Thursday, March 03, 2005

Second Verse, Same as the First

Last Wednesday, we had a brief taste of spring, and several of the moms from preschool took their kids to a local park. We had a brilliant time, the kids got to run off their energy and the moms all shared their snacks and we all agreed to do it again as often as possible. (It turned freezing cold over the weekend so we did a playdate at our house yesterday. Afterward, Wilder threw up his chocolate milk and grapes and then took a nap. He threw up three more times before 11pm. Sigh.)

Also at the park, I had an hour-long conversation with one of the moms about IVF, IUI, and the relative merits of stims when your diagnosis is male-factor infertility. We talked about wand monkeys and sperm analysis and the state of my ovaries. The awkward part? The mom in question is 42 years old, trying for her second child, and swears six ways until Sunday that both her eggs and her (tested last year) FSH levels are good to go. Etiquette and common decency require me not to gasp at any claim by a 42-year old woman that she knows "tons of women who had [non-ART] babies in their mid-forties," and Good Lord, she knows her FSH better than I do. But because the woman in question wanted someone to agree with her that she didn't need stims "because our problem is male-factor, not egg quality," I was hard pressed to know what to say. After an hour, I had pretty much used up my time-tested variations on "well, I'm not an RE" and "I had a different diagnosis so I have no idea" and "It certainly sounds like you're making the best choices for you."

Finally, I lost my head and confessed that I knew of several women in their early forties whose FSH levels took dramatic turns for the worst with no warning (as opposed to, you know, those women whose ovaries sent up warning flares), and hinted that the general consensus in the infertile world would be to act fast whatever she wanted to do. I suggested that if she wanted to do IUI without stims (against the advice of her RE), she should do it soon. I suggested that she could try IUI with stims (as advised by her RE) and call off the insemination if she responded too well for her particular comfort level. I suggested that she was wise to get a second opinion if that's what she wants, but it was my best guess that most other REs would want her to move right along to IVF, and that I heard they did a mean PGD up at Shady Grove. I aplogized six or seven times if I'd overstepped my bounds.

I get approached a lot about ART. I take to heart the advice of other triplet moms that I tread gently when asked, "are they natural?" Sometimes, the answer to "why do you ask?" isn't just stuttering silence as the questioner realizes she's overstepped her bounds. But this is insane. I've now had lengthy conversations about secondary infertility with moms in all but one of the major venues: preschool, Kindermusik, and swimming lessons. (So far, no one has queried my sex life at church.) No doubt it's a reflection of the socio-economic status of the women I meet, because all three SIF moms had their first babies at 38 years old. Probably people "come out" about their infertility to me more than to other women: I doubt the mom in the Kindermusik room whose only child turns out to have been conceived in an FET would have said anything if the SIF mom in the room hadn't raised the topic. I'm glad I don't move through a world where infertility, and especially secondary infertility, is a silent menace. But it does raise some interesting etiquette questions.

Yesterday, the new mom at the preschool talked for rather a long time about how "she wouldn't recommend having your babies so close together" (her daughters are thirteen months apart in age) and I couldn't stop myself from thinking that SIF mom probably didn't need to hear that. It's not my job to educate other women about SIF (my claims to that status being highly dubious) but simply changing the subject felt wrong. How to stand up for my sisters in arms? I have no idea.

Unhappy sidenote: I'm not entirely sure I like being asked about IUI when the question is prefaced by, "I just don't think I could survive having triplets. How did you decide what to do when you were infertile?" I have a fairly complicated answer to that question, and I'm willing to share it, but at some point, how appropriate is it to ask about my responses to triplet motherhood when my kids are tugging on my pants and shrieking for another push on the swings?

10 comments:

Elizabeth said...

I think it's perfectly appropriate for you to say "I'm happy to talk about it with you, but it's not a conversation I want to have in the park/with the kids around/ when we're both distracted."

By the way, I think your posts about selective reduction are by far the most thoughtful (and thought-provoking) writing I've come across on the subject.

Leann said...

I got pregnant at age 42 with insemination and had a great FSH, the doctor was actually shocked when I was pregnant with twins because woman over 40 aren't suppose to be fertile enough for that. My doctor also believes that IVF for over 40's is less successful than insemination for that age because taking an "old" egg out of the body causes a higher risk of damage. Now I'm 43 on my way to 44 with 1 year old twins.

Anonymous said...

I agree with you that most 40-something women are already past the age of happy fertility. However, when I had my FSH tested a couple of months before I turned 40 it was so low that it was comparable to a woman in her 20's. Having said that, though, I would hate for this woman to go around giving the mis-impression that women can continue to delay & delay & delay childbearing. That's what's got a large number of us older mothers in our current predicament, we believed we could wait, we didn't know/accept that there really IS a biological clock that has a "too late" hour which varies from woman to woman. And you're so right, when the clock does turn against a woman it usually happens suddenly, and with no warning. I would not presume that I could easily get pregnant again as I stare 43 in the face (one month away), if at all. I would not presume that my eggs are viable at all anymore because I know I've aged in the past several years. I'm sure the visible toll on the outside of my body mirrors the toll on the inside.

Your last two paragraphs are interesting. I would have been burning had someone assumed a position of authority and started lecturing on how others should space their children. I can't stand people like that. I doubt if I'd have been able to keep my mouth shut, but that doesn't mean I'd have been rude (despite what the yahoos at TC think!). I might have said something like, "hey, we don't all have a choice about when our children come along...".

As for the last question posed, dang, I don't think I've had THAT conversation. OUCH!

Tulip

(OH, that was me who ID'd all the places I've done my laundry.)

Jody said...

Leann,

Luckily, this mom sounds really informed about her options and isn't going to let her RE push her into a choice she's not comfortable with. They're DEFINITELY starting with IUI, the only question is, stims or no stims. And then the question was, how tough are multiples, REALLY. Not an easy one to answer with the kids pulling us in fifteen directions (and when the question is posed with an implicit, "it's hell, right?" attitude).

It just occurred to me that for someone with unexpected SIF, the expectations and assumptions that carry over from the fertile years are vastly different than for folks who had to seek intervention on the first pregnancy, too. I spend so much time on IF blogs, I have to remind myself that most women well into their late thirties still manage to get pregnant and deliver safely!

I really like this mom, I just found her unshakeable optimism so _strange_ LOL.

Jody

Moxie said...

Tulip, I wonder if you'd react the same way to someone who said that she wouldn't recommend waiting until a certain age to have a child. Not everyone can control that, either, but it doesn't mean it doesn't make for a painful experience. I think having kids 13 months apart must be incredibly difficult, and the mother isn't trying to imply that everyone can control that--just that it's not something to be considered lightly (and believe me, there are many women who specifically try to have kids 12-15 months apart, thinking it'll be easy).

I think you really need to consider the source. Was the mom being all breezy and "Oh, ha ha ha! I'm so fabulous and you're suffering from SIF!"? Or was she saying, "This was more difficult than I expected. I wish someone had warned me--maybe I would have made a different decision. I'm telling you because you deserve to have more information than I did."? I think there's a huge difference.

chris said...

I think you handled her questions really well. It can be a little alarming when someone who is pushing the absolute end (in general terms, not for everyone obviously) of fertility doesn't do whatever they can if they want a child and in fact, do it immediately. It can be frustrating when someone is poorly informed or just plain hard headed when you know they might be losing their chance of having another kid.

Personally, I had a really hard time accepting that my miscarriages were age related. It seemed so unfair and it seemed to confirm what everyone said about having kids young. My feelings were pretty irrational, but I couldn't wrap my brain around it, especially when my fsh was never higher than 3. But it is what it is and I think now that I've accepted it, I will be more aggressive than I would have been if I'd still been living in my own little dream world.

Honestly, I would have had a hard time not telling her to RUN to the fertility clinic immediately.

Anonymous said...

Moxie, I'm one of those who, if asked, recommends that a woman not assume her fertility is fully intact, and instead have it checked out via simple blood tests *if she's indicated that biological children are critically important to her*. Having gone through infertility, and being aquinted with literally hundreds of infertile women via the internet, I now know we don't control when, or even IF, children come to us. Having repeatedly read the heartbreak of relatively "young" women (usually in their early 30's) who have already missed the boat for using their own eggs, I cannot in good conscience agree with my once held notion that a woman should wait until she's 30 to have a child (because by then she's had a chance for a career, and to sow her oats, and to mature). This is even more clear to me now that scientists have demonstrated that a woman's fertility begins to decline around age 27. Not that I think sweet young teeny boppers should be popping kids out right & left! Oh no! But I do think that our fertility status, whatever it is, is just too important for us to not know. I think it should be automatically measured & reported at our annual GYN appointments if we've indicated we would like a biological child someday, whether or not we happen to have a partner or husband at the time.

I think women in general, and this includes me, have been thoroughly duped about our fertility.

I also don't think that people should tell others how to space their children (or how many children to have). I was told countless times that it would be impossible for me to mother triplets without help, but dang if I haven't done it! None of us know the capacity within others to handle stress or to parent with love & grace.

Tulip

Jody said...

Chris:

Yeah, it's just hard after knowing so many moms with SIF that _didn't_ end up having second babies, to watch someone else be reasonably laid-back about their own SIF. I just want to pack 'em up and drive 'em to the REs office that minute. And that's probably not so socially acceptable. Right?

Moxie and Tulip:

The other moms in the room had apparently ASKED the mom what it was like to have her two girls so close in age. The only reason I thought it was hard for the mom with SIF to hear about it was because I've heard from moms with SIF that it's frequently hard to hear moms critique having more than one kid. You know, "I'll trade you problems," that sort of thing.

The mom with SIF over at swimming made some comment about her only child at EVERY SINGLE session of the class: how she thought her daughter was lonely, how she felt guilty not doing more while I tried to help my _three_ kids shower, how she wished she could afford IVF. It was immensely painful: I felt like our mere existence was causing her grief. Yucky.

The mom who initiated the big park conversation about SIF seems so immensely HOPEFUL that it probably _didn't_ bother her to have other people talk about the pros and cons of raising two or more children, close in age or not. She actually told me that she's POSITIVE she'll have another baby because she's SEEN HERSELF (in her mind's eye) with more than one kid, in a sort of vision-like way. This tells me (a) that she has NO idea what infertility might turn out to feel like and (b) that I have no experience with visions. But I've known I was infertile since my early twenties (and actually had conversations about IF with doctors in my late teens) so the idea that my visions would be accurate predictors of my future family is really hard for me to embrace. I mean, I visualized myself nursing my single, full-term baby, while I was a vision of perfection in a hunter green velvet nursing dress, at my Grampa's at Christmas 1999, and that didn't exactly work out. And I'm here to tell you, the idea that this body could carry off full-length velvet is so laughable, I can't even express it.

Anyway, the mom at the playdate wasn't setting herself up as any sort of expert about family spacing. She was just talking about her experience, after being invited to do so.

HomeFireBlue said...

I just found your blog six minutes ago and am already compelled to comment ... how obnoxious is that, lol?

I just wanted to throw in some input on the 'close together' issue.

Due to infertility, I got a late start and had my (unexpected) first when I was 37. Since I wanted a large family and I was staring 40 in the face (or the arse, if you like) I have been 'forced' to crowd mine.

I'm not complaining, mind you. I have really enjoyed having mine so close and it's been much easier than expected, but I have to hear the crap all the time. Why didn't I stop at 2? Why am I 'doing this to myself'? Don't I know about chromosomal abnormalities? And worst of all: why am I 'doing this' to the children?

I try to take deep breaths and remember that these idiots weren't there when I was suffering through infertility. Plus they're ... well, idiots.

-Blue

Anonymous said...

I'm with chris. As someone who is 40 with 4 miscarriages all due to chromo. abnormalities, I would have a hard time refraining from telling her to RUN! but the thing is, if it hasn't happened to you you think it probably never will.

It's like the folks who tell everyone they're pregnant at 5 weeks.


marla
middle way