Feature image by K. Zinsser
I’ve wanted a baby for years. Many of my friends have toddlers already, and I was anxious to get the “have 2.5 children” box ticked off on my life goals. I felt a desperate need to “catch up,” which I know is both ridiculous and insulting to those good friends of mine who aren’t even in a relationship yet and also want children (and don’t want to parent on their own). I get anxious about completing tasks at some nebulous time in the future, and can’t fully feel relaxed until they’re complete.
For me, the bad days are triggered by fear: that it’s too late, that I’m too old, that horrible things will happen again. I am a box checker. In fact, completing items is something about which I am rather obsessive. In my entire life, for example, there has only been one book that I didn’t finish (Catch 22, if you must know). Several of my bookshelves contain books that I haven’t yet read but plan to, and I will feel a vague sense of dissatisfaction until they are complete; the stack of four by my bed is arranged in the order in which I will read them next. A new book may come out and move an older one farther down the pile, but the old book will remain until it is read. I tell you this because I think that this obsession about completing items on my to-do list is what contributed to my panic about not yet having a living child.
On good days, I remember that the problem is that I am the one who makes the to-do list. And it’s an arbitrary to-do list. There is no rule that says I have to read those books next to my bed, or on my bookshelves. If I didn’t read a single one of them, no one would know or care but me. This translates to child-bearing, too. In the ten months between my son Anderson’s death and the new baby’s conception, I was constantly anxious about getting pregnant again. About how old I’d be when we could start trying again. About how long it would take me to get pregnant. About if I’d miscarry. About if I’d have another abruption. About if I’d be on bedrest. About if something goes wrong with the c-section. About if the baby has a disability or heart defect. About SIDS. About childhood cancers and diseases. When I see another friend get pregnant, have a baby, have a second baby before me. About a whole lot of other things I had to learn to let go because they cannot be controlled.
When we were first trying to conceive Ander, I was the killjoy, the “remember our odds are only 25% each time,” the “we’ll see.” For the first ten weeks, I was the “remember one in four pregnancies end in miscarriage,” the “let’s not tell anyone until at least 14 weeks, to be safe.”
Ironically, the wild hope came later, after the bleeding started at 19 weeks, after the doctors told us to prepare for the worst. It was then that I became the “c’mon baby, we can do this,” the “let’s buy some clothes and stuffed animals just in case,” the “we should start a registry.”
When my wife and I were preparing to start trying to conceive again, we had to balance a lot of bad days and good days, a lot of “what ifs” and statistics and medical advice. The simple fact is, no one knows why I had an abruption, so we were left guessing as to what adaptations to the TTC process might lessen our chances of a recurrence.
In meeting with our Maternal Fetal Medicine (MFM) specialist, we could definitively say the following. All of these carry their own risks, so we faced balancing how reckless we wanted to be versus other, more practical concerns. The fact of the matter is, we cannot control for everything. So, what can we control that will help us feel more at ease? What must we absolutely do, and what can we leave to the fates? How can we feel both in control of the process, but not obsess over being in control (when we know now that ultimately, control only gets you so far)? Here are the risks we were balancing:
- There is a risk of recurrence. Because I used IUI (which, along with IVF, carries a higher abruption risk) and because we cannot eliminate other risk factors (such as smoking, since I never was a smoker), my risk is approximately 20% for a repeat abruption. Risk: moderate to high, but nothing we can do about it.
- I am CMV negative. I hadn’t gotten tested for this before, but now know I’m in the minority who has not been exposed to this virus. Our donor is CMV igG positive but CMV igM negative, meaning he has been exposed to the virus, but was not actively infected when he donated. There is an extremely small chance the virus could pass to me through the semen, but we’re talking really low. There’s a greater chance — though still small — that I could contract CMV while pregnant. If I do, there’s a 20% chance the baby could end up with moderate to severe birth defects. Great. But ultimately, not much I can do about it. It didn’t happen last time, and the CMV status had nothing to do with my abruption. Risk: low.
- Oh, the ever present donor question. Should we switch? On one hand, there is a small body of research that suggests some placental issues, such as preeclampsia, are tied to sperm, and that placental formation is likely driven by the male genes. Do we know this for sure? No. Are there any placental abruption studies that link it to sperm? No. Can we, in our doctor’s words, guarantee that we are selecting a “safe” donor if we choose to switch? No. So what we weigh is having a full sibling to Ander or not. Then, there’s the fact that we have only eight vials left, enough for four months of trying, and the donor is sold out. We thought eight would be enough for a sibling, and it will… but will it be enough for two, now that Ander has died? Unfortunately, we don’t know, on either count. Then there’s the cost; we already pre-purchased the sperm after we had made it 18 weeks into a “successful” pregnancy, so we’d be out a decent amount of money. Risk: moderate either way, unfortunately. My wife would like to use the same donor, so we decided to do so, and I’m letting go of the anxiety about that decision. There’s only so much we can do.
- What I could do, to eliminate or lessen another factor that makes me anxious: get tested for clotting factors. My MFM didn’t think it was necessary, though he left it up to me, basically saying that if I’m worried about it, I could get tested. He also said that if I did have a clotting factors issue, that might just make me more nervous, and that treatments such as Lovenox and baby aspirin carried other risks that could cause me additional anxiety. However, due to the fact that we decided to keep our donor, and due to a second opinion, I decided to get tested. This will at least allow me to manage my anxiety about this. If I test negative, great; I can let it go. If I test positive, at least I’ll have some weapons in my arsenal. Risk: low. I didn’t really have anything to lose, and didn’t think I had a clotting factors disorder anyway. (Note: I didn’t.)
So there’s that. We’re trying to balance being responsible and reasonable with being… not reckless, but rational? Are those all synonyms? It feels reckless, to keep the same donor, but on the other hand — if this were a male partner’s sperm, it’s not like I would trade him in for the hope of an improved model, knowing that the new version could also be a dud, so to speak. It feels like… a reasonable risk. As the wife points out, we did everything “right” the last time, and we know how that turned out, so maybe we should let go of some of the control this time and let things be. I vacillate between that and “must control or else I’ll blame myself if something happens again.”
So in our reckless optimism, we decided – and were cleared – to start trying again. When we started TTC the first time, we went to a fabulous clinic that specializes in helping LGBT couples have babies (yes, we know how lucky we are. Thank you, major city!). They are therefore used to working with women who have no known fertility issues except the obvious lack of sperm, which means that they fully support drug-free attempts at IUI and ICI. It also means, however, that they’re sticklers about charting for at least three full months before any doctor-assisted process (we chose doctor-assisted IUI, as this sh*t’s expensive and this has shown the greatest probability of success within four months of trying). At our clinic, when you begin the process, you are required to attend a one-hour consultation in which you learn all about charting and exactly how to do it, and are given sheets on which to track everything, daily (no app. A literal chart on a literal sheet of white paper, which you then take to work and surreptitiously photocopy).
The first go-round, I took extensive notes on everything, from my level of cramps and pain to the exact look of my cervical mucus. It helped a bit; for example, I discovered that I get a low, dull backache when I ovulate. But now that I’m a veteran at this, I’ve learned that really, only three things mattered for me when taking a good chart: cervical mucus, ovulation predictor kits (OPK), and basal body temperature (BBT). The first tells you that you’ll likely ovulate in the next few days, the second that your ovulation is imminent, and the third that you’ve ovulated. These three things in combination helped paint a picture for me and my doctor of what my specific ovulation pattern looks like. A breakdown is below. A disclaimer: I’m not a doctor. This is what I have learned, and what works for me. Talk to your doctor about what tweaks would work best for you!
Cervical mucus – don’t bother Googling images. They’re gross. And what your cervical mucus looks like isn’t necessarily what someone else’s will. Pay attention to yours, though. It will likely — and I say likely — start out watery and then turn egg white when you’re about to ovulate. This is good — healthy cervical mucus is what helps lubricate and protect the sperm on its journey. For me, it means a few days of discomfort at the gym, when running feels like I’m peeing in my pants. Good times. Also, however, it is the most accurate way for me to determine when it’s the right time to use an…
Ovulation Predictor Kit – necessary for pinpointing your most fertile window. I’ve heard doctors with various theories on when you’re most likely to get pregnant. I will say that I got my first OPK positive on a Thursday evening, and my IUI was scheduled for noon on Friday and 8 a.m. on Saturday (two per cycle was recommended by my clinic, to increase the likelihood of success). And I got pregnant. My friend’s doctor would have scheduled her for Saturday and Sunday (she’s not pregnant). So make of that what you will. When you’re actively trying to get pregnant, it’s not uncommon to test first thing in the morning, mid-day, and in the evening starting around day ten of your cycle. With the second baby, I only tested in the morning (a positive should be visible for 24-48 hours), though I did start at day ten. I didn’t want to get too obsessed over charting, knowing that controlling my need for control was important. That said, I described to my wife how anxious I was that it was day 14 and I hadn’t gotten a positive OPK yet (usually I ovulate around day 12). “Could you have missed it?” she asked. “Unlikely,” I shrugged, “but possible. After all, I’m only testing in the morning. I don’t want to obsess about it too much.” “Tell me,” she laughed. “Would testing twice a day make you obsess about it more than you are right now?” I had to concede this was an excellent point. So, twice a day it was. Other notes on OPKs – we found it best to buy the sticks in bulk from Amazon. You’ll save tons of money, and they usually come with a handful of pregnancy test strips, too. No frills, but less than half the price you’ll find at the drugstore. The only other thing you need is disposable cups in which to pee. Once you get a positive OPK, time to check your…
Basal Body Temperature – granted, you start charting your BBT the first day of your period (day one for charting). This establishes a baseline, as all a BBT will tell you is if you actually ovulated — a BBT should spike several tenths of a degree post-ovulation. This is helpful information for fertility docs, since this helps them determine if further tests are needed and provides evidence that a medical intervention like Clomid might be necessary. Taking BBT sucked the first time around, but as I’ve mentioned, I’ve learned a few things. One, I bought a good, reliable basal thermometer, cotton balls, and alcohol (for cleaning said thermometer). If you’re lucky, you have an alarm clock with a flat top, like mine. I put the thermometer right on top of my snooze button. Five days a week, the alarm goes off at 6:50, I reach over, pop the thermometer in my mouth, wait until it beeps, turn it off, hit snooze, and go back to sleep until the alarm goes off again at 7:00 (then I lounge around until around 7:15, when I drag myself into the kitchen for coffee, but that’s neither here nor there). Actually, when I finally sit up in bed, I first turn back on my thermometer, which retains the last reading, put a dot on the chart I taped to the wall next to my bed (it’ll ultimately look like a line graph), go pee in a cup and dip in my OPK, and let it do its five-minutes thing while making coffee. I take the coffee back to the bedroom, check the OPK (“stupid bleeping negative!”), throw out the test strip, and pout while handing the wife her coffee (I do weekdays, she does weekends. Pretty fair deal). Oh, back to BBTs. It’s a pain, true. And most of the time, it seems completely unnecessary. But the post-ovulation spike can be quite reassuring. Now, most of the time I get up around the same time, and my temp is pretty steady. But as I’m just looking for a pattern, I actually don’t worry too much about it. I take my temp regardless, whether I went to bed late, got up late, drank too much alcohol the night before, was hot, was cold, was traveling, etc. If I miss a day, I just miss it and take my temp the next day. Patterns, after all. I do note on my chart the time I took my temp and if there was any other anomaly that could explain an errant reading (like last Saturday, when we went camping and I was restless most of the night due to a thunderstorm). The time matters, because body temperature rises with time, so if you’re, say, at 97.0 every morning at 7 a.m., then a reading of 97.6 at 8 a.m. would be perfectly normal and within your pattern. On the other hand, a 97.6 at 7 a.m. might indicate you have ovulated…. or that it was 95 degrees in your bedroom because your air conditioning was on the fritz. I write it down, look for the pattern… but don’t obsess too much. BBT is helpful for a doctor in determining if you’re ovulating, but waiting for a spike in BBT to have sex would likely be too late for pregnancy purposes. It’s used as confirmation, not a predictor.
There you have it. It’s a pain. But it’s also a way to feel like you’re doing something to pass the time. Really, they should have taught us this in school. How many pregnancies could be prevented if teenage girls knew that cervical mucus was a big “danger/congratulations, you’re fertile!” sign? Especially knowing that our hormones prime us to feel randier during these days. So, not IF, but WHEN your baby is conceived and arrives, let me know if any of this worked for you. And don’t let it take a tragedy for you to indulge in reckless hope.