husband that her ovaries were reacting to the sound of the fertility doctor’s voice and got scared into getting pregnant in order to avoid another IVF. What she didn’t know was that the spotting was implantation bleeding. A few days later, she couldn’t ignore the symptoms anymore; she’d been pregnant so many times that she was completely in tune with her body.
“It was three o’clock in the morning and it sort of hit me,” she told me later. “I got up and did a pregnancy test in the middle of the night. After four years of trying to conceive, I was pregnant with Mia.” What surprised her most was that her husband had been away for work that month and they’d only had intercourse once, well before ovulation.
A woman’s fertile window is about five days before ovulation, and on ovulation day. After ovulation, the window of receptivity to sperm is twelve to twenty-four hours. The idea is to try to have sex before ovulation, allowing the sperm to swim up to and sit in the fallopian tubes, where they can live up to a maximum of seven days ready and waiting for the ovulating egg. This must have been what happened when Vanessa finally became pregnant—the old-fashioned way, with no technology.
2
The Everywoman of Fertility Challenges
It does not do to dwell on dreams and forget to live.
J.K. ROWLING, HARRY POTTER AND THE SORCERER’S STONE
Avery: Poor ovarian reserve
Avery was a hard-working, goal-oriented woman. At thirty-six, having achieved partnership in her law firm, she focused on her goal of having two children before she reached forty. After two years of trying to conceive with her husband of seven years, they sought help from a fertility clinic. After undergoing IUI unsuccessfully, she attended my clinic feeling desperate and frustrated.
Avery’s first impression of my TCM clinic was that it was calm, restful, welcoming, and warm, in contrast to the necessarily sterile medical environment of the fertility clinic. She sat on my treatment table, commenting on the comfort of the pillows and sheets in contrast to the disposable paper at the medical clinic. When our conversation turned to her unsuccessful IUI, however, her tears began to flow.
I encounter this almost daily in my practice. The women who come to me feel more than devastated; they feel broken, as if their inability to have a child negates every area of their lives—lives in which they are not only competent but sometimes very accomplished. I provide a safe space for much-needed emotional release. I told Avery there was nothing I could say to ease her pain. There’s no other way to describe it except to say it’s unfair, and, well, it sucks.
I call this the mourning period, a time to grieve the loss of a wanted child. In Chinese medicine, we view this as a healthy and necessary emotional purge. It’s important and healthy to experience your emotions and get them out rather than trying to bottle them up inside and get on with your busy life.
The seven affects of emotions
In Chinese medicine, we recognize the need to experience the “seven affects” of emotions. It is a healthy and necessary part of the human experience to express joy, sorrow, worry, grief, fear, fright, and anger. When we harbour and suppress these feelings over a prolonged period without expressing or purging them, we give rise to disharmony, which affects our physical well-being, including our fertility.
Infertility myths
Before coming to my clinic, or going to a fertility clinic, Avery and her husband had tried to conceive on their own for twelve months. After six months of having sex three times a week without conceiving, Avery used an ovulation predictor kit (OPK) from the local pharmacy to time their intercourse during her peak ovulation times. She would pee on a urine stick every day from eight days after her menstrual period began; when a happy face appeared on the pee strip, it indicated her most fertile time (when her surging luteinizing hormone triggered the release of a mature egg from one of her ovaries). This peak indicated the small window of opportunity each month in which she might conceive, typically about six days.
Avery, an overachiever, said she and her husband would have intercourse daily, sometimes twice, to “get the job done.” She admitted their love-making had become mechanical, timed, and devoid of spontaneity. Instead of focusing on their connection and mutual enjoyment, she strategized the best sexual position to maximize conception; after he gave his “sperm donation,” she’d stick a pillow under her bum and lie on her back with her feet propped up against the wall. She’d stay in that position until morning, not even peeing before she slept so no semen would leak out.
Like most of my patients, Avery avidly read books and online information about enhancing chances of conception. Collecting information from so many, sometimes conflicting sources, leads many women to gather unhelpful advice that can even interfere with conception.
Holding your urine may seem like a good idea, but you run the risk of a urinary tract infection (UTI), especially if you are prone to them, as Avery was. Also, by “holding it in,” there is a natural tendency for the pelvic floor to tighten and constrict, which can be counterproductive to conception.
Moreover, it’s a myth that the sperm readily “leaks out.” Sperm are dynamic; it’s unavoidable that some get left behind, but the dynamic sperm quickly separate from the seminal fluid as they swim up to the fallopian tubes. Once there, they may sit for several days waiting to fertilize a matured egg as it descends from one of the ovaries.
The fertility clinic experience
After twelve months of trying on their own without success, Avery’s family doctor referred her to an RE at a fertility clinic in Toronto. Avery described the process as impersonal and stressful. At their first consultation, she and her husband gave blood samples and spoke briefly with the doctor before being ushered to separate rooms for preliminary tests.
Avery was shown to one room for a trans-vaginal ultrasound. The technician watched a monitor attached to the probe while moving it inside Avery’s vagina, looking inside her left and right ovaries for the developing antral follicles as well as examining the thickness of the uterine lining. This invasive process, which every fertility patient undergoes, can be very uncomfortable, but is necessary to determine the state of your fertility in that moment and therefore the likelihood of IVF success.
At the same time, Avery’s husband, Walter, was led to a small room just big enough for an armchair, a TV with a DVD player, and a small collection of X-rated movies and magazines. He was handed a plastic specimen cup and told to produce a sample. Fifteen minutes later, he handed his sperm sample to the nurse to be tested.
Avery and Walter then met briefly with the doctor, who described their next steps, and talked about statistics and probabilities. Typically, the fertility doctor shares Western medicine’s facts and perspectives about fertility, often without having seen their test results. For a woman who is already feeling emotional, vulnerable, and stressed, the process can feel dehumanizing.
In a nutshell, the doctor told Avery and her husband that, reproductively speaking, at thirty-eight, she was old. They should start right away with cycle monitoring, where the clinic would track her ovulation and they would be directed to have intercourse at the optimal times. Their chances would be moderately better if they came to the clinic for IUI. If that didn’t work for them after three tries, they could try IVF. But they should decide quickly because Avery’s eggs were “getting older by the day.” So she returned to the fertility clinic on the third day of her menstrual cycle and for many mornings thereafter for early morning cycle monitoring (CM).
Leading
