Some Thoughts on Adoption

An old, very dear, friend of mine sent me the sweetest card last week.  It took me a while to process it because it was unexpected, but I have finally worked up the strength to address it now.


This friend was adopted.


She started out her lovely letter telling me she'd been reading the blog.  She told me how much her heart aches for what B and I have been going through.  She told me what a good Mommy she know's I would make.  She told me she admired my "I will be a better mother" post.  I love this quote from her letter:

"If we never experienced a rainy day, how could we ever appreciate the warm sunshine?"

With that being said, she also acknowledged that remembering such wisdom doesn't make the hard days any easier.


I also love that she said that while she agrees infertility doesn't define me, "it will shape you, cause you to grow and think in ways you have never known before, but it isn't you!"


She went on to tell me all the things I am in her eyes.  She reminded me of all kinds of childhood memories together (we've known each other since first grade!).  She told me she is here to support me, no matter what I need from a friend right now.


She left me with a few silly quotes to help me cope:

1. "The will of God will never lead you where the grace of God will not protect you"
2. "One day at a time... one day at at a time."

Then there was a P.S. at the end that kind of rocked my world for a minute.


She said that she wasn't even going to write this last bit, but in the end felt she needed to be honest.  She said that she completely resepects B's & mine feelings on adoption, but the sections in my blog on that topic where a little hard for her to read.


I had to go back an read what I had written, because I know there weren't any posts yet with a title like today's title... and then I remembered the post-turned-into-a-page, "What not to say."


At the end of this post I make two different statements about adoption, and now that I go back and reread them, they do come off as very dismissive and negative.  Rather insensitive actually.


I feel it is important to explain where I was coming from the day I wrote those words and a little bit more about where B and I are coming from on adoption in general.


B flat out doesn't want to adopt.  He is not interested in open or closed, foreign or domestic, baby or older child adoption.  He just keeps saying he is not comfortable with raising someone else's child.  He is afraid that if there are serious difficulties, handicaps, issues or whatever, that he won't be able to handle it, and would end up resenting me.  He says that if it was our genetic child, he'd feel differently, like it was more his responsibility to work through the tough times and so he'd be able to manage through it with our own child.  But if it was someone else genes and we didn't know what we were getting ourselves into, he'd regret it.  I hope I have articulated that accurately and with the spirit in which he feels.


Because it is all about the genes for him, not just the lifestyle of the mother or the environment of foster homes & orphanages, B is not interested in embryo adoption either.  For the same reason, he is not interested in sperm donation.


I don't know how he really feels about fostering, but I think he would be very concerned of my "falling in love" and pressuring him to adopt any children we welcome into our home/family temporarily, so I think he would be very against fostering as well, though I have not discussed this with him to the point of exhaustion as I have the adoption topics.


This has been very difficult for me to absorb and accept.  I know many people who have adopted or have been adopted, and I think it is a beautiful loving thing.  


I love babies.  I love children.  I am the oldest of four children, the oldest of seven grandchildren.  I grew up with my mother running a home daycare in our house.  I started babysitting other people's children when I was eleven.  I taught Sunday School.  I taught children's swimming lessons for years.  My friends with children always comment on how good I am with their kids and sometimes even call me the "Baby Whisperer."


For me, this whole infertility struggle isn't about our inability to conceive our own genetic child.  It would be beautiful and amazing, and world-changing (to us) for B and I to create a being that is part of each of us.  But I don't need to have my own genetic child.  I'd love to have the experience of being pregnant and giving birth, that rite of passage into womanhood.  But I don't need to be pregnant to feel like a woman, or an adult.


What I do need is to fill this empty hole that is growing inside of me.  This need to nurture, to give, to love something that depends on me for everything.  I need to be a mother.


I honestly believe I'd be very content and my needs would be beyond satisfied with adopting a baby.  An embryo adoption would allow me the opportunity to experience pregnancy and labor, but like I said before, I don't need all that.  I just want a baby.


Sometimes I even think fostering would help, though I'm sure it would be a very slippery slope toward wanting to adopt.  It would be hard to give them up once they've been part of our little family.  Maybe I'm putting words in B's mouth when I say he'd be afraid of me doing that... maybe I say he'll feel that way because part of me worries that I'll do it...


So when I wrote those comments about adoption, about how it's not for every one, about all the negative aspects and risks of it... I was trying to convince myself of these things.


I needed to convince myself that I too felt this way about adoption.  Or that it was ok for someone to feel this way about adoption.  I had to separate myself from my own true feelings about it because the fact of the matter is, I cannot adopt.  In the life I have chosen, I am half of a partnership.  My life is not just about me anymore, it is my and B's life together now.  He feels very strongly against something that I think could take away my suffering.  I have to accept that.


If I don't come to terms with and accept the fact that we will not adopt I only have two other options.  Continue to live in pain with tension between us, or abandon our relationship and pursue adoption without him.  The first is not healthy and won't solve anything and the latter is unimaginable and not an option at all.


I want a baby, but I want B more.  I can't imagine spending the rest of my days without him.  I can't imagine choosing to be a single mother over being a childless couple.  I can't imagine meeting anyone else that I could have children with and being able to love them the way I do B.  I never could have imagined myself not being a mother, but I also could never have imagined myself loving a man like B this much either.  Now that I have him, I don't ever want to let him go.  I'd rather have a good love story be the legacy of my life than an unknown future without the love of my life.


So that's why I have been struggling to come to terms with the fact that adoption is out for us.  Because it has to be.  Because I have to.


That's also why I put so much emotion, time, and energy into fertility treatments and options.  Because they are my only hope of having it all.  Of being the person I thought I was meant to be.  Of feeling complete as an adult woman in the only way I know how to...so far.


To all my friends and family who have either adopted or were adopted. I'm sorry if my comments in earlier posts/pages were hurtful to you.  I see now how insensitive they were.  I just want you to know that I wasn't thinking of anyone or anything besides myself and what I am experiencing with B when I wrote those.  I talk so much about wanting others to be sensitive to infertiles like me, and then I go and do something so thoughtless.  I'm sincerely sorry for any pain or discomfort I may have caused.

Varicocele Surgery: What are the success rates?

Varicoceles are identified in 35% to 40% of men with primary infertility and 81% of men with secondary infertility.  The majority of available evidence favors the surgical treatment of clinical varicoceles in men with infertility, which is thought to halt their duration-dependent effects.

Varicocele repair surgery can result in a significant improvement in semen parameters in 60% to 70% of men, with natural pregnancy rates up to 50%.  Men with larger varicoceles tend to have poorer semen quality than those with smaller varicoceles, and tend to have greater improvement with repair surgery.

Overall, a significant percentage of couples who undergo varicocele repair surgery will go on to achieve pregnancy without ART, and those who do need ART will have optimized their sperm quality.

It takes 90 days (3 months) for the male body to generate new sperm, so no improvements will be seen for 3 months following the surgery, with best results occurring in the first year, and some even into the second year following the surgery.

How this relates to us:

Since B and I have scheduled the surgery for the first week of April, that put our TTC routine on hold until around the week of the 4th of July.  Some things I've read online claim that better results are seen after 6 months, so that will put us at October before we'd really have our hopes up.  If it doesn't happen by the end of the year (trying naturally), then I think we'd be ready to allocate some money into our flex spending account for 2013 to try a few more rounds of IUI next year.

If trying naturally and with IUI's through 2013 doesn't work for us, then the next step would hopefully be saving up for IVF in 2014 or beyond.  I'll be 32, turning 33 by then, so our odds of successful IVF will still be high, but we'd only have a couple of years to get it done before my fertility starts falling.  

But seriously, IVF? The idea of saving up $13,000 for one round of fresh IVF cycle seems plausible by then... but what if that doesn't work what would we do?  With the plan described above, IVF is obviously our last resort.  

We could try to save up for the "shared risk" programs out there, where you pay $20,000 to $26,000 for 3 rounds of fresh and 3 rounds of frozen, and if it doesn't work, you get some or most of your money back.  But where would we come up with that kind of cash?  It would take longer, and then again my fertility will just decline further the longer we wait.

I wish I had a crystal ball.  I'd love to know that I'm just "catastrophe" thinking right now and we'll be pregnant naturally this summer.  Or that one round of IVF will get us twins and we'll be done.  Or that nothing will work but a 3rd frozen IVF cycle and so I should not bother getting my hopes up with anything else along the way.

Also, I wish we'd win the lottery.  That would solve a lot of our problems.

Varicocele Repair Surgery

• There are three methods in which varicoceles can be surgically treated: open surgery, laparoscopic surgery, and the third, which isn't even really surgical (it's performed by a radiologist), is percutaneous embolization.
  Open surgery. This treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Commonly, the surgeon will approach the vein through the groin (transinguinal), but it's also possible to make an incision in your abdomen or below the groin.
  Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.
• Laparoscopic surgery. The surgeon makes a small incision in the abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.
• Percutaneous embolization. A radiologist inserts a tube into a vein in the groin or neck through which instruments can be passed. Viewing enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure is done with local anesthesia on an outpatient basis. This procedure isn't as widely used as surgery.
• So what's best?
• According to Dr. J's article, "Do varicoceles really affect male fertility?" although most methods yield similar short-term results, open micro-surgery tends to have lower long-term complications, such as recurrences and hydroceles.  This is due to the ability to tie off all veins while sparing the arterial blood supply and lymphatic vessels.  
• Although laparoscopic varicocele ligation was once touted as a minimally invasive method of repair, several experts have demonstrated similar recovery rates with open micro-surgical methods along with equal efficacy, fewer complications, and the advantage of not having to enter the abdomen.
• The most common complications from any of these varicocelectomy procedures are hydrocele, varicocele recurrence, and testicular artery injury.  Use of the operating microscope allows for reliable identification of spermatic cord lymphatics, internal spermatic veins and venous collaterals, and the testicular artery or arteries, so that the incidence of these complications can be reduced significantly.  Thus, the microsurgical technique of "open micro-surgery" provides a safe and effective approach to varicocele repair that preserves testicular function, enhances semen quality, and improves partners' pregnacy rates.
• What to expect from Open Micro-Surgery 
  Most men prefer general anesthesia, though the procedure can be performed under local with intravenous sedation.  Time to recovery varies, but most men get back to work within 3-4 days and and resume full activity within 7-10 days.
• From mayoclinic.com:
• You may be able to return to normal, nonstrenous activities after two days. As long as you're not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.
  
  Pain from this surgery generally is mild. Your doctor may prescribe pain medication for the first two days after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to relieve discomfort.
  
  Your doctor may advise you not to have sex for one to two weeks. You'll have to wait three or four months after surgery to get a semen analysis to determine whether the varicocele repair was successful in restoring your fertility.

• **Dr. J has recommended Open Micro-Surgery for B.**

What the heck are varicoceles?

A varicocele (VAR-ih-koe-seel) is a dilation of the veins that drain the testis, known as the pampiniform plexus. A varicocele is similar to a varicose vein that can occur in your leg.

As it turns out, varicoceles are present in approximately 15% of the general male population. They account for up to 40% of male factor infertility, yet nearly two-thirds of men with varicoceles are fertile... so could varicoceles be causing mine & B's infertility?

The answer I've been able to come with so far is "maybe."

Causes

Varicoceles are typically not noticed until after puberty because testicular blood flow remains low prior to that and so these veins do not become apparent until adolescence when blood flow increases.  However many are not detected until a man is evaluated for fertility problems later in life. 

It's not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the spermatic cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate). 

Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles. 

Our doctor, Dr. Jay Sandlow (I like to refer to him as "Dr. J"), published an article called, "Do varicoceles really affect male fertility?" in Sexuality, Reproduction & Menopause, arguing that it is not the valve that is the issue, so much as the anatomy of the entire drainage system that plays a major role in the the development of varicoceles.

"Because the left side drains into a system with higher resistance (the renal vein), small venules may persist or open during embryogenesis." - Jay Sandlow

Don't ask me what that means... after looking up definitions for venules and embryogenesis, I think it means the way a man's anatomy is formed while still a fetus determines whether he'll have varicoceles, though they aren't detected until after puberty when things really start flowing down there.  Maybe I should ask Dr. J if I understand that correctly though :)

How can they affect fertility?

In cases of where men who have varicoceles happen to be experiencing infertility, varicoceles are thought to cause spermatogenic defects by raising the intratesticular temperature in both the affected and the adjacent testes. However, not all varicoceles affect sperm production, which explains why not all men with varicoceles (in fact, most of them), are fertile.

Diagnosis


When varicoceles are suspected of causing infertility, abnormalities in all of the seminal parameters are usually present.  However, they can also cause isolated defects in sperm count, motility, morphology, or function.  Therefore, according to the article written by Dr. J mentioned above, the results of semen analysis are not a good predictor of the presence or absence of varicoceles.  And so, they are typically diagnosed by physical examination.  Most experts agree that the only varicoceles to worry about are the ones that can be detected by physical examination, though ultrasound can be used to identify them as well.


In our case...


B's were visible right away upon physical examination, and he has them on both sides.  We discovered this back in April 2011, but because the results of his seminal parameters testing were all coming back within the range of normal fairly consistently, Dr. J instructed us to first continue trying naturally for 4-6 months, with timed intercourse (only every other day during the fertile period of my cycle).  


That brought us to September, when we did our first IUI, which failed.  That's also when we learned how low B's "good sperm" counts were post-washing.  It was at that time that Dr. J recommended doing one more IUI, and if the numbers came back that low again post-wash, then he would recommend varicocele repair surgery as our next course of action.


We attempted an IUI earlier this month (February 2012) and his count came back lower than last time, so in effort to save money, we didn't even go through with it.  I was on clomid that cycle for the IUI, so there could have been a chance of increased fertility for us naturally... but I got my period Wednesday night so [sigh] that's disappointing.


So we scheduled the surgery for early April.  I'll post more soon about what that entails and what the success rates are.

And I thought last week was rough!

So last week I posted about what a hard time I had preparing for 3 baby showers for the weekend.  Not that I was sad about it, but that it was just mentally taxing for me to spend that much time planning gifts, shopping in the baby section of stores, and picking out thoughtful cards for my friends and coworkers on one of the most memorable events of their lives.


The two coworkers' baby showers last Friday went really well.  I made homemade chex mix the night before as my snack to pass, I wrapped their gifts and signed their cards.  Before the shower I helped to decorate and set up the room.  During the party itself I had a great time socializing with the professors and staff that I work with, and any anxiety I had about the gifts I'd picked out went right out the window when the Moms-to-be squealed with delight and thanked me for my cute gifts!


B and I went out with some old friends that were in town over the weekend on Friday night.  I was kind of tired but we haven't seen them in years and I wanted to catch up with them, so we went and had a great time.  I was able to eat a vegan meal and enjoyed one specialty cocktail.  It really was fun and we all had a great time reminiscing about when we all lived in La Crosse and worked together, back in the early days of my & B's relationship.  It was fun to see that people just fundamentally don't change.  They may grow up, but they are still the same people that they always were, deep down.


Saturday we were supposed to get up, take the dogs to a dog park, and then drive down to IL for a "couples shower" for some of our closest friends.  Only I couldn't do it.  Not because I was "having a rough week," but because I woke up with the worst migraine I've had in over 3 years!  I stayed in bed until 2pm, when we were supposed to leave for the party, but it was still so bad that I had to text my friends and tell them I couldn't make it.  I stayed in bed and slept on and off that entire day.


I am really afraid that all our friends probably think we didn't show because I "couldn't take it."  To be honest, a small part of me did wonder if maybe the migraine was brought on by all the stress of the past week, preparing for all these baby events.  But if that was the case, you'd think that once we decided not to go to the party, you'd think my migraine would have subsided. Not the case.  It continued into the next day and I had to miss out on my father-in-law's birthday party too!  My entire body was starting to ache at this point and I started to worry that I was getting really sick.


Monday I woke up and my throat was sore, I still had the severe headache, and all my joints ached.  B worried I was coming down with influenza.  I had to call in sick to work which always causes a lot of stress when you come back, and I had to reschedule 2 meetings because of it, disrupting everyone else's schedule, not just my own!  Tuesday the sore throat was gone, but my head still hurt, so I took one more day off of work.  At least I know none of this could have been because of a baby shower!


Wednesday I was still weak but went back to work.  Found out my cousin and his wife had their baby.  I'm happy for them, but not really something I was super excited to read about first thing in the morning after emerging from my sick-cave.  It was like I left the real world in the midst of 3 baby showers, went into my hibernation cave for 4 days while recovering from whatever weird illness I'd picked up, and when I emerged afterward, I got smacked in the face with a birth announcement.  I know I'm hypersensitive to all things Baby right now, but I think anyone would agree that this stuff is pretty blatantly surrounding me right now, right? Right?


While I'm at work, I learn that my coworker was out Monday and Tuesday too, with the exact same thing, and it had also started for her with a severe headache on Saturday as well!  Maybe it was something we ate at the baby shower on Friday?  B said the secretary at his work had something similar last week too, so perhaps something weird is going around.


AF arrived last night.  I wasn't expecting her until today, but still pretty much on time.  Like clockwork.  Always like clockwork.  I have a normal 26 day cycle, ovulate on days 14-16, get all the appropriate signs in my body for each  phase of my cycle, and yet I can not get pregnant.  So frustrating.


Woke up this morning and found out my best friend down in AZ is in the hospital and they are going to deliver her baby today.  She wasn't due until April 1st.  She is only 34.5 weeks along.  My very first reaction was, "oh, no, not another premie."  Her firstborn came way to early as well.  I'm so worried about my friend and her baby.  Everything worked out fine last time.  My friend was fine, and the baby miraculously was absolutely fine as well, didn't need any kind of support or anything!  I hope it works out the same way this time, but I'll be worried about them until I hear more news.


Guess I should have picked up a little something for this friend after all when I was out shopping last week!

Surgery Scheduled

B's varicocele surgery has been scheduled for April 5th.  He'll need 5 days after the surgery to recover so we won't be going home for Easter this year.  This was the best time for us to schedule the surgery though because he only will have 3 days of sick time built up by then and his work gives him Good Friday off.  So between the weekend, the holiday, and his sick time, he'll have just enough time off.


I still plan to post more about what varicocele's are, how they can effect infertility, and what the surgery is all about soon.  In the meantime, we are just mentally preparing for this big next step.

I'm blessed to have such sensitive friends

To the friend who happens to be a former infertile and I wasn't sure if she'd been reading my blog or not, but sent me a private FB message today warning that she'd posted a few pics of her twin infant sons upon request of other friends & family today: thank you.  Thank you for reading my blog.  Thank you for being so sensitive.  And thank you for being so thoughtful.  You are a blessing in my life and I'm so lucky to be able to call you a friend.  And I love your little blessings and can't wait to see them again soon!