Treatment for Infertility: When are the costs too high?

Jen at This is More Personal recently stopped blogging for the best of reasons: in December, she and her husband adopted a baby girl.

Jen's struggles have helped me so much in my own journey. After one round of IVF, which resulted in a chemical pregnancy, and a few canceled cycles, Jen and her husband decided they couldn't take any more. Jen's experience put words to something I had been thinking for a while: IVF has emotional, financial and physical costs that are rarely, or perhaps never, acknowledged by the medical profession. Reading through Jen's narratives of her IVF journey made me clearly see that IVF would break me. The stress of spending $15K on a twenty percent chance of getting pregnant, the mood swings that come with high doses of hormones (for whatever reason, I'm extremely sensitive to all medications), the anxiety of being constantly poked and prodded.....I knew I could not do that. The emotional, financial and physical costs of IVF would be too high for me.

(This actually had very little to do with most religious arguments against IVF. I'm not convinced that the unitive and procreative purposes of marriage should never be separated. As for the destruction of precious embryos....what was my body was doing with my embryos every month for a solid year? I was unlikely to produce dozens of eggs, and a couple embryos would probably have been safer in the hands of a competent embryologist than in my inflamed womb.) 

So instead, I turned to alternative therapies. I had always had a healthy diet, but for a solid year, I eliminated alcohol, sugar, refined grains, fried foods, and caffeine. I ditched exercise that I loved, like swimming and intense yoga and instead stuck to the brutally boring Fertility Yoga. I took my temperatures every single morning, stressing out when I ovulated a few days early, because of course, women with DOR "always" ovulate early (except when we are completely asymptomatic). I meditated, I prayed. I structured my days around what supplements I needed to take and when. My entire life became about trying to get pregnant.

It didn't work. Eventually, I realized that these alternative therapies also have high costs. When you give up activities and things that used to give you pleasure in order to get pregnant, and you don't get pregnant, month after devastating month, you begin to lose your soul. Eventually, I realized that I could not continue to live that way; even if I did eventually get pregnant, didn't my child deserve better than the person I had become: jealous, bitter, joyless?

So, I've stopped. I need to update my supplements page, because beyond a few vitamins for basic health, I've stopped taking them. I still do Fertility Yoga, but I also swim and go to Ashtanga Yoga once a week (even in the luteal phase). I'm still staying away from fried foods, because they really do make me feel sick, but if I feel no immediate benefit to eliminating a certain food, I just go ahead and eat it (in moderation).

More joy in my life makes it easier to face infertility, and the fact that I might never get pregnant. Because really, nothing--not even motherhood is worth my soul.

Alternative Therapies: Restoring Fertility Yoga DVD

I ordered these DVDs in May of last year, and I have been using them most days (I took a break for my surgery and recovery). Each workout is 35-40 minutes long and coordinated with your cycle. There are four phases: Menstrual, follicular (end of menstruation to day 10), ovulation (days 10-14) and luteal. They claim to treat a variety of conditions that cause infertility: endometriosis, PCOS, irregular ovulation, etc. The creators of the DVD are practitioners of Chinese medicine, which views infertility as the result of imbalance in the body. The goal is to balance the various energies in the body, after which fertility should result.

Each workout is short. Even on days when I'm exhausted and busy, I can usually squeeze in Fertility Yoga. Before my surgery, the workouts seemed to be alleviating my cramps a tiny bit. (It would be unfair to expect 30 minutes of yoga a day to dissolve a 10-cm adenomyoma.) I love all the twisting and hip-stretches in the menstrual and follicular phases.

The authors are very on top of their Amazon reviews, and respond to the questions and comments therein. This is how I know that these DVDs have the potential to help women with DOR, but it takes as long as 13 months for new follicles to emerge.

This is where my issues come in. These workouts are very mild, probably because according to Chinese medicine, exercising to the point of depletion is a bad idea when trying to conceive. All well and good, but the exercises were so mild that after a few months, I had lost a lot of muscle. (I am a thin person who must really work at muscle building. I've never had nor desired a rock-hard, muscular body, but I don't want to be skin and bones, either.) While you can do other kinds of yoga, between the end of menstruation and ovulation, for me that's only one week, not nearly enough to prevent loss of muscle. The luteal phase yoga, on the other hand, offers no challenges for stretching or resistance for two weeks of every cycle. Doing this for a couple of months would have been fine, but for more than a year? It didn't seem like a good idea to scale back my exercise so much for so long.

Now that I'm not letting infertility steal my soul anymore, I still use these DVDs on days when I have no other workout planned--about 3-4 days a week. I go to my Vinyasa class, even after ovulation (though only once or twice a week). I go swimming because nothing, NOTHING soothes my anxiety like swimming.

The authors are very insistent that menstruation is a vulnerable time when women are pre-disposed to overextending themselves. I take their advice and just do the DVD menstrual phase workout and no other, which provides a nice rest during my period.

****This post is a reflection of my own experience and does not constitute any medical advice to anyone.****

Update: I take that back

It was slow in coming, but I had horrible pain, nausea, vomiting and LOTS of despair this morning. I'm feeling better now, but

YES, I'm happy I'm have surgery.

NO, there is absolutely no point in waiting.

YES, it will be worth the money, the inconvenience, the time off work.

NO, I cannot keep living like this.

Something is working

It's CD1. No disappointment this time, because we took a break this month. But here I am, sitting up in bed with minimal pain: no vomiting, no writhing, no tears, no wishing death upon myself. Last month was similar; I was even able to drag myself out of bed for a work function that I could not miss.

The hard thing about my kitchen-sink approach to alternative therapies is that I have no idea what's working. My periods took a turn for the better when I started taking blood movers (Chinese herbs) during the first part of my cycle. They aren't safe during pregnancy, so I would discontinue after ovulation. Around the same time, I started fertility yoga. The creators claim that this yoga, in which you do a different set of poses for each phase of the cycle, helps with endometriosis (or in Chinese medical terms, blood stagnation). And at the same time, I started avoiding stagnating foods. I've always eaten healthy food overall, but once a week or so I would indulge in french fries, potato chips, eating to excess. For months, I've been avoiding any food that gives me that bloated feeling.

And finally, after that dreadful experience being off the NSAIDS in anticipation of my hysteroscopy, I was reminded of the magic of prostaglandin inhibitors and starting taking them liberally at the first sign of PMS cramps.

So I have no way of knowing what's working and I don't intend to try any kind of process of elimination, because I have no desire to spend a day in bed disabled by severe abdominal pain and vomiting.

I'm feeling a bit silly for scheduling surgery because of my intolerable pain, when suddenly, it's become quite tolerable. On the other hand, my surgeon was quite clear that the adenomyoma could be causing implantation failure, and I don't want to spend another year TTC, only to find out it was the adenomyoma all along.

Why I don't take a prenatal vitamin

At the top of every communication from my RE, there is a reminder to "begin or continue taking a prenatal vitamin." I won't be doing this. There is nothing magic about pre-natal vitamins. They contain they same vitamins and minerals found in many other supplements.

WebMD recommends a prenatal vitamin with around

400 mcg of folic acid
400 IU of vitamin D
200 to 300 mg of calcium
70 mg of vitamin C
3 mg of thiamine
2 mg of riboflavin
20 mg of niacine
6 mcg of vitamin B12
10 mg of vitamin E
15 mg of zinc
17 mg of iron

With the combination of vitamins and supplements I already take, I have all of those bases covered. In addition, calcium blocks iron absorption; if you want to actually absorb the iron you're paying for, you shouldn't take it with any calcium at all.

Finally, like everything having to do with conception and birth, pre-natals are much more expensive than your average multi-vitamin. No one desperate to conceive would balk at the price of a vitamin, so they charge more.

I'm hardly against spending a lot of money on supplements, but have given and will continue to give pre-natals a pass.

Alternative Therapies: Centering Prayer

My name is Sarah, and I am anxious. I've been anxious as long as I can remember. I get anxious before I teach, every single day. I get anxious before I write. I get anxious in social situations. I get anxious before choir practice. I remember telling a couple of friends that I was getting dizzy at work meetings. "Um, Sarah?" they said.  "Those are panic attacks."

I can't take drugs for it, because all SSRIs make me sleep twelve hours a day, or more.

Every alternative-type infertility book I have read waxes expansive about the dreadful effects of stress on the reproductive system. This makes me feel terrible. I can't seem to control my anxiety, and the thought that anxiety is preventing pregnancy makes me even more anxious.

By the time Lent rolled around this year, my anxiety was out of control. TTC + bad test results will do that to you.

I decided I didn't really have any food stuffs to give up for Lent.  As soon as I got my test results I kicked alcohol, sugar, caffeine and most dairy. And I have to eat meat for my kidney yang. I decided instead to recommit to the Centering Prayer. The Centering Prayer is a kind of Christian meditation. Most of the time, when I pray, I talk to God. I talk and talk and talk. The Centering Prayer is a way of praying by intentionally listening to God's voice, rather than talking. I choose a sacred word (mine is Yahweh--and I apologize to Jews who may be reading this, but that's what it is), I invite God to speak to me ("Speak, Lord, your servant is listening). I relax and let my thoughts go. When an interesting thought comes along that commands my attention, I gently repeat my sacred word and let the thought go.

"What if I never get pregnant?" I let it go.
"What if adoption doesn't work out for us?" I let it go.
"What if I ovulate early/late/not at all this month?" I let it go.

God doesn't talk to me in English. In fact, God's voice doesn't usually sound like a voice at all. Sometimes I feel loved and at peace.  Sometimes, I battle my thoughts for my entire prayer time and I don't feel a thing, except a sense of disappointment for failing to meditate properly. I let it go.

I know God is speaking to me because my life becomes easier. I become easier to live with, more patient, less likely to pick fights with DH, more forgiving, less judgmental. I become less anxious (though I suspect that I will have a lifelong battle with anxiety).

Halfway through Lent, my DH said to me, "You haven't told me what you're doing for Lent, but I know that you're working on something, because I've noticed the difference in you and I want to thank you."

It's amazing how twenty minutes a day can change your life.

Current Alternative and Western Treatments

Here is a current list of my alternative and mainstream treatments:

Vitamins and Supplements

B-complex (overall health and energy, plus additional folic acid)

Cod Liver Oil (immune health, plus post-colonial children swear by it)

Vitamin D (diagnosed with low vitamin D 12/11)

Selenium (thyroid function)

Zinc (thyroid function and PMS)

Evening Primose Oil - only until ovulation (endometriosis and PMS)
Vitamin E (endometriosis) Discontinued post-surgery.

Pyncnogenol (endometriosis) Discontinued post-surgery.

Fish Oil Supplement (endometriosis) Discontinued post-surgery.

CoQ10 (egg quality)

Royal Jelly (egg quality) Discontinued 1/13.

L-arginine (egg quality) Discontinued 1/13.

Chlorella (egg quality) Discontinued 1/13.

Iron (iron deficiency, diagnosed 12/11)

Calcium (bone health)

Magnesium (cramps and PMS)

Wheat Grass (egg quality and FSH) 

Traditional Chinese Medicine

Weekly acupuncture (started 4/2004)

Prescription Chinese Herbal Formula

Spirituality and Psychological Health

Centering Prayer (1-2x/day)

Yoga for Fertility (Aiming for 1x/day)

Therapy

Western Medicine

Synthyroid (hypothyroid, diagnosed 4/12)