When Is Enough, Enough? Does Fertility Treatment Have an End?

Some things are really hard to hear. Whether it is as simple as how your hair looks or how you look in that dress to how to treat an aggressive medical condition, the truth can really hurt. And oftentimes, accepting the truth can be nearly impossible. However, there are only so many times that you can hold your hands to your ears and play deaf. There are only so many times that you can ignore the flashing red lights in front of you. Ultimately, if you don’t change lanes you will find yourself at a roadblock that you can’t overcome or pass. However, knowing when it’s time to get out of the lane can be the hardest part. That’s what we are here for.   

As fertility doctors, our job is to guide you, to support you, to educate you, and ultimately to help you achieve your dreams of becoming a parent. We take the information provided to us by blood tests, ultrasounds, medical history, semen analyses, and family histories and with it try to see what is off, which pieces in this puzzle are not fitting together and how can we put the pieces back together.  

However, our job goes way beyond diagnosis. We are also there to implement and design treatment plans. Some plans you may like, and others, you may not. Some may seem too aggressive; others, too lax. Some may seem too involved, and others, too casual. Whatever it may be, you have to take the information and options presented to you, process them, and then proceed.  

But we cannot simply stand on the sidelines and watch you run into a 320-pound linebacker without a helmet. While your fertility doctor should be frank with you throughout your entire treatment course, this is particularly true when deciding on the best treatment strategy.   

At some point, the seesaw of pros versus cons is no longer even close to even. The American Society of Reproductive Medicine defines this tipping point as futile treatment (≤1% chance of achieving a live birth) and very poor prognosis treatment (>1% to ≤ 5% per cycle). Allowing a patient to continue to try when the odds are so incredibly low and not sharing such information is, in our opinion, criminal. Honesty is imperative in any doctor-patient relationship, but it is especially essential in fertility medicine.  

While we want to help you achieve your dream, we must be honest with you about the likelihood of achieving these dreams. Sometimes, dreams must be modified (donor eggs rather than your own eggs, a gestational carrier rather than your own uterus) in order to end happily.  

Closing the chapter on any stage of life can be difficult. It is wrought with confusion and anxiety. We are here to help you through this process, to help you move through the pages, and to reach the ending that will make you feel the most complete and the most content. Telling you what you want to hear may make you feel better, but it will likely not make you a baby. And although hearing what we have to say may sting, it may be the bite that leads you to parenthood. And in our line of work, parenthood is paramount. 

The Waiting Game

As parents, we have all been there—the endless, time-stands-still, clock-barely-ticking waiting game. Whether you are waiting for the arrival of your baby or the arrival of your teenager (who is clearly late for curfew!), we have all stood by the door waiting for it to open. The anticipation and the anxiety can be debilitating. Not knowing what is happening and what could happen to your child can be incapacitating. And while we certainly don’t have any ways of making the clock move faster, we do have ways of dealing with the unknown. It’s called limits. We put limits on the situation, our surroundings, and ourselves to limit the negative emotions that can take over your mind and limit your ability to function.

  1. Limit the negative energy: The waiting game is not a solo sport. When you are waiting for news, be it good or bad, it’s nice not to be alone. It’s also nice not to be with people that drive you crazy. Find someone (or someones) who have good juju and can stay by your side as you are standing on the sidelines.
  1. Limit your idle time: When not occupied, your brain can go farther than a trans-Atlantic flight, especially when you are thinking about your children’s health. Your mind can concoct some pretty crazy stories. And while we are not recommending that you do algebra or geometry in your idle time, we are suggesting that you listen to music, read a book, consider meditation, and hop on the phone with one of your friends. Although these modalities won’t change the outcome, they can help speed up the clock and maybe even reset your psyche.
  1. Limit your Google search: On the heels of #2, be skeptical about what your searches reveal. While we too have many degrees from Dr. Google, the Internet can be a scary and sketchy place for advice (minus Truly, MD!). You can take any myriad of symptoms and make them into the Plague. Speak to a professional, and get their educated opinion before you make a diagnosis that is dubious, to say the least.
  1. Set limits for what you can and cannot do: So often, we try and do it all. It’s hard to find one woman who doesn’t want to be Cameron Diaz in There’s Something About Mary. But the reality is that there is no She-Woman (or He-Man, for that matter). We all need help. And we are all limited. Your limitations don’t make you less of a woman, a partner, or a mother. They make you real.
  1. Limit the what-ifs, the should-haves and the could-haves: Life is not lived in reverse. Unlike that car sitting in your driveway, it can only go forward. No matter how hard you want to turn back time, you can’t. At some point, you have to stop beating yourself up for what you “should have” recognized and what you “could have” done. It won’t change what happened; it will only change how you move forward.

Unfortunately, in this game there is no official time clock. There are no periods, no quarters, and no halves. To make it to the end takes fortitude and strength. Parenthood is a challenge. And while we may not be there on the field to cheer you on, we hope that just knowing how many other people have played the same game brings you comfort. You are not playing this game alone!

Goodbye, Diapers!

I think one of the greatest mom moments might be when you say goodbye to diapers: the moment when you realize you no longer need to carry a diaper bag, no longer need to search out bathrooms with changing tables, and no longer need to keep the app open at all times. For all of you moms of toddlers, both who are on the cusp or who have recently completed potty training, you get what we are talking about. It’s a goodbye moment that you never thought would come. And unlike the many places, events, and people you have waved goodbye to, this one evokes intensely polarized feelings: relief and reminiscing, escape and longing, and happiness and sadness (whoever thought they would miss a diaper!). But while most of us are not bummed about saying goodbye to cleaning someone’s bum, we feel a twinge of sadness for the mommying chapter that is closing.

In many ways, the early days of mommying are like running the hurdles. And even if you are not a track star, you get the reference. But it’s not only the ups and downs that those infant and toddler days bring, but also the major events that need to be tackled, one after another: feeding, sleeping, crawling, walking, talking, peeing, and pooping. You clear one, and it’s on to the next. And these hurdles, unlike that track and field event you watched on TV, are not all the same height. Some are super, super high.

Potty training is one of those skyscraper-like hurdles. And whether you decide to follow the “Child-Oriented/Brazelton Approach” or the “Toilet Training in Two Days or Less Approach,” it can be a bear or a major pain in the behind. And trust us, we are not here to tell you one approach is better than another or criticize what you have done. You do what works for you and your little one. But we are here to say that, whichever you chose, bear with your baby (and yourself) as you tackle this giant milestone. Don’t let the pressure of those around you, an impending trip, or a summer camp requirement stress you out. It will happen. As moms who have jumped this hurdle twice, we promise you it will.

We are pretty confident that you won’t find a mother who will miss those poop explosions or trying to wipe, change, and hold their little one down with one hand while searching for a clean place to change their diaper with the other. But you will find many moms (us included) who will mourn the passage of time. Saying goodbye to diapers symbolizes that next phase. It symbolizes their growth and ours, both as mothers and as individuals. In many ways, no matter how dirty it is, it is the end of an era.

While that era may have been soiled and smelly, there was also something special about it. So, while we eagerly wave goodbye to diapers, don’t rush what’s to come. As a wise mother once said, “No one ever goes to college in diapers, so don’t stress about potty training.”

Is There an eXXception for Those without the Double XX?

You’re not seeing things…we at Truly, MD, are turning our pens and paper towards the guys. While everything up to this point has been girl (or what you need to know about your plus one if he’s a guy)-related, we are breaking the mold and making this piece about men. Specifically, what happens when you have double the sperm and no eggs (a.k.a. same-sex male couples). And while the options may seem limited or even impossible without two key baby-making ingredients (eggs and uterus), there are ways to work around this.

Where do you find an egg(s)?

Close your eyes, and take a trip back to your childhood—specifically an Easter egg hunt. And while it may be a bit hazy at first, you can probably remember searching and collecting dozens and dozens of eggs. And although your brother, sister, or BFF may have come in at a slightly higher egg count at the end of the day, everyone made out pretty well (and consumed lots of chocolate). Finding an egg donor that is healthy and fertile while also possessing the characteristics (e.g., ethnicity, race) and traits (e.g., artistic, athletic) that you and your partner desire in a donor is just the opposite.

The screening process is intense—physical exam, personal and family history, blood testing, ultrasound, and genetics. Bottom line, there are many hurdles that must be cleared before an egg donor is cleared to give her eggs. Egg donors can be anonymous or directed (a.k.a. known). While most couples opt to go the anonymous route, whom you select is up to you and your partner. However, whomever you pick will need to go through IVF to extract her eggs.

Where do you find a uterus?

Finding a uterus (that is, a gestational carrier or a surrogate) can be laborious (no pun intended)! It is a big decision for any woman to make, and therefore, finding a woman who is willing and able can take a lot of time and a lot of resources. Just as there are for egg donors, there are agencies and attorneys who focus on identifying gestational carriers. Getting hooked up with one shortly after you get hooked up with your plus one is a good way to start the process.

Where do you find sperm?

While this question might seem somewhat misplaced (are they kidding me?), deciding whose sperm to use and when can be a bit complicated. If both partners want to provide a sperm, then you must decide whose embryo(s) will be transferred and when….

Today, parenthood is possible no matter who your partner is and what you are “lacking.” And although you may be missing one or two of the core “necessities” (eggs, uterus, or sperm), you already have the most important core necessity for parenthood—a major desire to be a parent. So don’t worry about the rest. That, we can help take care of!