Fertility Cinic

When it's a period.

Trying to conceive is not an easy process, but that moment you get your period and you know, you know that for sure you are not pregnant is devastating. We are grateful to a client of ours who has shared how challenging trying to conceive has been for her, and just how difficult it is when it ends with a period. 

 

I never imagined that I would struggle with fertility. I suppose no one ever does. But somehow we are surprised whether we get pregnant quickly, or when we don't get pregnant at all. I've known people who planned for at least six months of trying before a positive pregnancy and then when that positive pregnancy happened right away they were actually disappointed and wished they had more time. On the other hand, I also have friends who have waited until all their ducks are perfectly in a row, and then when it doesn't happen right away it's heartbreaking. 

Back about 6 years ago, when the idea of kids was a little seedling, I had travelled to Chicago for the weekend with my married friends to catch a Cubs game. Like one does at a baseball game, in one of the oldest ball parks in the world, is to indulge in the park's delicacies - hot dogs and beer. We were of course disappointed to find the hot dog we had been given had been boiled, soggy, and limp, but nothing a little ketchup can't fix. 

After the game, my friend started to feel ill, so ill she spent the rest of the evening in the washroom, followed by the next two mornings, and our whole drive back to Toronto not feeling herself. Her husband and I could only assume it was the not so delicate hot dog, we clearly just had stomachs of steel. Turns out she was pregnant. That bad ballpark hotdog was her little man - we couldn't believe it - and well neither could she. 

The significance of this story is that I think about it often. Now that I'm trying to conceive, I seem to mistake my indigestion for a positive pregnancy on the regular... it can't be that chicken I ate!? It's been two years of trying, and it's tough. I always seem to waver between hopefulness and hopelessness. Every twinge I feel I wonder... could it be?? 

There are so many aspects that can be unpacked when trying to conceive, the monitoring, the fertility clinic, the fertility drugs, the constant stream of well intentioned but unsolicited advice. But it's that very real and very brief moment when you know you've got to pick yourself up, dust yourself off, and find what little hope you have for another month of monitoring, tracking, and trying, is the one moment I struggle most with. That moment your body tells you another month has passed, another failed attempt. That moment you get your period. 

It feels weird to look back at those decades of relief (sometimes glee) when you get your period, and then just like that you dread it, and not just because of the bloating, and cramping, but because it simply magnifies the sadness, the sadness of another month gone and your dream of having a family a little more crushed. But then again, I can't help but feel hopeful as I near my expected period date, wondering if the bloating, or tiredness I feel is a sign of a positive pregnancy. And then it arrives, as if shedding the aftermath of a battle that's just happened in my uterus. And I feel a loss, a great loss. I had dreamed, hoped and imagined that I would soon begin a new life with babe in tow. But instead I have to clean up the blood and move on. A lost opportunity, and my life in suspension waiting for another month, another attempt, and potentially another loss.

Written by Spectrum Doula Collective Client

 

At Spectrum Doula Collective we work with families who are trying to conceive, we will attend important appointments at the fertility clinic for uncomfortable tests, such as the egg retrieval process, hysterosalipingogram (fallopian tube test), and insemination/in vitro fertilization. Our goal is to be emotional and physical support for our clients who are trying to conceive, or hope to be a parent later on.

 

 

 

Book Review: Choosing Single Motherhood

Choosing Single Motherhood
I wasn’t prepared when my two and a half year old son asked, ‘So did my dad die or what?’ I thought the question would come up later than that. [. . .] By the time he was 6, he’d introduce himself by shaking hands and saying ‘Hi, I’m Ryan and I’m a donor baby.’ It wasn’t intended to shock people. For him it was simply part of who he was
— Wendy Kramer, Choosing Single Motherhood (270)

Perhaps you're thinking about being a single mom, parent, or you have a friend who has been considering it, and every time you look for a resource online, in the library, or book store, your search is largely dominated by resources targeted toward two-parent families. Although the #choicemom community has been around for decades (yes! decades), unfortunately, there are still limited resources for those looking to be a parent on their own. However, we are lucky that Mikki Morrissette, founder of ChoiceMoms.org (another fantastic resource), has written a wonderfully comprehensive book about Choosing Single Motherhood.

Choosing to be a choice mom (a woman who chooses to conceive or adopt without a life partner) is not a choice that comes without significant thought and planning around finances, security, sacrifices, and changes that will need to be made to support this new little family member. And this is before any thought is given to how this little one will come to meet us. In Choosing Single Motherhood: The Thinking Woman's Guide (2008) Mikki Morrissette walks you through each step from those initial considerations whether being a single parent is right for you, choosing how to bring this little one in to your life, and the challenges faced by choice mothers.

Where this book succeeds

Considering this book is nearly 10 years old, it is still very relevant. It does justice to the very serious questions around how to conceive as a single mom, key issues to consider when weighing the pros and cons between choosing a known donor (i.e. someone you know), or unknown donor (i.e. sperm bank), and if an unknown donor is chosen the debate between an open ID donor versus a closed donor, and of course Morrissette dedicates a whole chapter to adoption as an option.

With every topic that Morrissette covers, whether it be about loss of a family dream, the debate around being raised 'without' a father (and how to answer the 'daddy' question), or how to get through the day-to-day parenting grind when doing it solo, she provides an array of anecdotes from choice moms, some of them positive, some of them not so ideal, but providing a full spectrum of considerations to each thoughtfully chosen topic.

Points worth noting

Morrissette shares several anecdotes from her choice mom peers about discrimination from various doctors and fertility clinics who either denied or made it difficult for single women to receive fertility support. I do genuinely hope that there has been a shift in care for single women seeking to conceive or adopt as a solo parent since this book has been published. I can attest that this kind of discrimination is exceptionally uncommon or nonexistent among fertility clinics in Toronto. Because Morrisette is based in the United States it is also important, whether you plan to use a known or unknown donor, co-parent with a known-donor, get help from a surrogate, or adopt, to explore the legalities in your community. Parental and legal rights vary from province to province, and state to state, and of course from country to country and it is important that you be fully aware of any legal roadblocks no matter how you choose to create your family. 

This book is written specifically for cis-gendered women who want to be single parents, and is not trans-inclusive. Despite the lack of inclusivity, this book can still be used as a springboard to harvest more information for single trans-men who may want to use donor sperm or adopt, OR trans-women who may be interested in adoption (unfortunately the book does not talk about surrogacy as an option). Many of those basic questions around finances, security, how to handle the daily grind are relatively universal to all parents doing it solo, although every person has unique circumstances that play a role in their family structure.  

Becoming Single Mother

We would definitely recommend this book to anyone who is considering being a single parent. There are not a lot of resources out there in print for women considering to be choice moms, and although there is room for some updating, Morrissette a choice mom herself, provides a relatively unbiased perspective on all the major topics around choosing single motherhood (plus a ton of solo parenting and self-care survival tips).

At Spectrum Doula Collective we work with new parents daily, and parenting can be and feel very isolating. One thing that Morrissette talks about as essential for the solo mom is widening that social circle even if this is something that doesn't come naturally, she explains: "Most of them won't become close, long-term friends" (236), but a network is necessary for support, to normalize your experiences, and to provide balance for both you and your child's.

Have you heard the parable of the glass of water? Lift a glass of water and it doesn’t take much effort. One minute, okay. One hour, your arm start to ache. One day, you need a doctor. The weight never changes, but the longer you lift it without a break the heavier it becomes. You need to put it down and rest before holding it again. After we’re refreshed, it doesn’t seem like such an effort again.
— Mikki Morrissette, Choosing Single Motherhood (250)

Acupuncture + Fertility

Whether trying to conceive at home, or with assistance from a fertility clinic, acupuncture has proven to have many benefits in increasing the chance of getting pregnant. Special thanks to Michelle Kapler, acupuncturist, herbalist, and founder of MuLi Fertility, for sharing with us how acupuncture can help support conception.

Fertility work is something I take very seriously. It is a privilege and and honour to be with a growing family on their very sacred and personal path. Its the elation and joy of those emails that come through my inbox with the subject line “it worked!” after multiple IVF failures. Or text messages with screen shots of positive pregnancy tests, after they have waited for such a long time. Then there is the darkness. The disappointment. The longing. The heavy and brutal exhaustion. The self doubt. I feel so fortunate to witness the inevitable evolution in people as they go through something that is so hard and so heartbreaking. There are fewer things that are so raw and so real, than a person’s journey to parenthood.  

For Acupuncturists, fertility work is not a new concept. We have known for a long time that by simply putting the body into an optimal state of homeostasis and health, we can have a profound affect on fertile potential. We believe that by using gentle therapeutics such as acupuncture, herbs and food, we can encourage the body to heal itself and thrive.

Achieving that optimal state of health is an important goal for any person, regardless of where they are in their fertility journey and regardless of whether they are providing the sperm, the egg or the womb. Whether a person is in the preconception planning stage, the actively trying to conceive (TTC) stage or in the process of using Assisted Reproductive Therapeutics (such as IVF), the odds of conception can be significantly increased, simply by working on improving overall bodily health.

5 Things that A Fertility Acupuncturist Works to Improve

  1. The menstrual cycle:  The ideal cycle (one that is optimal for conception) is 28 days in length, has four days of bleeding (where on day one, the pad needs to be changed every 4 hours) with no cramps, clots, spotting or PMS of any kind. When a woman comes to acupuncture clinic, we compare her cycle to the ideal cycle and work toward it - as a way of measuring our success in improving fertility.
  2. Digestion: Proper digestion is essential for optimal fertility, as both absorption and elimination functions are an integral part of the manufacturing and metabolism of hormones. If you have indigestion or constipation - it is one of the first things we work on.
  3. Sleep: Sleep is very important to health and conception. Hormone production is greatly affected by sleep. The aim is to have at least 7 hours of good quality sleep every night. If someone isn't sleeping well, we work to resolve this issue as quickly as possible.
  4. Nutrition: The diet that we consider to be “healthy” in North American culture is not necessarily optimal for conception. We encourage a nutritionally dense diet, which may not be what most people are used to, when they think of “healthy eating”.
  5. Stress: It is widely known that stress has a huge impact on fertility. Acupuncturists work to improve the way the body and mind respond to stress, and offer tools on how to deal with it.

By improving these five things, we can have a positive impact on a more microscopic level, meaning we can

  • Improve egg quality
  • Improve lining
  • Balance hormones
  • Work toward resolving established conditions such as PCOS, endometriosis and uterine fibroids
  • Achieve a more predictable menstrual cycle
  • Decrease changes of miscarriage
  • Decrease the chances of medical side effects if a person is working with Assisted Reproductive Therapeutics (at the fertility clinic)

For some, using the treatments at a fertility clinic is the only option for conception. In this case, working with a fertility acupuncturist can still be beneficial. The most recent research has revealed that there is a significant increase in chances of conception for people who use a whole systems TCM approach (acupuncture, food, lifestyle, etc) in conjunction with their IVF cycle. This includes on site acupuncture at the fertility clinic, before and after the embryo transfer. The most significant development about this particular research is that the findings have reflected the improvements in outcomes of bringing pregnancy to term and live births. For more details, go here.

about Michelle Kapler

Michelle Kapler R.Ac is a Registered Acupuncturist and Herbalist. Since graduating in 2010, from the Institute of Traditional Medicine in Toronto, she has focused her practice exclusively in fertility, pregnancy and maternal health. She is passionate about helping women to achieve hormonal balance, pleasant periods, successful conception and healthy pregnancies, with acupuncture, herbal medicine and food.

When she is not at work, you can find Michelle hanging out with her husband Peter and daughter Leah – making delicious meals from their backyard veggie garden – shucking and eating oysters – watching baseball – and attending epic family snuggle parties.

If any questions arise, she offers a complimentary 30 minute consultation for all new patients. To connect with Michelle - you can find her on her website www.mulifertility.com, Facebook, Instagram or Twitter.

Cycle Monitoring: What to Expect

Image courtesy of Functions of Cells and Human Body (www.fblt.cz/en/)

Image courtesy of Functions of Cells and Human Body (www.fblt.cz/en/)

When trying to conceive sometimes we find ourselves needing a little extra assistance. When deciding to get additional help from a fertility doctor, you can feel both relieved for potential answers and solutions, but also overwhelmed by trying to decipher what the hitch might be. Furthermore, with the multiple monthly visits and simply trying to reconcile that conception has moved from the bedroom to a clinic can be a process.

Cycle monitoring may be the only thing you need the clinic for, or it may be a part of further assistance that you require from the clinic, whatever the reason, if you've reached out to a fertility doctor you will likely be cycle monitored.

So what can you expect from cycle monitoring...?

Cycle monitoring allows your fertility doctor to find out exactly when you're ovulating to know when the best time to inseminate or have sex would be, and to increase the chances of a pregnancy. However, because everyone's cycle is different, it is hard to anticipate how often you'll need to visit the clinic, or when ovulation will occur.

When menstruation starts, so does your cycle monitoring schedule. You will need to visit the clinic on day two, three or four of your cycle, so your fertility doctor can review your blood work, how many follicles you have, and if one follicle is beginning to mature. At this visit your doctor will let you know when they would like to have you return which is usually somewhere between day 6 and 12 depending on the length of your cycle. After which, you will be asked to come back every two to three days until you get closer to ovulation, where you will then need to return on a daily basis until ovulation.

Each day that you're asked to visit the clinic, you'll need to get blood work done to monitor your hormone levels, have a trans-vaginal ultrasound to monitor your maturing follicle(s), and to meet with your fertility doctor to let you know when is best for you to return to be cycle monitored again.

Now what should you expect from your follicles?

During that first visit, or around day 2 - 5 of your cycle, your fertility doctor will be counting your ovarian reserve and is looking for between 6 - 10 follicles that will range between 2 - 10 mm in diameter. You should expect your follicle to grow 1 - 2 mm a day in size and when your dominant follicle reaches 20 - 24 mm, in combination with good hormone levels, this will indicate to your doctor that ovulation can happen with ease.

Lastly, what can you expect emotionally?

Cycle monitoring demands a lot more emotionally than physically, in particular when your follicle(s) are getting close to maturing and your fertility doctor would like you to return daily to keep an eye on that dominant follicle. Each clinic demands a different time commitment, some clinics schedule you in 15 min time slots, so you can be in and out (although you might end up with a time slot that doesn't work great in your schedule), while other clinics have you drop in between 7am and 9:30 am, so depending on how busy the clinic is you could be there for a couple of hours! Regardless of this the anticipation (or sometimes boredom) can be taxing. As you likely know, stress is not a friend of fertility. So what can you do:

  • Pack a Cycle Monitoring 'Survival Kit' including: if you're at a clinic that doesn't schedule visits, think about packing snacks, a good book, your computer to do work (this can decrease the stress of being away from work and keep you occupied), and your phone loaded with your favourite podcasts, audio books, or an audio meditation series.
  • If it's safe to do so, let your employer know, there will be times that you'll be late for work, and if your employer knows they'll likely be more flexible and accommodating with your schedule, which can help lower stress around time commitment.
  • It's so easy for us to want to keep conception on the down low to avoid unwanted questions and unsolicited advice. It is, however, worth letting in a close circle of friends that you can reach out to during those times you may be feeling overwhelmed or exhausted by the constant monitoring.
  • If you have a partner, a supportive friend, or a fertility doula, ask them to come with you if you need a little extra support or company on a particular day.
  • Often fertility clinics offer support groups for individuals or couples that are struggling with their fertility or need some assistance to get pregnant. They're not for everyone, but before you discount support groups, it is definitely worth inquiring if your clinic offers a support group.
  • Think about recruiting fertility practitioners outside of the fertility clinic such as a Naturopath, or acupuncturist, they are equipped with trade secrets that can help support and enhance the fertility treatments you're already receiving.

How cycle monitoring ends depends on what additional fertility assistance you require, whether it be simply help with timing, IUI or IVF.

I’m grateful that I’m getting help. But there are so many other things that I would rather do than be cycle monitored. It takes a bit of time to adjust being ‘on-call’ to your follicles.
— Client on Cycle Monitoring