We Are Seen: July 2020

Disclaimer: I am not a doctor, and none of what follows should be construed as medical advice. I am simply sharing what I have learned in the hopes that it may make you more aware of the information that is out there and that can benefit you on your journey. Any medical decisions should be discussed with your doctor.

1. Not all doctors are the same.

This may seem like a “duh” statement, but it’s not something I really thought about much during our first couple of years of trying to conceive.

In traditional allopathic medicine, many women start with an OB/GYN and then eventually move on to a fertility specialist who can perform ARTs (assisted reproductive technologies). The goal in this model is usually to take the quickest route to a healthy baby, which often equates to medicated cycles, IUI (intrauterine insemination – also known as the turkey baster method), IVF (the petri dish method), and possibly even things like ICSI, sperm donation, egg donation, and surrogacy. They are not necessarily as concerned with discovering and healing the underlying causes of infertility as they are with achieving the desired outcome of a successful pregnancy.

On the other hand, there are many types of doctors who take the approach of healing the underlying causes through either medication and surgery or through lifestyle changes and more holistic treatments. Some examples of these include OB/GYNs who specialize in NaProTechnology (natural procreative technology), functional medicine doctors, Chinese medicine practitioners, and chiropractors who also practice acupuncture and nutrition, and the list goes on. Some doctors practice a combination of those things I just mentioned.

Even within a specific field or medical model, individual doctors have different levels and types of training, different specializations, different experiences, different goals, and different approaches. Not one way is necessarily right or wrong, but knowing the differences may help you find a quicker path to the doctor that most aligns with you and your husband’s goals, beliefs, and desires.

2. You are not married to your doctor.

Having covered number 1, it’s important to realize that you are free to switch doctors at any point in the process. If you don’t feel like you are being heard or if you see that your goals are not lining up with those of your healthcare provider, you don’t have to feel bad about seeking out a new one.

3. The lifestyle choices you make now will affect your fertility months down the road.

Lifestyle changes are so important regardless of which medical approach you take for fertility treatments! When your body is not healthy, reproductive function is often the first thing to shut down because it is not necessary for immediate survival. Our overall health has huge implications for our fertility. One thing I recently learned that shocked me a little was that the egg that is released this month started developing toward ovulation about three months ago. That means that your nutrition, sleep, stress, and exercise habits from at least three months ago are affecting your current ovulation, and those same habits today are affecting the egg that will be released three months from now. Also, anyone who has ever tried to lose weight knows that lifestyle changes don’t change the body overnight. Lifestyle changes are crucial, but time and consistency are required in order to see noticeable and lasting physical changes.

4. Food is important.

The types of food you eat are important, and the amount of food you eat is important. Your body needs nutritious whole food in order to support both you and a baby. Filling your body with foods to which you may have an unknown (or known) sensitivity or filling it with processed and sugary foods causes inflammation that diverts all your body’s energy away from making a baby and toward healing the inflammation. Here is one good article with a few tips as far as eating habits. My acupuncturist also recently told me that women who under-eat or frequently skip meals are much more likely to struggle with infertility. Our bodies recognize that we won’t be able to provide the nutrition our baby needs when we aren’t even getting sufficient nutrition for our own bodies.

5. Exercise is important.

Intentional exercise supports blood flow, blood sugar utilization, healthy weight, muscle building, inflammation reduction, and so much more. Cardio and strength training are both beneficial for overall health and fertility. However, it is important to be careful with this. Exercise that is excessive or too intense can cause extra stress on the body, raise cortisol levels, and mess with your hormones. At a certain point, your body doesn’t know whether you are running for pleasure or running from a threat, and pregnancy is a no go if your body is in fight or flight. Making sure you are eating enough to provide the energy for the amount of exercise you are doing is also crucial. Anything less can be considered under-eating and can affect you in the ways we discussed in point number 4.

6. Sleep is important.

Poor quality or quantity of sleep compromises your immune system and makes you more prone to getting sick, which is not productive for fertility. Lack of sleep also aggravates stress levels, which can then in turn affect sleep, and we can get into a vicious cycle of sleeplessness and stress. Again, this type of cycle doesn’t signal to the body that now is a safe time to have a baby. Our bodies also work on healing while we sleep, so depriving yourself of sleep could mean depriving your body of the healing it needs to be healthy enough to support a pregnancy. If all that isn’t enough to convince you, sleep deprivation also contributes to decreased libido – which unquestionably puts a damper on the trying to conceive process.

7. Stress is bad.

Stress comes in multiple forms, such as physical stress from over-exercising, sleep deprivation, or mental and emotional stress from everyday internal and external factors. Stress is characterized by an increase in cortisol, which affects your reproductive hormones. Stress can cause things like delayed ovulation, compromised immunity, decreased libido, inflammation, and other side effects that are problematic for fertility. We can’t get rid of all the stress in our lives, but we have to learn to manage it well in order to achieve optimal health and fertility.

8. Community is crucial.

Living with infertility can feel extremely lonely – but it doesn’t have to be that way. Our journey was so much harder in the first year before we shared with anyone that we were having a hard time building our family. The well-meaning, hurtful comments were much more plentiful during that time. Once we decided to open up about it, the comments all but stopped, and we found ourselves being loved and supported in very tangible ways – from hearing the stories of those who have walked the same road to having friends bring us meals through surgeries and pray for us and cry with us through each difficult decision and everything in between. Being open has also created ministry opportunities for connections and conversations with people that would never have happened otherwise. Not everyone is comfortable sharing this part of their lives with the whole world, and that is absolutely understandable. However, I think everyone struggling with this should open up to at least one other trusted person or couple. God created us to walk through life together, and we place ourselves in real danger when we try to face something like infertility alone. I highly recommend being open with friends or family you can see in person, but if you’d like to start with joining a Facebook group where you can find community outside of your immediate circle, encouragement, and answers to questions, check out Moms in the Making!

9. Pain and PMS aren’t normal.

For the longest time, I thought severe cramps and half a month of things like backaches, sore breasts, wild mood swings, and fatigue were just part of being a woman. Everything from sex education in the school to movies and commercials seemed to communicate that these types of symptoms were just to be expected. There were pills you could take to help manage it if you were one of those weak, dramatic women who just couldn’t deal, but it didn’t mean that anything was really wrong inside your body. Now I know that period pain can be a sign of something like endometriosis and that while one or two days of PMS might be normal, one or two weeks of it indicates that your hormones are probably off. If you suspect something might be wrong, don’t be embarrassed or think that you are just being overly dramatic or sensitive. It’s not all in your head.

10. Not all women who have PCOS are overweight.

Polycystic Ovarian Syndrome (PCOS) is one of the primary contributors to infertility in women. It is diagnosed when at least two of the following three criteria are present: elevated male hormones (which can cause acne, excessive facial or body hair, etc.), many cysts on the ovaries or enlarged ovaries, and irregular or absent periods. One common symptom of PCOS is weight gain and difficulty with losing weight; therefore, this condition is often associated with women who are overweight. A quick Google search reveals this information pretty quickly, but the part that I didn’t know for a long time is that there are different types of PCOS, and one of those types is found in lean women. I have been around 110 lbs since middle school, and I was still diagnosed with PCOS. I also have hypothyroidism (another condition that is often associated with weight gain). Don’t assume if you are at a healthy weight that it’s impossible for you to have these types of conditions.

11. Mindset matters.

I’ve put up several posts on my personal Facebook and Instagram lately about how I’m learning how closely the mind, body, spirit, and emotion are connected. What we think and feel does affect our bodies. A few techniques I’ve been learning to work on my own mindset include deep breathing, practicing awareness of how stress is affecting my body, celebrating successes, and pursuing faith and gratitude. Deep breathing is pretty simple. When I feel my stress levels rise, I consciously breathe in through my nose for about 4 counts, hold it for another 4 counts, and then let it out slowly for 4 counts. There are several more ways you can do this (find what works for you), but deep breathing helps bring your body back down from a stressed state. When I am stressed, I’ve also started paying attention to where my body feels like it’s reacting. For me, a lot of times it shows up in clenched teeth, shoulder tension, and tightness in my stomach. Once I notice that it is happening, I can intentionally relax those muscles. Celebrating successes in the area of infertility means celebrating the progress you’ve made on lifestyle changes, the improvement in hormone levels, the return of ovulation, etc. It means refusing to see each month as a failure simply because the end goal of becoming pregnant has not been achieved yet. Finally, pursuing faith and gratitude reminds me that no matter what the end of my journey looks like, I am still loved and valued by God and that I have been incredibly blessed. It keeps me from sliding down into dark despair, or lifts me back up when I have fallen there again.

12. You don’t have to take every single piece of advice that comes along.

There will be a lot of it. It can come from anywhere, and most of the time the source has good intentions. Choose to see it as a sign that they care and just want to help you, even if the advice itself is unhelpful, something you’ve already tried before, or just a plain terrible idea for your particular situation. Be grateful for their heart, but research any advice before diving into it, and don’t feel like you have to try everything that everyone suggests. There isn’t enough money or time in the world – which brings us to number 13.

13. There is no magic pill.

There are hundreds of pills that people will recommend. Supplements and herbal remedies can be helpful, but they can also be a waste of money or even detrimental to your health and your goal to become pregnant. The fact that they do not require a prescription doesn’t mean that you can try whatever you want without the guidance of a healthcare professional and expect that they won’t have a huge effect on your fertility, possibly in a negative way. Don’t just trust your own research. There is a reason that healthcare professionals spend years in school. Don’t think that you can gain the same knowledge from a few Google searches. Some supplements are fine and useful short-term, but can have bad effects if taken long-term - but this doesn’t always show up in the research. Also, it is highly unlikely that any one supplement or herbal remedy is the key to finally getting that baby in your arms anyway. They are simply tools that can work alongside lifestyle changes and medical treatments to create a healthier, more fertile you.

14. Each woman’s body has its own unique needs.

Speaking of supplements, herbal remedies, and advice – don’t assume that just because something worked for your friend, your co-worker, your favorite online blogger, or even your sister that the same thing will work for you. Our bodies are so very unique, and we all have our own set of health, history, and lifestyle factors coming into the equation. Infertility does not have a one-size-fits-all solution or even really a one-size-fits-most solution. Each woman needs her own individualized plan for testing and treatment. Again, depending on what all is going on, something that may have been beneficial for your friend might actually aggravate things that are going on in your body. Do your own research, but also talk to your doctor.

15. Podcasts are one helpful source of information that won’t turn you into a screen zombie.

If you’ve been on this journey for any time at all, you know how easy it is to get sucked into the vortex that is Google. I researched everything in the beginning – causes of infertility, treatments for infertility, earliest symptoms of pregnancy, symptoms of underlying infertility-causing disease, chances of having a false negative pregnancy test, baby names, herbal remedies, and so on. My eyes and my head would ache, but I wanted to know more. In the past year or so, podcasts have become one of my new favorite sources of information. Books are good too, but those cost money (or an awkward trip to the library), and finding current infertility literature that doesn’t feel like reading a textbook or swing to the other side and have very little scientific information can be a challenge. Podcasts are audio recordings that you can listen to as you do the dishes, drive to work, fold laundry, or get ready for the day. They require minimal screen time, and they are free! Here are some of my favorites (there are many more out there!):

16. There will be needles. Lots of them.

I thought I could get away with minimal needles when I started – even though I read online that I basically had no choice but to get over my aversion to them. I thought I’d be one of the exceptions. Don’t we always think that? I’ve lost count of how many times I’ve had my blood drawn. One month I had to get it drawn about every other day for the entire month. Then, after we discovered my PCOS, I had to do a fun little test for checking my insulin resistance that involved getting it drawn four times in one day. I had IVs with my surgeries (along with more blood tests) – these were by far my least favorite needle experience so far. I’ve done acupuncture with little thin needles all over the place, at-home intramuscular progesterone injections (which require a needle the size of Texas injected in a “dart-like” fashion into your rear end), and recently switched to at-home HCG injections (a much smaller needle to the thigh, arm, or stomach – I chose the arm). All this and I haven’t even done IUI or IVF at this point – both of which typically require lots of needles. There will be needles – but you will get fairly used to them.

17. When you go in for testing, be prepared to be asked (possibly multiple times) if you are currently or have ever been pregnant.

They have to ask. Knowing that they have to ask doesn’t necessarily take away the sting each time you have to say, “No, I am not pregnant,” “Yes, I am sure,” “No, I have never been pregnant before.” The time that cut me the worst was when I went in for my HSG (the test they use to see if your tubes are blocked). I expected the question when I went to my initial visit with my OB/GYN, but then I thought it would be recorded in my paperwork, and they wouldn’t have to keep asking. My HSG was performed by a different doctor I had never even met before – that fact alone threw me off a bit. Then the questions were asked by her young assistants as I sat exposed in my breezy hospital gown with all the fear and anticipation of both the test itself and of what the results might be shaking up every nerve in my body. I just wanted to scream, “OF COURSE I’M NOT PREGNANT – THAT’S WHY I NEED THIS STUPID TEST!” and “NO, I’VE NEVER BEEN PREGNANT – THANK YOU FOR MAKING ME SPEAK THAT DEVASTATING TRUTH OUT LOUD.” Of course, I didn’t. I just responded flatly with a blank face and felt like I was dying a little inside. Just know that that those questions can and will come and not always at expected times. Along the same lines, if you have to have a surgery, they will likely want to test you for pregnancy beforehand. It can feel like a cruel joke when you haven’t been able to conceive for years, but it has to be done.

18. Testing too early only creates more stress.

I couldn’t resist in the earliest months. Online, I read stories from women who got positive results just 8-10 days after ovulation. I usually didn’t test quite that early, but I did often test before my period was really due. Part of me irrationally hoped that I could sneak a positive in and somehow that would stop my period from coming. Testing early always came up negative for me, and as a result, I would start mourning prematurely while also trying to convince myself that false negatives happen all the time. I’d obsessively look even more for any tiny symptom that might indicate the test was wrong. I stressed out so much worse and grieved multiple times – with each negative test and then again when my period started. It isn’t worth it. I know you’ll still test early anyway – at least for a while – but I had to say it.

19. You can have all the signs of ovulation without actually releasing an egg.

You can have regular periods, the correct cervical mucus pattern, a BBT chart with a distinct shift, and positive ovulation tests and still not release an egg. I don’t think it’s very common, but it is possible – it happened to me at least once. Instead of releasing an egg, the follicle forms a cyst (sometimes a fairly sizeable one) called a luteinized unruptured follicle. Your hormones still do their thing, so your body still looks like it ovulated, but the only way you can know for sure that you’ve ovulated is through an ultrasound. If I understood this sooner, I may have made some different decisions along the way.

20. You will have uncomfortably specific conversations about awkward things – like cervical mucus.

Like needles, you will need to get over any embarrassment about talking about awkwardly private things – at least with your doctor. Your doctor isn’t embarrassed and likely talks about these types of things every day. It’s their job, especially if they specialize in fertility. Depending on how public you have been with your struggle, various people (family, friends, friends of friends, acquaintances, etc.) will also ask you questions. Sometimes they are completely unaware of how awkward the answer may be for either you or for them or both. You don’t have to answer all the questions if you don’t want to – you still have a right to privacy. Being open doesn’t suddenly mean that every person has a right to hear every single detail of your story. For those that you do want to answer, you’ll learn how to gauge your answers so as not to completely shock your listener while also giving them just enough information to answer their questions. Or at least you will try and hopefully get better at it over time.

21. Speaking of conversations about awkward things – lubricant matters.

Many lubricants either kill sperm or make their swim significantly more difficult. There are already enough obstacles stacked against the little guys – you don’t want them to be essentially trudging through mud. If you need it, swap whatever you’ve got out for Pre-Seed or something similar. It is specifically formulated for couples who are trying to conceive. For some people, this one change was enough to result in pregnancy; however, remember there is no single cure-all for infertility. Some people don’t have any other issues at play, and this was their only obstacle. For many others, this is just one of many obstacles. Regardless of which camp you end up being in, it will be beneficial to switch; just don’t expect it to be a miracle cure.

22. It’s possible to celebrate life while also allowing yourself room to grieve.

Pregnancy announcements, baby showers, gender reveals, and birth announcements will continue to pop up throughout your journey. Life doesn’t stop for everyone else even though it can feel like you are frozen in time. For me, the hardest part is the first time I find out that another baby is on the way, particularly when it is a firstborn. Depending on the day, I find that my initial reaction is usually a strong emotional upheaval – not against the new life, but bubbling up from my own sad, unfulfilled longing. This reaction is normal, and we can’t deny it or feel guilty about it. However, we also have to learn to move through our own grief to the other side and refuse to feed any thoughts or feelings of jealousy and ill will. For me, these don’t always come up, but they can, depending on the circumstance. In the context of temptation and sin, one of my Bible teachers said, “You can’t help it if a bird flies over your head, but you don’t have to let it build a nest there.” It’s not wrong to feel sad for yourself, but it is wrong to dwell in bitterness or to become angry because in your pride you feel like you deserve what the other person has more than she does. It’s easy to fall from grief to sin, but one preventive measure you can take is to celebrate the new life once your initial response has calmed down. You, more than many, know and understand the miracle that is required each time a baby is conceived. Choose to celebrate that miracle regardless of the circumstances surrounding it. Praise God, and ask Him to do it again. And take a break from social media if you need to.

On a side note, my younger brother (my only sibling) and his wife chose to write a letter to me when they found out they were pregnant for the first time. That letter was such a gift both because of the written record it is of their sweet care and thoughtfulness and because it allowed me the time to process that initial wave of grief on my own without feeling like all eyes were on me or like my sadness was detracting from the joy of their main announcement. It was such a selfless and grace-filled act on their part and one that they were in no way obligated or expected to do. One of my friends asked me what the best way is for me to find out about a new pregnancy, and I told her about what my brother and sister-in-law did. Later on, she too used a letter to inform me of her own pregnancy. While I don’t think it’s reasonable (or even necessarily desirable) to expect this type of special time and care with every pregnancy announcement, in these cases it was a sweet gift for me. If someone close to you asks you the same question (someone you’d rather not just find out about on social media), I’d recommend the letter method – but keep in mind that it would indeed be a gift and recognize that they are free to celebrate and announce their news however they would like.

23. Your husband can’t read your mind.

This point could just be for marriage in general, but for infertility in particular, communication is so important. Just because your husband is walking through infertility with you doesn’t mean that he experiences it the same way you do or that he automatically knows exactly how you are feeling or how to help. Let him in to your grief. Let him take care of you in the ways he knows how, and tell him specifically how he can support you. Talk to him about medical decisions, and wrestle through those together. Ask him what he thinks and feels (you can’t read his mind either, no matter how well you think you can) and how you can support him. The weight of this journey is lessened when you make sure you are on the same page as a couple, when you hope and grieve together, and when you work together toward making difficult decisions.

24. Mother’s Day may catch you off guard.

We were only a few months into trying to conceive the first time that Mother’s Day changed for me. I didn’t even think about the fact that it was Mother’s Day when I woke up that morning. I had seen the church tradition many times before: mothers were asked to stand up so that children could bring each of them a flower as the pastor spoke about the high calling of motherhood. This time was different. This was the first year that I wanted so badly to stand, but instead I was sinking into my chair and hoping I might disappear. I hoped and prayed the longing and ache of my heart wasn’t written across my face as I avoided all eye contact and wished for the whole thing to be over. I’ve been more prepared in the years since then. I still would rather fade to into the background; motherhood should be celebrated, and I don’t ever want to take away from that.

25. While motherhood is a high calling, that doesn’t mean that your calling for your current season isn’t just as valuable.

I’ve really only ever wanted to be a stay-at-home wife and mother. I do believe it is a high calling, and it is a calling I greatly desire. It is a calling for which I feel I was made. Even so, it is not my calling for right now. That doesn’t make me any less of a woman, any less blessed by God, or any less valuable. God just has a different job for me right now. Part of that job is being a part-time nanny for two sweet little girls. Part of it is giving myself more fully to ministry than I could otherwise. Every season of life is valuable, and as long as I’m following my Savior, I’m right where I’m supposed to be. If you are following the Savior, you are right where you are supposed to be too. Motherhood is a great gift, a great service, and a great honor, but it is not the only great gift, service, or honor. Don’t think that you can’t be whole until you become a mother – you can’t be whole with children if you aren’t whole without them. Seek Jesus first and His calling for you today. Don’t give up hope, but don’t let your satisfaction and healing rest on your future children. They can’t live up to that, and you will miss out on so much in the meantime.

26. Toxins are real, they are everywhere, and they do affect your body and fertility.

This is still a fairly new subject for me. I recently learned that a huge percentage of whatever I put on my body is absorbed through my skin and into my bloodstream in less than thirty seconds. I also learned that a product’s availability on a store shelf is not an indicator of the product’s safety. Many current products have ingredients that are known to cause or contribute to all sorts of problems, including infertility. Some of those products look to be “clean” but actually have sneaky ingredients hiding under terms like “fragrance.” This podcast from The FU Project was eye-opening for me. I’m working on switching out skin and hair care products, hand soaps, and more. If you know you have high levels of oxidative stress or inflammation, think seriously about the products you use.

27. Even perfectly healthy couples have only a 15-25% chance of conceiving in any given month.

Even with the perfect lifestyle and no underlying disease, conception is still a miracle. It can still take several months to conceive naturally even once everything is as healed, balanced, and optimal as possible. You cannot try something for one month and assume it doesn’t work or that it isn’t helping just because you didn’t get pregnant that month. Pregnancy can take time even in the best of circumstances.

28. This journey WILL affect your relationship with God, your marriage, and your relationships with others. HOW it affects those relationships is largely up to how you choose to respond.

You can become bitter, angry, and isolated while blaming anyone and everyone for your plight. Or, you can grow into a stronger faith, a deeper love, and a richer community than you ever could have otherwise. Choose to be grateful and see all that you have been given instead of allowing what you don’t have to consume you. Pull your spouse closer instead of pushing him or her away. Pray for, protect, and pursue your marriage. Cry with God, and allow Him to comfort you. Believe that you are loved. Allow people to help and encourage you. Accept that your life is not your own, and don’t cling quite so tightly to the specific dreams and expectations you had for yourself. Come to God with an open hand, and a submissive heart, and see that He will fill your cup to overflowing. It may not be in your time or in your way, but He is and always will be enough.

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24 July 2020

28 Things I Wish I Knew Earlier in My Infertility Journey