Infertility Myth: If you already have one child, you know you are fertile and will have no problems conceiving again.

In honor of National Infertility Awareness Week, I am sharing my story to bust a common myth about infertility and hopefully encourage those that are currently fighting for family.  It is also my heart’s desire to open the eyes of those that did not endure such a fight so they can be better equipped to support and encourage women that are struggling to become mothers. Infertility is often taken too lightly by those that do not understand its pain. Whether a woman is believing for baby #1, #2 or #4, the realization that your body will not do what it was created to do and your dream of a child (or another child) may never come true is devastating. But there is hope. . .

It was the same month my husband had finally agreed to start trying. I received a call from my OB/GYN with the news. . .I had a hormone imbalance (as she simply put it) and it would be hard to conceive. “Don’t worry,” she said. “We have drugs for that.” Not knowing nearly as much as I know now, I didn’t want to hear about drugs. I didn’t want to have to take drugs to make a baby. How unnatural! I hung up the phone and cried. What do I do now?

The battle began.

A few weeks later I discovered that a new member of my church small group was an OB/GYN. I boldly asked her if she would look at my test results. She said it looked like PCOS (polycystic ovary syndrome) and told me she’d be happy to see me if I wanted to look further into it. This was more information and support than I had received from my current physician so I was anxious to make the switch. Thus began my incredibly encouraging and fruitful relationship with Dr. Rupe.

Within 4 months of first seeing Dr. Rupe, I had conceived with no fertility drugs (just the use of Metformin, which has been known to help regulate the hormones that become imbalanced with PCOS patients).  We were thrilled. At 7 weeks however, even after seeing a heartbeat, I miscarried our first baby. And then we were devastated.

The battle continued.

After much thought and prayer, my husband and I decided we would try fertility drugs (specifically Clomid) as they were pretty successful in helping women with PCOS conceive. The cost was low and the side effects were minimal. As I wrestled with the idea of not conceiving naturally, a good friend said to me, “When you believe it’s time to start a family, you do everything you can to fight for that family.” I knew this was part of our fight. Within 5 cycles, I had conceived again. And we were thrilled. . .again. This time, I made it through 8 weeks with a good ultrasound and strong heartbeat. But when we went in for our 12 week ultrasound there was no heartbeat. The baby had died around 8 1/2 weeks and we never knew it. This time I had to have a D&C which enabled us to test the baby and discover she had Turner Syndrome (one of the most common abnormalities that cause miscarriage).

And the battle raged on. Should I continue to fight?

At this point my doctor advised that I see a fertility specialist since I had experienced multiple miscarriages. We made an appointment immediately and after our first cycle with Clomid, close follicular monitoring and an HCG shot, we conceived again. Nine months later our daughter Hope was born.

I went back on the pill after having Hope because the pill helps regulate PCOS symptoms. We decided we’d wait a few years and go off the pill a few months before trying for baby #2. I believed what everyone said. . .

If you already have one child, you know you are fertile (or can get fertile) and will have no problems conceiving again.

I suppose that was true for us to some extent. We started Clomid in December and conceived in February. Almost immediately after seeing the positive pregnancy test, I began to bleed and knew I was miscarrying again. This time I didn’t have time to become attached to the idea but it was still hard. How could this happen to me again?

We grieved and the battle continued. Was this a new battle or were we still fighting the same one?

I waited for my cycle to start so I could begin another round of Clomid. Four weeks later I began to have very serious pain in my abdomen. I thought perhaps it was just indigestion but it seemed too severe for that. After passing out twice, my husband took me to the ER. They performed a thorough ultrasound and discovered an Ectopic pregnancy. I had conceived twins. One miscarried around 4 weeks and the other continued to grow in my right fallopian tube. The tube had ruptured and I was bleeding internally. I had emergency surgery in which they had to remove the tube. As if conceiving wasn’t hard enough before, now it had to happen with even more obstacles.

The battle grows. Were we supposed to have another child?

Four months later when I was released to try again, I returned to the fertility clinic and continued on Clomid. We knew I needed to produce eggs in my left ovary as that was the side with a tube. Each month for 4 cycles I produced 1 or 2 eggs on the left side. We were so happy my body was cooperating. We decided to do IUI for these cycles to increase our chances of conceiving. But each time we were met with disappointing news. It didn’t work, despite all of our ducks being in a row. I went in for my follicular ultrasound on the 5th cycle and to my surprise, I hadn’t produced any eggs on either side. This had never happened to me. Was it over? Was I out of eggs? The doctor explained we could try more aggressive measures such as injectables and IVF. It’s not that I was opposed to any of those measures. At this point I believed in any and all measures that could be taken to conceive and that the good Lord above, that I so intimately trust, had provided these measures for miracles to come to us. But we couldn’t afford it and I was weary, very weary. I left the office fighting back tears as I checked out at the front desk. Then, the sweet girl there let me know some of my insurance that I thought had gone through actually had not and I owed $800. $800 for treatments I knew hadn’t worked. Why not just flush the money down the toilet?!

Fighting, fighting, fighting.

Right before I walked out the doctor suggested a step-up Clomid protocol that they had been trying recently. He would give me Clomid again, immediately to see if I responded mid-cycle. I was not hopeful but took the prescription and headed to the pharmacy. Two weeks later I returned for monitoring and they discovered I had two big, fat eggs. . .on my right side. The doctor told me to go home and tell him when I got my period. I would not be getting pregnant this month. That evening I had dinner with two dear friends, one of which was my OB, Dr. Rupe. I explained what happened and Dr. Rupe said, “I believe this is the month for you. It can happen. Those tubes can flop around in there.” I knew it wasn’t likely but because my friend (and ironically my physician) said it was possible, I was filled with more hope than I’d had in months.

And the battled continued. . .with hope.

A few weeks later I reluctantly took a pregnancy test, expecting a negative result. To our surprise, we saw double pink lines. I was pregnant from eggs that somehow made it to where they needed to go.

A miracle. A battle won.

I am now 29 weeks along with this miracle boy. Looking back I never could have imagined he would come to us in such an amazing way. It’s not true what they say. . .that once you’ve had a baby, you won’t have trouble conceiving again. But you should have hope.

The truth is we never know what story is being written for our family.

Click here for more information about the battle of infertility: RESOLVE.ORG. Click here for more information about National Infertility Awareness Week.

Still fighting,

Jessica

It’s that time of year again!

No, not fall, at least not in Tennessee where it’s still 90 degrees outside.

No, not football season, at least not in our house.

Its Flu shot time! Or as I like to call, time to argue to strongly encourage patients to get their flu shot. My passion in medicine is prevention. By helping my patient make healthy choices and prevent illness, I feel I am accomplishing so much more than by just passing out a pill to treat their disease. It’s challenging though, to get people to make lifestyle changes at times, but the flu shot is one of the easy things that women (especially pregnant women) can do to improve their health, and prevent illness. The flu shot in young healthy adults reduces the risk of getting the flu by 75%, yet there are still many misconceptions that surround it.

I had a recent conversation with a young mother of an infant (she was not currently pregnant) that went something like this:

Me: It’s recommended that you get a flu shot, because your baby is too young to get one.

Patient: I don’t know…. I’m really worried.

Me : About ????

Patient: autism.

Me : Ummm????? In yourself? But you are 22 years old?

Patient : Yeah

Me: You think you can suddenly ‘catch autism’ from the flu shot at the age of 22?

Patient: yes, I saw it on Oprah.

Me: (working as hard as I can to suppress laughter) Girl, you’ve got your conspiracy theories all mixed up!

This conversation illustrates how fear and misconceptions can interfere with your health.

The risk of being hospitalized from the flu in pregnancy is about 1 in 1000. Those are often life threatening cases. Also, babies born during flu season cannot be immunized and are also at increased risk of flu complications, so having household contacts immunized is helpful. Each year 100 children die of the flu, not a huge number but so preventable! Also, when the flu is contracted, the person is infectious for 24-48 hours before they have any symptoms. This is another reason it’s so important for health care workers to be immunized, especially those that work with babies.

Flu season in the northern hemisphere is October through May. Getting the flu shot as early as possible, will help your body form immunity before the virus becomes widespread in the community. The live nasal mist is not recommended in pregnancy. Also, if you have an egg allergy you should not get the vaccine. Preservative free (thimerosal free) vaccines are also available.

The vaccine is not perfect. Scientists estimate the flu strains that they predict will be the most prevalent and that is not always easy. Also, with age one’s ability to become immune decreases so in the elderly, who are the most vulnerable, it is not as efficacious. Side effects may include pain at the injection site and redness. It’s important to note that the flu shot does not cause the flu!

So the flu shot is not perfect, but it’s the best offense we have. It’s preventative medicine at its best, and I think that’s why I get so worked up about it. So use common sense, lots of hand washing and hand sanitizer, as well as eating a healthy diet rich in fruits and vegetables. In addition, for pregnant women and those with young children, the flu shot is a must.

I recently was forwarded the following link. At first I laughed it off… how silly. Everyone knows that no special products are required for vaginal hygiene??? Right? Perhaps not. At least the advertising execs at Summer’s Eve would have us believe that not only are the lady parts “dirty” in need of special cleaner much like my complicated granite, but also in need of hourly ’touch-ups’ in case they get to stinkin’ in the middle of a business meeting.

The ad, (which if you haven’t followed the link, please do so now) which originally ran in Women’s Day has now been pulled from circulation. To list feminine hygiene in the list of “keys to success” in business is not only offensive, but also feeds into long held myths concerning vaginal health.

So what is normal? Let’s talk a little about vaginal discharge (Bye Dad! I’m assuming he just clicked off this link… if you made it this far) Vaginal discharge is produced by glandular secretions from the cervix, which sits at the tops of the vagina. These glands are similar to the glands in your nose that make snot. (Aren’t you so glad you subscribe to this blog?) They consistency changes during this cycle from thin watery discharge to a thicker discharge, to more like an egg white. This is the body’s way of making a female reproductive tract more accommodating for the sperm. The discharge also helps to flush unwanted bacteria and yeast out of the female reproductive tract. That’s right the vagina is in essence a “self cleaning oven.” Simply needs its outside washed off here and there and then to be left alone. No douches, special sprays or complicated washes needed.

Now, there are a lot of bacteria that make their home in this environment. So, yes much like your arm pits after a couple hours at the gym the area may have odor, but remember external cleaning only is needed. Yes, there are yeast infections and bacterial infections that can occur when the bacteria and yeast get out of their normal balance. What’s a good way to get the bacteria out of balance? Douching and using excessive vaginal cleansers. Yes, douching actually CAUSES infection not the other way around.

That brings me to my final topic: what actually does stink? When women come in for their pelvic exams they almost always say two things as they ‘assume the position’:

#1 “I really hate this”

#2 “I am sorry I didn’t ‘shave my legs’ or ‘get a shower before coming’ ect. Essentially they make some apology about hygiene that is almost always unwarranted.

Generally, all women (myself included) hate getting a pelvic exam, this is understood. Also, due to the design of the exam table my nose is usually quite a distance from your ‘nether regions’. What my nose is right next to is your stinky feet. I think women get so concerned with their ‘Summers eve’ products they don’t realize is that their odorous toes are right next to my nose.

So next time you are running late for your pap appointment, pass on the feminine wash and head to the foot powder instead.

There are just so many myths about the birth control pill I barely know where to start, but I wanted to address a few of the more common ones. One of the most common questions I get is:

“I’ve been on the pill for 2 years, so how long will I need to go off the pill before I want to get pregnant?”

The answer is 2 months.

“But I’ve been on the pill for 5 years, so how long will I need to go off the pill before I want to get pregnant?”

The answer is 2 months.

But I’ve been on the pill for 10 years, so how long will I need to go off the pill before I want to get pregnant?”

The answer is 2 months.

The good (or bad ) thing about the pill is that it has a short “half life.” It is only in your system for about 24 hours. That’s how people get ‘pregnant on the pill,’ they miss one or two and their ovary slips out an egg. There is not some kind of tolerance that your body builds up to the pill over time. There are a lot of women who think the longer they are on the pill the harder it is going to be to get pregnant. THIS IS NOT TRUE. Actually, if you are prone to ovarian cysts or have a history of endometriosis then being on the pill can be PROTECTIVE of your fertility. The pill helps prevent cysts from forming and endometriosis from growing. As a general rule, we recommend having one cycle off the pill and then try to conceive the month after that.

Another common myth is that you should give “your body a break” from the pill every few years. This is also not true. Now there are certain people who should not take the pill at all (such as smokers over the age of 35), and obviously if you don’t need the pill you shouldn’t take it (yes, I know, I’m starting to sound like the announcer that talks fast at the end of the drug commercials). However, if you are happy with the pill and your doctor says that you have no medical problems that would interfere with it, then there is no need to give your body a break from it.

So, those of you considering pregnancy should definitely start taking prenatal vitamins, but don’t stop using birth control until you want to get pregnant. I was once asked by a patient (not Jess!) if she should stop her birth control pills when she started her clomid? Hmmmmmm. I’ll go with yes on that one.

FYI: if you are on the depo-provera shot, that is another story. It can take up to year for ovulation to return.

I’m going to start a series of posts that I’ll call Mythbusters. The idea is to address certain myths associated with fertility and pregnancy. The purpose of our book is to help take some of the fear our of pregnancy and make it a journey of faith and peace. Misconceptions by friends, family and the media can add to the fear, often unnecessarily.

I recently had a nice patient come in for her pap smear who had the wonderful news that she had just gotten married. She was 26 and her husband was 27. She then proceeded to say something along the lines of “We don’t feel ready to have kids yet, but I’m worried since I’m SO old! Should we go ahead and try?”

Okay, so my first reaction, as an elderly 34 year old, was indignation.

Next I had one of those medical day dreams (like JD does on Scrubs):

I picture a serious scene with dramatic music.
“I need a crash cart STAT! These ovaries are dying!” I say.
“1-2-3….CLEAR!”
I then proceed to use the paddles to coax the dusty shriveled up old ovaries back to life.
” Phew! I saved one last egg in the nick of time.” I say with much bravado
“Thank you doctor! You’re so awesome! “ says patient
“All in a days work ma’am” I say and walk away into the sunset

Then, she clears her throat and I come back to reality. I begin to discuss the facts with the patient. First off you should not have kids until you’re ready. Period. While there is a slight decline in fertility at the age of 27, there is not a sharp decline until age 37.

“Yeah, but everyone says you need to have your kids by 35 because that’s ‘Advanced Maternal Age’” says patient.

How I hate that term. I hate it more since I’m breathing heavily down the neck of 35 as we speak. This term has to do with the risk of Down’s syndrome, which does increase with age. The age of 35 is when the experts originally recommended testing, because the risk of the test (aminocentesis) was less than the risk of the disease. Technology has changed and we don’t base our testing only on these figures, but much to my chagrin the terminology has remained. This has helped perpetuate the dusty old ovary myth.

Here’s the numbers:
At the age of 20 your risk of having a baby with Down’s syndrome is 1 in 2000
At the age of 35 your risk of having a baby with Down’s syndrome is 1 in 250
At the age of 40 your risk of having a baby with Down syndrome is 1 in 69
At the age of 45 your risk of having a baby with Down syndrome is 1 in 19

Let’s look at the numbers another way. What’s your chances of having a baby that DOESN’T have down syndrome:
At the age of 20 its 99.095%
At the age of 35 its 99.6%
At the age of 40 its 98.6%
At the age of 45 its 94.8%

Yeah. I like the second set of numbers better. So yes, in an ideal world, medically we should all have our babies when we’re 20. Socially, however, that’s usually not the best time. This is a personal decision for each couple.

Ok. So watch a good scrubs clip. Now, I’ll try to stay off you-tube,and get back to writing this book!