Today, I’m #20 on the call schedule after being #2 last night. It wasn’t bad… I left work around 7:30p and never got called back to the hospital. That’s a great #2 night! A couple of days ago, I awoke with a pinched nerve along the left side of my neck and it’s incredibly uncomfortable turning my head and just doing regular tasks (i.e. making the bed). Right now, I wreak of Bengay and I’m partially comforted with some Aleve. Hot compress, you are next! Sometimes, it’s really nice to enjoy a lazy morning with zero agenda other than to catch up on life and maybe even do some self reflection.
A buddy of mine sent me this article and asked me my thoughts….
I gave it a once over and thought, this is interested. A small sample size of various parents from various geographical regions all commenting on their children. Their is italicized because it seems like commenting on what the perfect number of children to have is so personal and completely unique to their experience.
It’s a heavy duty article with a lot of good perspective. I kind of agree with them all. I liked the one with 3 kids best… and the one with no kids the least. Since when did the purpose of procreation become about supporting the older generation? I had a tough one with that. I don’t think people have kids to look after them in old age.
What do u think?
This article came at a perfect time for me. Bear and I just got married; we’re older… and we’re looking to start a family. I just went on an Amazon spending spree for knowledge:
Even as an M.D., I am thirsty for knowledge in an area that I know pretty little about. Sure, I’ve rotated on OB/GYN as a med student — but that was back in 2005. Plus, doing two months of a rotation doesn’t equal a full understanding of mom’s body and baby’s development. It taught me how to safely deliver a baby, but I need to know and understand the building blocks leading up to that. Secondly, I’m an anesthesiologist who places labor epidurals for our pregnant ladies getting ready to welcome their little bundles of joy into the world. I typically meet the moms when they are having contractions and wanting pain control and follow-up with them at delivery. So you can see, there’s a 9 month knowledge gap that I need to fill in.
If you’re a future mom and are interested in an epidural, educate yourself on the pros and cons as well as what you expect to feel and when to ask for an epidural.
Remember, it is dependent on YOU as you are in control of your pain. A pain scale will vary from person to person (i.e. everyone has different pain tolerances). There’s no magical dilation number that tells you when to ask for an epidural. Keep in mind that you will need to hold extremely still when you do ask for an epidural. So please make it easy on your anesthesiologist (and yourself) and ask for an epidural when you are able to be as motionless as a statue — otherwise, it may be too risky to request an epidural if you are in too much pain to stay still.
Today, I’m the OB anesthesiologist on call. Hours in the L&D OR have provided me with a “real” understanding of what is involved in a C-section (C/S). I’ve seen countless spontaneous vaginal deliveries (SVD) including natural birth (without pain medications), deliveries with epidurals, vacuum-assisted deliveries, shoulder dystocias, postpartum hemorrhages, etc. A lot can happen to both the mom and the baby — and it can be scary. Someday, I’d like to have my own family, and it got me thinking about what I would like to choose for my “birth plan”. As much emphasis is placed on this…it’s really out of your control. The idea seems nice in that you feel like you have control, but nature has a very interesting way of doing what it will do irrespective of your plans.
One of our OBs had her two children via elective C/S. Given that a C/S is major surgery, I often wondered why one would electively choose to go that route vs. vaginal delivery. I opted to take a poll on the OB floor (nurses, docs, midwives, staff, etc.)….
The older I get, it seems that relationships get more complex. I’m not sure if people are just more set in their ways or maybe if it’s my own internal struggles/thoughts/vulnerabilities that lead me to wonder if relationships are worth it? I have a fantastic group of friends all of whom have different interests. It’s rare for me to pursue a relationship out of loneliness. Other than wanting to start a family and build the next chapter of my life, I often wonder: Is it worth the struggles? More and more articles are talking about delayed marriage and childbirth.
No relationship is perfect…and that probably stems from the fact that no individuals are perfect. Put two different individuals together in a busy world with stresses and then some… well, I can see why the divorce rate is so high. But what happened to morals and believing in the sanctity of marriage? Are spoken vows on the wedding day just for show?
Yet, I want to believe that marriage is as good and wholesome and loving as I think it is. I don’t believe a lifelong partnership such as marriage is a fairy tale. Indeed, what I hear from my friends and family is that MARRIAGE is work — but isn’t that true for anything of WORTH? Why do we allow ourselves to just be passive with marriage? Do we allow ourselves to be complacent in pursuing a stalled career or obtaining financial independence? I hope not.
What does that even mean? My best guess is that it means I went to school for a long time and entered a career where I get to behave professionally and interact with people. Fast forward 18 years after graduating high school and I have a successful career in medicine doing anesthesia. I have met some fantastic people along my journey and I’ve traveled and experienced life to the fullest.
So why this post?
Because I’m 35 and according to the OB/GYNs…I’m AMA (advanced maternal age). In a nutshell, it means that after the age of 35, there are significant (possibly exponential?) risks of chromosomal abnormalities with my eggs or there could be serious problems with my baby at my age. The older I get, the more I’d like the option of having a family… and that’s whether I meet the right guy or not.
What’s it like to undergo hormone stimulation?
Tues, March 3: I’m currently on day #5 of injections and I still feel normal (i.e. no crazy hormonal emotions or anything; no bloating; no weird experiences, etc.).I don’t have any emotional drama; no crazy hormonal thoughts or outbursts. I actually feel pretty normal. No bloating, no PMS, etc. I don’t know what I’m supposed to feel bc I feel just normal… like a normal day without the injections. Now, the injections –> I’m starting to dread the 7pm hour bc these injections are starting to hurt! I’m a pretty tough cookie… don’t be fooled by the smiling youngish face.
Fri, March 6: I’m bloated. Cravings are starting to kick in, but maybe it’s just stress at work? No crazy emotional stuff.
Sat, March 7: The bloating continues. In fact, my ovaries are pretty sensitive — any big bounces in the car or if I sit down hard is painfully noticeable. The Ganirelix stings a little bit more than the others on injection. No big hikes or active things: no trail running, no running (period!), no elliptical, no jumping. I’m starting my couch potato life and getting stir-crazy! But, I did do a 7 mile flat hike today — I couldn’t help it!
Sun, March 8: The bloating continues. I definitely feel the pull/sensitivity of both my ovaries. Even when I empty my bladder, the pressure/tug release is definitely present. Huge mishap today: I underestimated how much Follistim I had! Today, I was supposed to go up on Menopur, but I didn’t have any extra, so I was told to take my standard 150 dose. Yet, they told me to go up to 300 on Follistim today and I barely had any when I stuck the needle in! I remembered I had an extra vial with just a small amount left and injected that. it was only 150. 3 injections in one night is no fun.
Mon, March 9: Gave myself an additional 150 follistim this morning once the pharmacy opened. 15mm follicles are looking good! My left ovary has a ton! The right ovary is doing alright as well. Just waiting to get the estrogen level up. Same bloated feeling. No physical activity or heavy lifting.
Tues, March 10: Estrogen is finally above 1,000! Apparently after many years of birth control pills, it suppresses estrogen… on track!
Thurs, March 12: All systems go for Friday retrieval. 🙂 My last injection was this morning. I’m incredibly happy to be done with those! The indomethacin makes my head cloudy — not sure I like the feeling.
Fri, March 13: yes it’s Friday the 13th. But I’m not superstitious. Showed up at 6 am and proceeded with paperwork. Estrogen and progesterone levels were fantastic. Went back to the OR around 7am. A little propofol and fentanyl for my MAC case. I requested no versed. Some Toradol in the pacu to help with cramping. Had a fine relaxing day after. Took some tylenol for cramps. They retrieved 13 eggs. 6 mature ones and 5 not quite mature ones. Wonder what we do from here. I’m still super bloated and my doc said no physical activity for 2 weeks.
Tues, March 17: The bloating is getting better. There wasn’t much cramping or pain or spotting after the retrieval. Maybe I am lucky? I only took Tylenol twice since Friday. The bloating was extremely intense Saturday, Sunday, and Monday. I feel that it is better today.
Wed, March 18: I was thinking more about the numbers of eggs retrieved and came upon a couple of different articles and resources. I haven’t chatted with my doc yet.
Sun, Mar 15: Doxycycline 100 bid. Baby aspirin, prenatal vitamins.
Mon, Mar 16: Doxycycline 100 bid. Baby aspirin, prenatal vitamins.
Tues, Mar 17: Doxycycline 100 bid. Baby aspirin, prenatal vitamins.
Wed, Mar 18: Doxycycline 100 bid. Baby aspirin, prenatal vitamins.
Thurs, Mar 19: Could this be my first normal day??? Holy cow!
Fri, Mar 27: They said they got 13 eggs… but they didn’t tell me 6 were mature and 3 were intermediate. When i had my initial consultation… i told her i wanted 2-4 kids possible. If i assume wcs (worst case scenario), which i should in this case… that would mean at best only 1 or 2 kids. I was completely deflated. so i am going to do a second round. it’s not what i want to do, but it’s my best chance. She thinks it’s bc i’ve been on bc pill for so long, so i can’t take those from now until my next go. She’s aiming for July 2015. She saw plenty of follicles (which is good)…. but my hormones had been suppressed so long bc of the bc pill. I’m sad bc i have to do this again…. and it was hard enough the first time.
In this whole process, I met a wonderful man. We are looking at doing embryos for a higher success rate.
Mon, July 13: Prolactin level is 38 on re-draw from fri. 😀 that is normally where I hang out. We decided no repeat MRI (I had been getting them annually for 5 years after surgery to assess growth — I think last was 2010). No growth with drawing prolactin at those times as well as checking for visual field defects annually still. All points to good signs. She’s going to reach out to my endocrinologist and I’m going to get back on bromocriptine (to make my prolactin normal). I wanted to normalize prolactin first before getting on an estrogen stimulating med (that can grow the old prolactinoma). So… I also told her about you and that we’re looking at a possibility of embryos instead of just eggs. She felt very positive about that bc she said I had plenty of follicles and that would ultimately a higher success rate. And she also knows about my prior long use of birth control pills for regulating periods (bc of prolactinoma). All of this points to a good sign that things are normalizing and we have a plan. She said she’d like to see me on bromocriptine for about 3months and would be getting another prolactin draw 6mo after starting that med.
When I was a kid and had to get immunized, my dad used to tell me “don’t be a chicken shit.” And I wasn’t. When I was 4, I vividly remember putting my arm out voluntarily when I had to get a shot. What’s more odd, is that at the tender age of 4, I would watch the needle placement into my arm and not look away. It was single-handedly one of the best lessons my dad ever taught me. Face your fears directly. So, my present-day self is perhaps a bit more squeamish giving my own shots into my abdomen. The injections are given subcutaneously, which means that it goes into the fat layer below the skin but above the muscle.
Why Am I Doing This?
I wanted to preserve my fertility and not feel so rushed to find “Mr. Right For Me.” To be honest, I never thought I would be taking this journey… let alone by myself. I always envisioned being with the love of my life and starting a family once I achieved my career. But nature and the biological clock don’t stop. That’s life. So I’m making the best of my situation and hoping to preserve my future and share it with someone who will explore and share this journey of life with me.
Because in the end, happiness deserves to be shared.
In the United States, more than 100,000 women of reproductive age receive a diagnosis of cancer each year, and they are at risk for diminished reproductive potential or infertility as a result of treatment. The freezing of oocytes has become a clinically viable option for women who wish to have a child in the future but are facing either an age-related or iatrogenic decrease in the quality and quantity of oocytes.
What is currently the preferred method for cryopreservation of oocytes?
The large size and high water content of oocytes make the formation of ice crystals and subsequent cell injury or death difficult to avoid during the cooling process. Vitrification has replaced the slow-freeze method as the method of choice for cryopreserving oocytes, since it minimizes ice-crystal formation and results in higher rates of cell survival, fertilization, embryo development, and pregnancy. As compared with the slow-freeze method, vitrification involves exposure of oocytes to relatively higher concentrations of cryoprotectants for a shorter duration, followed by ultrarapid cooling either through direct immersion into liquid nitrogen (in so-called open systems) or with the use of small, volume-sealed straws (in closed systems). Once vitrified, the cells can be stored indefinitely in liquid nitrogen.
Is there an association between cryopreservation of oocytes and subsequent congenital abnormalities?
Oocyte cryopreservation by means of slow freezing or vitrification has not been shown to increase the incidence of aneuploidy or congenital abnormalities in children, although long-term studies involving large numbers of births resulting from thawed oocytes are still lacking. Collection of data on long-term outcomes by the Society for Assisted Reproductive Technology is under way.
Morning Report Questions
Q. What factors are central to the likelihood of achieving a live birth using cryopreserved oocytes?
A. In determining the probability of achieving a live birth with the use of cryopreserved oocytes, the two most critical factors are the woman’s age at oocyte collection and the total number of oocytes available. Rates of embryo implantation decline as women age, owing to increased embryo aneuploidy; this risk applies also to cryopreserved oocytes obtained from older women. Whether cryopreservation further damages the oocyte beyond the normal age-related decrease in oocyte quality is unknown. In a prospective study evaluating the efficiency of oocyte vitrification, the proportion of vitrified oocytes that resulted in a live birth was 8.2% (12.1 oocytes per live birth) in women 30 to 36 years of age and 3.3% (29.6 oocytes per live birth) in women 36 to 39 years of age. In a multicenter observational study that assessed predictors of outcome when oocytes were vitrified, the live-birth rate decreased by 7% for every year of increase in the age of the woman. For every additional mature oocyte, the delivery rate increased by 8%.
Q. What are the guidelines of the relevant professional societies concerning oocyte cryopreservation?
A. The American Society for Reproductive Medicine suggests that oocyte vitrification and warming should be recommended to women facing infertility due to chemotherapy or other gonadotoxic therapies. The American Society of Clinical Oncology recommends that “even if women are ambivalent” about having children, they should be referred to a reproductive endocrinologist. However, the guidelines of the American Society for Reproductive Medicine also recommend caution regarding the use of oocyte vitrification to circumvent the effects of age on the reproductive potential of healthy women. These guidelines specifically state that “ . . . there are no data to support the safety, efficacy, ethics, emotional risks and cost-effectiveness of oocyte cryopreservation for this indication.”
Table 1. Reasons to Consider Cryopreservation of Oocytes.
Cycle day 1- Call doc to schedule a BASE US and blood draw for cycle day 3.
Begin checking for ovulation surge with ovulation predictor kit on cycle day 8.
Call me when the surge is positive.
o Doc will make me a calendar when I surge that maps out the rest of my cycle
6 days post surge you will begin taking Estrace for about 2-3 weeks
After Estrace course you will begin stimulation with Menopur and Follistim again or Menopur and Clomid
Curiosity has always been a driving factor for my learning. Lately, I’ve been curious about what makes relationships thrive. Around the holidays, people always seem so happy and connected and together. This led me to lookup various TED talks (thanks Google search) on the subject matter. I’m intrigued by others’ relationships — and not just romantically. A friend of mine shared some interesting pearls on the progression from dating, committed relationship, marriage, to kids and the dynamics/changes that occur through each of these phases. I just want to know what other people’s experiences are through this journey. What my search revealed…
According to your own brain, love is right up there with cocaine and cash. And it can last if you treat it right.
Want to be attractive? Make yourself look good, emphasize similarities, and let the person know you’re picky — but that you do like them.
A great first date is something that creates excitement and energy. Share things about yourself and respond positively when your partner does.
Relationships often fail because of individual issues, not because of a bad match. Resolve difficulties as soon as you can; they don’t strengthen relationships, they cripple them.
Improve your relationship by dealing with your personal issues, doing exciting things together, celebrating your partner’s successes and showing gratitude.
There’s a lot of meat here. Very insightful. I will probably listen to these several times… not just today but throughout the years. I love her definition and timing of foreplay. Waxing and waning desire — it’s not spontaneous…but erotic couples know how to resurrect this desire.
This summarizes three books that I’m intrigued to pickup and read.
Several talks on Love
A numbers game. It’s up to us to make a relationship — it takes work. Technology cannot solve relationships. It takes human capital…. human work.
Couples’ and sex therapist. See #1.
Non-sexual, non-romantic love. Family love. Parents and favoritism. I wish someone would go into more depth between spouses and siblings. I had a great talk with another friend of mine who has a twin sibling. This has got to be one of the closest bonds ever known. Yet, he was telling me the difficulty of introducing someone to his sister and how that can sometimes add jealousy, loss of priority, etc. between the siblings. I don’t think one needs to make a black and white choice — I think siblings and spouses can co-exist…in fact, they should. Perhaps a better working is the prioritization of spouse to sibling. I don’t know what that entails…I have no siblings. However, I have not had any problems introducing any of my significant others to my family without worry of priorities or jealousy. I think it’s a natural progression in life to introduce an SO to your family and be able to make that individual a priority without having massive panic attacks or arguments. Yet, I’m still trying to wrap my head around why there would be such sibling rivalry without introduction of SOs. Does anyone know of a study on this?
43 years of marriage! Whoa! The important roles of fathers in daughters’ lives.
This one was humorous!! Find good in everything! Men doing chores around the house –> women desire them more –> men become nicer. Positive good cycle.
At least this was a good start… there’s so much to learn. I’ve digested this small piece of information, and I have come to the conclusion that relationships need positivity, communication, consideration, honesty, dependence, independence, desire, and cooperation/teamwork. But, these were things I knew. From this information, I think both people involved have to be open and receptive to the other’s needs. How does the positivity loop get started? A kind gesture, a sweet compliment, a flirtatious look, a warm touch… all of these are positive vibes to make your partner feel loved. This in turn generates positive feelings and prompts positive outward energy of love.
So, why are so many people unhappy if these elements seem so simple?