Parenting after infertility

Tuesday was my anatomy scan for my fourth child. (I know this doesn’t sound like a typical infertility post, but bear with me.) I was a nervous mess. My husband came with me but wasn’t allowed into the room because of COVID precautions. My ultrasound tech was a woman of few words, who mostly complained about having to wear her surgical mask all day (another COVID precaution).

Some women announce their pregnancies the second they know about them, with elaborate pregnancy announcements and social media posts. I’m in the other group – moms who worry every step of the way. It’s exhausting. As soon as I find out I’m pregnant I worry that I will miscarry in the first trimester (for the record: I have never had a miscarriage). I hold my breath at every ultrasound until the doctor finds the heartbeat. I worry about the results of my nuchal translucency/first trimester screen (perhaps for good reason: I have tested positive – false positive – for Trisomy 21 twice now). I hold my breath waiting for the cell-free DNA results (normal 3 of the 3 times I have had to take this test). The anatomy scan is the worst, because by 20 weeks I tend to look pretty pregnant so people know, and how would I break the news to everyone that the baby had some terrible congenital abnormality that was incompatible with life? It sounds ridiculous as I am typing this out, but this is the world inside my head. When I was pregnant with my first, I refused to wash any of the clothing we had purchased for him until late in the third trimester. I couldn’t imaging folding it all up and putting it away if something terrible happened. With each pregnancy, I have worried about the baby not moving enough. With my first I vividly recall drinking orange juice at night and jostling my belly around to get him moving. Perhaps that is why he was born a night owl! Just today I took a 5 minute break to lay on my side in bed because I hadn’t felt this baby move in some time. Last year, my best friend lost a baby at 31 weeks. It was every mom’s worst nightmare. My heart aches for her, thinking of how she waited for labor to start days after she had learned that her baby was not okay, and ultimately delivered a stillborn baby. I flew out to see her right after the birth and there were no words to remedy how unfair and cruel the world can be.

My struggles have been minimal by comparison. I had hypothalamic amenorrhea and stopped getting my period for a decade. When I got married and decided to have kids, it (surprise!) did not suddenly make an appearance. In retrospect, I can summarize the story like this: I had hypothalamic amenorrhea and started eating more, gaining weight, and working out much less in order to promote natural fertility. I eventually got pregnant with minimal assistance from a fertility clinic. My subsequent pregnancies occurred without any intervention. However, the period from May 2012 to March 2014 was so more stressful than that paragraph reflects. I had no idea why I wasn’t able to get pregnant. I knew hypothalamic amenorrhea was playing a role but what if (a) it was irreversible and (b) there was something else? What if I would never be a mom? What if I had messed up my body so much that I would never carry a baby?

Once you have had any degree of infertility, you never take being a parent for granted. My first wouldn’t sleep. He had a strong startle reflex and broke through every swaddle combination we tried. He would cry all day and night unless we held him. I remember being exhausted to the bone, crying on the phone to my friend, telling her how guilty I felt for not savoring every waking moment after everything I had been through to have him. This has been my thought process on repeat for every child and for every step of the way. Every decision I have made for them has been fueled by the knowledge that their lives may not have been if things had worked out differently.

I know how fortunate I am to have these children. Once you are pregnant with your fourth (and to some degree your third), people start commenting on your reproductive decisions. “Isn’t the world populated enough?”, “Yeah, probably not a good idea”, “Why would you have another child?”. Quite frankly, it’s rude. In the same way I was hurt and offended when I couldn’t get pregnant and people asked me when I was planning to have a baby, I am hurt and offended by these comments. I don’t push back though – I’m never going to convince people who say those words out loud to consider another viewpoint. I know how much my children mean to me and my husband, and that’s all that matters. Although I would have preferred not to have gone through those years of infertility, I am grateful that they provided me with this perspective.

My nanny is drinking pregnancy tea

This hurts my heart because she’s preparing for her second round of IVF and I feel like a terrible person for having two children already and now being pregnant with a third (and I haven’t told her about this yet, although I’m pretty sure she’s figured it out). It hurts my heart because I remember those days very vividly – wondering why everyone seemed to get pregnant so easily and why it was taking me forever. What was wrong with me? Would I ever be a mother? I wore fertility bracelets, temped, took supplements, checked CM, joined a yoga for fertility group, set up a meditation corner in my bedroom to relieve stress, started acupuncture, and on and on and on. And I think: how much harder would it have been if my job was to take care of small children? And how conflicting it must be when that job is paying for your opportunity to have your own child.

In addition to my nanny, I haven’t told a lot of people I’m pregnant yet, but there are two people in particular who I should have told but I have not. They are very dear friends to me. One recently miscarried in her first trimester after deciding to have a second child, and the second is undergoing her second round of IVF, having failed a first in an attempt to have a second chid. I should have told them, but didn’t know how to break the news directly after they announced what they had been through. And, to be honest, distance and our busy lives make it easy to evade. But I am 15 weeks tomorrow, so it’s time. And eventually I’ll need to tell my nanny, who likely already knows. I only hope that in a few weeks to months she shares the news that she’s expecting as well.

Trying to conceive

My two attempts at becoming pregnant went something like this:

Pregnancy #1: Got married, starting trying to conceive (TTC), started to think that I most likely had hypothalamic amenorrhea (HA), was diagnosed with HA, underwent fertility treatment and became pregnant almost 21 months after we started trying. Those are the facts. The reality is that it was an emotional rollercoaster – hope, anxiety, disappointment, anger, sadness. And most of all, terrible fear that I would never be able to have a child.

Pregnancy #2: Oldest was 11 months, period came back naturally (hurrah), and the next month it didn’t come. I naturally thought my HA had returned (especially because I had a negative pregnancy test at 35 days), but I was actually pregnant. Second hurrah! I literally had to do nothing and I pretty much worried 0% about getting pregnant that time around.

And now, here I am. 16 months post-partum (!) and I had expected to be pregnant by now. Although I initially thought my second should have a few more months of being the baby than my first did, I really did want them fairly close together. But now, if we do get pregnant, my last two would be >2 years apart. This bothers me.

It probably bothers me because I am a Type A person and want everything my way. But it also bothers me because I am afraid that maybe it will not be easy for me to become pregnant again. I’m conflicted on this point. First, I feel somewhat selfish for wanting a third child. Is this normal? I have two perfectly healthy children! Our lives are FULL. It’s not like we have oodles of time to fit a third child into the mix. I think about people who are going through infertility struggles for the first time, and I feel terrible for having this blessing and wanting more. How greedy of me! Second, it’s giving me more time to think about logistics, and I don’t want to be dissuaded from our decision to have a third. Financially, emotionally, etc., does it make sense to have a third child?

What it boils down to is this: if we can’t become pregnant naturally (and if we are not able to, I am not sure that I know the reason because I am nowhere in HA land and cycling naturally), would we go down the infertility work-up/treatment road? I don’t know the answer to that.

But this third attempt is bringing up a lot of emotions from my first attempt, and the synopsis of my month is as follows:

Week 1: period is here, wah(!), lots of negative emotions closely followed by attempts at positive thinking and planning for the upcoming cycle (fertility window is X and baby would be born on Y)

Week 2: TTC

Week 3: More TTC, then the 2 week wait begins. This week feels like the calm before the storm – anything is possible but nothing can be done to change what’s coming down the pipeline.

Week 4: Time to type every symptom into Google to see whether it could herald a pregnancy (AND I’m a doctor AND I’m been pregnant twice!). Is nasal congestion a sign of pregnancy? How about back pain? Cramping? Bloating? What about spotting for 5 days…oh wait, that’s just my period.

And the cycle starts again. What else can I say except that it sucks. I think about myself ~5 years ago, feeling so dejected and low. I remember sitting on my “meditation” mat where I was supposed to relax with incense and practice Yoga for Fertility, except I was sobbing. It was a hard, hard time. This time, it is not as hard because the stakes are lower and part of me does feel crazy for wanting to add a third to the chaos of my life. I also do feel incredibly fortunate to be cycling naturally (without birth control) for the first time since high school!

But I am still sitting here wondering whether the new acne I’ve noticed and the low-grade back pain I’m experiencing could have anything to do with pregnancy…and what will I do next week if it is instead a sign of my period?

Acupuncture for infertility

When I was trying to get pregnant with my first, I turned to acupuncture. I should clarify that I turned to acupuncture in addition to (most importantly) seeing a fertility specialist (a doctor). I also: purchased and wore a fertility bracelet (how can it not be legit if it’s featured on Real Housewives of NJ!?), signed up for a yoga for fertility course, read countless books about infertility, and tried to meditate. In sum, I desperately wanted to get pregnant.

Although stressful at the time, I now have very fond memories of my acupuncturist. She was very close to my (then) home in southern California, close to downtown. She burned herbs during the treatment session so I always left smelling like I had just smoked weed. Once the acupuncture needles were in place, she lay some of the herbs on the acupuncture needles and burned them (or something of the sort). I don’t quite know because my eyes were closed the entire time, as I was trying to both meditate/unwind while also trying not to freak out about the needles.

I got pregnant after one such session. It was a Thursday in February and we had just finished our in-service exam (a test all dermatology residents across the US have to take to prepare for the actual boards). I fit in an acupuncture session before flying up to northern California, where my husband lived. I was pretty sure I was going to ovulate because the ovulation stick had shown a solid smiley face, which is different, apparently, than a blinking smiley face.

I parked my car in the downtown area, where they happen to have a farmer’s market on Thursday evenings. I completed my acupuncture session only to find that my car had been thisclose to getting towed. That would have put a real damper on the conception plans. In any case, to make a long story short: I made it to NorCal and our baby was conceived that night. When I am feeling particularly dramatic, I’ll say to my husband: “I got pregnant thanks to acupuncture” or “I got pregnant thanks to my fertility bracelet”, to which he’ll reply “I’m pretty sure you got pregnant thanks to medicine – aren’t you a doctor?” This is when I’m most proud of him, because I did get pregnant because of medicine, although I’m sure everything else helped a little bit.