Tag: parenting

Parenting after infertility

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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.

The Village

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I was recently surprised to learn that I had lost my desire to move back to New York. As recently as a few months ago, when people would ask me whether I envisioned myself staying in California forever, I used to respond with “Probably, because I don’t think I can convince my husband to live anywhere else.” Now I pause, because the answer is that I can’t quite imagine living anywhere else.

When and how did this drastic shift occur? I left New York when I was 18 years old. To be honest, I was thrilled to do so. I lived in the suburbs outside of NYC, had moved during my freshman year of high school (NOT a good situation), and was excited to “discover the world”. I floated around New England for college and medical school, and spent a requisite year living and working in NYC. When it was time for residency selection, my husband (also an East Coaster) and I were adamant that we needed to get out of the cold. He wanted to work in California and I was game to live in California and so I applied and was accepted.

We flew to the West Coast with one suitcase. (I can imagine myself telling this story to my children one day, at which point they’ll roll their eyes at this particular sentence.) We had less than $5,000 combined in our bank accounts. My husband was unemployed (“between jobs”) and I was days shy of starting my intern year. We rented a small unit in a house of four units total and decked it out in IKEA furniture. My husband bought a Samsung flat screen TV which we still own 8 years later. We weren’t married yet but reasoned that we needed to move in together because the rent was too expensive to swing two apartments. When he proposed to me, the engagement ring was the most expensive thing we owned. We didn’t have much but we were so happy.

In the past 8 years, we’ve spent 5 of them living together (we were apart for 3 years while I completed my residency), got jobs, got married, bought a house, tucked away money for retirement, had 3 kids, tucked away money for college education, and created the life we always wanted – one we could have never quite imagined when we landed in California in 2010.

Yet there were bumps in the road. I started my first job out of residency in 2014 and had a baby 3 months later. I’ve had 2 additional children since. I had no idea how difficult it would be to raise a family away from our families. It often felt impossible. I vividly remember those first colic-filled weeks with our oldest. We had help for a few of them but were on our own most of the time and I cried constantly. When I went back to work I was convinced there was no way I could juggle motherhood and my career without help. Most of our acquaintances at the time were my husband’s friends and, although mostly good people, they just weren’t my people. Is that a terrible thing to say? I hope not. You know that feeling when you just click with someone? When you can tell them anything – lay all your cards on the table, be completely vulnerable – and they will accept you wholeheartedly? Let’s just say I didn’t get that vibe from his people. And that’s what I struggled with the most – not having someone I could text frantically when our first was up at all hours of the night, not having someone I could ask to watch him for an hour while I took a breather, not having a tribe to commiserate with.

So I put myself out there. I met a group of women I now call “The Mommies”. My first mom friends! Now, the group has changed dramatically these past 4 years as moms move away and group dynamics shift, but we have each other’s backs, an ongoing calendar of events, never-ending birthday parties, and most importantly the knowledge that we have known each other since our little ones were just months old. I rekindled friendships with people from my intern year and became closer to co-workers with young children. I met more moms through preschool and subsequent “new mom” groups as more children joined our family. We acquired a network of people who have helped us out in some capacity around the house – gardeners, painters, nannies, cleaning crews, etc. Today, our nanny saw that I was clearing out our shed for some upcoming work and (unsolicited) called her husband to see if he would be willing to pick up all of the items we were throwing out to save us the hassle. He came by an hour later and I was so happy I could have cried. With such distance between ourselves and our families, these random acts of kindness mean everything.

I also have to admit that there are serious perks to living in California: great weather, tons of diversity, generally liberal politics. It’s also true that we both love our jobs and our house. But the game-changer for me was truly the evolution of our community and little village. We’ll see how we feel as the kids get older and schedules become more demanding but, for now, I am truly loving where we live, and this is the first time since 2014 that I’ve been truly able to say that.

Trying to conceive

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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?