Posts from — February 2009

Even though yesterday was Thursday the 12th, it somehow didn’t occur to me until this moment that today was Friday the 13th. I would say that it doesn’t bother me, but then the what ifs start cropping up inside my head. What if I said it didn’t bother me and then all hell broke loose just because I said it didn’t bother me. What if my Friday the 13th would have been unremarkable if I had just admitted that the date bothered me?

What if? I mean, really, what if? And aren’t what ifs more powerful than any superstition? Or are they really one and the same thing?

So instead of discussing superstitions, throw out your best what if or answer another one that you see in the comment section.

I’ll start: what if you were told that if you didn’t delete your blog in the next three seconds (giving you no time to back it up or save any entries–you would lose the whole thing), you were going to have your car stolen. Is your blog worth more than your car?

And don’t just answer mine–leave your own so I have something to muse on all weekend.

So I obviously didn’t post the first A Side Order of Help With That (ASOHWT) yesterday because I’m now doing the final proofread for the book and have been sidetracked. So feel free to send in any other questions this weekend via email because I’ll post on Monday (read the post if you don’t know what I’m talking about). The ones that have come in so far are interesting. Um, including mine. At least I think my question is interesting.

The offer for the sessions is closed. I put everyone’s name on scraps of paper and pulled one out of a hat. I’m contacting them today and contacting everyone else who put their name into the ring. It would be wonderful if more people would donate to the community in exchange for the advertising space. Spread word that we want free Gonal-F, many boxes of pee sticks, an IVF cycle.

Dear People Who Have Been Googling About the Octuplet Woman:

I’m glad the news story has made you curious and you’re seeking information about fertility treatments. Since you have ended up here, I thought I’d compile all of your general questions that have been bringing you to my blog into one post and address them all at once.

We’re with you–octuplets are just not a great idea. And no, the community in general is not happy about all of the news coverage concerning the octuplet mum. We’d love to see news stories about the other 99.9% of us–the ones that had success with fertility treatments (since not everyone does–you can go through IVF and still not have a child in the end) and have one or two kids and live happily ever after. But since the general public tends to like their news with a side order of extreme, those aren’t the stories that end up on the Today Show. But we agree, we also are watching the story unfold with our mouths open.

Is it normal to transfer 6 embryos (by the way–the correct term is “transfer” with IVF. A doctor can transfer embryos and there are even additional techniques that they think help embryos implant, but a doctor cannot manipulate the embryo to dig into the uterine wall and stick around for 9 months. So let’s use the term “transfer” which is placing the embryos inside the uterus and hoping for the best)? Well, no.

The goal of IVF (and all fertility treatments) is to produce one healthy baby. Multiples are a side effect of treatments but not the goal. Because IVF is so expense and most people are paying out of pocket, doctors will transfer two embryos in order to increase the chances for implantation. Even with transferring two embryos, more often than not, if the cycle is successful, the person ends up with a singleton. There are also cases usually based on age or past experience where a doctor will transfer more than two embryos.

But six? Well, that’s pushing it. Especially since one news story reported that IVF has worked for her on the first try every time. If that were the case, it would make more sense to engage in eSET which stands for elective single embryo transfer. Of course, the news could have it wrong. Her medical records should be a private matter and perhaps there was good reason to transfer six embryos all at once.

Is IVF selfish? Well, I already answered that question back here.

Yes, there are more options with fertility treatments than just IVF. IVF is just one of many things a person can try including surgery, oral medications, injectable medications, IUI, PGD, ICSI, and assisted hatching. In fact, IVF itself is not a static procedure–there are dozens of protocols used as a starting point and then each cycle is tailored for each individual with daily sonograms and hormone monitoring to ensure the best possible outcome.

Do people have IVF because they’re lazy? Well, I just told you that there are daily sonograms and hormone monitoring. Beyond that, there are daily injections of different medications, a surgical procedure, and an uncomfortable transfer. I think it’s safe to say that just as people don’t have g-tubes inserted because they just don’t have time to eat, people don’t engage in IVF just for the hell of it.

Listen, we’re on your side with this. In general, this is a highly educated and rational community. We want exactly what you want–a healthy child–it’s just that we need assistance to make that possible whereas you can reproduce privately at home. I think a good rule that most of us believe in the community is that just because something is possible doesn’t mean it should be done.

Most of us think that medicine works best when it mimics what should happen if all body parts were functioning properly. For instance, I think the guideline of using a woman’s gametes until 45 and donor eggs until 55 is fair because it is based on the reality that 5% of women can conceive without assistance using their own gametes at 45 (so it’s possible) and 55 is the general age (again, we have to speak generally because every body is different) where menopause is complete. A body couldn’t have a child without assistance simply due to the course of nature, therefore, we shouldn’t override that just because we can. But I also believe that each case is different and I can also see where a 56 year old should not be denied donor gametes simply based on a cut-off point.

IVF is meant to mimic a naturally-conceived pregnancy. It’s aim is not to produce multiples, though it is a reality of the procedure. Still, bodies naturally produce twins and even triplets. The chance of a body naturally conceiving higher order multiples such as octuplets is so far out of the realm of possibility in nature that I don’t think it should be done just because it can be done regardless of where the person is in life.

So, to sum up, we’re with you on thinking the octuplets probably were not well-planned. We’re sort of creeped out that she has a PR person and is doing television appearances. I sort of expected that she’d be at the NICU and not on the Today Show. But that’s just me. I know when our twins were in the NICU, I didn’t have time to eat a proper meal much less get hair and make-up done for a television appearance. IVF is not selfish or for lazy people or for crazy people. It is merely a tool that is used to circumvent a problem (infertility) and like all tools, it can be used irresponsibly.

Oh, and for the person who googled “how did ancient queen check up their genital…with photo,” well, I can’t answer that question and I’m sorry that you ended up somehow on a post about progesterone supplements. I would guess that they squatted over a mirror or had their ladies-in-waiting check out the goods…if they checked them out at all? I just haven’t come across a lot of information about genital checking in ancient times. Especially with queens.

Love,
Mel

P.S. If you want to hear more of my thoughts, I actually wrote about this topic recently on BlogHer.

This is the 28th installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

Barren Advice is posted each Tuesday-ish. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you’re addressing if there are multiple questions in the post.

Dear Mel:

Hi, I have looked at INCIID and RESOLVE sites for information on cancer survivors and their experiences with domestic adoption. I also bought a book about adoption and the information on this topic is insufficient (Godwin & Godwin Complete Adoption Guide). Can you talk about this issue?

–Anonymous

The core idea in this question is what are the tipping points for adoption agencies and expectant parents seeking placement–what sorts of things are skeletons you shouldn’t have in your closet or conditions you wish you didn’t have to list when it comes to adoption.

The best advice I’ve ever read on this topic came from Elizabeth Swire Falker’s book, The Ultimate Insider’s Guide to Adoption. The over riding idea when she covers the homestudy is that social workers know that you’re human and you’re going to have problems, but it’s how you deal with those problems that makes a difference.

The big red flags for social workers (and by extension, expectant parents too) are lying, felony or child-abuse arrests, and recent addiction issues. With lying, it’s better to disclose everything than to have it discovered later. And with addiction, “recent” is a general term. Showing that you’ve taken steps to treat the condition and that you’ve logged a substantial amount of sobriety time prior to starting the adoption process makes a difference.

But there was nothing in the book specifically about cancer, so I wrote Swire Falker (who is an attorney in the area of adoption in addition to being a writer) this question. Her thoughts on the matter follow idea above–that there are few skeletons in anyone’s closet that are going to wholly keep them from becoming an adoptive parent.

Starting an adoption plan isn’t easy stuff for anyone. Most prospective adoptive parents come to the process carrying a hefty amount of baggage. Whether it is from infertility treatment, or being an “older” adoptive parent, or our marital status, most of us are really scared about what a birth family, adoption agency, or even a foreign country may think about us and who we are. There is no doubt that the fear of rejection is daunting. It’s amazing what we do to ourselves through this process. How we compartmentalize our personalities and our features and try to “predict” what it is that might make us more appealing to a birth family or what might make us less “pickable” to another country. It has gotten so out-of-control in some respects that I now lovingly call it the “Pickable-Factor” or the “Pickable List.”

The Pickable Factor is anything that we think might disqualify us or make us less attractive to a birth family, an adoption agency, or another country; ultimately causing her/it to choose another adoptive parent(s) over us or rejecting our application to adopt. Every one of us has our own list of “pickables” that we think will make our wait take longer or stop it altogether.

The reality is that some of your “pickables” may play a role or even prevent you from pursuing some type of adoptions. For example, China has new regulations (don’t get me started!) that require that applicants be married for a specified period of time, not be obese, and not have taken antidepressants. China probably wouldn’t look so favorably on an application from someone with disabilities and/or who is a cancer survivor. I would check with your adoption agency if you have any of the “pickable factors” I just listed before you submit your application. I didn’t say this was fair, I just said these were some of the new regulations that went into effect in 2007.

However, these same “pickable factors” may not play any role in your adoption process if you were open to consider other types of adoption. If you chose a domestic newborn or infant adoption, a foster-care adoption, much if not all of what China disqualifies might not raise an eyebrow for your attorney or your adoption agency. A history of cancer or a history of depression, or any significant item on your “pickable list” should all be thoroughly addressed in your home study, but as long as you are healthy today and have the ability to care for a child, your social worker should be able to navigate successfully around what might have been a huge stumbling block in another adoption program.

I think the bottom line is to be educated about the criteria that various countries and agencies have for accepting applications from prospective adoptive parents, and then see if your list of “pickables” precludes or limits your participation in certain programs. Domestic adoption, and especially foster-care adoption tend to be more flexible avenues than international or some agency-assisted adoptions. But every prospective adoptive parent should – armed with a good home study – have a program or avenue to become a parent. No single criteria whether it be sexual orientation or a history of cancer should ever preclude you from becoming an adoptive parent. Your individual Pickable Factors may mean you have to do more research and be more creative, but unless you’ve got a felony child abuse arrest on your Pickable List, and as long as you’re honest with yourself and your social worker, then you shouldn’t encounter too many problems on your path to parenthood (I mean, other than the 1,001 you’ve already had to endure).

So it would appear that being a cancer survivor shouldn’t affect adoption as long as your disclose this information to your social worker.

Dear Mel:

My RE suspects I have endometriosis, which explains A LOT of things that have been happening to me the past couple of years. The hubs and I are going on 4 years of TTC with one miscarriage 3 years ago and a whole bloody trail of BFN’s. We are currently scheduled to do 2 more IUI cycles, before having a laparoscopy and moving on to IVF in June. I have been reading about endo quite a bit,trying to understand how it works, if there is anything we can do to ease the symptoms, etc, and I stumbled on some blogs and forums where it was stated that there is sometimes a connection between endo, infertility and gluten.

I saw that there are quite a few books written ab
out the gluten free diet increasing fertility. That, and, shazam, I got an email from a dear friend this morning, who has been trying to conceive with her husband for EIGHT years now. She’s pregnant, from real live sex with a man, and believes that going gluten free, combined with acupuncture is what helped her. She had only been gluten free for two months when she got her BFP, so we could say it was a coincidence, but seriously… after eight years of BFN’s? I have a sneaking suspicion that she might be onto something. I’d love to have your take on this. Thank you so much.

—Sassy

First I started in books and when I couldn’t find a lot on gluten-free diets in regard to endometriosis, I took to the Internets (yes, plural, because there are so many of them). I found many forums, but no formal studies. This speaks nothing to how factual it is and more to what avenues researchers are interested in pursuing and what they can get funding to study.

What I did find were books that spoke about that general diet that is used to treat everything from endometriosis to human African trypanosomiasis. While I’m being sarcastic, there is no harm in a diet that is low in refined sugar and carbs, alcohol, caffeine, preservatives, and fried foods–which is the basic rundown of most fertility diets.

You could ask your doctor what she thinks about gluten-free diets and their effect on endometriosis, but she’s likely to tell you that it’s of the “can’t hurt” category along with drinking green tea or chowing down on whole milk ice cream. If endometriosis is your problem, is not eating gluten likely to stop the spread of endometrial cells? Well, no, I can’t really think of any situation where the omission of a food cures a condition (with the exception of food-related illnesses). Removing a food may be helpful in not exasperating a condition, but it won’t cure it.

So what should you do? If sticking to a gluten-free diet isn’t going to make you feel like you are giving up one more thing as a sacrifice to infertility, I say go for it. The only problem I can see arising is not knowing enough about substitutions which could create a deficiency in your diet. But if you look into it carefully and pay attention to your overall diet, I think it’s a great idea. My concern is only if it doesn’t work. Will you feel like it was still worth a shot and a worthwhile investment? Then yes, you should go ahead with the diet. But if you fear that you’re going to look back on this time period and say, “I made myself give up everything I like to eat and it still didn’t do anything; all it made me was miserable,” then I’d forgo it. To be honest, I like my gluten so much that unless a study was unearthed strongly proving a connection between gluten consumption and premature ovarian failure (my diagnosis), I probably wouldn’t try it out just in case. I feel like I’ve denied myself too much as is from events to food. I’d rather be happy in the places I can be happy. But that’s me and my unnatural love of gluten.

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.

Leave a comment in the reaction box below–only keep in mind that conflicting advice is embraced and rudeness is not. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday’s installment of Barren Advice.

Updated at the bottom

I am claiming the second Thursday of every month for blogging questions. I’m not just talking about the “do you return every comment?” type questions but the technical side of blogging: how do you create links within a post, how do you embed a poll within a post, what is the best hosting site if you want to self-host your blog? The questions that arise when you first start blogging, but also the questions that come up about new programs or glitches with old programs. There are people out there who can probably explain quite easily how they did something on their own blog. Let’s just collectively pool our knowledge.

The posts will be called A Side Order of Help With That. They will be labeled as such and old posts will be accessible via the label list on my left sidebar. My only request is that as we do a few of these, that you check the old posts to see if your question has already been asked and answered.

This is how it works:

• You can send a question at any time and I’ll post a reminder usually the Friday Blog Roundup the week before. I’ll hold on to the questions until the next installment.
• Email me (comments are closed for this post) your question. Please place ASOHWT in the subject line. Try to keep it brief, but include as much detail as possible. Make sure you include your blogging program (Typepad, WordPress, Blogger, etc). In addition to technical questions, you can ask for a general opinion (eg. “why do you think it’s worth it to switch to self-hosting instead of staying with a free program”). Unless you wish to remain anonymous, please include your blog name and url so people can click over to see your blog if they have questions.
• I will compile the list and post it on the second Thursday of the month (this month, it will be the 12th and if I can’t get to it in time, it will go up next Monday. After that, it will always be on the second Thursday of the month).
• When the list goes up, please answer the questions in the comment box so you can (1) see if someone else has already answered it and not waste your time and (2) others who realize they have the same question can see the answer. Oh, and (3) the answers will all be in one place so others can access them in the future.

That’s it. I am doing this selfishly: (1) I have a technical blogging question and (2) I receive a lot of technical blogging questions that I absolutely cannot answer because I turn to Bea and Calliope for all of my blogging questions.

The turn around this month is quick–I’m putting up the post on Thursday. In the future, you’ll have a few days to turn in questions. But I ask that you always email the questions so we can streamline this and not have the same questions answered again and again. Seriously, nothing is too simple: if you don’t know how to do it or what something is, ask.

Before I begin this story, I will readily admit that many cool things happen to me. The flip side of this is that for every random gift that falls in my lap at the right time, I am also the type of person who attracts the one crazy person on the Metro. People can ride the Metro daily and never have another person speak to them. But if they bring me along, I promise you that someone will sit beside us and ask us if we want to see his penis and then proceed to tell us all about the Prince Albert he got that week. So you see, there is a flip side to being the person who wins a month a free groceries or gets a strange gift in the mail…

I promised you that the game would be explained, but you’ll need to draw your own personal understanding from your answer. After all, what you did on Friday was access your subconscious for a moment–maybe the most accessible tip of your subconscious, but your subconscious nonetheless–but if you sat there longer, you probably could have named many other B.K.s or perhaps people with other initials who were in disguise as someone named B.K.

There was absolutely no thought behind choosing the letters.

Let me explain. Actually, to explain and get to the incredibly cool part, you’ll need some background information.

Last week I was cleaning, right? So the folder that gave me pause after I threw out the first box of teaching materials last weekend was labeled Dada Club. The Dada Club was a group I started at my middle school. Once a week at lunch time, students in the club came to my room to eat and play Dadaist/Surrealist parlour games–Exquisite Corpse and the like.

The point of surrealism was to access and use your subconscious. Maybe this explanation will give you food for thought for many a future blog post if you’re currently stuck. Think about it this way, up until now, I think most of us have grabbed at things to write about in our consciousness–the way the stirrups feel against the heels or how we felt when we sat on the floor with a negative test. What happened this week. But surrealism is not about floating hats or pipes that are not pipes. It is about meditating until you reach back and randomly pluck moments that you have somewhat forgotten about until your memory is jogged. It is about making connections and finding the meaning behind the act. Accessing the subconscious.

It’s taking the first B.K. that came to mind but also then sitting still for a bit and allowing other B.K.s to float into your head. To play out scenarios with them. To set them in a situation and think about how you would act. I spent the whole weekend coming back to the initials and coming up with more and more people that I had pretty much forgotten about who hold those initials as well as wondering why some pretty obvious people didn’t pop into my mind until Sunday.

So the students and I would play these games like Exquisite Corpse where you pass around a piece of paper and add to a story, only seeing one sentence before your own at any given point. Or free writing as many linking thoughts as we could get down on paper in a given amount of time. Or playing Conditionals.

That’s the only part I miss about teaching and truthfully, I have that same space here sans the students–having time in my day to try out something that matters to me. The Dadaists mattered to me so I brought it to the students and they shared it with me. Look how many other things I’ve thrown out there via this blog through the years and others say, “sure, I’ll join along too.” That is my favourite part about having found this community.

Okay, so why the Dadaists? It now comes in four acts, and you read the third act above.

Act One: The first time I learned about the Dadaists and their writing games, I was in high school. A recent graduate came back around Thanksgiving to visit the high school and speak to us about writing programs at college. He started out his visit by teaching us how to play Conditionals. By the end of the hour, I knew I wanted to find a college that had a writing major.

Act Two: In college, we had an ongoing game of Exquisite Corpse that lasted a whole summer. The pages were left out and people added to them at random. It grew to be several hundred pages before fall. That manuscript held huge sentimental value. I still wonder what happened to it.

Act Three: Resurrecting the Dada Club for the middle schoolers since I was no longer friends with all of the people I played Exquisite Corpse with back in college.

Act Four: Here is the story of the mystery gift: about two weeks ago I received an anonymous email. The writer told me that a package was being sent and this item helped her “conceptualize the way I set out to explore the world. Because of this thing, I started to become untrapped.”

“Am I trapped?” I asked Josh. I got really hung up on this idea for several days. I kept opening up the email. This person obviously knew me semi-well because they had my address, but I had no idea who they were or if I had ever emailed with them about feeling trapped. Maybe they could tell that I was stuck and needed unsticking. I kept asking myself if I was stuck.

And the fact is that yes, I was stuck. Well, stuck is not the right word. I felt like I was in a canoe without oars. I was still moving forward but slowly; and it was pretty relaxing. Every once in a while I fretted that I had no oars or that I had to be somewhere at a certain time. And then I’d be lulled back into a state of non-worry. I have lived too many years worrying about time. It actually felt nice to make a conscious decision to live the oar-free life for a bit longer.

But the problem with the oar-free life is when you know there are rapids ahead and you don’t have a plan to navigate them.

Enough with the analogies: we hadn’t really come back to a decision about how we conceptualized the future. Would we return to treatments? Now? In the future? When in the future if not now? Never? Would we choose a different path instead of treatments? Would I go back to work if the twins started school full time? Would I still write? Write and work? Work outside the house? What would we give the twins if we weren’t using our savings for treatments? Would we leave the money sitting there or would we use it to enrich their lives?

We made the decision not to do anything active (since trying without treatments is passive) right now without really making a decision. We were supposed to return to treatments this winter once the book was out of my hands, but when the time came to make the appointment, some other things started happening and it ceased to be a sound decision. We made the choice not to return right now to my RE, but we didn’t set any other plans.

I am the type of person who needs to know exactly what is going to happen throughout the day. I don’t like surprises. Therefore, not having a plan felt very unsettling and yet, we weren’t making a plan. And then I’d get lulled into forgetting that we didn’t have a plan. I guess my hope was either to get a plan or get comfortable with the idea of not having a plan and letting life play out with the belief that the right time would open without planning for it. Does that make sense?

We almost didn’t stop treatments last year even though I was spinning too many plates because stopping treatments strayed from the path. Oh, you should probably know this about me: I don’t like to stray from the plan, even if a new idea is presented that is obviously better. Even if sticking to the pl
an is like trying to shove Cinderella’s shoe on the stepsister’s foot.

Returning to treatments right now would essentially put us in the same place we were last winter when we quit–it doesn’t work right now with our life, with our finances. It would be unfair to the kids we do have and unfair to ourselves. And yet, even knowing all of that, I still felt like we needed a month, a date. A time that we would be returning. Because without it, life felt too up-in-the-air and undecided. But here is the problem with that way of doing things: we could say April, but if life is still like this in April, is it better to stick to the plan and be foolish or break the plan and be miserable? Or, as you’ll see in a moment, is it better to not have any plan at all and trust that one day, we will wake up, think about it for a moment and say, “you know what; we have a great window right now. Let’s try stepping through it.”

Enough navel gazing.

The package arrived and I opened it warily at the post office. I considered asking Susan, the kind postmaster who knows your business because I often tell her what I’m mailing or tell her who I got a letter from if I open my mail before I get home, to take a photograph of me so I could show you the huge grin as I saw the book as well as the identity of the mystery gifter.

The person will continue to remain a mystery at her request, but the book was Lonely Planet’s Experimental Travel. It is travel using the ideas from Dadaism and Surrealism. In other words, leaving the beaten path and seeing what transpires, traveling without the sole focus being the destination, treating all possible paths as equal. The book contains forty or so ideas that can be done locally or globally to see the world in an entirely different way. It is about setting aside your old, personal travel rules (always make a plane ticket three weeks in advance, always bring a camera, always buy postcards on the first day and mail them home) and picking up someone else’s ideas in order to become untrapped. Unstuck. It is like travel’s version of fixed form poetry.

If you have expectations about how things need to go; preconceived beliefs of how travel (or life) should be, you’ll often be disappointed. I once had a boyfriend tell me that I would be infinitely happier if I let go of expectations and I told him it was impossible. But now a guide has fallen in my lap that essentially tells me how to do just that. To let go of expectations.

It’s a travel guide, yes, but I’m also seeing it as a life guide. Because we should all be able to do with books as we please.

I opened the book randomly to my first travel game–Experiment 14: Counter Tourism: “Varies, but could include travelling to a famous landmark and taking a photograph with your back to the sight; alternatively, photograph some tourists practising classical tourism (see the boxed text The Classic Shot, p104). Other ways of practising Counter Tourism might be to take the opposite approach to instruction. If your guidebook advises you to avoid something, deliberately seek it out.”

And you know what, I have been so focused on fulfilling this vision in my head that I haven’t ever considered turning my back on it and seeing what else exists. I don’t even know what else exists. I guess that is the point–to actually do the experiment; to figuratively travel even through your own decision-making process.

I have a strong feeling that I will find something in the book that we can all collectively do in our home towns. I will post the new project soon. It is slowly forming inside my head; a nice distraction with the possibility of pulling thoughts to the front of the mind.

So to sum up: we’re not returning to treatments right now. Upon deep reflection and many talks, we’ve come to the decision that we can find comfort with a multitude of paths. We are going to throw the travel book in the bag a lot this spring and take some random trips that the ChickieNob and Wolvog will hopefully remember well into their college years (so they can discuss us around the pizza late at night). We are not going to pick a date to return but will allow the moment to come to us. There will be a third child in our family one day.

Thank you, Mystery Gifter, for recognizing that I was stuck and for helping me become unglued. For knowing me well enough to know that this book is a perfect fit. And thank you, happenstance, for having the book arrive three days after that folder went to the dump. Isn’t that an amazing coincidence since the gift was sent BEFORE I ever started cleaning?

Would you like to play another game?

Come up with a new superstition (good or bad) surrounding treatments.

Example: If the nurse calls directly on the hour, it means your cycle will be cancelled.

And then answer this question: will you pay attention to these signs even knowing they’ve been randomly created?