Category — Barren Advice

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

Barren Advice is posted each Tuesday. 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:

I have a history of recurrent pregnancy loss and am currently 5 weeks pregnant. I’m taking 200mg prometrium suppositories three times a day. If this pregnancy fails, will the prometrium cause a missed miscarriage?

–Antigone from Antigone Lost

It’s a complicated question because not only does every body respond differently to the medication, but so many other elements–both known and unknown–contribute to how our body deals with a loss. Boiling it down to the most basic level, Prometrium does not trump all other functions or hormones. It is not powerful enough to hold the body at bay: there are women who bleed regardless of Prometrium (either related or not related to a loss) and there are those who do not.

Prometrium definitely can delay a period if the cycle is going to end regardless, which is why REs run a beta at the end of the cycle to know definitively your status before stopping the medication. There are those who are given the advice to keep taking Prometrium until their period arrives, but this isn’t the correct use for the drug. Prometrium may not delay a period in everyone but as a progesterone supplement, it will certainly delay a period in a large portion of women since the drop in progesterone is one of the signals to your uterus to lose that uterine lining.

With loss: if one of the reasons for early loss is low progesterone, then Prometrium can aid the body in maintaining the pregnancy. If the reason for early loss is not tied to low progesterone, taking additional supplements is not going to maintain the pregnancy. Which is when we come to the situation you asked about–can Prometrium cause a missed miscarriage; in other words, can Prometrium keep the body from letting go of an embryo that is already lost?

I consulted with a doctor to answer this question and these are her thoughts:

Generally progesterone, either natural or artificial, simulates a luteal phase. This phase promotes a secretory endometrium in the normal menstrual cycle which is best for implantation.

The practice of giving progesterone in early pregnancy in the face of low progesterone levels is supposed to decrease the likelihood of loss due to poor implantation or poor development of a nice hospitable lining. The lining matures under progesterone’s influence.

So about missed miscarriage. Progesterone can indeed make it more likely that you will not bleed after a 1st trimester loss, but it is not the only factor since people not on exogenous progesterone still have missed miscarriages until the conceptus stops producing enough hormone to trigger the uterus to expel the tissue.

Thus progesterone can make it more likely but it is not the only factor.

And I’ll just add that I hope this isn’t a situation you have to deal with this pregnancy. Sending many good thoughts to you.

Dear Mel:

Lately, I have been really trying to read a lot more blogs, be present, be available to other women who struggled with IF or are still struggling. In doing that, I knew that I would be reading things that would be about things not quite working out for some couples. I thought I was really ok with that, when we were still struggling I know that some people wouldn’t want to read about how we our IUIs failed or the decision we came to try IVF. I know that in the world of IF–as in the greater world–there would be stories of success and stories of failure. I am, by heart, very sentimental and emotional and in knowing that about myself, I knew that reading about both the good and bad would touch my heart for lots of different reasons. I guess what I am trying to say is that I thought I was prepared for the failure stories and could read them with a heart that could take it. I am not so sure these days (and it really bothers me).

I am feeling a whole lot of survivor guilt, enough that I am crying almost daily about other couples and their losses. I wonder if I should step back from the blogs and then I feel even more guilt, because I truly want to “be there” for other women, to show them the same kind of support they showed me. Yet, when I read about the losses, I can’t comment, there is nothing in my heart or mind that is good enough to say and I can’t just forget them.

–Anonymous

When the war started a few years ago, I stopped reading the newspaper and listening to NPR. It was too upsetting and it was affecting my whole day. The decision was definitely the best choice for my mental health. But how could I not think of the people who were over in Iraq who didn’t have the choice to flip off a radio or stop buying the newspaper? The ones who couldn’t blot out reality and go about their day–those serving our country or living in Iraq or the people they left behind at home? It felt like by not reading or keeping up with the news, I was turning my back on them. And certainly, there are those who will still agree with that statement regardless of what I write after this point.

My lack of newspaper reading is different from my unwillingness to watch movies that scare me including war movies, stories about serial killers, or child endangerment. I know my limits and I know how things affect me. And while some movies are not placed out there for entertainment value but to raise questions, awareness, and conversation, I still cannot take partake in watching them. Yet I don’t feel badly about this even if I’m not supporting film makers or actors by carrying through on this decision–and they’re real people too. It just feels different somehow.

As much as we are a community and part of being a community is taking support and giving support, at the end of the day, we also have to be for ourselves. Which is why I always believe that a person needs to do what a person needs to do in order to keep putting one foot in front of the other. If the stories of loss or cycle failure are affecting your day and the way you are living your life and the idea has already come to you that you may be better off stepping away, I would recommend stepping away. Either temporarily or permanently–whichever one brings you greater peace of heart.

At the same time, I return to the newspaper and film boycott. There is more than one way to support a person or group of people and I think that a one-size-fits-all approach only builds guilt. Some people are wealthy and can afford to contribute financially to causes and others feel guilty when they
receive the same request for funds yet can’t afford to participate. At the same time, some people have an abundance of creative energy and are great about pulling together a fundraiser whereas others simply don’t excel in that area. I can support our troop by reading about the war, or I can participate in numerous programs established to support the troops or their families back home.

Reading their blog is simply one way to support a person. But there are so many other things you can do that also show support or bring comfort. It is harder to come up with a unique way to support a specific person–in other words, not a random group of those experiencing loss but specific people who are currently experiencing a loss who supported you through IVF. Harder, but not impossible. And sometimes, it simply takes time for the good idea to come to you, but I trust that it will.

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. Make sure you indicate which advice you’re addressing by numbering your comment with a 1 or 2. 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.

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

Barren Advice is posted each Tuesday. 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:

Basically, I have a mad, burning crush on my RE—let’s call him “Dr. Love”. It’s totally innocent, all in my head of course. He is a very good-looking guy, extremely accomplished yet also very sensitive, charming (and damn, he gives good ultrasound). I’m sure I’m not his only patient who shaves her legs extra, extra-carefully if I know I’ll be seeing him.

Now I’m guessing I’ve developed this crush as some kind of way to cope with all the treatments, surgeries and pregnancy losses I’ve experienced over the past year or so. I recall, for example, laying on the table after my IUIs giggling to myself as I fantasized about Dr. Love coming in, seducing me and “adding a little extra just for good measure.” Or clinging to the comfort of his gentle hand squeeze before being knocked out for my lap—all giddy like I’d just met Brad Pitt.

It also reminds me of being younger, in the more carefree days before infertility. I’ve always been a sucker for those older, distinguished types. In college I lusted after half my professors. Plus, there’s no doubt some element of wanting to be taken care of by this guy. Wanting to get the best treatment, be his “favorite”, etc. And let’s not forget it’s this guy’s task to actually get me pregnant, which is pretty sexy when you think about it.

My husband has no idea, and I hope he never will. I totally love him to pieces, and we have a fantastic marriage, which I think has even been strengthened by going through infertility together. But I feel sooooo guilty for lusting after Dr. Love! I want to stop finding him so sexy and having dirty thoughts about him. Yet it’s also one of the only ways I can drag myself back to that clinic time and time again. What on earth is wrong with me?! Please say I can blame this all on the drugs…

–Anonymous

You can blame it all on the drugs.

Actually, you can blame it all on being human. Humans fantasize–about other people, about other jobs, about other houses. We are dreamers and our dreams are often reflections of our desires, though, like all dreams, sometimes there is a direct line between “want” and “vision” in our daydreams and sometimes there is a long, twisting path that brings out the daydream’s meaning.

I’ll start with saying that there are two different levels of fantasy–enjoyable what-if daydreams and what I’ll call “I wish” dreams. And I see them as two very different beasts. What-if daydreams include fantasizing about someone you see on the television or in a magazine. You don’t know them and you probably have no chance of meeting them and what you are attracted to is not the actual person (since you don’t know them), but an element of that person. Perhaps you’re attracted to men with brown hair or women who have long legs. Maybe it isn’t a physical trait, but something more intangible–they are a fire fighter and you’re attracted to the bravery or the selflessness in the position.

I think it’s impossible and somewhat boring to pull apart our crushes. I think when we look too closely at the “why” it becomes like putting a toothbrush under a microscope. We’d probably throw up if we looked too closely at what we’re putting in our mouth and cleaning with a rinse of water. So we look away because brushing our teeth is healthy just as fantasizing a bit is healthy. Those fantasies give us a barometer of what we want; of what we wish would be.

The line that you’re worried about is what divides the what-if daydreams from the I-wish daydreams. The I-wish ones are about actual people–people we can touch and see. They are very specific even if we don’t know the other person particularly well. An example in myself–I knew Josh for a long time before we started dating. One night, I was at a film with another man that Josh was introducing. As I listened to him speak, I thought to myself, “I wish I were here with Josh instead of this guy.” I didn’t really know Josh yet though he was a real person that could potentially move from fantasy to reality. I ended up leaving the first man within days because I realized that fantasizing about being with another person was a huge sign that something wasn’t right in that relationship. The difference in statements between I-wish and what-if is huge because one pushes for action while the other one simply muses.

What I think is confusing right now is that you have someone who could potentially be an I-wish daydream since he is right in front of you though you are actually treating him as a what-if daydream. It’s not that you want to run away with your RE–what you want is what you already stated inside your question when you spoke about having crushes on professors. You want the care, you want the knowledge, you want the figuartive arm around you. Most of the time, those things come from your husband. But you have a medical issue within infertility which bypasses your husband’s capabilities–he doesn’t have the knowledge of how to get you pregnant, but this other man does. Your husband can put a figurative arm around you to protect you, but your health and safety is really in the hands of the RE at this point. Since you can’t have a crush on knowledge, the crush transfers to being about the person.

There is nowhere in your question that I hear an “I wish” statement about your RE. Of course, it sounds like you do wish that you didn’t have to deal with the what-if statements either therefore, perhaps a trip to the microscope with your RE is in order to see what really lurks below that crisp lab jacket.

Dear Mel:

We just found out that a couple we know had their baby very early. The mother was dx with preeclampsia and delivered at 27 weeks. So far the baby is thriving. But… she was born about 2 weeks ago. Previously we would have been one of the first ones notified of the birth but things have become strained long before we knew they were expecting. What would be an appropriate response? We would like to let them know that we are thinking of them and that if they need anything to let us know but beyond sending a card/email etc… would it be okay at this juncture to send a baby gift? How have other NICU moms felt about people coming out of the woodwork or so to speak when this happens… did you find it offensive or supportive? The last thing that we would want to do at this time is overwhelm them or put any pressure on them.

–Deb from All Things Deb (read more about the situation here)

The nice thing about helping out is that there are different levels. What would be appropriate to offer if you were her sister is very different than what you could offer if you were a friend or even simply a member of the community. But there is always something people can do and I think it’s better to do too much (within reason) than do nothing.

There is a sociology term called the bystander effect and what it means is that the more people who are around to help, the less likely help is to come. The reasons vary but one of the common understandings of why people don’t help is that they believe someone else in the vicinity is more qualified to help. And within your question, what I’m hearing is also that you feel that you’re not “close” enough to help–meaning, you’ve fallen out of touch and the helping should be done by those closer emotionally to the couple.

But what happens when it comes to the bystander effect and help is that the people closest to the person are not necessarily in the best position to offer specific help. A sibling who may be close emotionally may also live hundreds of miles away and not be in a position to take care of a load of laundry or cook a meal. Each person who sees the need to step in and aid the couple can play a unique role in offering support.

As we can see when a church group pulls together meals for a member who is ill or collects money for a family in the community who has lost their home, we don’t need to be emotionally close to a person to offer certain levels of help and that help is less about the actual action and more about letting another person know that they are not alone. As someone close-by physically, you could drop a meal off at the hospital or send a note with a gift card to be used at an establishment close to the hospital.

When offering help, specific is always good and general is not quite helpful. Saying, “let me know if there is anything I can do” is good as a placeholder as you try to seek out something specific to do, but people rarely utilize general help. What does make a difference is to email and say, “I heard about the early birth and how well the baby is doing. I know it’s hard to carve out time for yourself when the baby is in the NICU so I’d like to drop off a meal for you to eat at the hospital on Tuesday. Could you let me know a good time to drop it off and any food likes/dislikes.” Even more helpful is sending a gift card because it removes any necessary response from the other person. Simply mention the same facts in that note and add that you know that there is a Starbucks adjacent to the hospital and the card should be used to treat herself.

What comes next will be up to your old friend–whether she asks you to come by the hospital and see the baby or whether you simply get a thank you note down the road and no further contact. This is helping for helping’s sake.

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. Make sure you indicate which advice you’re addressing by numbering your comment with a 1 or 2. 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.

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

Barren Advice is posted each Tuesday. 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:

How do you think the experience of infertility would be different if our entire society basically was infertile? Let’s say, for political reasons or medical reasons (environmental pollution perhaps?), it just wasn’t possible to get pregnant naturally. Let’s say you grew up with the expectation that parenthood was not necessarily a given. That you would have to possibly meet a set of criteria to have public approval & funding to reproduce – or at least, that you and almost every other person out there would need treatment. How would the experience be different personally? How would it change our society?

–blogless Andie

Well, if the whole world were infertile, the media would finally learn the difference between transfer and implant.

It’s an interesting question that looks at whether we truly want to have children or whether we feel we should want to have children. Because we can never undo societal pressure (not to mention the expectations placed on us by anxious family members), it’s impossible to untangle our feelings–to know if we want children simply because it is a deep-rooted desire (something encoded in our DNA like all survival impulses) or if it’s an expectation placed on us that we follow without knowing that the impulse comes from somewhere other than ourselves.

It’s hard to predict. The first generation would definitely still be fueled by societal pressure. But later generations could start playing an enormous game of “not it.” Certainly, once you place the pain and embarrassment of fertility treatments into the mix, reaching parenthood becomes less enticing for some people.

Except the infertility community now can be seen as a tiny microcosm for this scenario. We all need assistance to reach parenthood. Some opt for treatments or adoption because the emotional and physical pain is outweighed by the chance at emotional and physical joy. And some opt to live child-free after infertility. It isn’t that the impulse to parent isn’t as strong–it definitely is–but the weight balances differently and the chance at emotional and physical joy doesn’t balance out the emotional and physical pain.

Just as we all have a certain amount of money in the bank, we all have a certain amount of emotional capital in the heart. We can try to withdraw more than we have at hand–but that usually leads to a crisis later on when our emotional account is depleted and we’re overdrawn. Some simply have a different amount of emotional capital–due to outlook, due to circumstance, due to resources. There are things we can do such as therapy that can earn a person more emotional capital, but there are also limits. Just as I couldn’t turn a six figure salary as a school teacher, we can’t earn unlimited emotional capital. We can wish we were richer and we can wish we had larger emotional reserves, but we have to work with what we have. Sometimes, we have enough emotional capital to pay for treatments or adoption. And sometimes, we simply don’t regardless of how much we want to reach parenthood. And it’s a healthy person who can recognize their limits and respect them.

Which is a long way of saying that I think the impulse to have children is taught to us AND it is imprinted in our genetic code. Therefore, I think the drive would still be there, even if everyone in the world required assistance in order to reproduce. There would also be those who choose to live child-free without the desire to have children. And there would still be a group–as there is today–who wish with all of their heart that they could become parents, but the roads to reach parenthood simply contain obstacles that are insurmountable if one is to remain true to their heart.

Turning this over to the blogosphere at large–what do you think would happen?

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.

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

Barren Advice is posted each Tuesday. 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:

I want to keep TTC, but I need some dental work. The dental work may not be complete before my next cycle, and I definitely need it done. Should I not keep TTC?

–Queenie from Baby, Borneo or Bust

You didn’t specify what type of dental work–if it would be a one-shot deal or a multi-part surgery such as a root canal, but regardless, the answer remains the same: focus on one medical crisis at a time and take care of any problems with teeth and gums before trying-to-conceive.

If something (and teeth fall into this category) affects pregnancy or trying and you can address it and remove it from your plate, I would simply take care of it and move on. Once you become pregnant, teeth can also play a possible role in some types of loss. I say this with a slight cringe because so many times with loss, you are seeking an answer and there isn’t a clear one. Emotionally, that can be very difficult to accept and leads to many fears in future pregnancies (or can stop someone from trying again). Studies have been done that show a correlation between gum disease and preterm labour (according to the AAP, women with periodontal disease are 7 times more likely to have a preemie). Beyond that, the hormones in pregnancy–higher levels of estrogen and progesterone–can change the way your body processes bacteria and create gingivitis even if you never had dental problems prior to getting pregnant.

You can drive yourself crazy with the what ifs that arise out of each study that states or disputes a correlation between loss and another aspect of your health. I seriously wonder–even as someone who believes everyone should be a key player in the medical decision-making process–if Google Medschooling and reading all of the studies as they come out is emotionally healthy or if it simply leads to more fodder to beat yourself up with when things aren’t going as planned. Regardless, the bottom line is take a break from trying and address the dental problem simply to be done with it so you can return your focus (and give over the enormous time commitment inherent in treatments) to trying-to-conceive. And I give this advice even in the face of time and sensitivities with age and conception. When things go right, we don’t have to deal with the what ifs. But I always lean with the insurance of addressing the what ifs just in case things do go wrong.

Dear Mel:

In real life, I am very open about my infertility with family and friends. As a result, I have a lot of conversations with people about infertility. A situation has arisen recently that I’m not sure how best to approach. I’d like your input: what can I do when someone tells me something about their infertility that sounds medically incorrect? I’m not talking about something like minor variations in IVF protocols, but something that makes clear that this person isn’t understanding or isn’t being communicated with appropriately. How might I get involved, ideally without making a total ass of myself? How can I help encourage someone to take control of their infertility in real life?

–submitted anonymously

Here’s the one silver lining in being infertile in this particular situation. You can take your own experience with infertility and ask yourself what you would want to hear, keeping in mind the unique needs and desires of the other person. If the other person is extremely private and you are open about your infertility, what you would want to hear may not match what she would want to hear or vice versa. But it can be a useful barometer.

It can be painful to read or hear someone you care about stumbling around on a path when there are clear steps they could take to help themselves. Sometimes, those steps are very personal to how we view the world–we can look at someone struggling with a piece of information and think to ourselves “their life would be so much easier if they just came out with the truth rather than keeping it hidden.” Other times, the steps are a different shade of grey–a person may be making choices you would never make such as not visiting an RE after recurrent losses because they don’t wish to enter treatments. And still other times, those steps are clearly black-and-white: their RE is telling them that recurrent loss is okay and not running any tests or encouraging them to transfer 15 embryos at a time.

In the first example, I would always caution a person not to place their own opinions or what works for them on another person. We need to keep in mind that even with the people closest to us in life, we only have a small portion of information–whatever they wish to reveal to us. We can never be inside the head of another person or know how their previous life experiences are affecting this current decision. Therefore, do nothing. If you can’t stand the decisions they are making, remove yourself from those conversations.

In the middle example, the greyer situations bring about greyer answers. I always take a step back and ask myself if they are doing something physically, financially, or emotionally harmful to themselves. If the answer is no, I move these situations into the first category. If the answer for any of the three is a yes, I sit with it longer before moving it into that third category.

The third category does require attention–if not to help them than to relieve your own guilt over watching someone you love doing something harmful to themselves. How would you feel down the line if the worst case scenario happened and you could have stepped in and helped? That said, much like beauty, help is in the eye of the beholder. Meaning, you may see yourself as helpful and the other person may view your actions or words as meddlesome. There is always the chance that stepping in will create a wedge between you and the other person. That said, sometimes I would take the wedge over standing by and watching someone get hurt.

A case in point, I had a student who was cutting herself and asked me not to tell her parents. Of course, it would be irresponsible of me to know that she was hurting herself and not pass along that information to people who could help her and needed to know. The student never spoke to me again, but I’d rather take the wedge and know that I have her eternal frustration than know that I could have helped and did nothing in case the worst case scenario came about.

Often times, people share information with us because it doesn’t quite sit right with them either. Perhaps this person is sharing details with you because
they want your opinion. Or they may be sharing details out of a sense of obligation or because they simply need to vent. Regardless, weigh out which category they fall into on the spectrum and act accordingly.

A handy chart to summarize…

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. Make sure you indicate which advice you’re addressing by numbering your comment with a 1 or 2. 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.

Though I’ve kept One Smart Mama for almost a year, I’ve decided to integrate my advice column into my main blog and make it a weekly feature. Barren Advice is posted each Tuesday. 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:

What did you find helped you through the uncertainty and seeming hopelessness that found you during your IVF cycles?

–Manda from I Think I Hear Your Mother Calling

I can’t speak specifically to IVF, but I can speak generally about hopelessness. I think we’re programmed–probably for good reason–to always try to be moving towards happiness. This extends into people being uncomfortable around those who are not in a state of happiness (since we would rather deal with pleasant vs. unpleasant things) and it speaks to our own discomfort with non-happy emotions. No one wants to feel hopelessness and I’m certainly not saying that people should try to move in any direction other than happiness. But, I also believe that sometimes we need to sit in the state that we’re in and experience it in order to move through it. There are obviously exceptions to this rule.

Which is a long way of telling you to feel what you’re going to feel. Instead of trying to talk yourself out of it or brush it under the rug, allow yourself to feel uncertain and hopeless and not feel apologetic about being in that state. Of course, you are still programmed to move towards happiness so once you’ve acknowledged this state and felt the uncertainty and hopelessness, it is time to bid it adieu–at least until it creeps in again since each cycle is a roller coaster and the same emotions tend to come around the bend again and again.

Hopelessness is a strange state. Sadness looks backwards–it’s a reaction to something in the past. Hopelessness looks forward–it’s a belief that we can predict what will happen based on our past shitty experiences. Hope also looks forward and the same definition holds except that we base hope on our past good experiences. When you expect good things to happen, you walk into a situation with hope. When you expect bad things to happen, you walk in hopeless.

The way which we lean is hardwired, built from experience and the way we process the world. To believe anyone can change their hardwiring simply by making a choice to do so is simplifying human complexity. Those who walk with hope do so without probably knowing how they do so–attitude comes partly from experience but is also partly built long before we can control how we view the world. Just as you can’t change your hair colour by simply wishing it a different colour, I don’t believe you can change the way you view the world without some hardcore work–work that should probably be done under the guidance of a therapist.

Back to hopelessness: you do not and should not always exist in this state, but it means you should work with what you have rather than what you wish to be. If you are a sunny, positive person by nature, you probably don’t have trouble getting yourself out of a bout of hopelessness. If you are someone like me, you sometimes need to acknowledge the doom and gloom and then push yourself out of it.

Accept that you feel hopeless or uncertain and own that. Keep it in check by taking out a pack of cards from time to time and trying to predict the next card you turn over simply based on your past experiences with poker. I give a lot of weight to intuition, but I’ve also been proven wrong in my predictions so many times that I have to embrace the beauty of chance. Without it, we’d never leap.

Dear Mel:

I have a what-to-tell-people dilemma. My husband and I have always told everyone that we didn’t want to have children, because up until a couple of years ago that was true. When we did gradually change our minds and started TTC about a year ago, we kept it to ourselves in order to avoid pesky questions. So now we’re dealing with IF. We’re not pursuing very aggressive treatment options, so in terms of practicalities (finances, schedules, etc), it’s not difficult to conceal. Between my husband and online communities, I feel like I have plenty of emotional support. The difficulty is that I don’t like lying, especially about something like this. Part of me thinks it would be better just to fess up and deal with the unwanted questions and advice. But even if I do decide to tell, how the heck do you start a conversation like that? “Hi Mom & Dad, you know how we said we didn’t want kids? Well, we changed our minds but it turns out we probably can’t anyway!” Any advice on what I should do, or suggestions on how to decide?

–Blogless Kate

Here’s the strange thing about people–we are simultaneously nosy and so self-focused that we forget about anyone else’s situation. Isn’t that bizarre? We want to find out every detail of another person’s life, and at the same, we don’t notice half the things that they are experiencing right in front of our face.

I’m willing bet that family members and friends–those who would be affected by a child because it would be related to them or play with their children–are thinking about whether or not you are trying to conceive even if you expressed a lack of desire prior to this point. I’m also willing to bet that family members and friends–the same ones who might be thinking about your situation–are probably completely oblivious to your conception woes and aren’t giving whether or not you’re trying a thought.

If you have an overwhelming urge to tell–if it’s something you think about while you’re having a conversation with someone or you’re trying to figure out a way to jump into having this conversation like an enormous game of Verbal Double Dutch–you should tell simply to have the telling behind you. Yes, you will probably have to deal with questions except if you haven’t received them incessantly by this point, you probably have some pretty polite people in your life and it sounds like they could continue to do well with only a bit of gentle guidance: “you know, I’ve been having a hard time coming out and telling you this but we changed our minds about children and we’ve been trying for a while. We were recently diagnosed as infertile and we’re trying some stuff now. I don’t really want to talk about it, but I felt strange not telling you at all since it’s a huge part of my life and you’re a huge part of my life.” Truthfully, I think it is something you can send in an email if you feel better doing that and think you won’t be able to say it when a break in
a conversation occurs.

If you don’t have an overwhelming urge to tell and it feels more like something you should do rather than need to do for your own emotional wellbeing, I don’t think you should tell. You have no obligation to inform everyone around you about each decision. You didn’t call everyone to tell them when you started trying a year ago and you don’t need to tell them now.

But they will probably appreciate being let in. Sometimes, people just sense that something is up and having words to put with what they’re sensing goes a long way in building and maintaining relationships and clearing confusion.

Dear Mel:

What is the true shelf life of injectable meds? If the bottle says it has expired…has it really?

–Cali from Creating Motherhood

I had to consult with an expert and the quick answer is don’t use them. I know, not the popular answer. The longer answer is that it depends on the drug and how quickly the drug’s potency declines after the expiration date. Liquids degrade faster than solids that need to be mixed with sterile water and solids degrade faster than pills. Therefore, the injectible medications are probably degrading at a faster rate than those expired Tylenol that were tested by the FDA and military. The problem is that the studies on potency and the rate of degradation are not going to be accessible to the general public for most fertility drugs (which are often used off-label too!) therefore, while the drug may be good after the expiration date, you’ll never know if it has lost 5% of its potency or 10% or 90% when it’s a month after the date.

The longer answer includes your own emotional well-being. Regardless of the answer, how comfortable do you feel using the expired drugs? If the cycle works or goes well, you probably will have no qualms. If the cycle doesn’t work, will you always wonder about the quality of the drugs you used? Will it become a stumbling block as you try to process emotions after a cycle? I always believe in removing any known what ifs so they don’t come back to haunt you in the future. When the what ifs don’t come to fruition, we sometimes forget how emotionally dangerous they can be. But in order to proceed without regrets, process how you would feel about the cycle if it were to be successful as well as unsuccessful.

One solution would be to go to a pharmacy and see if they can exchange the unused medications for ones with a later expiration date. Pharmacies close to fertility clinics that specialize in providing fertility drugs sometimes informally run programs where people can turn in unused medications after a cycle. You may look into this and see if you can exchange your medications there or at your fertility clinic–which is probably teaming with samples regardless.

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