Pregnant and depression

Some women are high when they are pregnant and I had been one of them, once, when I became pregnant at age of 26 unexpectedly.  The fetus inside the worm emitted tons of dopamine to make me believe that I was the happiest person in the world.  However, the ecstatic state of mind was short-lived and soon replaced by shame and guilt because having children without a marriage was (still is) illegal in China.  So the fetus was terminated secretly before the end of the first trimester to save face of the family and future of myself.  I still remember the condemned look from the ob/gyn and nurse whose conscious must have been taken away by the education that they received.

The A&D abortion did not seem to cause any psychological damage to me, though. I was feeling relieved afterwards.

Moving forward 20 year later in 2006, I finally became pregnant once again after rounds of IVFs.  This time, the pregnancy was longed for and struggled to get, however, I did not feel ecstatic.  All I had in the first 10 weeks was worries and fears of losing the baby, following that was the never-ending morning sickness, food aversion, frequent urination, heart burn, random fall (I am bad at balance, could not walk right with a baby inside), irregular sleeping pattern: sleepiness in the first trimester and sleepless in the third trimester... the physical troubles were the easy ones to deal with, in fact, the constant psychological/mental illness such as stress and depression, which I did not even know that I was living with during my two pregnancies, were harder.

We Chinese rely on friends, not psychiatrists or therapists, in situations like this.  Yet all my friends were done with pregnancy issues, long ago!  They could not relate to "pregnancies at advanced maternal age".  Plus, we moved from one city to another, twice (due to job transitions) within two short years, which added more stress to the already stressful life.

Yes, my pregnancy at age of 44 led to chronic depression, except that it had not become clear to me until years later when the following series of events had happened:

- First, my big boss committed suicide at the time that I was struggling with my postpartum depression that I also had no idea about;

- Second, my direct boss and mentor was falling terminal illness when I was pregnant with my son.  He passed away one year after I gave birth for the second time.  Now when I come to think of it, my theoretically temporal pregnant-related and postpartum depression may have transformed into chronic one at this time without my knowing.

- Third, my bright PhD student unexpectedly became pregnant, which led to a baby and her ditching all the ongoing research projects.

The last one hit me hard, both professionally and mentally.  I started a self-blame game, back and forth, forth and back, endless.  Soon I found myself losing sleep and developed prehypertension.  It was then when I suspected that depression was no longer a word, it was reality.

It was almost unimaginable for me that I, a stereotypical extravert who often attributes faults to others, was depressed.

"Chronic illness into a good doctor (久病成良医)".  What, no, you have not heard this saying before?  It's Chinese wisdom.  We Chinese believe one becomes a good doctor if he has been ill long enough. Luckily, I did not isolate myself, nor did I conceal my mental problems.  So 2 pregnancies and 5 years later, I am slowly and progressively getting out of this depression.

I must say that I am now a much happier person than I was a few years ago.  Life again becomes good when the depression is out of it.  And I'll share with you what I did about my depression in my next post(s).

Stay tuned.

IVF Journey - Part I, first cycle

IVF or in vitro fertilization, is one of the most effective ARTs (assisted reproductive technology) that many infertile couples or fertile women at advanced age rely on to get themselves pregnant nowadays. If you are trying to conceive but not able to in a year or two, you may know exactly what I am talking about here.  I belong to one of the these normal women who is fertile when young but infertile when aged.  I don't really know when I had become infertile.  What I know for sure is that I used to be fertile at age of 24.  I also know that my mother had my little brother at age of 40, although that was the third child my mother had.  I discovered painfully that I was too old to get myself a baby or two at age of 43 and started to go through ivf process in last quarter of 2005.

At the first try, we, like many other ivf newbies, were quite confident and optimistic.  The reproductive endocrinologist (RE) had us started right away since I was very close to the cut-off age - the clinic we went does not take any woman who is older than 44 if she wishes to use her own eggs.  So, I was instructed to get started immediately.  The protocol that my RE used on me was the most effective one for women of advanced age called mini-dose flare protocol, which involves taking regular birth control pills (BCP) for 14 to 21 days - depending on where you are at your cycle - to make sure that the ovaries don't produce any eggs.  Following this so-called suppression period is a flare stage, which involves to take mini dose lupron to jump start the ovaries.  After 3 days of lupron, one needs to take FSH (follicle stimulation hormone) to stimulate follicles (eggs) to grow in the mean time of continuing the mini-dose lupron for entire course of FSH stimulation, which lasts 7 to 10 days, depending on how fast your eggs become mature.  Just in case some of my readers here are from the ivf message boards or undergoing ivf at the moment, here is the detailed protocol and progress in my first and the only ivf fresh cycle:

10/17/05 ~ 10/31/05: BCP, for 14 days

11/4/05: E2 = 23, egg = 3.5 mm
8 pm, Lupron, day 1, 20 U (diluted, 50 mcg/ml, 0.2 ml)

11/5/05 ~ 11/7/05:
8 am, Gonal F (FSH), 300 U + 20 U Lupron
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 2 vails + Lupron, 20 U

11/8/05: E2 = 706, eggs = L10 + R15, 7.7 mm
8 am, Gonal F (FSH), 300 U + 20 U Lupron
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

11/9/05:
8 am, Gonal F (FSH), 225 U + 20 U Lupron
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 2 vails (a mistake, was told to use only 1 vail) + Lupron, 20 U

11/10/05: E2 = 2344, Eggs = L14 + R11, 9.6 mm
8 am, Gonal F (FSH), 225 U + Lupron, 20 U
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

11/11/05:
8 am, Gonal F (FSH), 150 U + Lupron, 20 U
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

11/12/05: E2 = 3000, eggs = L18 + R18, 11.2 mm
8 am, Gonal F (FSH), 75 U + Lupron, 20 U
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

11/13/05: E2 = 6328
8 am, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U
9 am, HCG, 5000 U
8 pm, Lupron, 20 U

11/14/05: E2 = 6772; HCG = 156
8 am, Lupron, 20 U
8 pm, Lupron, 20 U

11/15/05:
12 pm, egg retrieval, 24 mature eggs collected.

No transfer due to hyperstimulation!

As you can see, this mini-dose flare protocol worked extremely well.

During ultrasound exams, I found many black holes in my ovaries.  They looked like a grape bunch and those grape-looking follicles were becoming bigger and bigger with time.  The ultrasound technician carefully measured the sizes of each of them and then reported to my nurse, who was quite happy at first, then she became less happy and finally nervous.  Of course, she tried her best to hide her emotions, but my professional sensitivities allowed me to detect her panicking state of mind.  At the 4th day into FSH, I was told to decrease the FSH dose, two days after that, I was told again to decrease the dose even more!  My crazily growing follicles seemed to become more and more of a concern than of an excitement!  I did not know why the nurse was nervous at all, because I thought the more follicles, the better.  The increased number of growing follicles also raised the estrogen (E2) level in my blood stream, which caused severe fluid retention.  My lower abdomen felt very bloated but I did not know it was fluid retention - a side effect of high estrogen!  I was jogging every other day for 5K each time!  I could have died from stroke!

At the day of egg retrieval (ER), Fabrice was sent to a small room to make his contribution to the baby producing process.  After a short while, he came out and handed a brown bag to the nurse, who was waiting outside with me then she immediately disappeared from our sight after receiving the brown bag.  She must have gone to store the bag in a cold and safe place because inside that bag hiding a plastic cup filled with Fabrice's little swimmers.  "That was quick, did they allow you to watch pornographic movies in there?" I joked to Fabrice once we were left alone.  He gave me an evil look and said, "I wish."  Later that day, he told me he was seriously thinking to suggest the clinic to make some effort so that small sperm-collection room could be more exciting.  I wanted to be sarcastic but I could not since I was quite sympathetic of him.  I have to admit even though that was the only contribution he had to make in this whole ivf business, I would not have traded anything I have done for that 1 minute or two that he had to spend in that room.  I could not imagine how awkward that he must have felt while being confined within a strange and small room masturbating.  Yuck!

After that, Fabrice followed me into the ER room.  I was drugged up with an by someone who looked familiar but I could not recall where I saw her before - Few days later I met her again in the same building, I suddenly remembered that she was the same anesthesiologist who knocked me off few months ago for my ob/gyn who was performing laparoscopy to find out what happened to my female organs then - The RE was chatting and asking how I felt. Then slowly I could not hear him anymore. It felt like merely seconds later I woke up, I heard that the nurse was telling me that the RE collected total of 24 mature and beautiful eggs excitingly. I, on the other hand, was not exciting nor happy because I was expecting 36 or so. So, I asked, where were the rest of these eggs? "Oh, the RE was too exhausted to collect them all since they were still small." REs usually collect as many eggs as possible if ivfers do not produce enough eggs since they can mature them in the incubator. But in my case, there was no need to go this route. The nurse then hand us some instructions and told us to wait for another 15 min to leave. On our way out, the RE stopped us and told us that the sperms were being prepared (washed, centrifuged, cleaned?) and they would check the quality and quantity. If more sperms needed, they would call, he said to Fabrice. "my office is right across the street and just call me." Fabrice showed, for the first time from the start of our ivf cycle, some enthusiasm. 

However, we did not receive any phone that afternoon, nor next morning. Everything must have been fine, Fabrice told me, when I was bugging him with all my suspicions. The Clinic finally called in the next afternoon. "We have some good news." She said. I knew it. Something must have been terribly wrong. Because of it was only good news, she would not start her conversation like this. None of my eggs were fertilized? Survived? I started to imagine the worst scenario. "The good news is that 20 out of the 24 eggs matured and fertilized well and 19 grew to 2-cell stage." "Wow, that sounds very good. I am do glad that you had enough sperms for the in vitro fertilization." I said to her with some kind of suspicious tone. "Oh no, we had to do ICSI (intracytoplasmic sperm injection)." She told me but this made me upset, because that would cost us additional $1000! "Why did not you call to ask my husband for more sperms! We were just here waiting for your call." Now I was bit upset that our clinic did not keep us informed and did a procedure without our consent. She probably gave me tons of reasons to explain why ICSI was necessary, but I was worried about that did not select the best quality sperms ti do the job. Based on what I learned from text book, only the strongest and healthiest sperms can make their long journey to meet and enter the egg. How could they omit this important natural selection step? "Oh, ICSI has better fertilization rate." She explained.

I am sure she said something more, but whatever she said, it did not matter anymore. Finally, she continue to tell me what I did not like to hear, "The bad news is that you now need to stop all the medications and wait for next cycle to call us back." "What, why?" I asked her to repeat and made sure what I heard. "I won't come back tomorrow for the embryo transfer?" I asked. "No, just stop all the medication. And it is important that you and your husband won't have intercourse in the next few days."  I was so upset for not being able to continue the ET step and must have been shouting in my end at this point. "Your have 19 good quality embryos, don't worry." She tried to calm me down. She explained to me that the estrogen level in my blood was too high, which was a indication of over-stimulation. If we proceed the next ET (embryo transfer) step, I would have a high risk of OHSS (ovarian hyperstimulation syndrome). I did not want to listen to her for all these reasons. I argued, complained, and begged that she would talk to the REs and let me come back for the next step. "But all your embryos have already been kept frozen." She tried to end the long conversation. "What will it be next cycle?" I asked with disappointing tone. "Sometime next January." She said. I could not believe my ears. Now, I was very upset. Not only I could not proceed for the next step, but also I had to wait for longer than expected. "We would not have enough time to start and finish your next cycle, since we will close in week of Thanksgiving and 20 days of Christmas and New Year." I was speechless, I was shocked. I never knew that Americans had real holidays for more than a long weekend, let alone it was 20 days!

That was a long phone call and possibly the most difficult phone call my nurse had to make on that day, if not in her entire nursing life. I thought that I reached the end of the world. I had to let her know how I felt until I finally realized that she was merely doing her job as my nurse. She was not paid as my psychiatrist. "Okay, I will call you when my January cycle comes." I let her go on her life, finally.

I am not an easy customer. I admit. I demand every penny's worth of service. 

The next of the few weeks, I sent my lovely husband Fabrice to hell and I will tell you how in my few posts. Stay tuned!

IVF, 好, and scored 100!

好 (hao) means good and is a compound Chinese character of girl (女) and boy (子). If you have a girl and then a boy, mainland Chinese would congratulate you with a saying "You wrote a 好 character!" Taiwanese would say, "You scored 100 (out of 100)!" If you have boy and then a girl, you score 90, two boys, 80, and two girls, 70, and so on. This just to introduce to you about what the most common wish is for typical Chinese family.  I am one of these who has always wished for an 好 in my family planning.  I even have wished for their age gap to be two years apart so they could grow together without fighting with each other.  I got it all planned out, you see.
When I entered early fertile age, I believed that a girl could be knocked up if she would swim in the same pool with men and I was watchful for any usual suspects whenever I went swimming in a pool.  Like many girls of my age in China, I had my menarche at 14.  But after that, the period would only show up every two to three months and most of the times when it came, it was so unbearably painful that I had to curl up in the fetal position in the bed wishing to become a man.  Since all the books that I could find mentioned my symptoms were normal, it was just oligomenorrhea, which were expected for young girls, I had not been overly concerned about my menses.  But when I reached 20, I became a bit sensitive to my woman issues.  At that time, I just got out of college.  A Biology Bachelor's degree might have alerted me that I should attend my female parts.  So I made my first visit to an Ob/Gyn.  She pressed my belly a bit, probed my lower half with something called B ultrasound scanner, and then announced, "Your female organs are under developed and you'd better take some hormones from now on to help them to catch up."

Did I listen to her? Of course not, I didn't have to because I did not even have a particular someone with whom I wished to have kids.  As a biology newbie, I decided to challenge the doctor and let the nature take care of my fertility.  Deep in my mind, I must have wished the Ob/Gyn to be wrong.  Regardless what my subconscious mind was telling me at that time, I had find that out by the most economical and natural way.  Lo and behold, after only ONE unprotected sex I became pregnant, at age of 24 or may be 25.  I was as fertile as any most fertile woman can be!  I was happy even though I had to endure the shameful D&C to terminate the pregnancy (it was/is illegal to have a child without a marriage in China.)

(BTW, given this particular case, I do not believe "accidental pregnancy" anymore.  Do you believe that almost all the so-called knock ups are in fact the results of intentional (mis)conducts?  Admit it, don't we all know that unprotected sex can lead to pregnancies?  Don't we all want to find out whether we could be knocked up or impregnate others? Sure we all do!)

...

Fast forward to 14 years later, I was now in the U.S. graduating and facing a transition from poor foreign student to still poor but semi-independent researcher.  Keenly knowing that my fertility was slipping away, I started to toy with the idea of becoming a mother.  "Next handsome guy comes around, I would totally prostitute myself."  I announced determinedly to my best friend, Zee, who often encouraged me to take the advantage of the U.S. freedom.

However, many good-looking guys later, I was still not pregnant.

Few years later, my lovers were concentrated from few to one who soon moved in with me, which by the way miraculously cured the oligomenorrhea that I lived for more than 30 years.  Now it should not be long before I would became a mother, I'd predicted.  Yet after 2 years of random trying, that didn't happen.  Eventually I tricked my French Xishi to believe that marrying me was the best decision that he could have ever made in his entire 32 years of life.  Following an official marriage at 43, we began the timed mating journey.  Boy, wasn't that fun.  I was religiously monitoring my ovulation month after month, and in the mean time, carefully trying not to tell him in order not to spoil the mood.  I even arranged several romantic trips in order to keep the activities alive.  Never in my life time had I ever been so looking forward to a delayed or better yet no-show period!  Yet it had never failed to show, month after month and after month.

I did not just want one child, remember, I wanted to write a 好!  When the nature did support it, I took Fabrice to seek for the help of modern technology.  My first U.S. Ob/Gyn patiently finished listening my stories and then turned to my baby-looking husband who was obviously quite annoyed by being there.  He questioned, "Have you seen a urologist?" "No?" he possibly feeling stupid then after answering the obvious question since he is also a biologist who should have known he could be the part of all these ordeal too.  "We thought that I am the likely infertile one since my previous oligomenorrhea and advanced age." I tried to defend him.  I am in fact 10 years older, plus men usually do never lose their fertility, lucky bastards!

Then he had few visits to his urologist and one small surgery to remove his varicoceles, which boosted the viability of his little swimmers from 35% to 75%. "Lo and behold, he IS the one to blame and I was pregnant soon after that" - no, scretch that, that is just what I wished what I could tell you.  The reality was 9 months after that, my belly was still as flat as the earth surface.

Finally, my Ob/Gyn gave up and decided that I was infertile, although secondary.  So, she sent us to a local fertility center, where the reproductive endocrinologist put us on the most powerful ART - IVF. $30,000 dollars, 5 cycles (one full IVF cycle, 4 frozen cycles), and 19 embryos later, at 44.5 and 46.5, I became a proud mother of Mia/Zhuzhu and Remy/Niuniu.  The IVF worked to its perfection.

We wrote "好". Life is good with these buggers in it.