and the learning moment was lost. Is it like this with kids? Do you have to catch them in the act? Or is it possible to sit down a two year old and explain to them the benefits of using the potty instead of the pants? Or is two even the right time to potty train? I remember telling K the other day that if everything goes as planned I'd have to buy a baby book. When she asked me why I responded "Obviously so I can learn how to keep our child alive!"

"Puppy Jail"

We tried everything to get Ruger to stop peeing in the house. We started tethering him to our belts with a leash, which worked really well (although did remind me of those people in the mall that put leashes on their kids), but wasn't always possible. For the times where it wasn't, we put him in a playpen which we dubbed "Puppy Jail". This particular strategy worked really well until he got big enough to push the playpen around the house. In one instance I went upstairs to talk to K about something and came downstairs to find Ruger's playpen panels twisted all up close to the back door (after he had pushed it all the way across the living room) and he was standing in a giant puddle of pee. We took this as a sign that we were on the right track because even though he was confined, he did try to make it to the back door. It also told us it was time to retire his playpen. I feel like the playpen will be my go-to with children, except I think I'll change the name to "Baby Alcatraz" - for some reason "baby jail" flashes images in my head of a baby sitting on the drunk tank floor with a heart tattoo reading "mom" on his forearm, and a half-smoked cigarette hanging out of his mouth...I guess at least at that point we would have taught him some respect for his mother.

The cats never really warmed up to Ruger but that didn't stop him from walking right up to them to sniff them until they ran away. One lovely day my brother came inside with Ruger from taking him out to pee and Ruger surprised our cat Winslow who promptly struck him - with a fully clawed swat - in the eye. His eye was red and swollen and he was in a lot of pain and kept screaming and crying. We immediately packed him up into the car and drove him to the vet who gave us two types of eye drops to be given 4 times a day, and an oral antibiotic to be given twice a day. She also referred us to a veterinary Ophthalmologist (yes that's a thing), who's name was Dr. Woof (I swear I don't make this stuff up) who gave us two additional eye drops on top of the two we were already giving him. About a month and $600 later, Ruger's eye was completely healed, he had no infection, and Dr. Woof said there was no damage to the lens in his eye so he shouldn't have any resulting vision issues.

Of course it was after all this happened that I read about how a puppy's blink reflexes were still developing up to six months of age, so when Winslow swatted him, Ruger didn't automatically blink to protect his eye. While lost in Google-land, I also read an article which explained that how close or far you perceive things to be is something that is learned. I always thought it was something that "just was" like sight itself "just is". Again I was wrong; babies learn depth perception by reaching out and touching and grabbing things. My mind is continually blown by the things I don't know about babies and children, and it honestly scares the shit out of me. Had I known that Ruger's reflexes were still developing, could I have prevented the scratch on his eye? I imagine my future child walking around and slamming into walls because I didn't give it the right kind of toys or place it in the right kind of sleeping position.

It was around this time that peeing in the house became less of an issue and Ruger developed a sudden love of eating random objects. He was always a chewer and we kept a steady supply of interesting chew toys for him to alleviate this, however, chewing wasn't the problem. He started eating and swallowing everything he could find. He dug up the grass and swallowed it attached to clumps of dirt, he pulled used tissues out of the bathroom garbage; basically anything that was within his reach. After K watched him poop out a cat toy we removed all the small cat toys from the premises and our house became endlessly clean. When Christmas came we made sure to put only the big and unbreakable ornaments at the bottom of the tree and we did a damn good job of keeping him away from it, but apparently our luck had run out long before and we didn't even know it.

The night before Christmas Eve Ruger stopped eating and started throwing up every twenty minutes like clockwork. We took him to the emergency vet and sat with him until two in the morning, cleaning up his never-ending supply of vomit before the vet came in and told us they couldn't see anything on his x-ray, but wanted to put him on an IV and monitor him overnight. We left him there that night and after a few hours of not sleeping they called us at 07:00 to tell us they were recommending exploratory surgery. The quote they gave us was for $5000 - Ruger was an asshole, but he was our asshole - so we gave the go-ahead for surgery. We feel very lucky to this day that we had the forethought to get pet insurance the very first day we brought him home - or we likely wouldn't be able to afford our IVF baby now! Our best Christmas gift that year was having Ruger back and healthy - minus the cat toy the size of K's fist that got lodged in his bowel after bouncing around in his stomach for a month. The very same toy I thought I saw in his mouth in November, but was gone by the time I got to him. I hadn't been worried about it because I didn't think there was any possible way he could have a swallowed it. Obviously I was wrong.



I tell myself that raising a child will be easier because they won't be walking immediately and therefore wouldn't be getting into things to eat like my dog does, but I know I'm just deluding myself to make myself feel better about knowing sweet nothing about parenting. I read another article that said not to buy soft blankets for babies because they can cause suffocation. I would have bought my baby the softest blanket I could find! I could have literally suffocated my baby with love! This is why people pair up - because K will be such an amazing mom and I'll just be stumbling around in the dark stubbing my toes on everything in my way.

Since all of this, Ruger has graduated from obedience school and I've started teaching him retrieving skills (which he is amazing at), he listens better, and has found his ability to relax in the house. He relaxes by finding the biggest and hottest sunbeam and basking in its warmth. Ruger is still only 8 months old at this point and I'm not sure all of our issues are in the past - but I have learned a lot - and I'm preparing myself to learn everything I can when it comes to raising a child, but if it's anything like raising a Lab puppy, I'm in for quite the rollercoaster ride.