Reflecting on 2015

2015 sure was an interesting year. 

The year started out with us being disappointed that our 2 embryo transfers with 2 different surrogates did not work in India.  We were getting ready to ship our 4 remaining embryos over and try again.

Then, like it seems to always do, things changed.

A family member offered to be our gestational carrier in January. 

I admit that I did not get very excited about this at first....we've been burned a couple of times before. 

But then things started to fall into place.  Her paperwork got sent in to the clinic.  The clinic approved her medically.  The psychological screening came back OK.  We all met to discuss contract terms.  We all worked with a lawyer to execute a contact.  We had our consent signing.  Our GC started her medications.  Our GC's lining looked good.  One embryo made it to day 5.  One embryo was transferred.  We had a positive first beta.  We had a positive second beta.  There was a heartbeat at 5 weeks.   The Harmony test came back negative.  The nuchal scan came back negative.  We made it out of the first trimester.  The quad screen came back negative.  We made it out of the second trimester.

By yearend our little guy was doing well - measuring right on track and so far seems normal and healthy.

Who would have thought?  Especially not us.

What a difference a year makes! 

I'm Back!

Last week I received an email letting me know about the upcoming meeting of the Infertility Support Group that I had regularly attended.  Included in the notice was that the leader of the group was stepping down as of the first of the year and that they were looking for volunteers to to lead the group in order to keep it going.

I was dismayed surprised to see this.  The group had been so helpful for me and for so many other people.  What would happen if no one stepped up to lead and the group went on hiatus?

I admit that I had thought about coming back to help with the group since it had been so helpful to me, but the timing right now was not great.  There was no way that I could commit to leading with Baby S coming right around the corner.

I decided to respond that I would be interested in helping out, but only in a co-leading capacity, and that I would need to take a couple of months off around the birth.  Best I could do.

Luckily there were a couple of other women in a similar boat - those who wanted to help keep the group going, but just couldn't do it all themselves.  They were happy with co-leading and could cover the couple of months that I would not be able to attend.

Our contact information just went up on the Resolve.org website, so it's official....

....I'M BAAAAACK!!!!

A Very Special Hospital Tour

Sometimes being pregnant via a gestational carrier has its perks.  One of these perks is that we got our own personal hospital tour.

When I met with a lactation consultant a while back she mentioned that adoptive and intended parents can get their own room at the hospital when the baby is born so that the baby can room in with them.  I was ecstatic to hear this since the days and really hours after birth can be crucial in beginning to establish a breastfeeding.  Being able to stay at the hospital and have our baby room in with us would give us time for bonding right away.

I called the hospital to find out what we needed to do to "reserve" our room.  The care coordinater that I spoke with was so happy that I had called.  She explained that they would start a file for us with all of our paperwork and that we were encouraged to come in for a special tour for just us and our GC to go over any questions.

That is pretty cool.  Our own special tour!

We are very lucky that in Minneapolis there is a third party reproduction agency that has worked with several surrogates/gestational carriers.  And, that the agency encourages births at our hospital.  So, our hospital is well versed in surrogate/gestational carrier births.  Since there are less than 1,000 surrogate/gestational carrier births across the entire US each year, we are very lucky that our hospital hosts around 10 of those each year.

Our care coordinator was awesome.  She answered all of our and our GC's questions and was very reassuring that all of our needs would be met during and after the birth process.  She went through our file and made sure that all of our paperwork to date was in order and even contacted our lawyer for us to ensure that everything would be ready for the time of our birth.

So, there is a perk to living where we live :)

A Tale of Two Teris

Today we are at 28 weeks gestation. If all continues to go well, we will meet our son in about 12 weeks. Our journey to parenthood has been long and often rocky. We have experienced miscarriages, IVF, and gestational surrogacy. Since I am unable to carry a child to term, our little bun is actually in someone else's oven. Our gestational carrier is someone who is very close and who we love very much. We are very blessed to have someone so special in our lives who is sacrificing much to give us such a special gift.

Today I broke my infertility silence on Facebook.

Although I have been very open with my infertility struggles online, I have done so anonymously, under my alter-ego "Nothing is Certain Except Death and Taxes".  (Which is a bastardized Ben Franklin quote for those of you who didn't already know.

I have basically been living a double life - "Infertility Teri" is active both online and at her local Resolve.org support group.  She bares her soul surrounding her struggles with infertility and shares her story in the hopes that it will inspire and help others who are struggling. "Regular Teri" works in corporate taxes, is a perfectionist, loves to cook and do crafts, supports the opera and local theater, and is a bit of a sci-fi nerd.  She likes to keep things all running smoothly and rarely bares her soul to anyone.

The two Teris sometimes meet and a few people know both, but it is not very many people.

Both Teris are sensitive, secretly fear rejection, and generally just want to be liked and get along with most people.  (As are most people).

"Infertility Teri" exists in the sphere of the world of the infertile.  In this place everyone there has struggled with miscarriages, third party reproduction, fertility treatments, month after month of negative pregnancy tests and disappointment (for some all of the above).  Everyone is understanding and supportive since they "get it" because they have "been there".

"Regular Teri" exists in the sphere of the "real world".  In this place few have struggled with infertility if anything at all and they are not going to share even if they have.  This is the world of the 7 in 8 couples who get pregnant easily and many times accidentally, and these pregnancies end with a healthy baby instead of heartbreak.  Many people are not understanding and supportive since they do not "get it" because they have not "been there".

I know that I am generalizing and that there are a lot of really good people out there.  It is just that they tend to be sprinkled with, if not outnumbered by, a lot of jerks.

Since "Teri" has struggled and has sometimes been hurt by the careless (but usually not intentional) remarks of others, she tries to protect herself by not sharing herself unless she trusts the individual with whom she is sharing.  For her there is a lot more trust in the world of the infertile.

But, in order to there to be trust, there needs to be sharing.  Sometimes we need to take a leap of faith and share.  It can be scary, but often when we do we find that there are more caring people than jerks out there in the real world.

The Facebook post was my leap of faith.

At 20 weeks I had announced (through the mail and on Facebook) that we were expecting.  I just had not filled in all of the details as to how we were expecting.

Announcing the pregnancy itself was a pretty big deal as that meant that I believed that the pregnancy was going to produce a healthy baby instead of ending in heartbreak.  This is a hard concept for those who have suffered a prior pregnancy loss to believe.  We tend to believe that the pregnancy will end too soon, just as our other one had.  Until we are holding a healthy baby in our arms we just don't believe that it exists.  A "prove it" pregnancy.

At 20 weeks I still wasn't completely convinced that the pregnancy would indeed produce a healthy child, but I also realized that it was "time" to announce.  20 weeks is halfway there and most people have announced by this point.

Although I was "ready" to announce the pregnancy itself, I was not ready to share all of the details.  I was scared to tell the world the truth - that I was not the one carrying this pregnancy.  How would they react?  Would I receive support or damnation?  I did not know.  I also struggle with the fact that I cannot carry a pregnancy.  Too often with infertility comes self doubt and even shame.

Our fantastic counselor helped me to realize that I had nothing to be ashamed of - that this pregnancy was a beautiful thing and really something of a miracle.  This was our last chance - our last embryo that the doctors did not have high hopes for.  Somehow it has made it and is here today because someone loved us enough to endure legal contracts, dozens of intramuscular hormone shots, morning sickness, back pain, and near constant heartburn (just to name a few things).  This IS a beautiful thing that should be celebrated.  If people don't understand this, they are probably people that we shouldn't have in our lives anyway.

The response to my post was overwhelmingly positive.  People were genuinely happy for us and commented that this was a happy and inspiring ending to our story.

Maybe it is OK for the two Teris to meet after all.....

Why I haven't posted for a while....

.......because we've been on our babymoon in Australia and New Zealand the past 3 weeks.

Pretty much every pregnancy blog/website/magazine etc., etc. out there stresses the importance of taking a trip together, generally in the second trimester, before the baby is born.  This trip is commonly called the "babymoon" and is important as it is probably the last big trip and the last trip as a couple for a while.  You will be spending the next few years most likely not traveling, and then the next few years going to Disneyland, Six Flags, Mount Rushmore and other "family friendly" locations.  Don't get me wrong, there is value in the family vacation, but sucking down cocktails in exotic far away locations as an unhibited couple is not overrated.

Our journey began in Cairns, Australia where we spent a few days diving the great barrier reef, meeting the local animals, and enjoying the tropical atmosphere.

We then traveled to Sydney where we spent the next few days exploring with our Australian friends.  We ate at a 5 star restaurant (complete with Dom), climbed the Sydney Harbour Bridge, sailed on an Americas Cup boat (even worked the grinders), and explored the city.

From there we traveled to Melbourne for a few days where we went winetasting, had an amazing lunch on the train, went on a ghost tour of the Melbourne jail, and spent even more quality time with the local animals.

After that we were off to the North Island of New Zealand for five days of adventure.  We went spelunking, white water rafting, horseback riding, visited a thermal park, spent the day on an active volcano island, looked for shells by the sea and even handfed some eels!

  

It was an amazing trip, possibly the best trip we will ever take.  We had so much fun and experienced so many new and cool things.  We are very blessed to have the ability to take such and trip and especially for having our Australian friends.  The trip would not have been possible without them and we will be forever grateful.

We're Going To Need A Bigger Deerstand

Sitting alone in a deer stand for most of the weekend gives one a lot of time to think.  Well, in between reading, scanning for deer and some naps (seriously, we were up at 4:30 in order to get in our stands at least an hour before sunrise - naps are part of the process).


Like most deer hunters, there is a group of us that hunt together.  This particular group started with our friend's father-in-law and his buddies many, many years ago.  The group has changed over the years with members coming and going and member's children joining the group.  Mark and I were the newest members, joining just two years ago. 

It is an interesting group with members spanning all ages.  There are even some of the usual deer camp suspects....

http://www.startribune.com/the-characters-in-a-minnesota-deer-camp-which-are-you/341023031/

Although I have deer hunted off and on (more off than on) for 15 years now, this year felt a lot different.

This year we are (finally) expecting, and expecting a little boy at that.  As my mind started to wander during my long sit in my stand I started to think about that little boy and how things will change once he arrives.

I was worried that this might be my last year deer hunting.  It is typically a men's sport, although many younger women do hunt with their families.  But, as these women get married and especially have children, they tend to hang up their rifles and/or bows and end up letting the boys hunt while they stay at home with the rest of the family.

Mark and I have talked already that we will need to find some creative ways to make sure that neither of us needs to give up hunting.  We may try to alternate mornings/afternoons or maybe entire weekends.  I am happy that Mark is being considerate on this as hunting is something that I enjoy and would like to continue.

Our friend is the one who introduced us to this hunting party.  He has a little boy who has been hunting with him for a few years.  I see how much hunting means to both of them and how excited his boy gets about being able to sit in the stand with his dad.  Our friend is the hero of his little boy.  It touches my heart to watch them together.

This year I started to think about my own little boy.  I pictured him sitting in the stand next to me, dozing in his little sleeping bag, getting excited when he thinks that he heard a deer, and maybe taking his first deer next to me.

I did not grow up deer hunting, I only picked up it later in life as an adult.  Most people don't understand it, and especially why a woman would hunt, but I like it.  The anticipation of getting a bird or a deer is exhilarating.  And when you finally do see that bird or deer in your sights, and take that shot, the adrenaline rush in unbelievable. 

But, really it is not about that for me.  What I enjoy most about hunting is the relationships.  My husband loves that I go hunting with him.  It is a nice way for the two of us to get away and spend time together.  Our deer hunting party is made up of some hilarious characters but just really good people.  While everyone enjoys a funny story and a little ribbing, we all want to see each other succeed and are there to help when they are in need.  This is why I hunt, and this is what I would like to share with my boy.

While I have been hunting for a few years now, I have not been the luckiest.  I have gotten a few grouse over the years, but never a deer.  As I climbed into my stand this morning I thought to myself, "How am I going to teach my little boy to hunt if I have never even gotten a deer myself?".  I knew that this was going to be my year, that I was going to get a deer today for my little boy.

It was a warm weekend, which unfortunately is not good for deer hunting.  When it is warm the deer move around at night and don't come out during the day.  While we hear some shots yesterday, today was eerily quiet.  Dusk was coming soon and there was only about a 1/2 hour left of hunting for the day.  That is when I heard the crack of a branch breaking.  I looked up and about 50 yards ahead of me was a deer.  I raised my rifle, shaking with excitement, and pulled the trigger. 

I then realized that in my excitement I had forgotten to remove the safety.  SHIT!  I removed the safely quickly and re-sighted in the deer.  I breathed out and took my shot.  It was a great shot, she dropped right there. 
 
It was amazing and I almost could not believe that I had finally gotten my first deer.  But then I reminded myself my thoughts earlier in the day, that I would get a deer today for my little boy.

In my heart my little boy was right there next to me the whole time.

Trick or Treat?

Halloween comes with mixed emotions this year.  Today Baby S is 23 weeks along and so far everything has been good and he seems healthy.  A year ago we had just found out that our surrogate had lost our little maybe baby at just 5 weeks along.  While we knew that the initial beta was not strong, it still was not negative and there was still hope.  I read story after story of others who also had low betas and that low beta turned into a happy healthy baby.

Against my better judgement I got my hopes up, even if it was just a little.

OK, maybe more than a little.

Very much against my better judgement I started to dream.  I pictured us meeting maybe baby for the first time and the thrill of holding Maybe in my arms.  I picked out nursery bedding......

I figured that my womb was the problem and if we removed my womb from the situation then we had removed the problem.

I was wrong.

When we had our second transfer in December I was much more cautious with my hope.  Even so, I still got my hopes up a little only to have them dashed by another failure.

So now I find it extremely hard to be hopeful.  Especially right now.

I find myself thinking about our little maybe baby that never became a real baby.

Tricks and not treats.

I feel guilty when I am happy about Baby S as I feel like I am taking away from the memory of those I have lost.

It's a tough line to walk.

Pregnancy and Infant Loss Rememberance Day

 

It is 7 pm on October 15th and I am lighting my candle for Pregnancy and Infant Loss Remembrance Day.  If everyone lights their candle at 7 pm and keeps it burning, the world would be bathed in a continuance wave of light.  I like to think that this wave of light burns so brightly that our lost loved ones can even see it from wherever they may be.

I have two more candles lit this year.  

Last year we were just coming back from India, hopeful that one of our little embryos had found a cozy home for the next 40 weeks.  That we would finally realize our dream of becoming parents.

We never even contemplated that it would not work, not just once but twice, and that instead of being parents we would be lighting more candles today.

Today Baby S is 20w5d.  Most people would be overjoyed and would be working on their nurseries.  I am still conflicted and uncertain that I will someday meet him face to face.

Although I am happy that we have made it this far, I am still very scared.  Scared that next year there will be another candle.

I fear that this would be the last candle, and that this candle would break me.

Baby S, someday you may be an only child in this world, but your are not alone in my heart.  You share that space with Daniel, Marilyn, Gavin and Grace.  Four beautiful babies who I was not able to meet, not able to hold in my arms.....but I hold in my heart.

October is Pregnancy and Infant Loss Awareness Month

 
In 1988, President Ronald Reagan designated October as Pregnancy & Infant Loss Awareness Month – an action that launched the Pregnancy and Infant Loss Awareness Movement. Although over a quarter century has passed, this issue remains prevalent as, each year, approximately a million pregnancies in the United States end in miscarriage, stillbirth, or the death of the newborn child.

Did you know that:

• One in four pregnancies ends in the loss of a baby
• The loss of a child is recognized as the most intense cause of grief
• Parents never "get over" the loss of a child – no matter the age
• Parents experiencing grief without supportive care can have debilitating consequences such as PTSD, depression and anxiety that could further result in job loss, divorce, difficulties in daily living, or impediments with parenting of living children

The loss of a child stays with a family forever, but the emotional and physical impacts are often challenging for others to truly understand. Having support through grief is paramount to recovery. Raising awareness is the first step to accessing available help. 

Here is a link to find local support groups in your area

http://www.firstcandle.org/grieving-families/grief-resources/local-support/

Until We Meet Again....

Today was bittersweet.  To quote my favorite Big Head Todd and the Monsters song "It's bittersweet more sweet than bitter, Bitter than sweet, It's a bittersweet surrender"

I have mentioned before that I have been going to an infertility support group that I found through Resolve.org.  I almost cannot put into words how helpful this group has been for me.  Infertility often makes you feel isolated.  You feel like you are suffering through an almost insurmountable difficulty all alone.  Because so few of us are open about our infertility, most of us don't realize that so many others out there are suffering too.

I am lucky that I flipped through a family building options magazine in my RE's office and saw an ad by Resolve.org.  And that I checked out their website and found that there are support groups in my area.  And especially that I put aside my fears and went to a meeting.  That was a pivotal moment for me.

The group was wonderful.  Everyone was kind and supportive.  As we shared our stories I felt a kinship with these men and women.  We were all suffering, and we were all trying hard not to give up.

As beautiful of blessing that a child is, and not matter great the dream is to have a child, sometimes the journey to having one can seem too hard, too painful, and too futile.  For many, infertility is resolved by the decision to live child free.

I have at times thought of giving up.  I have thought that if I was meant to have a child that I would have one.  That maybe I am tempting fate and the wrath of the gods by trying to sneak in a child through alternative means.

Listening to the stories of others who were also struggling with infertility gave me hope and gave me to the courage to keep going on my journey.

It was very hard for me to have to leave that support behind once we had a BFP.

Resolve does encourage those who attend their groups to come back to make their pregnancy announcement.  The thought is that we all need good news once in a while.  We need to know that it can work.  We need to know that our struggles may not be in vain.

I was nervous about making my announcement.  I worried that it would be hard for some to hear.  I have cried tears of agony at my empty womb when an ultrasound picture pops up on Facebook, or when I hear yet another pregnancy announcement.  I did not want to be the source of that horrible pain for someone else.

But it turns out that I wasn't.  Several of us have been attending the group for a while.  Each month we hope that we won't see someone at group - that it finally worked out for them.  When we see them month after month we know the sad truth. 

When I went through my story I choked up describing my losses.  It sometimes surprises me that even though now we are very likely finally realizing our dream of having a child that my losses still hurt, and hurt just as much as they ever did.

But the ending to my story finally changed.

We finally had a BFP.....a BFP that was at 18 weeks.....and had gone through prenatal testing that kept coming back good....a BFP that may actually be a real baby someday.

Everyone was happy for me.  They shared that my story gave them hope.  That is a beautiful gift that I never thought I would be able to give.  A bittersweet gift.

I hope that I see all of the members of my group again someday.....maybe at the hospital with their newborn, or at daycare or school.  I hope to see them holding the child that they so desperately want.  I see us looking at each other, realizing how we know one another, looking at each others children and giving one another a knowing smile.

Until we meet again.....

 

An Unexpected Benefit of Expecting Via Gestational Carrier

 Is that I can drink this while "pregnant"

We spent a long weekend touring San Francisco, Napa and Sonoma with friends.  It was a much needed break/stress reliever.  While expecting via gestational carrier is a happy event, it is also a very stressful one at times.  I have been very grateful that I can still have my wine :)

PALS - Pregnancy After Loss Support

https://pregnancyafterlosssupport.com/

I have been struggling with mixed emotions throughout this pregnancy.  I have been terrified that we were going to lose the baby, or even worse, that something was horribly wrong.  That has been mixed with sadness, since this pregnancy sometimes makes me think of the pregnancies that I have lost.  Every now and again, a little bit of anticipation and happiness pops up.  But that is quickly washed over with fear, sadness and sometimes even guilt.  Guilt that this baby may make it and there were ones who did not.

It has been hard to say the least.

What has also been very hard is that I feel very misunderstood.  For most of the population, a positive pregnancy test equals a baby.  And for most of the population, that positive pregnancy test came without months or even years of trying, without medications, procedures or even third parties.  For many it was even a complete surprise.  For most of the population, pregnancy is a time of joy, and they don't seem to understand how anyone would not also be joyful.

For most women who have suffered a pregnancy loss, their partner also suffered that loss.  So, while people (and often the sexes) process loss differently, the couple is at least processing together.

True, Mark and I suffered a failed transfer and a chemical pregnancy together.  But those happened half a world away and via a gestational carrier.  For Mark they were disappointments, for me they were losses.

The two pregnancies that I myself lost happened 14 and 15 years ago, with another partner and even in a different state.  Mark hasn't gotten the thrill of a positive pregnancy test, only to start bleeding a few weeks later.  To then start having horrific cramps and passing big clumps of things that you knew once were a baby.  To have to go to the doctor to make sure that everything actually did pass and that you don't need a procedure.  To have seen a baby moving on an ultrasound, that later never was.

We have had very different experiences.

Mark has tried to be supportive despite not completely understanding my feelings.  He has been doing a great job, but I really still needed more support.  Thankfully I found out about PALS - Pregnancy After Loss Support, and even more importantly, found a local support group through them.  They have been wonderful so far and I have learned some very important things:

1. My feelings are normal for someone who has experienced pregnancy loss.

2. I have not fully grieved my prior losses.

3. I need to work through my grief and my fear.

4. My grief and fear will never completely go away, but it will be less often and less hard if I work on it now.

I have rationalized my losses for so long, telling myself that "It was for the best".  It has been hard, very hard, but I have been working past the rationalization.  I had never named my angel babies.  I think that I probably didn't see the point - why name a baby that never was?  But, Daniel, Marilyn, Gavin and Grace deserve to have names.  They were are real, even if it was only for a few months, weeks or days.  When our little one is born, they will not be alone, they will have four siblings that  they will meet someday in Heaven. 

This is hard for me to write, or even think about.  I don't know if I ever had a great relationship with God, but it definitely changed after my first miscarriage.  I have been so angry that he would give me a miracle pregnancy....only to take it away.  To give me hope, after hope, after hope, only to take it away.  I know that I shouldn't be.  I have to remember that even through sometimes God may seem careless, that there is a plan.  Maybe our little one needed to have these angel babies to watch over him/her.  That my angel babies are so that Baby S someday will be.  I have to believe that is the plan.

I have to keep working through my pain, so that I can be fully here once Baby S is here.  I will continue to go to my support group and work with our fantastic counselor.  I am very lucky to have found their support.  I will also work on a way to memorialize my angel babies - something very special for my little ones that were too beautiful for here.

Daniel, Marilyn, Gavin and Grace, I will hold you in my heart until I hold you in Heaven.

And I thought Fertility Treatments Were Expensive.....

Now that we've ventured into the second trimester, I felt more comfortable with looking into child care for Baby S (I also think I need transition names since Maybe Baby doesn't feel appropriate anymore since he/she is becoming more and more real with every passing week).

The pregnancy checklists that I have seen say that right now is a good time to start looking.  I have heard, however, that in the Twin Cities, daycare is at a premium and maybe we should have starting looking sooner.  Turns out we may be a little late to the party.

Mark talked to one of his clients who owns several daycare centers in southern Minnesota (unfortunately none in the Metro) to get some pointers from an expert.  What she said generally echoed what Mark and I had already talked about ourselves.  In-Home vs. Center.  Each has its own pros and cons.  Centers are more expensive, and can sometimes feel impersonal.  In-Home is less expensive and is VERY personal.  Some of our friends and coworkers have had not-so-great experiences with in-home, and we liked the convenience and the educational programs that many centers offer.

We decided on 3 centers that are close to our house.  It was recommended to us to "sneak attack" - just show up without an appointment so that you get a feel for what the place is really like.  That gets a little complicated when each center has a code to get in to keep out the creepers.  Each place was very accommodating and each had its own pros and cons.  One I liked more than the others, one all of the kids seemed very happy, one they separated the kids in rooms by age (much more than the others), keeping each group small, one just felt "right".  To the complete shock of my husband I whipped out the checkbook and put down our deposit.

Here's why I said we might be late to the party.  The center has an opening next year, but not until May 1st.  We need an earlier opening.  Unfortunately since I will not be giving birth, I do no qualify for disability, meaning that my leave is unpaid unless I use vacation and whatever my company offers for family leave (six weeks).  Also unfortunate is that we spent all of our readily accessible savings just creating Baby S, so unpaid leave isn't an option.  Thankfully we get a week of backup daycare, the center may be able to accommodate us a little earlier, and both sets of parents would be able to fill in some time.  Covered, but a lot of coordinating.

Daycare favors the fertile.  Apparently we should have booked an opening the minute we found out that we were pregnant, or even when we decided to start trying.  I think I speak for the 1 in 8 couples who experiences infertility when I say that it RIDICULOUS!

Also RIDICULOUS is how much daycare is going to cost us.  I thought just creating Baby S was expensive.....now I know why people with kids are always broke.

http://childcareawaremn.org/families/paying-for-child-care/child-care-costs-in-minnesota

Average Weekly Cost of Child Care

Below are some average ranges of weekly child care costs in Minnesota as of June 2015. Rates for part-time and drop-in care may be higher than those listed below.

Metro	Centers	Family Child Care
Infant	$320.99	$178.86
Toddler	$274.06	$169.45
Preschool	$242.49	$160.45
School-Age	$198.05	$140.60

Out state	Centers	Family Child Care
Infant	$199.34	$133.86
Toddler	$179.88	$127.69
Preschool	$165.51	$123.13
School-Age	$143.78	$112.50

Statewide	Centers	Family Child Care
Infant	$283.93	$153.65
Toddler	$245.70	$146.14
Preschool	$218.83	$139.61
School-Age	$181.59	$125.48

A Lactation Consultation

Just as I hope that my blog may in some way help others, I have been greatly helped by other peoples blogs.  One thing that I found out through another intended mother's blog is that just because you did not give birth to your child, you may still be able to breastfeed him/her.

What did you say?  What sorcery is this?

Not exactly sorcery. It turns out that any woman (with breasts) may be able to breastfeed regardless of whether or not she has given birth, or even has a uterus or ovaries.  Lactation is actually governed by pituitary hormones, not ovarian hormones.  It should be noted that while nearly every woman can do it, it is not necessarily easy or quick, and is generally more successful if you have previously nursed or been pregnant.

When we started in this process, I had been asked by a few people if I intended to breastfeed.  I thought that was a funny question mainly because I had not really considered it.  I guess that I knew that I actually COULD.  I mean, even men can lactate.  But I hadn't really thought that I WOULD.

I think that I just figured that we would bottle feed.  Most adoptive mothers bottle feed.  Millions of children have been bottle fed over the years and virtually all of them have turned out just fine.

I think that I also feared trying to induce lactation since I knew that it was tricky at best.  I thought it would be just another thing that could (and probably would) go wrong.

But as Maybe Baby started to hang in there week after week, and the tests and ultrasounds started to come back OK, some of my fears started to subside and I started thinking that Maybe Baby may actually become a real baby.  Whoa!  This is a new concept.

As I started thinking in terms of an actual vs. theoretical baby, I started thinking about what we would do when the baby comes.  I started reading other IMs blogs about the importance of infant bonding and how it is even more important in an adoption or surrogacy.  Of how important skin to skin contact is, and breastfeeding.  Wait.....breastfeeding.

Breastfeeding is not just about getting nutrients to your baby.  It is also very much about bonding.  I read that it is not important if you make enough milk yourself or if you have to supplement, it is about the time together and the skin to skin contact.  I read blog after blog and story after story of how amazing it was to be able to connect that way with their baby, of how it in some ways made up for the loss of not being able to birth their own child, of how it made them feel more like a mother, and of how it gave them a way to get ready for their babies arrival in the absence of being pregnant.  I read that it was not easy, but that the juice was worth the squeeze.

I decided that it was worth giving it the old college try.

As recommended by everything that I've read, I decided to consult with a professional - a lactation consultant.  I have done a decent amount of research on this, so I was able to jump right into recommendations and protocols with her during our visit.  Since I have a good amount of time before the birth, since it is (arguably) the most successful protocol for induced lactation, since Maybe Baby is essentially the product of a metric crap ton of hormones, medications and other supplements, and taking more hormones, medications and other supplements does not phase me in the least at this point, I am interested in using the Newman-Goldfarb Protocol for inducing lactation.

After talking through my health and pregnancy history and the protocols, my lactation consultant had some good news and some bad news.

The good news:  milk ducts grow rapidly primarily during the first trimester of pregnancy (that is why your boobs get enormous and terribly sore, and why that soreness gets better as you enter the second trimester).  I have been pregnant before, and my second pregnancy almost made it past the first trimester.  I was pregnant long enough for my boobs to get enormous and terribly sore - meaning that I probably went through some milk duct formation, meaning that I will probably be more successful in inducing lactation than someone who has never been pregnant.

The bad news: the magic ingredient in the Newman-Goldfarb protocol is a Domperidone - a drug that is given to relieve nausea and vomiting.  A drug whose major side effect is that it induces lactation because it increases decreases the body's release of dopamine which in turn increases prolactin, which in turn causes lactation.  It is probably used more often for its "off label" use than it is for its primary intent.  Domperidone is not FDA approved - meaning that it is nearly impossible and possibly illegal to get in the US.  There is a legal drug that can also increase lactation called  Metoclopramide, but it has some pretty nasty side effects (much more nasty than Domperidone) and can also be passed through breast milk - making it not really a suitable alternative.  Also, to add insult to serious injury, my insurance may not cover a breast pump since I will not have given birth.  I will need a hospital grade pump for this to work and those are NOT cheap.  Since those cost over $2,000 to buy new, I would need to looking into renting one, or buying a gently used/refurbished model.

I left feeling very defeated and like the visit may have just been a waste of time.

I am now trying to focus on the positives.  While my consultant had heard of using domperidone (and could not and did not recommend it) and the herbs that we discussed (fenugreek, blessed thistle and goat's rue), she had not heard about adding the birth control pill before.  This really intrigued her.  Taking the birth control pill nonstop for a minimum of two months (four or more is even better) essentially tricks the body into thinking that it is pregnant.  The estrogen and progesterone in the birth control pill mimic the levels produced in pregnancy and can help to build milk ducts and breast tissue.  Stopping the birth control pill and then pumping, should cause a rapid decrease in the serum progesterone level while causing an increase in the serum prolactin level. This process attempts to mimic what happens after a normal pregnancy and birth.

My consultant thought that this hormonal "push" may be the key to successfully inducing lactation.  When just beginning to pump, or pump with the addition of herbs, the process can and often does work, it just takes a long time.  She was very interested in pursuing this method and hoped that it could be successful for other patients.  In addition to the BCP, goat's rue is often recommended in the "building" phase as it tends to act like estrogen.  It can be effective taken on its own, but tends to be more effective when taken in conjunction with progesterone.

About 8 weeks before Maybe Baby's due date I should stop the BCP but keep taking the goat's rue and over the nest two weeks begin pumping working up to pumping 8 times per day and 20 minutes each session.  Once I start pumping, I should start taking fenugreek and blessed thistle (alfalfa, fennel, saw palmetto, and shatavari are also recommended, but not as highly as fenugreek and blessed thistle).  I should try to eat oatmeal for breakfast at least 3 times a week - many mothers on the protocols have noticed a significant increase in their milk supplies when they began to add oatmeal to their diets regularly.  I also need to drink at least 6 - 8 glasses of water a day if possible and keep my caffeine to a low level.

I say low level since stopping completely could mean harm to those around me and low levels have not been found to be harmful to babies via breast milk.

When I am ready to start pumping, I will visit my consultant again and she will show me how to use the pump and map out a pumping schedule for me to follow.

After pumping for a while, my milk supply should begin to arrive. It will begin with a few clear drops which become more frequent and more opaque and whiter in color.  These drops will turn into spray which will eventually turn into a steady stream of breast milk. It may take a few days, a week, or two, or more for the milk supply to come in. Everyone responds differently.

I know that this sounds like a huge commitment.  It is.

But, it is a way for me to get ready for Maybe Baby's coming, a way for me to feel like more of a "normal" mother, and most importantly, a very special way for us to enhance our bond.

And that, my friends, will be worth it.

Everyone Has Something (Carrier Screening Results)

We received the results of our genetic testing.  As suspected, we each have something......but luckily we both have different things.

Mark's results:

Positive: Carrier

Salla disease

Teri not found to be a carrier. Mark is a carrier. Risk of affected child: 1 in 2,000

The most common form of Salla disease causes a slow, progressive decline in motor and intellectual abilities, with symptoms beginning in the first year of life. There is no effective treatment available. Adults with the disease are profoundly intellectually disabled, but live normal lifespans. Another form of the disease is more severe, causing death in early childhood. Learn More

This is a pretty terrible and also very rare disease.  This is the first time our genetic counselor has even seem someone be a carrier. It is mostly found in northern Finland - there are only 30 documented cases outside of Finland.  (Mark must have some Finnish that he didn't know about?)

Luckily carriers are only that - they do not typically experience any symptoms.  Also lucky is the fact that I am not a carrier so our risk of passing to our children is very, very, very low.

My results:

Positive: Carrier At Risk for Symptoms

Pseudocholinesterase deficiency

Teri is a carrier. Mark not found to be a carrier. Risk of affected child: 1 in 640

Pseudocholinesterase deficiency causes sensitivity to particular forms of surgical anesthesia. After receiving these drugs, people may experience a longer than normal period of breathing paralysis, but medical teams are typically equipped to handle such an event. The condition does not cause any other symptoms. Learn More

This is more common than Salla Disease, but not exactly super common either.  It is more commonly found in Native Americans (possibly from me being 1/16th Mesquaki?) and the Persian Jewish community.

Luckily this isn't really that bad - basically it takes you longer than normal to fully come out from anesthesia - and Mark is not also a carrier.

Not so lucky is that carriers can also experience symptoms, although not as severely as those who have the condition.  It may have taken me a bit longer to come out from anesthesia but probably so little time that it never became a concern.

So good news.  So far things are going well and we now have a few less things to worry about.

The Many Faces of Maybe Baby

We arose early to get to the Perinatal Specialist's office by 7:30 am.  With the many doctor appointments that our GC has had lately an early appointment meant less of an issue with work.  Normally I would push for a little later appointment (I am not a morning person, at all) but we have also had a few appointments ourselves.  I have not yet announced at work and am running out of plausible reasons to have so many doctor appointments, so one early enough that I didn't even have to miss work was actually a blessing.

As a mentioned in an earlier post, I have agreed to postpone, and possibly even forego, invasive prenatal tests if our noninvasive prenatal screening does not indicate any potential issues.  Today's noninvasive prenatal screening was the nuchal translucency scan which is a detailed ultrasound that measures the nuchal fold thickness.  Increased thickness measurements are also associated with Downs Syndrome and some other chromosomal birth defects and also congenital heart defects.

The procedure for the NT scan is pretty much the same as for any other pregnancy ultrasound.  Our GC needed to have a fairly full bladder, have some cold goo rubbed on her belly, and endure some pressing on her fairly full bladder - not too bad.  The technician moved the screen so that we could all see and went to work.

Maybe Baby is a pretty active baby.  MB kept moving around making it a little hard for the technician to get the measurements and pictures that she wanted.  Our GC cannot yet feel MB's movements but is dreading the later stages of pregnancy if MB is going to be as active as we think MB may be....

Despite MBs in utero acrobatics, the technician was able to take a number of cross-sectional views and pictures.  She seemed very thorough.  She showed us that the top of MBs head and that you can see both halves of the brain developing.  She pointed out MBs heart and stomach.  She said that the placenta was at the top of the uterus (our GC thought to ask about that - good call).  We got to see MB moving both arms and both legs.  Right now MB measures 2 inches from top of  head to rump and has a heartrate of 167 bpm.  The technician can't give us the official OK, but so far things seem to look good.

We also got to take home a cute view of what look to be a nice long pair of legs.....

We Passed the Test

Drum roll please........

The Harmony Test came back negative.

It's All About the Genes

Today was our visit to the Genetic Counselor.  Please refer to the "Family History and Genetics" page for more information on who Genetic Counselors are and what they do.

Due to our unique situation there were three of us at this appointment - me, Mark and our GC.  Really only Mark and I needed to be there - it is our history and our genes that are in question.  But, our GC needed to get the referral and make the appointment since it is her pregnancy.  In the end, it good that she was there since we discussed screening and testing options and since she is impacted by our decisions regarding these it is good for her to also understand the risks.

I would never ask our GC to do something that I would not myself do.

We went through our family history and what our risks are.  Unfortunately, chromosomal abnormalities increase with age.  By the age of 40 the risk of a child being born with some sort of genetic abnormality is as high as 1/38.

Our family history can help predict which abnormalities we may carry and pass on.  For example, since Mark and I are both of Northern European descent, we are more likely to be carriers of Cystic Fibrosis.

Carrier screening can be done to tell for sure if you are a carrier of a specific disorder.  Most disorders are recessive meaning that both you and your partner both need to be carriers for a particular disease to present itself.  And even if you both are carriers, you may not pass on that disorder to your child.

Mark and I had not had carrier screening done.  We had asked our RE about it before our first IVF and he did not recommend it.  His logic was that everyone is a carrier for something.  Everyone.  And sometimes people make decisions about even having children based on these tests.  Again, being a carrier does not automatically mean that you will pass a disorder to your child.

Luckily we are early enough into the pregnancy that carrier screening can still make a difference on our prenatal testing choices, so we headed to the lab for a blood test right after our consultation.

Unfortunately, we did not have PGD or PGS testing (see Embryo Testing in IVF page for more info)  done on our embryos, so we do not know definitively that Maybe Baby is chromosomally normal.  We did not do PGD testing since we had not done carrier testing and did not know which specific genetic disorders to test for.  We also did not do PGD testing and additionally PGS testing since this needs to be done on day 5 blastocysts and we were not sure that we would end up with any day 5 blastocysts to test.  Maybe Baby was a day 5 morula and previously frozen, so testing was not recommended.

Our counselor went through our screening and diagnostic testing options.

As I have mentioned before, I like the idea of diagnostic testing.  It is definitive while screening is not.  It also carries risks.

I have been talked off the CVS ledge and am now leaning towards amniocentesis.  

Amniocentesis is a prenatal test that allows your healthcare practitioner to gather information about your baby's health from a sample of your amniotic fluid - the fluid that surrounds your baby in the uterus.  Amniocentesis produces a karyotype – a picture of your baby's chromosomes – so that your caregiver can see for sure if there are problems.  It is more than a 99% accurate test.
 
Amniocentesis carries various risks, including:

• Miscarriage. Second-trimester amniocentesis carries a slight risk of miscarriage — between 1 in 300 and 1 in 500. Research suggests that the risk of miscarriage is higher for amniocentesis done before 15 weeks of pregnancy.  Our counselor indicated that the risk goes down significantly for practitioners that perform this test regularly and that this clinics risk rates were as low as 1 in 1500.
• Needle injury. During amniocentesis the baby might move an arm or leg into the path of the needle. Serious needle injuries are rare.
• Leaking amniotic fluid. Rarely, amniotic fluid leaks through the vagina after amniocentesis. If the leak seals, the pregnancy is likely to proceed normally. It's possible, however, for chronic leakage to lead to orthopedic problems for the baby.
• Rh sensitization. Rarely, amniocentesis might cause the baby's blood cells to enter the mother's bloodstream. If you have Rh negative blood, you'll be given a drug called Rh immunoglobulin after amniocentesis to prevent you from producing antibodies against your baby's blood cells.
• Infection. Rarely, amniocentesis might trigger a uterine infection.
• Infection transmission. If you have an infection — such as hepatitis C, toxoplasmosis or human immunodeficiency virus — the infection might be transferred to your baby during amniocentesis.

Since our GC does not have any diseases to transmit (per testing), is RH positive to the RH factor risk is not there, infection can be easily treated with antibiotics, needle injury is rare as is leaking amniotic fluid and the risk of miscarriage at our clinic is as low as 1 in 1500, I still think that the benefits of amniocentesis outweigh the risks.

However, I have listened to our Genetic Counselor and Mark on utilizing noninvasive screening tests first.

We had the Harmony test done which is a simple blood test (of our GC's blood) that screens for the most common chromosomal disorders - 99%, but not all, of the fetuses with trisomy 21 (aka Downs Syndrome), 97% of fetuses with trisomy 18 and 92% of fetuses with trisomy 13.  The Harmony test also tests for gender and sex chromosome related disorders. The Harmony test does not provide information on other rare chromosomal abnormalities.  The Harmony test also does not provide information on physical defects, such as heart or brain abnormalities and spina bifida, or fetal growth.

It is therefore advisable that you still have ultrasound scans to screen for other potential defects - a scan at 11-13 weeks and at 18-22 weeks to examine the fetal anatomy and at 30-32 weeks to examine the fetal growth. 

Additionally, it is also advisable to also have a quad screen — also known as the quadruple marker test or simply the quad test — at 15 to 20 weeks of pregnancy  This test measures levels of four substances in a pregnant woman's blood: Alpha-fetoprotein (AFP), a protein made by the developing baby, Human chorionic gonadotropin (HCG), a hormone made by the placenta, Estriol, a hormone made by the placenta and the baby's liver, and Inhibin A, another hormone made by the placenta

Results of the quad screen indicate your risk of carrying a baby who has certain chromosomal conditions, such as Down syndrome, and can help detect neural tube defects, such as spina bifida.


We are scheduled for our 11-13 week scan next week.  This is the Nuchal Translucency Screening Test which screens for major defects, such as exomphalos, holoprosencephaly, heart abnormalities or megacysis, and some other rare chromosomal defects.  It uses ultrasound to measure the thickness of the fluid buildup at the back of the developing baby's neck. If this area is thicker than normal (more than 3.5 mm), it can be an early sign of major defects and further testing such as a CVS or amniocentesis may be recommended for actual diagnosis.

This test is noninvasive and basically just like a regular ultrasound.  The major difference is that it must be done by a specially trained ultrasound technologist, radiologist or obstetrician who has received special training to do this test.  Basically that you will probably need to go to a different clinic than your regular OBGYN.

We are then looking to do the quad screen at 15 weeks, another noninvasive test.  Our genetic counselor said that actually we don't need to do the full quad screen since we did the harmony test and parts of the quad screen would be duplicative.

We are then looking to do the anatomy scan at 18 weeks.

We will tentatively schedule an amniocentesis for 19 weeks, which will only be performed if an issue arises at one of our earlier tests.  Otherwise, we may be chancing risk that we would otherwise not need to undertake.

I think that this is a good plan as it utilizes as much noninvasive testing as possible. 

Each hurdle that we clear and test result that comes back good starts to make me more and more confident that Maybe Baby with become a real baby someday.

Right now is still early and we have a lot of tests to do, so I am staying only cautiously optimistic at this point.

OK at 9w4d

 

Today was our first prenatal visit.  I admit that I was very nervous.  Up to this point everything was with our infertility clinic - a familiar environment for me.  Now we were venturing into uncharted territory.....

Luckily our GC has had two successful pregnancies of  her own and has an OBGYN that she really likes.  She had talked to her doctor while we were still in the exploration phase this spring to make sure that her OBGYN and her OBGYNs staff would be comfortable and supportive of a surrogate pregnancy.  

This is actually a very important step in the exploration process.  The lawyer that we used for the GC contract actually runs an agency.  He was extremely helpful in offering advice along the way that we would not have thought of or known to ask.  One of the things that he recommended was to make sure that the OBGYN was comfortable with this special arrangement.  Unfortunately he has run into a doctor or two along the way that had some strong biases and added some extra stress to an already stressful situation.

Everyone was really nice and was very supportive of our situation.  

It is strange situation.  There is the pregnancy and health history of our GC, but also my and Mark's history that all needs to be incorporated.  While our GC's history is hopefully indicative of how this pregnancy will go (I say hopefully because each pregnancy is different, and our GC is now over 35 which carries extra health risks), my and Mark's history is indicative of the health of the baby and potential of birth defects.

There is the important phrase - birth defects.

Because our GC has a very healthy and normal uterus, I have not been scared of miscarriage due to structural issues.  I have, however, been very scared of miscarriage due to chromosomal issues.  Or, even worse, having to make a tough decision due to chromosomal issues (not all severe birth defects lead to miscarriage or stillbirth).

I admit that this fear is probably higher than it should be.  Our risk factor of birth defects is only around 2% and our miscarriage risk is around 15% (birth defects could be a contributing factor to this risk).  Each week that passes decreases our miscarriage risk.  Now we need to look into how to assess our birth defect risk.

I am all about doing as much testing as possible as early as possible to assess our birth defect risk.  Probably to a fault.  I am ready to go right to diagnostic tests vs. screening tests.

http://www.webmd.com/baby/tc/birth-defects-testing-what-are-the-tests

Birth Defects Testing - Types of Tests

You and your doctor can choose from several tests. What you choose depends on your wishes, where you are in your pregnancy, your family health history, and what tests are available in your area. You may have no tests, one test, or several tests.

Screening tests show the chance that a baby has a certain birth defect. Diagnostic tests show if a baby has a certain birth defect.

Screening tests	When they are usually done
First-trimester screening (first part of integrated screening)	10 to 13 weeks
Nuchal translucency (usually done as part of the first-trimester screening)	11 to 14 weeks
Cell free fetal DNA (an option for women at higher risk)	10 weeks or later
Triple or quad screening (second part of integrated screening)	15 to 20 weeks
Ultrasound (pictures of baby's body)	18 to 20 weeks

Diagnostic tests	When they are usually done
Chorionic villus sampling (CVS)	10 to 12 weeks
Amniocentesis	15 to 20 weeks

Screening tests have little to no risk, but they also only indicate if there is a chance of a birth defect.  Diagnostic tests have risks - miscarriage being the biggest risk - but they also show for sure that there is actually a birth defect.

Going into this appointment I am pretty much convinced that I want to do CVS so that we definitely know if we have birth defect, and would find out in the first trimester.  If we do need to make a tough decision, the earlier that decision can be made the better for all parties involved.

Thankfully our OBGYN is pretty awesome, immediately senses that I am stressed beyond belief and talks through my fears on the issue.  I acquiesce to her expertise that the CVS is very risky and that we can do other noninvasive tests first.  She also recommends a genetic counselor visit to discuss our risks and discuss further screening.

Now that we are past that it is finally time to hear the heartbeat.  I really need this reassurance that there is still a heartbeat.  I am really bummed that she attempts it via doppler.  I want an ultrasound!  I want to see for myself that Maybe Baby is still there, and is developing on track.

Well, nothing is happening.  There is no heartbeat.  We are all getting very, very tense.

Our OBGYN explains that we are still a little early to hear the heartbeat via doppler and we proceed to the ultrasound room.

Not only is Maybe Baby still there, Maybe has a very normal heartbeat, and has little arm and leg buds like Maybe is supposed to at this time (the "gummy bear phase" as my friend likes to call it).  Maybe was even moving around!

Phew.  Huge sigh of relief.