That Mythical Second Pregnancy

I suppose opinions might vary on this, but on my list of things I DIDN'T want to experience while taking care of an infant, contracting a nasty stomach bug was right at the top. Thankfully O is fine - we think I might have gotten food poisoning, actually, and since he rarely eats takeout he probably wasn't exposed - but the past few days were not pretty. We've spent all this time and energy worrying about how to keep O safe from the influenza epidemic that's affecting the entire country, but it never occurred to me that I might suddenly become nauseous, feverish, and spend two days unable to get off the couch. Harry helped out as much as he could, but at one point I was alone and I needed to get O from our living room downstairs up to his nursery, change him, and put him to bed for the night. I swear to you that accomplishing that task while trying not to vomit was equally as difficult as actually giving birth to him back in October. So why am I already obsessed with planning for baby #2? I mean, I spent weeks upon weeks of my pregnancy feeling debilitated with nausea. I also lay on the couch for entire weekends and routinely slept 9-10 hours on weeknights, and still felt exhausted. I complained about being pregnant to anyone who would listen. Yet even a tiny reminder of that nausea and exhaustion wasn't enough to dissuade me from daydreaming about when I can start my next IVF cycle.

It's not just that I'm excited about the possibility of having another baby - it's more than that. I'm also incredibly nostalgic for my pregnancy, believe it or not, and that feeling started almost as soon as they placed my tiny little boy on my chest in the delivery room. Right after we got home from the hospital, only one day after my official due date, we brought O to the pediatrician to check his bilirubin levels. Their office is located on the same floor as a very busy Ob-Gyn practice, and on our way in we encountered no fewer than three pregnant women. One looked like she was ready to deliver, her belly just as huge and as distended as mine, now deflated, had been mere days before. Did I give her a sympathetic glance and a cheery "Good luck!" like some sort of recent Pregnancy Academy graduate? Nope. Instead I got really sad, because all I could think was, I wish I were still pregnant. And it didn't stop there. Right up until I had passed what would have been my 42nd week, every day I would think, You know, I could still be pregnant. Right now. A lifetime has passed since O was born, but it didn't have to work out that way. We could still be the way we were, living in a state of nervous excitement, sleeping long hours, fielding phone calls from expectant relatives, feeling our little boy wriggle and kick from inside my belly. And when the sadness peaked, I would console myself by thinking, I can do this again. I can get pregnant again - probably. I can try, anyway. I bet it will work. And then I get to go through this incredibly special thing, this absolute miracle, at least one more time.

At this point, I'm going say what longtime readers have been thinking: are you CRAZY? You hated being pregnant! Don't you remember the constant stress, the worry, the wear and tear on your body, the daily obsession with whether the baby was going to survive, not to mention the psychological damage from a traumatic IVF cycle? You were miserable for your entire first and second trimesters - as in, really miserable, clinically miserable, miserable enough that you didn't dare bring it up with your doctors because you knew they would be horrified and start talking about drugs and therapy and all sorts of unpleasant things. That kind of miserable. All you wanted was the baby to be out and safe so you could have a chance at feeling like yourself again; you wanted him to be happy and healthy and now he is and why isn't that enough?

I've spent the past three months going over and over these questions, and what follows is my best guess at why I've had this unbelievably surprising reaction:

- Hormones, plain and simple. Postpartum changes are generally acknowledged to be terrible and make you think crazy things. (By the way, did anyone else catch the fertility drug references on 30 Rock recently and maybe laugh a little too knowingly?) But... it's been three months. And I still think all the time about getting pregnant again.

- We really do want to have another baby. Harry and I both grew up with siblings, and the picture in our heads of our eventual family has always had more than one child in it. I'm often hesitant to bring this up in conversation because I know that people can hear "we want to have another baby" as "my existing baby just isn't enough to satisfy me," and that's not it at all. I would frame it more that we love O so much, we can't wait to love his sibling(s), and we're excited for him to love those siblings as well.

- I just want to get this over with. Who knows how much longer I have with my ovaries intact? Could be months, could be decades. (In other words: my biological clock is ticking!) There's that, but there's also the outgrowth of my initial hesitation to have a baby. We've now had a baby, he's here, he's wonderful, and he is also most definitely a ton of work. I'm back to looking at my other life goals with a bit of a longer lens and thinking, you know, in ten years maybe I could do this... in fifteen, maybe that... but if I extend my childbearing years, those goals just get farther and farther away. If we're committed to another child, then let's just get the show on the road already.

- Pregnancy is really special. Yeah, I'll go ahead and say it. I miss the attention more than I would have ever predicted. But I also miss walking around with an amazing secret inside of me. It was a time outside of normal cares and concerns; everything else in my life took a backseat while I concentrated on my #1 job: create a tiny human. Now that things are back to "normal," I am surprisingly wistful about the ability I had over the last year to determine what was important and what wasn't. In other words, I'm back to sweating the small stuff.

- I feel like I screwed it up last time. Oh, it's not like I did something really awful while I was pregnant that I now regret. I didn't ingest banned substances or spend nine months skydiving and eating sushi and generally ignoring all of my obstetrician's advice. But I did spend a large amount of my pregnancy weeping, fretting, and generally feeling sorry for myself and my baby. I know I can't control for all of those things (or for actual medical complications), but I also can't imagine how different it would be to go through a pregnancy that felt... joyous. Or at least not so upsetting.

So we'll see. For now, just to follow up on a recent post, I did decide to take a progestin-only pill while we wait to see what my ovaries do next - for the moment, they're stable with endometriomas between 1-2 cm on each side. I feel generally okay although I think I'm a bit "flat" compared to my usual pre-surgery, pre-IVF, pre-pregnancy self... then again, I have no idea how I would feel with just the hormonal changes that come along with breastfeeding, so it's hard to blame anything on the pill. Nothing remotely interesting will happen in my reproductive life until at least April, which is O's six month birthday and the absolute earliest anyone would entertain a discussion with me about another IVF cycle (and even I recognize that jumping right back into things this soon isn't great for my body overall.) So we wait. Who knows, by April I might feel differently, and in the meantime, I have the most wonderfulest little baby in the world to snuggle and love.

More Bears!

An actual mama bear and her cub, from goo.gl/UtK0X

This is just to say:

I went for a run. A real one. And I guess that now my body thinks a bear was chasing me. A big, giant, angry bear who made me run so far and so fast that today my legs are killing me. (Actually, it was a pretty mild workout, but I am massively out of shape!) For the record, my last official run was on Martin Luther King Jr. Day last year, January 16, 2012. Through a combination of factors - IVF, pregnancy, postpartum healing, a stupidly broken foot, and last but not least, a treadmill that was only fixed last week - I managed to get back to exercising on Martin Luther King Jr. Day 2013. The big question is when I'll be able to do it again after yesterday... a week? A month? Once O learns to run himself, and I'm constantly chasing after him? :-D

Breastfeeding and D-MER

It's taken me a while to complete this post. Why? Because it's hard to type with an infant suckling at your breast!

Yes, we are breastfeeding. At the moment, we're even doing it exclusively, and O is growing like a champ! It isn't terribly difficult, painful, or frankly that interesting. Several times a day, I hold O so his little mouth is near my breast, he latches on and drinks his fill, and then I bounce him up and down a few times until he belches. No muss, no fuss (well, okay, sometimes burping turns into spitting up and there's a little muss and fuss.)

I know we're very lucky to have had such a good experience. I was bracing for the worst, based on articles like this one, and instead we got through with only a few minor hiccups. The beginning was a little rocky, mostly since my milk took six days to really come in and in the meantime O was turning Jersey Shore levels of tan from jaundice, so for about a week we were plying him with formula in order to stop his weight loss (13% at the lowest point, not great!) and prevent him from having to go under the special lights at the hospital. My nipples also took one for the team, to say the least: it hurt them quite a lot to have near-constant sucking from a hungry baby, and lanolin was my constant friend for the first three weeks or so. But then, as with everything relating to newborn care, it started getting easier. He went longer between meals, my milk seemed to satisfy him more, the pain disappeared completely, and I even figured out when I could pump a little to put something away for a rainy day. My supply is meeting his demand pretty much as I expected, and hopefully it will continue as I go back to work. If not, we'll start giving him some formula, which is hardly the end of the world.

There's only one notable thing about my experience with breastfeeding that I want to mention in case it ever helps someone else. For several weeks after giving birth, I didn't feel my milk let down the way I had been told to expect (tingling, a "whoosh," warmth, etc.) I also didn't feel a particularly warm and fuzzy feeling while nursing, but whatever, I was sleep-deprived and hormonal and things were all topsy-turvy. About a month into it, however, I finally felt my breasts tingle a bit right before or during the beginning of a feed. If I didn't happen to be nursing when it happened, my breasts would even leak a bit (thank goodness for breast pads.) Ah, I thought, this is let-down! And once I had identified it, I also noticed that I would have a very weird and unpleasant feeling about 60-90 seconds before my breasts started tingling and leaking. It was a fleeting sensation of dread, of revulsion, of sheer unhappiness and depression. Just a wave of blah. I wasn't actually unhappy, far from it, the feeling just came over me no matter what I happened to be doing or thinking when my milk let down. It ended as quickly as it had begun, although it would recur if I had multiple let-downs during a nursing session, but usually not as strong. 

I mentioned it to my mother, who remembered it well from her own days nursing, and that made me feel better. It didn't bother me too much once I identified it, because when the bad feeling came over me I could say to myself, this is fake, it's not real, just ignore it. But I love my obsessive researching and my Dr. Google, and presently I thought to look up my symptoms.

Lo and behold, I discovered that not only was my vague bad feeling real, it had a name: D-MER, or Dysphoric Milk Ejection Reflex. Well, what do you know! It seems to be rare, but it's actually documented in medical journals, and it may have to do with the release of hormones during nursing and a temporary drop in dopamine. It's not a sign of postpartum depression (thank goodness) and it doesn't mean there's something wrong with my body or my baby, which I appreciate. It's just weird, and annoying, and frankly those two words can be applied to quite a lot of early motherhood experiences.

So - if you feel an ill-defined sense of unhappiness before or during breastfeeding, you are not alone! That and having a tube of some primo lanolin or nipple cream on hand before you come home from the hospital are my two biggest pieces of nursing wisdom. Good luck!

Happy Christmas, Even If War Isn't Over Yet

You have no power over me, Yoko Ono!

You may be thinking to yourself, well, duh, of course Yoko Ono has no power over you. Do you even know Yoko Ono? Are you secretly a Beatle and just forgot to mention it all this time?

See, here's the thing. I'm Jewish, but I've always loved Christmas music. Besides, living in North America in December, it's not like I could avoid it if I wanted to. And I have always had a particularly strong reaction to one song in particular: Happy Xmas (War Is Over), which combines John Lennon's probing, vaguely passive-aggressive questioning of the listener ("So this is Christmas / And what have you done") with Yoko's seemingly wordless wailing. I cry every time I hear it, I swear. It's practically Pavlovian at this point. I hear the opening chords and a lump forms in my throat as I think about how the song is about war and war is so terrible and John Lennon's death was so tragic and you know, when you get right down to it, what exactly have I done over the past year?

Except this year. This year, I was prepared. When Yoko started to wail, I was going to look at my delightful little baby and think, this year I had a baby! Ha! Put that in your "life accomplishments" pipe and smoke it! Except it didn't really go that way.

Pregnancy-after-infertility blogging tends to follow a few conventions: there's the post about how getting pregnant doesn't mean you won't always feel infertile and remember your struggle. There's the quick post immediately after the baby's arrival that is followed by several days or weeks of silence and finally followed up with some variation of "wow, I've been really busy!" And then there's the post written a few months later, as the calendar begins to display dates that match up with important events of the last year: one year ago today, I was just starting to stimulate my ovaries/chugging water before my embryo transfer/looking in disbelief at a positive pregnancy test. And you think to yourself, I could never have predicted at this time last year how different my life would be now.

For instance, there was my one year blogiversary, just passed. There's the anniversary of my first Lupron injection. There's the holiday party I recently attended - same venue, same guest list, same menu, but this time the slight headache was sleep deprivation from caring for a newborn, not a side effect of the artificial menopause I was putting my body into. Coming up, we get to celebrate the one year mark from my total and utter freakout about my egg retrieval. There are good memories on the horizon, too, like the Superbowl party I attended where I knew I was pregnant and nobody else did. It was, simply, a huge year.

And that's why I thought that for once, "Happy Xmas (War Is Over)" would have no power over me. Except that I found myself welling up right on cue, this time because I just couldn't believe how massively fortunate I have been over the past year. Look at what I've done, Yoko! A new year just begun, indeed!

I know this is a hard time of year for many people, so before I close I want to say this: you are not alone, and you are not forgotten. Infertility is desperately hard and dealing with illness and disappointment can be devastating. But life can, and does, change. Be strong and be well.

Next Steps and Continued Hormonal Funtimes

Hey, look, we've made it to six weeks! Good job, everybody!

Six weeks means that O is smiling (sometimes), cooing (occasionally), and extremely cute (all of the time.) It also means that I had my six weeks postpartum checkup, which ordinarily would have focused on healing Down There and birth control plans, but was a bit more interesting for me. The endometriosis that got us into this whole IVF mess is a problem that won't go away, so there are a few things we're going to continue to monitor going forward.

First of all, some good news. I passed another milestone this week: I'm off Lovenox! No more enoxaparin sodium for this girl, at least until/unless I get pregnant again. For those of you keeping score at home, this was nearly a full year of daily injections, with a few short breaks here and there. Someday I'll post the total number of needles that it took to get O from theory to reality, but for now I'm content just watching the bruises fade.

Also, the preliminary results suggest that the endometriomas have not recurred (or are pretty small if they did.) The one on the left was 4 cm right before my IVF cycle and we'll see what continued breastfeeding does to keep things quiet. I've seen it described as "natural Lupron," which would be nice since I want to avoid taking that stuff again if at all possible.

Since I had a complicated pregnancy, I also wanted to go over whether I'd have to be concerned about attempting any other pregnancies in the future. Yes, I will likely have to be on Lovenox again, but my risk of placenta previa is only slightly higher than normal and the fact that it resolved this time is a good thing. I also had some weird liver stuff that popped up on my bloodwork at the very end, but that just means they'll be on the lookout for pre-eclampsia as they would for anyone. Overall, I guess I'm not a terribly complicated patient when it comes to another pregnancy, which is nice!

Now for the tricky stuff. The endometriosis which caused my tubes to scar over and my ovaries to grow endometriomas will theoretically get worse every time I have an ovulatory cycle (though how much worse, and how much it will bother me, is kind of a question mark.) Ordinarily I would probably be prescribed a combination estrogen/progesterone birth control pill, but thanks to my DVT, I'm not a good candidate for that. I'm likely headed towards a progestin-only pill or maybe a Mirena IUD - and yes, I really am considering taking the pill despite my earlier protestations about systemic hormones. Why? Well, partially because the side effects are theoretically less problematic than the combined BCP, and partially because I can wrap my head around taking a pill if I know it's only for a short period of time.

All this to say: it's a matter of time before we're back on the IVF train. Don't think I've forgotten about those three embryos on ice, and because of a combination of family and medical factors, we're probably looking at attempting another cycle in a year. Or less. Or maybe a little bit more. There are a lot of moving parts to consider, even though we're committed to giving O a sibling - or at least trying our hardest to do so. We've been so blessed to have him, and I hope and pray that our luck continues!