Wednesday, July 19, 2006

How soon is too soon?

I forgot to mention that while I was waiting at the doctor's office the other day, I picked up someone's abandoned Wall Street Journal and read an article about how more and more younger women are going in for fertility treatments. (I'd link to the article directly, but I'm not a subscriber and so can't access it online.) There was the usual stuff about younger women being more aware of fertility issues, media panic about decreasing fertility, and an "exploding fertility industry," as well as the not-so-subtly-misogynistic bit about young women having watched 40-something women put off childbearing too long for the sake of their careers, don't want to make the same mistakes, blah blah blah.

(Can I just say, I have yet to meet this mythical too-focused-on-career-and-now-full-of-regret woman? I live in probably the career-woman capital of the world, and in all the time I've spent in RE waiting rooms over the past year, I'd say that most of the women I've seen look like they're around my age--early 30s. Even at Cornell, which is a lot of women's last stop on the ART train, 32 percent of fresh IVF cycles in 2003 were done by women under 35. Finally this is a gross generalization, but I'd say that of the women I've encountered online for whom age may be a factor in their IF, not one has said that she intentionally put off having kids until her 40s because of her career--it seems like the real issue was finding a partner they wanted to parent with. So can we please drop the whole "working women are destroying the children!" crap?)

Anyway, what struck me about this story was the lead anecdote, about a couple in their early 20s (I think she was 24) who sought treatment after TTC for just four months. She ultimately conceived with the help of Clomid. Now, far be it from me to dictate who "deserves" IF treatment or not--certainly there are infertile women of all ages, and perhaps this woman already knew she had an underlying health condition like PCOS or endo and was just being proactive (the story didn't say), but what OB or RE in their right minds gives Clomid to a 24-year-old who's only been TTC for four cycles? (I guess art does imitate life.)

I worry that women who jump the gun on seeking fertility treatment (again, far be it from me to define what that is--certainly, if you have a known health condition that might affect your fertility, there's probably no such thing as too soon, and if you're 25 and have been TTC for a year, you have just as much right to be taken seriously as infertile as a 35 year old) give the rest of us a bad name. It just feeds the assumptions of people like my coworker, who believes that a lot of women seek treatment unnecessarily and just need to be patient.

Then there was this recent study, which took two groups of women with unexplained infertility, one group receiving IUI plus ovarian stimulation, the other receiving no treatment at all. After six months, the researchers found that the ones who didn't undergo treatment were actually slightly more likely to achieve an ongoing pregnancy.

Again, I fear that this study will only give ammunition to the "Just relax!" crowd--when of course the key is that these were all women with unexplained infertility. I don't discount the very real pain of women who experience unexplained infertility, but a lot of the women in this study probably just fell into the statistical fraction of women who take a little longer to conceive naturally. I would hate for someone to see this study and think, "Maybe I just need to wait another year," and delay seeking treatment that they really do need.

Anyway, thinking about all this made me curious: How long did all of you TTC before seeking treatment? Were you actively TTC right away, or did you just stop using birth control for a while, then later started charting etc.? What other factors affected how long you waited? (For example, I already knew I had PCOS, so I actually consulted an RE before going off the pill, and I started charting right away to see if I was ovulating--but I didn't begin treatment until after nearly a year and a half, because I had no IF insurance coverage until then.) And how old were you when you got started? (I was 30.)

And if there's anyone reading who didn't have trouble conceiving, or who hasn't started TTC yet, how long do you think you would wait before seeking treatment?


Blogger Amy said...

My husband and I were TTC for a year before we went to my OB/GYN seeking answers and then we were sent to our RE. We were actively trying for a year. I stopped taking birth control three months before we actively started TTC. That was my mother's suggestion. She felt that she didn't give her body enough time off birth control when she became pregnant three times and lost three babies before having my older sister. Knowing more now, I don't think that it had anything to do with her birth control. Anyway, I started charting as soon as we started actively TTC, it was clear that my body was way off because I only had my period 3 times a year, I'd bleed for a month or more, and then I would never ovulate. At first we thought it had something to do with coming off of birth control and my body just hadn't regulated itself. When I went in for my pap smear after a year of TTC I told the doctor about my cycle. After a few tests my husband and I were sent to our RE. My husband and I were 24 when we started TTC on our own, 25 when we were sent to the RE. We also found out that my husband had a varicocele which caused him to have a low sperm count, it's one of the most common causes of male infertility. My main issue is that my hormones are all off, my brain doesn't communicate with my ovaries at all. Most women ovulate when their estrogen reaches something like 600, I wouldn't ovulate until I was well over 1,000 and pumped full of fertility drugs. I know that my husband and I were one of those younger couples, but we didn't start trying to have a baby or go to an RE because I was afraid to be "one of those 40-something women who put off childbearing for too long" at all. We were just ready to have a baby, we both wanted to have kids and for us it was time. We were finally married after knowing each other for 7 years, first being close friends and then dating. We both had stable good paying jobs that we liked, we had a house, we had money in savings, it was just time for us. Even though my cycle was clearly not right and I wasn't ovulating we gave it a year and then we went to an RE. I agree that most women aren't waiting to have kids because of their jobs, I think most are waiting for the right partner. I also have to say that the "just relax" crowd totally pisses me off, because all of us were relaxed in the beginning and nothing happened! A woman already feels bad enough when her body isn't operating the way that nature intended it to, but to blame her for doing it to herself, like she has control over it isn't fair. If all we had to do is simply calm down and then we'd suddenly be pregnant then we'd all do that, but we all know that there is more to it then that. Same goes for men with a low sperm count. I doubt that if my husband was in the habit of meditating morning, noon, and night that he wouldn't have ever had a varicocele and that he'd in fact be producing super sperm. Ok, I've gone on long enough. Good post, those articles always get me wound up.

2:01 PM  
Anonymous gabby said...

Great post. I have noticed the same thing: where are all these late 30s, early 40s women who simply put off child bearing due to their career? I was one of those people who sought treatment early. I went off the pill in late February but was not ovulating at all regularly. My luteal phase was short as well. By my 4th cycle in (in 8 months), I saw my OB/GYN at my annual exam. She suggested we try clomid for 3 rounds. She didn't suggest DH go for an SA but I had him do one anyway. When my progesterone came back only as 7 on my first round of clomid and my GYN thought that was OK, I knew I needed to seek the help on an RE. Couple that with a bad SA. If I had been o’ing regularly, I wouldn’t have needed to seek help but I knew something was up. I’m actually on my second clinic now and doing my first round of IVF. In fact, when I started IVF, we had only been ttc for a year. Part of it seems like I rushed in to things but really, I could have waited a whole year having irregular and weak ovulations throwing lots of 1% morph sperm at the sad eggs and it wouldn’t have changed the fact I knew pretty early on—we needed help.

But the people who get worked up over it not happening after 2 cycles and everything seems fine, I just don’t see most of them immediately hopping to IF treatments. Who would willingly take the sex out of baby making, stick themselves with needles, or take drugs with wicked side effects when they don’t absolutely need to?

2:15 PM  
Blogger Robber Barren said...

Oooh - you'll probably hate me. I was aware of my menstrual/ovulatory issues (hadn't heard of "PCOS" then) since my mid-teens, and since they persisted through college, my then-gyn told me it was unlikely I'd conceive without some medical help. I went off of birth control in January of 2005 (around my 25th birthday), started charting immediately, and had my first "I'm not ovulating! I'm not even cycling!" in March of that year. By June I was having blood drawn (by my FP) for Day 3 tests, and within a month I was on metformin. She offered Clomid, but I said no. I stuck with the metformin (and occasional Provera to induce bleeds) through the rest of 2005, and in early December finally called for an appointment with an RE. That appointment was in February of 2006. I did two rounds of Clomid (both in one cycle) in March 2006. We took April off, and then our first Follistim/IUI cycle in May got me pregnant with twins.

And I think that I was too slow with things. If I'd really been doing this the right way, I'd have been in the RE's office in the summer of 2006, 25 years old and with only five months of TTC under my belt. And I'd have asked for Clomid immediately just to rule out the possibility of it's working. And if we then went on to Follistim/IUI right away, and that first cycle worked, I'd be one of those 25-year-old women who got pregnant right away with treatment after less than a year of TTC.

I hate that there are people out there who look the same on the surface (young, sought aggressive treatment early) who likely did not need such treatment. (That is, the people who don't bother getting tested at all and whose doctors hand out Clomid like candy.) I feel like they give people like me a bad name, and I really dread the first time someone who doesn't know my full medical background makes a snide comment about us seeking treatment oo early, when I was so young and probably just needed to give it time. But it's important to remember (and I think you do, ElectricLady, but I'm going to repeat it anyway) that there are young, seemingly fertile women out there who absolutely cannot get pregnant without help, and who are lucky enough to be aware of their medical issues early enough to avoid a year or two of heartbreak before they even start treatment.

OK, off my soapbox now.

2:55 PM  
Blogger electriclady said...

Amy, Gabby, Robbie, that's exactly the point I was trying to make--that there are younger women (like all of you!) who right from the beginning clearly have issues that need addressing. That was the subtlety that the WSJ article didn't address (wish I could post the whole thing for you!). Maybe that 24-year-old in the article didn't get a single period in four months, and so she knew right away something was up and sought treatment. But the story didn't say, and made it sound like these were just women who got impatient with pregnancy not happening on their timetable. As you said, Robbie, that kind of thinking just lumps together all young women into one can't-wait category, which is really unfair.

And I definitely waited too long--I was even told by an RE when I was in college that I should start treatment if I didn't conceive in 6 months. But my sort-of cycles (40-70 days long, but with definite temp peak and perfect luteal phase) seduced me into thinking we had a shot at doing it on our own.

3:38 PM  
Blogger Shana said...

We sought medical help after ttc for two years. We were both 25 when we started ttc. Full range of testing on both sides left us with an official diagnosis of unexplained IF though I did have some luteal phase issues.

It took us another two years to get pregnant as we moved slowly down the path of fertility treatment. Finally ended up conceiving our first IVF cycle. We had started ttc right after I turned 25. Our daughter was born one week before my 30th birthday.

So I'd say no, we definitely didn't jump right into aggressive treatment despite our young ages.

4:43 PM  
Blogger Rachel Inbar said...

I waited 14 months, making excuses to myself like, "well, the first month we weren't REALLY trying..." I was only 21 at the time & it turned out that without IVF it was completely hopeless. After 3 years of TTC, I got pregnant after my 2nd IVF. I went on to do 2 more fresh & 1 frozen cycle & got pregnant with twins from the frozen cycle. I even went back again, did another fresh IVF and got pregnant again on the first try, but I ended up having a late miscarriage because of a hematoma.

5:08 PM  
Blogger GZ said...

I agree with you completely. I just hope my mother doesn't read that article....

I'm only 23, but I suspected somewhat early on that my husband might have problems as one of his older brothers had. However, even then, we didn't get into our first appointment with an RE until cycle 19.

10:58 PM  
Anonymous apey said...

Hi. I've been a lurker on your blog since March '06.

I'm 24, turning 25 in Dec, but I had known at 15 that it may be hard to conceive. One of my friends whose parents were both doctors said "Hey, you know your wacky periods? My mom says it would be difficult for you to have kids." At the time I thought she was being mean. Why else would she say that? I found out later that her dad had male factor infertility, and I'm very grateful that my possible IF was pointed out to me, albeit in a strange fashion.
So yes, I've always known that there may be problems with my plumbing. I've been perusing China adoption blogs since I was 17, thinking that this may be in my future if medical help fails.

You might hate me for saying this, but I did not actually 'ttc' before seeing an OB for annovulation. We did however have 2 years of unprotected sex, which equals to about 9 or 10 of my PCOS cycles. I tried charting when we got married two years ago, but after taking my temp for 60 days straight without any changes, I got bored and frustrated. Gave up. I too fell into the trap of thinking "Oh, I should give this 12 cycles at least before seeking medical help."

I didn't run to an OB or RE earlier because I was afraid of what I would learn. I hoped and prayed that I was one of those "lucky" PCOS-ers that ovulated during their cycles. No wait..I prayed that I didn't have PCOS at all! I laugh at myself now..why else would someone's periods last for months instead of weeks? Anyway, I went to the OB, got dxed, got Provera and Clomid. My OB is great and didn't give me grief for not officially ttcing before seeing her. So far: 3 clomid rounds, 2 ovulatory, 1 not. No pregnancy.

I'd like to highlight something that I don't see many IF blogs talking about. There are young IF-ers out there, myself included, who can't afford fertility treatments. I'm talking about injectables and up. I live in a state where fertility coverage is not mandated, so I pay out of pocket for everything. It's depressing when I think about my fertility being limited to the number of cycles I can pay for. Well then. I might as well be 40 if I can't pony up the cash. Sometimes I do infertility math in my head: If I get 4-5 cycles a year, two of those may be ovulatory. I'm turning 25, so that means 15 more years and 30 ovulatory cycles. Huzzah!

I know it's all very doom and gloom, but I'm a pessimist and a worst case scenario person. If I could change one thing, it would be to start charting, TCOYF methods, the whole works when I got engaged. I beat myself up constantly for not doing anything for the last two years. Sorry this was so long.

2:13 AM  
Blogger electriclady said...

This comment has been removed by a blog administrator.

10:51 AM  
Blogger electriclady said...

Apey, you may not have considered yourself to be "ttc," but two years of unprotected sex without conception definitely qualifies you as textbook infertile and needing treatment.

Also, people, what's with assuming I will hate you for being medically responsible? :) I don't hate anyone we're talking about here, except maybe the journalists who are too lazy to do their research and spread misinformation far and wide.

Re: affordability, I've been meaning to sit down with all my receipts and figure out just how much my one cycle of injectibles would have cost if I'd paid out of pocket. (My clinic breaks it down so you can see exactly what each visit costs out of pocket, even if you only pay a copay. I think a single 15-minute monitoring visit with bloods and ultrasound costs around $300.) I'm guessing around $3K or more. I doubt I'd be able to afford it without going into debt, though I suppose I would have been even less able to afford it at 25.

10:51 AM  
Blogger Alli said...

This comment has been removed by a blog administrator.

11:36 AM  
Blogger Alli said...

Sorry - that was me. I messed up.

It took us a year after my m/c to concieve our youngest son. He's now 6 and we have been ttc since he was 2. We sought medical assistance after about a year.

11:38 AM  
Blogger heather said...

we ttc'd for a little more than 6 yrs when we jumped into ivf. i also have pcos. i'd done clomid countless times (always o, never get pg), was in a metformin/clomid study, had a torsion due to ohss from clomid. we found out in nov that dh's insurance would start covering ivf, so i called right away for an appt. we got a bfn with our fresh cycle, but bfp with a fet of 2, now p with one. i'm just a couple of days behind you. so good to read someone else feels the same things i do. i've just read your entire archive (in the past couple of days...while "working) and i've found so many things i've said myself..esp the "cautiously optimistic" comment. that was the title of my post when i got my first beta of 27. can't wait to read more...good luck!!

4:26 PM  
Anonymous Erin said...

I was TTC#1 for about 6 months (and 24 years old) when I made my first RE appt. The reason? I'd been charting the whole time and had just ovulated for the second time in those 6 months. When my NP heard that at my annual Pap, she looked horrified and immediately gave me a referral. It took another month before I saw that RE, then four more months (during which I had 3 unsuccessful Clomid cycles, only one of which made me ovulate any sooner than normal) before I made an appt with my current RE, who figured out that I have PCOS and got me started on Met, which ultimately got me pregnant with P.

When we decided to TTC#2, I gave it a few months to see if my PCOS had gotten better. I'd heard it could get worse or better after a successful pregnancy, so I thought I'd give that a try. After 3 cycles in 6 months (ha, an improvement ;-) ), I went to my OB who gave me a prescription for Met again. That was last May. I went back to him in late October because my pre-period spotting had gotten so ridiculous. He gave me a post-O progesterone test and an Rx for Clomid. Before I'd even gotten the Rx filled, I'd made an appt with my RE. I saw him when we'd been TTC#2 for about a year, 6 months of which were on Met. Since then, I've had 3 more cycles on a higher dose of Clomid and one IUI (not to mention an HSG and countless blood tests and u/s).

I started TTC#1 at 23, was 24 when I saw my NP and got my first RE referral, saw my second RE right after I turned 25, and had P 6 weeks before I turned 26. We started TTC#2 when I was 26 (P was 11 months old), saw my OB when I was 27, and have been seeing my RE again since right before I turned 28.

5:42 PM  
Anonymous Erin said...

Oh, and I'm like you: I did actually ovulate on my own. It just took between 33 and 57 days for it to happen each cycle. So I was semi-lulled into thinking it could happen without help. Even when the NP gave me the referral, I thought "Oh, but I won't need that!"

5:44 PM  
Blogger heather said...

oh, i forgot to say that we started ttc when i was 22, dh 23. i'm now 29, he's 30 and this one will (hopefully) be born right after i turn 30 and he turns 31. my cylces have always been long...since i was 13 and i thought it was great. didn't know what pcos was until we'd been trying about a year and saw my first re.

5:51 PM  
Blogger wavybrains said...

I'm 27 right now. He's 34. I've known for 3 years that I have PCOS and accompanying severe insulin resistance/borderline diabetes. I've been on Met for 2 years now and that's given me respectable cycles, but my hormones are still all messed up. We've been TTC for two months, but we've known that how iffy this road is for a long time now, and we're already exploring adoption options. Thanks for this great post!

1:32 PM  
Blogger Emma B. said...

I actually got pregnant on my first-ever ovulatory cycle of TTC. I had wildly irregular cycles in early high school, went on the pill at 15, and didn't come off until last May, when we were ready to start TTC. I started charting right off, and when it became obvious I hadn't ovulated, I started on Provera at the 45-day mark. When I didn't bleed after the Provera, it was immediately obvious to everyone that Bad Things were afoot. I flunked a couple more rounds of Provera, a cycle of letrozole, and a cycle of Clomid, before getting pregnant on our first injectible/IUI cycle.

I should also say that my mom is my RE's nurse, and had infertility troubles herself. I also have central hypothyroidism, which gave us advance warning that all might not be peachy. Still, it felt fast even to us -- I was on letrozole three months after coming off the Pill -- and I got a lot of "just be patient" comments from friends who didn't understand.

11:43 PM  
Blogger Heather said...

I probably fall into that category of the younger person who maybe should have "just waited longer." Who knows. I went off the pill in July and at the end of January I had a doctor visit (annual not especially for this) and that is when he put me on Clomid. So that makes it what 6 months.

My only unusual thing was that I was anti-ovulatory so the chances of me concieving on my own were non-existent. Obviously if you don't ovulate, you don't get pregnant. I'm not sure if we would have waited a little longer if I would have started to ovulate or not.

I'm 26, but my mother didn't ovulate regularly so I knew this could be a possibilty for me. I got pregnant on my third dose of 100 mg Clomid, so I don't consider myself truely infertile, as I know there are others who have been through so much more.

8:46 PM  
Blogger K77 said...

I sought out an RE in late 2003 before ttc as I knew I didn't ovulate (PCOS) and didn't see the point of throwing donor sperm up there with no waiting egg. I did 6 rounds of Clomid without success - ovulated but not pg. Went the natural therapies route until I saw a new RE in April 06, where I demanded the whole shebang - lap, hyst, HSG, after hormone tests in January indicated everything was perfectly normal. And, as you know (if you've figure out my secret identity yet) that gave me the dx of severe endo, UU, 1 ovary, 1 tube, 1 kidney, crooked cervix.

12:32 AM  
Blogger K77 said...

Oh yeah, and I'm 29 now, was 26 at first RE consult.

12:33 AM  
Blogger K77 said...

Oh and I also should add that I had over 7 years of haphazard contraception use prior to all this.

1:13 AM  
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9:23 AM  

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