Movie Review: “Don’t Talk About the Baby”

Movie Review: “Don’t Talk About the Baby”

HopingForBaby.com Rating: 4 out of 5

Don’t Talk About the Baby” is a great documentary to watch if you’ve experienced Pregnancy and Infant Loss and you feel you are prepared to hear other people’s difficult stories. I believe sharing stories is so important for healing, especially sharing to others who understand. I’ve dealt with a lot of loss over the years and I believe I’ve developed more resiliency over time. This movie is great if you also feel you are at a point where you are mostly past the initial stages of grief. That is the only reason I gave it a 4 out of 5 rating because it may be too triggering for some viewers. 

I strongly believe in people sharing their story, but I personally choose to not tell everyone graphic details of the trauma of pregnancy loss. I believe this part of my story was best processed with a therapist or through journaling. I also believe expressing this through works of art can be therapeutic for others. Everyone processes their grief in their own way, so if you believe in fully expressing every aspect of your loss more power to you. If you find yourself easily triggered by traumatic details, I’d recommend taking that into consideration when you decide to watch this documentary. 

Don't talk about the baby

Image Source: princetonlibrary.org

 

On the flip side of that word of caution, I think this movie did an absolutely fantastic job of showing so many different stories of courage and hope. I felt a huge sense of connectedness to the women that were interviewed. I’ve watched a handful of other documentaries about infertility and IVF, but this one really touched my heart. There were several instances I just wanted to reach through the TV screen and hug the woman being interviewed. There was such a rawness with the emotions they shared, that takes an immense amount of courage. I find it hard sometimes to write some of my blog posts about my recurrent miscarriages, but I always feel better after I do.  My hope is maybe someone reading my posts might feel a little better knowing they are not alone during their struggles. I feel this film was created with this same spirit. 

I love how the documentary interviewed a variety of women who are at different points in their journey. Some are still deep in the emotions of their recent loss, others are a little further along, and some who have moved on from their loss and share their stories of how they healed. Another important aspect of this movie is that they take the time to interview multiple doctors who specialize in pregnancy and infant loss. The statistics they share may initially seem overwhelming to hear. But I believe the filmmaker’s intention was to emphasize that so many women experience this kind of loss and to show viewers they are definitely not alone. 

Finally, the subject that I found most important in this film is the need to fight the stigma of pregnancy and infant loss. There is a huge stigma in our culture around this type of loss. As our culture becomes more comfortable talking about the hard subject of pregnancy and infant loss the stigma will begin to fade away. One of the women in the film remembers how cancer actually had a stigma and some people would avoid talking about it. But over time more people openly talked about cancer which created more awareness. More awareness resulted in more funding for research. Now there is an immense amount of energy put into raising funds for cancer research and education today. All of that effort has lead to a greater understanding for the public to know when to get screened for cancer, helping to catch it early on and save more lives with treatment at just the right time. The film “Don’t Talk About the Baby” discusses our culture can do the same exact process of openly talking about pregnancy and infant loss just as we now openly talk about cancer today. 

That cultural shift can be duplicated with conversations about pregnancy and infant loss and maybe one day there won’t be as much of a stigma. The more people actually talk about it the more likely funding efforts will increase. Increased funding can allow for more research efforts to potentially find the causes to “unexplained infertility” which is said to account for up to 30% of pregnancy losses (Sadeghi, 2015). More research also needs to be put towards learning more about Sudden Infant Death Syndrome (SIDS). Even the diagnosable conditions still have many questions surrounding what the root cause might be. It is incredibly important to increase research and educating the public to help prevent pregnancy and infant loss, and this includes  reducing the stigma.

Thank you for reading. 🙂

 

Today’s Question:

What have you done to help reduce the stigma of pregnancy and infant loss? Have you educated a family member or friend on this subject by sharing your story? 

Comment with your response to receive a bonus entry to the current contest.

 

Click here to watch “Don’t Talk About the Baby” on Amazon

 

Check out my previous posts by going to my archives page.

 

This post may contain affiliate links. You can read the disclosure here
Sources:
Featured Image: https://www.donttalkaboutthebaby.com/
Full Image of “Don’t Talk About the Baby” Poster: https://princetonlibrary.org/event/film-and-panel-discussion-dont-talk-about-the-baby/
Sadeghi, Mohammad Reza. “Unexplained infertility, the controversial matter in management of infertile couples.” Journal of reproduction & infertility vol. 16,1 (2015): 1-2.

Remembering My Babies on October 15th

Remembering My Babies on October 15th

This was the first year I participated in the October 15th event of Pregnancy and Infant Loss Remembrance Day. I had to work that night and chose not to go downtown to participate in the community event, but I took the time to do this at home. I didn’t even realize a new miscarriage and infant loss group had started up again in my city. That group organized the event downtown for October 15th. A few years back I went to one of those meetings but I was only one of two people, shortly after I went I got a letter in the mail saying that group had ended. Maybe I’ll start going to the new group. The other reason I didn’t go downtown for the October 15th events is that I didn’t feel like sharing that moment of remembrance with strangers. I’m sure it could have been nice for some people, but I felt like this first year of doing it would be more meaningful if I did it at home.

Several things happened on the 15th that were really difficult, I’ll address those in a future post. But for this post, I wanted it to focus on Pregnancy and Infant Loss Remembrance Day. I wanted to light a candle for each of my pregnancy losses and remember each of them individually. I decided to take some photos to remember today. After nearly four years of infertility and six miscarriages, I finally decided to take part in my own way at home. 

I used my Moroccan candle holder as the centerpiece, and put six tea light candles inside, each one representing one of my pregnancy losses. I lit each candle and took one minute between lighting each one to pause and remember each baby. I said a prayer for each one, each prayer slightly different than the last. There was something about this process that gave me a sense of peace and I could feel the heaviness in my heart lifting. 

 

Lighting the candles one-by-one, saying a prayer for each of my babies.

 

I have a temporary keepsake box (good ol’ shoebox) of my letters, cards, ultrasound pictures, and this little stuffed elephant. Eventually I will get a nice keepsake box. I bought this elephant with my first baby and gave it to Kurtis when I first shared my pregnancy news with him. Someday this little elephant will be cuddled, drooled on, squished, and dragged around by my future baby. I put flowers around the candle holder to add some color and bring a delicate beauty to the centerpiece. 

 

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Overall I found the experience to be more emotional and meaningful than I had anticipated. Some women choose to honor their baby on the day they would have been born. Initially I had done something like that but after six losses I honestly cannot remember the dates. I think part of that is that I was emotionally blocking out that info. I plan on contacting my doctor in the future to find out this info so I can either buy or create a necklace with the birthstones for each one. I have a necklace with a birthstone for my first pregnancy loss but I haven’t added on to it. I believe it would have been too overwhelming for me to honor each of my babies at six different times throughout the year on their would-be birthday. So the idea of doing it once a year on October 15th is easier on me emotionally. I think it’s important to remember our babies and the hope that they brought to our lives. Just as when someone comes to the end of their life it’s important to remember the good moments. I remember the good moments of announcing the pregnancy news to Kurtis, family, and friends. I remember seeing strong heartbeats on the ultrasound that I never imagined possible, I saw this two times. Those heartbeats were a sign of hope. 

 

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Writing a letter “To each of my babies in heaven.” Writing a letter to your baby, to God, or journaling your emotions and thoughts can help you process the loss and feel more at peace.

 

It’s important to take care of yourself emotionally. I think participating in Pregnancy and Infant Loss Remembrance Day is a way to stay connected to our past and not forget how strong each of us really are. If you’ve experienced this kind of loss just know that you are not alone and there are so many others out there going through the exact thing you are. 

 

Comment below to Today’s Question and receive bonus entry to the current contest.

Today’s Question: 

If you’ve experienced pregnancy loss and/or infant loss, what healthy coping skills have you done to help you heal?

Thank you for reading. 

Catch up on past entries by clicking here for the archives page. 

ENTER TO WIN THE LATEST HOPINGFORBABY.COM CONTEST.

This post may contain affiliate links. You can read the disclosure here
Learn ways to improve your egg quality. Purchase Rebecca Fett’s book “It Starts with the Egg: How the Science of Egg Quality Can Help You Get Pregnant Naturally, Prevent Miscarriage, and Improve Your Odds in IVF.” It’s currently the #1 Best Seller on Amazon.com’s Reproductive Medicine & Technology list.


Pregnancy & Infant Loss Remembrance Day on October 15th

Pregnancy & Infant Loss Remembrance Day on October 15th

This post may contain affiliate links. You can read the disclosure here

pregnancy-infant-loss-remembrance-day

 

Did you know that October 15th is Pregnancy and Infant Loss Awareness Day? In 1988 President Ronald Reagan declared the month of October to be Pregnancy and Infant Loss Awareness Month. President Reagan gave the following speech on the subject:

“When a child loses his parent, they are called an orphan. When a spouse loses her or his partner, they are called a widow or widower. When parents lose their child, there isn’t a word to describe them.  This month recognizes the loss so many parents experience across the United States and around the world. It is also meant to inform and provide resources for parents who have lost children due to miscarriage, ectopic pregnancy, molar pregnancy, stillbirths, birth defects, SIDS, and other causes.

Now, Therefore, I, Ronald Reagan, President of the United States of America, do hereby proclaim the month of October as Pregnancy and Infant Loss Awareness Month. I call upon the people of the United States to observe this month with appropriate programs, ceremonies, and activities” (October15th.com, 2019).

 

Small-Bird-image

 

Years later in 2002, October 15th became the official day of Pregnancy and Infant Loss Awareness Month. In 2004 the International Wave of Light is a global candlelight vigil, “Lighting begins at the International Date Line, in the first time zone, remaining lit a period of one hour, with the next time zone lighting respectively, moving through each time zone as the Wave of Light circumnavigates the globe. The result is a continuous chain of light encompassing and spanning across the world and around the globe for a 24-hour period, illuminating the night in love and light in honor and remembrance of our children” (Wikipedia, 2019). It is both a beautiful way to remember as well as feel a greater sense of connection to others who know exactly what you are going through.

 

5 Ways to Remember Your Baby

1) Light a single candle or one for each of your losses.

 

wave-of-light-candle

2) Write a letter to your baby or journal your feelings.

 

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3) Share your story. Join a support group or talk with a friend you trust.

 

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4) Make a donation to a charity in your baby’s honor.

 

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5) Wear remembrance jewelry or clothing.

 

I have a necklace with simple silver wing with a diamond for the birthstone for the month my first baby would have been born. I have yet to add more birthstones for my other losses but I will probably do that in the future. It felt really nice to have that to remember my baby and to help me heal.

Jewelry

  

Baby Name Necklace – ROI – Dainty Feet Footprints Charm – Memorial Infant Loss Gift – 5/8 Inch Disc – Handstamped 14K Gold Filled Jewelry – Personalized Birthstone

 

 

Gold Angel Wing Necklace – ROI – Dainty Memorial Charm Gift – Delicate Loss Pearl – Handstamped Jewelry – Personalize Initial Crystal Color


 

 

Angel Baby Memorial Charm • Miscarriage Necklace • Tiny Winged Heart • Sterling Silver • Too Beautiful for Earth

 

 

Tiny Angel Wing Necklace – Dainty Silver or Gold Guardian Wing Necklace Minimalist Jewelry – Memorial, Miscarriage Infant Loss, First Communion Gift

 

 

GLAM ”Always in My Heart” Sentimental Quote Thin Brass Bangle Hook Mantra Bracelet

Clothing Items

TeesPass October is Pregnancy and Infant Loss Awareness Month Shirt Hoodie

 

Heart Blue Pink Ribbon Pregnancy Infant Loss Awareness T-Shirt

 

Mom of an Angel Shirt Infant Loss Grieving Mom Gift Gift for Mom Miscarriage Gift Gift for Grieving Mother Angel Mom Shirt

 

Angel Mommy T-Shirt. Miscarriage Awareness Infant Loss Tee

 

Daddy Of An Angel T-Shirt National Pregnancy and Infant Loss

 

Grandma Of A Little Angel Pregnancy & Infant Loss Awareness Long Sleeve T-Shirt

 

Comment below to Today’s Question and receive bonus entry to the current contest.

Today’s Question: 

Have you participated in a Pregnancy and Infant Loss Awareness event? If so, how would you describe your experience?

Thank you for reading.

Catch up on past entries by clicking here for the archives page. 

ENTER TO WIN THE LATEST HOPINGFORBABY.COM CONTEST.

 

Learn ways to improve your egg quality. Purchase Rebecca Fett’s book “It Starts with the Egg: How the Science of Egg Quality Can Help You Get Pregnant Naturally, Prevent Miscarriage, and Improve Your Odds in IVF.” It’s currently the #1 Best Seller on Amazon.com’s Reproductive Medicine & Technology list. 

 

 

Image Sources:

Featured Image:
https://www.funeralwise.com/digital-dying/october-15th-pregnancy-infant-loss-remembrance-day/
Wave of Light Image:
https://cmvaction.org.uk/news/baby-loss-awareness-week-9-15-october-2017
Woman Writing Image:
Photo by Negative Space from Pexels
Support Group Image:
https://fcionline.com/fertility-blog/monthly-infertility-support-group/
Donate Image:
https://www.kiplinger.com/article/taxes/T032-C001-S003-donate-your-rmd-tax-free-to-charity-in-2016.html
I Will Always Wonder Image:
https://handtohold.org/national-pregnancy-and-infant-loss-awareness-day/

 

Best & Worst States for Infertility Services

Best & Worst States for Infertility Services
This post may contain affiliate links. You can read the disclosure here

 

During my research for my post Top 7 Websites Comparing IVF Clinic Success Rates, I came across Resolve.org’s State Fertility Scorecard. It shows a color-coded map of the United States as quick visual of the states that have better grade for access to infertility services. You can see your state’s grade and compare your state to others based on the following criteria (quoted from Resolve.org):

 

  • “Number of peer-led RESOLVE support groups in state for people experiencing fertility issues
  • Number of physicians specializing in infertility in state, at SART-accredited fertility clinics
  • Number of women in state who have experienced physical difficulty in getting pregnant or carrying a pregnancy to live birth
  • Insurance mandate information in each state” (Resolve, 2019).

 

 

Best States for Fertility Services with a grade of “A”:

  • Massachusetts
  • Connecticut
  • New Jersey
  • Maryland
  • Illinois

 

Worst States for Fertility Services with a grade of “F”:

  • Alaska
  • Wyoming
  • Mississippi

 

 

Resolve.com Fertility Score Card

Resolve.org’s Fertility Scorecard map of the U.S. The states with the best access to fertility services are in green, the worst states in red.

 

 

Overall Alaska ranks the worst out of every state, with Wyoming shortly behind when based on the highest number of women with zero access to fertility services. Although I was somewhat surprised that Alaska (my state) ranked so low, I didn’t imagine we would be one of the top three worst states to live in for those struggling with infertility. But in a way it also makes sense. I’ve had to fly out of state for both my first and second round of IVF treatment. We have zero support groups of any kind for infertility. A few years back I attended a miscarriage support group and I was just one of two in attendance, but I learned that group has since ended. That was the only group in the city related to infertility. Since my reproductive endocrinologist (RE) retired earlier this year there are zero RE’s within my health insurance’s network. I’ve heard from my OBGYN there isn’t a single RE in the state anymore. That means 15,612 women who have dealt with infertility or pregnancy loss does not have any access to a fertility specialist either (Resolve, 2019). Yet there are zero laws on the books regarding fertility treatment, which also means there is no obligation to provide insurance coverage of any sort. Not even partial coverage is an option here.

 

 

Resolve.com Fertility Score Card Alaska

Alaska’s Fertility Grade of “F” as viewed on Resolve.org’s Fertility Scorecard page.

 

 

Having learned all this, I feel very strongly that I should speak up and encourage our legislators to include at least partial insurance coverage for fertility treatment. I believe reproductive rights should include fertility treatment.  There are so many women like myself who are unable to have a child naturally. I understand that I will probably have to navigate many questions during my time advocating for change. But through everything I’ve already faced, I feel like I’ve developed thicker skin which is probably going to serve me well when I get involved in the legislative process. When I think about it, not only am I advocating for legislative change for other women but it would also benefit myself too. I’ve got nothing to lose and a lot to gain. 

 

Comment below to Today’s Question and receive bonus entry to the current contest.

Today’s Question: 

If you live in the U.S., what is your state’s Fertility Grade on Resolve.org’s Fertility Scorecard?

 

Thank you for reading. 

Catch up on past entries by clicking here for the archives page. 

ENTER TO WIN THE LATEST HOPINGFORBABY.COM CONTEST.

 

Learn ways to improve your egg quality. Purchase Rebecca Fett’s book “It Starts with the Egg: How the Science of Egg Quality Can Help You Get Pregnant Naturally, Prevent Miscarriage, and Improve Your Odds in IVF.” It’s currently the #1 Best Seller on Amazon.com’s Reproductive Medicine & Technology list. 

 

Sources & Images:

Resolve.com Fertility Scorecard: http://familybuilding.resolve.org/fertility-scorecard/

Results from Anora Test

Results from Anora Test

This post may contain affiliate links. You can read the disclosure here

 

My husband and I were debating whether to do the Anora test from this pregnancy loss. We’ve done the test before with two of our other miscarriages. Both of those tests determined that the embryos had a chromosomal abnormality caused by maternal origin. One had Trisomy 15 and the other had Trisomy 16. My other miscarriages we did not test. At first he and I were leaning towards not doing the test for my most recent loss this September, because we assumed it would be the same exact scenario of a Trisomy due to maternal origin. We believed it would have been a waste of time and money. But my doctor had a good reason to try to talk us into doing the test again.

 

Now that we have recently found out I have the MTHFR gene mutation, my doctor wanted to determine whether this embryo had a chromosomal abnormality. He said, “If the embryo does not have a chromosomal abnormality we might have you try Lovenox.” Lovenox is a medication used to help during pregnancy for women who have a MTHFR gene mutation. He said that he would talk to my out-of-state doctor as far as the next steps after the Anora results.

 

When my doctor called me several days later with the results he said, “It was a triploidy of paternal origin.” This was the first time my egg quality had nothing to do with the chromosomal abnormality. But unfortunately, now we also have a chromosomal abnormality issue from my husband’s side (paternal origin). So I’m unsure whether I will still need to take Lovenox or not as a precaution with my next pregnancy. That’s one of the questions I need to ask him. He explained there were two YY chromosomes in this embryo, in other words two sperm had entered one egg. I remembered that the clinic I went to just prior to my current doctor believed this pregnancy was either one of two things; 1) pregnancy with multiple embryos, or 2) a molar pregnancy. 

 

But he confirmed this was not a pregnancy with multiples, and that it could be a partial molar pregnancy. A molar pregnancy is bad for several reasons. I was feeling very overwhelmed because I had done prior research and understood that molar pregnancies could cause some serious complications. Even with the D&C surgery, it is possible the partial molar pregnancy could have already triggered issues in my body.

 

A partial molar pregnancy, from what I understand, is when the cells of the baby can mutate within the mother’s womb and cause tumors within the uterus. The worst case scenarios for a molar pregnancy is permanent infertility and/or cancer. Even as I am writing this now I paused my typing for a few moments and I feel a sense of dread. Two terrible possible outcomes. So why does my doctor think it might be a partial molar pregnancy? He said one of the possible complications of a triploidy of paternal origin (the results of my Anora test on the embryo) is a molar pregnancy. And one of the possible complications of a molar pregnancy can lead to something called Persistent Trophoblastic Disease (PTD), which is caused when tissue from a molar pregnancy isn’t completely removed. 

 

Genetic-events-occurring-in-normal-conceptions-and-complete-and-partial-molar-pregnancies

Image of normal conception compared to complete mole and partial mole. Partial mole shows two paternal sets of genes resulting in in non-viable fetus.

 

PTD can lead to Gestational Trophoblastic Disease (GTD) and this can lead to Choriocarcinoma which is a fast-spreading cancer that starts in the uterus. Needless to say I’m feeling overwhelmed. I asked my doctor how they would know if it was a partial molar pregnancy and he said, “We have to check your blood levels weekly to make sure your hCG levels are dropping back down to zero. If they don’t drop down to zero within a few weeks it could indicate a partial molar pregnancy.”

 

I did some research about molar pregnancies prior to talking to my current doctor, the reason being that my previous doctor said, “It’s either multiples or a molar pregnancy.” With a molar pregnancy the hCG level rises so dramatically it can be mistaken for a pregnancy of multiples. My first doctor said my hCG level was 81,000 when a normal range at that time would have been around 3,000. Clearly my levels were very high.

 

So there is a very real possibility that I might have to deal with the after effects of a partial molar pregnancy. It’s already affecting my plans. I was planning to do my Frozen Embryo Transfer (FET) in December 2019. I was going to do the Saline Infusion Sonohysterography (SIS) procedure to make sure my uterus was good to go with no abnormalities and then be jetting off to my procedure in Seattle. My doctor said, “Unfortunately both [doctor in Seattle] and I think that it would be best to postpone your FET until we rule out a partial molar pregnancy. Two months is just not enough time to figure that out. We will need to do weekly blood draws until your hCG drops down to zero. Once it drops down to zero we will need to monitor your blood levels each month for six months. He and I think that you should wait at least six months before you do the transfer.” Some websites suggested waiting 6-12 months before trying again. The risk of doing it too early is it could trigger the cells to become cancerous. So at the earliest I could do my FET in April 2020. 

 

I have my 2-week post-op doctor appointment here on Thursday. I’ll be doing my first weekly blood draw on that day. My doctor will also be putting me on birth control for a while, I’m assuming until I am ready to start my FET protocol which could be anywhere from 6-12 months from now. My little embryo has been waiting so long already and I hate to think that it has to sit even longer. But like my doctor and I agreed over the phone, “It’s better to be safe than sorry.”

 

I’ve had so much bad luck over these years I’ve come to expect it. I suppose it has become a defense mechanism of sorts. “Hope for the best but expect the worst.” Part of me feels like if I don’t expect the worst then I won’t be mentally prepared to handle it when it comes. Like with this situation for example, I was already learning what molar pregnancies were before my current doctor said this is what we might be dealing with. Initially I was very overwhelmed after that phone call. But what can you do? You just have to follow the doctors orders and learn what you can online about whatever issue you are dealing with. If there is nothing you can do about the situation in that moment you just have to let it be. Personally, I think it’s better to do research shortly before meeting with your doctor so you can at least be prepared with certain questions. By doing that closer to your appointment you are less likely to sit there stewing on potential negative outcomes. Granted, I am saying this about a diagnosis that has not been confirmed as cancerous. I believe if I was diagnosed with cancer I would probably be researching every corner of the internet to figure out how to get rid of it. But for now, I am trying to guard myself against “worst-case scenario” thinking. The best way I know how to do that is to distract myself.

 

I’ve been listening to my audio book and watching TV lately as a distraction.  Maybe I’ll listen to my audiobook while I clean the house. My house could use a good clutter clean, deep clean, and every other clean in between. I suppose that would help me take my mind off of this too. I think it’s so important to lean on healthy coping skills during the times that we are worried about the future. Beyond distraction comes acceptance, learning, and healing. With each new obstacle that comes my way I choose to remain determined to keep moving forward and do everything I can to create our family. I want to look back on these times and know without a doubt I did absolutely everything I could.

 

Thank you for reading. 

Catch up on past entries by clicking here for the archives page. 

ENTER TO WIN THE LATEST HOPINGFORBABY.COM CONTEST.

 

Comment below to Today’s Question and receive bonus entry to the current contest.

Today’s Question: 

What are some healthy ways you choose to cope with infertility challenges?

 

Learn ways to improve your egg quality. Purchase Rebecca Fett’s book “It Starts with the Egg: How the Science of Egg Quality Can Help You Get Pregnant Naturally, Prevent Miscarriage, and Improve Your Odds in IVF.” It’s currently the #1 Best Seller on Amazon.com’s Reproductive Medicine & Technology list. 

 

Featured Image Credit: Doctor Reading Results Photo by rawpixel.com from Pexels

Image Credit: Partial Molar Pregnancy Diagram by Phillip Savage on ResearchGate

Top 7 Websites Comparing IVF Clinic Success Rates

Top 7 Websites Comparing IVF Clinic Success Rates

This post may contain affiliate links. You can read the disclosure here

 

Question: 

How do I find the top-ranked IVF clinics based on success rates? 

 

Answer: 

The answer to this question is not as clear as you may think. The most important thing to consider before undergoing your search is to understand that “success” can mean different things. Those struggling with infertility may assume “success” means a live-birth, which would make sense, because that’s the end goal. But many fertility clinics view success differently. The statistics of an IVF clinic’s success rates can be skewed for different reasons. How is that possible? One way is they can alter the definition of success. 

 

Here are different ways a clinic may define “success”

5-Day Blastocyst stage reached

Embryo Implanted

Transfer results in one implanted embryo (but multiple embryos were transferred at one time)

Positive beta (positive pregnancy test)

Live birth

 

Aside from the varying definitions of success, there are many variables that can influence the outcome. Some IVF clinics turn away people due to the difficulty of their case, which would increase the clinic’s success rate. Essentially, the clinics that accept the harder cases also accept that they may take a hit on their success rates. There are variables some IVF clinics choose to avoid and they might suggest to patients to seek treatment with a different clinic. This is an example of lowering the pool of patients which increases the odds of more favorable results for the IVF clinic to report.

 

“Difficult Cases” Certain IVF Clinics Avoid

Higher Maternal Age

Poor Egg Quality (Low Ovarian Reserve, PCOS, etc)

Infertility Diagnosis (Hormonal, abnormal uterine structure, etc.)

High Body Mass Index 

Treatment used prior, including number of prior attempts

Patient history of miscarriages and previous live births

Male Factor Infertility

Genetic predispositions (MTHFR gene mutation, balanced translocations, etc.)

 

As you can see there are many variables that affect fertility. Those variables combined with the different definitions of success can make it challenging to find a truly balanced report of IVF success rates. Ultimately it is up to those dealing with infertility to do their due diligence with researching the clinics they may be interested in. Simply knowing that data can be potentially skewed can help someone be more careful while researching whether a clinic is right for them.

 

Selecting an IVF Clinic is Not Just About Statistics

  1. Consider your specific diagnosis, expected treatment, and rule out the clinics that are unable to provide the assistance or technology for your specific need. 
  2. Read what patients are saying based on their experience with their doctor, nurse, and office staff. Seek out reviews from those with a similar diagnosis as you. 
  3. Good communication with your clinic is vital. They should listen carefully to your concerns and respond promptly to your questions. Any miscommunication can lead major issues such as incorrect administration of medication. 
  4. Provides information on the realistic odds of a live-birth for you as an individual. 
  5. Find a clinic that creates a protocol to fit your specific situation and diagnosis.  

 

Top 7 Websites Comparing IVF Clinic Success Rates

 

#1 

CDC’s NASS 2.0 (United States)

I recently asked Rebecca Fett, writer of “It Starts with the Egg”, what website she would recommend that ranks IVF clinics and she responded with a link to The Centers for Disease Control and Prevention’s page about the National ART Surveillance System (NASS) 2.0.  This website shows a map of the United States. You can click on individual states to view statistics. The CDC’s NASS site has become one of the most reputable sources for finding statistics on success rates. The general consensus among many online infertility groups is they overwhelmingly recommend this site as their go-to source for information in the United States. Before the CDC’s website became the number one source of IVF clinic success rates, one of the top sites was SART (now in our #3 spot).

CDC Clinic Summary

 

CDC NASS Data

 

 

Link:

The Centers for Disease Control and Prevention’s page about the National ART Surveillance System (NASS) 2.0: https://www.cdc.gov/art/artdata/index.html

 

#2 

FertilityIQ (United States)

If you want to read what actual patients thought about their experience with a certain clinic FertilityIQ.com is one of the best resources out there. You can choose how you want to filter your results when you click the Research Doctors & Clinics button, these include View by Patients Like Me, View by Doctor, and View by Clinic. The View by Patients Like Me option is great if you have a diagnosis that is considered harder to treat, and you want to see where you can go for treatment that is more individualized to your needs. This site also integrates the CDC’s success rates which is a great feature of FertilityIQ, but if you read the FAQ section of  FertilityIQ you will see they point out some of the data may not have been updated for several years. 

 

FertilityIQ Clinic Overview

FertilityIQ View by Clinic

 

FertilityIQ View by Doctor

 

FertilityIQ Patients Like Me

Links:

Fertility IQ: https://www.fertilityiq.com

FertilityIQ Research Doctors & Clinics: https://www.fertilityiq.com/#doctor-search

 

#3

SART (United States)

The Society for Assisted Reproductive Technology (SART) shows data that was reported by clinics. One criticism of this site is that the data has not been updated since 2016 (as of 2019), whereas the CDC’s site was updated in 2017. On the Arizona Center for Fertility Studies (ACFS) website they point out the main distinction between SART and the CDC site, “According to the Fertility Clinic Success Rate and Certification Act, all ART cycles performed in the United States fertility clinics are legally obligated to report to the CDC.” Due to clinics being required to report their data only to the CDC, some clinics like ACFS chose to discontinue reporting to SART. The SART site still has helpful information but overall it is not as comprehensive as the CDC’s site. SART is better viewed as a supplemental source of information.

 

SART SRM

SART SRM data with graph

 

Links:

Society for Assisted Reproductive Technology (SART): https://www.sart.org

SART Find a Clinic: https://www.sart.org/clinic-pages/find-a-clinic/

 

#4

HFEA (United Kingdom)

The Human Fertilisation & Embryology Authority (HFEA) is similar to the CDC’s NASS, both are regulating organizations that collect data the IVF clinics are required to report. You can do a search on a fertility clinic’s”Inspection Rating” given by the HFEA as well as view the “Patient Rating.” These ratings are shown side by side for comparison, which is a great feature to quickly gauge how a clinic is doing overall. But keep in mind that the pool of patient participants can greatly affect the patient rating. Fewer patient ratings can equate to less reliable of a rating due to the smaller pool of people. Two bad ratings with a small pool of say five people can dramatically change the rating. Another nice feature is that you can click “View birth statistics” then “View detailed statistics” to use their filters to narrow down categories such as age and treatment type. 

 

HFEA

 

Links:

Human Fertilisation & Embryology Authority (HFEA): https://www.hfea.gov.uk/

https://www.hfea.gov.uk/choose-a-clinic/clinic-search/results/9141/

 

#5

CARTR (Canada)

The Canadian Assisted Reproductive Technologies Register (CARTR) is where the data can be found that is reported by the Canadian Fertility & Andrology Society (CFAS). The CFAS was originally founded prior to the invention of IVF and initially it focused studying infertility. You can view the CARTR Annual Reports here. The annual reports are useful for looking at the overall picture of ART statistics gathered in Canada. The reports do not show individual clinic success rates and currently there does not seem to be a website that Canada has to compare clinics. 

 

CARTR

 

Links:

CARTR Annual Reports: https://cfas.ca/cartr-annual-reports.html

Canadian Fertility & Andrology Society (CFAS): https://cfas.ca/index.html

 

Additional resources to find clinics in Canada:

Fertility Clinics: http://www.fertilityclinics.ca/

Infertility Network: https://www.infertilitynetwork.org/fertility_clinics_cda

 

#6

EIM & ESHRE (Europe)

European Society of Human Reproduction and Embryology (ESHRE) focuses on testing and research and publishes their findings for members to access on their website. ESHRE created the European IVF Monitoring (EIM) to gather the data as part of their publications. Similar to Canada’s CARTR Annual Reports, there is not a comparison of individual clinic’s success rates but rather an overall look at the data compared as a whole. You can view the annual publications of the reports here

 

List of Included Countries with EIM:

Albania

Armenia

Austria

Belarus

Belgium

Bosnia

Bulgaria

Croatia

Cyprus

Czech Republic

Denmark

Estonia

Finland

France

Georgia

Germany

Greece 

Hungary

Iceland

Ireland

Italy

Kazakhstan

Latvia

Lithuania

Macedonia

Malta

Moldova

Montenegro

Norway

Poland

Portugal

Romania

Russia

Serbia

Slovakia

Slovenia

Spain

Sweden

Switzerland

The Netherlands

Turkey

Ukraine

United Kingdom
ESHRE 2014 Publication on ART in Europe - Edited

 

Europe data

 

Links:

European Society of Human Reproduction and Embryology (ESHRE): https://www.eshre.eu/en

European IVF Monitoring (EIM):

https://www.eshre.eu/Data-collection-and-research/Consortia/EIM

 

#7

GCR (Worldwide)

I had issues at first navigating the Global Clinic Rating (GCR) website. But once I figured out the problem I was able to access some helpful information. Their search fields on their homepage were not setup correctly. I would type in “IVF”in the first field and it would automatically send me to the clinic of IVF Spain’s rating page, even when I had not entered a location yet. Finally I figured out that I needed to type in “fertility” in the first field and then I typed in the location in the second field. There were a few times I typed in IVF and I ended up with a list of dentists. If you run into issues with your search try slightly adjusting your search terms to see if you get the result you wanted. Although initially very frustrating, I found the site helpful once I figured out the specific terms needed they actually accept.

 

Some locations seem to have much more detailed reports and reviews from many patients, while other locations are significantly lacking data and reviews. Depending on the popularity of your clinic, you may find this site useful. If you cannot find as much detailed information I would suggest viewing this site as more of a supplemental source of information. 

 

GCR

 

GCR Clinic pt 1

 

GCR pt 2

 

GCR pt 3

 

Link:

Global Clinic Rating (GCR): https://go.gcr.org/

 

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HopingForBaby.com’s Beginnings

HopingForBaby.com’s Beginnings

I started my blog HopingForBaby.com in March 2018, almost two years into our infertility struggles. At the beginning, my blog was anonymous, like many infertility bloggers tend to start out. I just wanted a place to freely write what was on my mind and to help me cope. I love to write and I’ve always found writing to be cathartic. In my day-to-day life more of my friends and family were opening up about their infertility and miscarriages. I began to feel less alone and felt more support in “real life.”

After a little while I built up the courage to post a picture of myself in my blog. It brings a smile to my face when I see more and more infertility bloggers step out of the shadows and actually post pictures of themselves. It is such a simple act that helps to break down the silence surrounding infertility as well as the stigma. Posting a picture is a way to say, “This is who I am and this is my story.” This allows other people dealing with infertility and pregnancy loss to know they are not alone. Before I actually started this blog I was incredibly inspired by infertility bloggers who not only wrote their story but also took to YouTube and created podcasts. 

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So how did I choose the name of my website and my motto? The title of my website is pretty self-explanatory, “Hoping For Baby” is about the dream many of us share to have a child. I also chose this title because I wanted it to be flexible enough to allow for a future where I could write about a biological baby and/or an adopted baby. I don’t know what my future holds, and I may truly be unable to have a biological child. In that case, I would probably shift gears with my blog and write more about adoption or fostering. But for now, I am focusing my efforts on trying to have a biological child, hence all of my posts are related to this right now. 

The motto “Overcome Infertility & Create a Family” also has a double meaning. I chose “Creating a Family” as a flexible phrasing to allow for the many possible ways one can create a family. Whether it’s biologically from both parents, an egg donor, embryo donation, fostering, or adoption, etc. There are so many different ways to create a family. As far as “Overcome Infertility” most people may assume this to be literal, they may think of the steps to get them to their end goal of a biological child. 

But life isn’t always that simple, and sometimes people decide to stop pursuing a biological child. In this case, the idea of “Overcoming Infertility” takes on a new meaning. It can mean overcoming all of the emotional, physical, relationship, and financial struggles that come with infertility. You can overcome infertility by letting go of the pain and focusing on what is really important to you. One person may decide overcoming infertility means they can now move on to the idea of adoption, while another may decide that they would like to live child-free. For most of us with infertility, there is no straight path to parenthood, and there is nothing wrong with that. 

bath-ducks-bathroom-bathtub-226597

And on a final note, I chose to incorporate a ducky in my logo for a special reason. I started a little habit a few years ago, whenever one of my friends had a baby shower I would get them a rubber ducky to include with their other baby shower gifts I bought for them. I was doing it for everyone to where I told myself, “Don’t forget the rubber ducky!” In my mind the rubber ducky became synonymous with the celebration of new life. Plus it’s just so darn cute!

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Week 10 of Pregnancy: 6th Miscarriage

Week 10 of Pregnancy: 6th Miscarriage

Even without the ultrasound tech saying a word I knew something was wrong. There was no pulsating heartbeat like I saw with the last ultrasound. It was just complete stillness. My doctor and nurse seemed to be feeling the weight of sadness for me, they said they were sorry to see me going through this. I cried a little bit in the bathroom after the ultrasound, but then focused on what needed to be done afterward. I held it together while I was still in the office so I could think clearly enough to ask the questions I needed to. 

 

The ultrasound tech said the baby stopped growing around the 9th week based on their measurements. On the bright side, this is the longest pregnancy I’ve ever had. So maybe it being nine weeks could be attributed to some of the changes I’ve been making with how I eat and the supplements I’ve been taking. Unfortunately I didn’t find out I was positive for a MTHFR gene mutation until a couple weeks ago. Maybe had I known I could have started the Baby Aspirin sooner and maybe it would have protected this baby. 

 

My doctor highly recommends I do the Anora genetic testing on the baby to see whether it had a chromosomal issue. If it had a chromosomal issue, there’s nothing that could have prevented it. But, if it is chromosomally normal this may help determine whether I need to be on the medication Lovenox. In other words, if it’s normal maybe medication is what I need to prevent this from happening again. My geneticist said that with my particular type of gene mutation I do not need to be on Lovenox, but I’d like to get my Seattle doctor’s opinion. My local OBGYN says he communicates with the doctors at Seattle Reproductive Medicine (just like my prior Reproductive Endocrinologist). He said he will ask the question regarding whether Lovenox might be needed for my next pregnancy. My local doc seems to be on the fence about the Lovenox. I’ve also heard that some women with my issue also take progesterone, even if their levels show normal. I think I will also ask my Seattle doc this question too. I need to do my own research as well.

 

I have to have surgery Wednesday, due to this being a “missed miscarriage.” My doctor advised me to cancel my trip to Denali I had planned for the weekend. I’ve been dealing with some cramping, no bleeding yet, and still very nauseous. The most worrisome symptom have is that I feel like I’m going to pass out several times a day. The other day I was in the shower and all of the sudden my upper body felt really heavy and weak. My vision started to go black from the outside moving inward to where I could hardly see. I got out of the shower and lied down right away. I ate breakfast before my shower with two cups of water and some juice, so I had enough in my stomach. In hindsight, each of my miscarriages I felt this same way, like I was going to pass out or like I was incredibly dizzy. I asked my doctor about this and he said it could be due to the dropping levels of progesterone from the miscarriage. He suggested I eat small and frequent meals throughout the day and drink plenty of water to prevent this.

 

As far as how I’m handling it emotionally, it hasn’t been easy. But I decided to take a week off work for several reasons; 1) I don’t want to start miscarrying while I’m at work, 2) I need several days to recover from the surgery, 3) I need to take this time process the loss before I jump back into work. Based on my past experience with missed miscarriages and surgeries, taking a week off seems to be the perfect amount of time for me to move on physically and emotionally. With my very first loss I needed two weeks, mostly to deal with it emotionally. I suppose I’m bouncing back faster than I used to.

 

Honestly, at first I was inundated with all the “should have, could have, would have” thoughts. It was overwhelming to think about all the variables I could have adjusted, and maybe this wouldn’t have happened. If you are going through a difficult situation like myself, I think it’s incredibly important to not place blame. It took me so long to come to this realization. Don’t place blame on your doctor, don’t place blame on God, and don’t place blame on yourself. The sheer amount of negative energy that comes from those thoughts can make you become blind to possible answers that can lead you in the right direction. Blame closes off opportunities, whereas acceptance can bring clarity. By acceptance, I mean accepting what you are dealing with right now in this moment and moving forward.  

 

The other day I visualized myself standing at a fork in the road. I could take the dark, bleak path or I can choose the more vibrant path. The dark path is depression, confusion, negativity, and feeling stuck. Whereas the brighter path is gratitude, strength, inspiration, and growth. Admittedly, I was already in motion toward the darker path. But instead, I made the turn and began walking the brighter path. You can also choose the direction of your journey, no matter how far down the dark path you find yourself, you can always turn it around. Yes the outcome with each pregnancy may be out of my control, but what is in my control is my perception. Some people have told me I should maybe give up trying to have a child. But there is something inside me that says, “No way! Not yet.” It’s like a fire that is still going strong inside me, despite everything that has happened. As long as that fire is still burning, I’m going to continue this journey. 

 

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Week 10 of Pregnancy: Yuckiness

Week 10 of Pregnancy: Yuckiness

(Entry written prior to posted date)

Date Written: 9/10/19

 

PLEASE READ FIRST: Although this pregnancy ended in a miscarriage, I still wanted to share my experience of this pregnancy. I wasn’t ready to talk about my pregnancy as it was happening, so I wrote this entry prior to the date it is posted.

 

Right now I’m in the middle of my 10th week and feeling extremely tired and nauseous. I threw up only one day so far, but six times in that single day. I’ve learned that I need to be constantly snacking on things every 3 hours or so in order to prevent nausea. Saltine crackers first thing in the morning has really helped me. I think that I do feel the worst in the morning but it doesn’t go away during the rest of the day either. My husband bought me some ginger root and ginger ale that I think has been helping me. I’ve been making ginger tea out of the ginger root. 

 

I’ve never felt this tired in my life. Just totally wiped out and have zero motivation to get anything done around the house. If I’m not at work I’m a total couch potato at home. Speaking of potatoes, I’ve been craving them constantly! I must have some form of a potato daily. I haven’t been able to eat an entire meal lately because of the nausea, mostly half meals or smaller. 

 

img_20190917_144048

Started Methylfolate at beginning of pregnancy and Baby Asprin more recently.

 

Last week I was waiting to hear back from the geneticist about whether I should take Lovenox and if there was anything else I needed to be taking for my specific type of MTHFR gene mutation. She said that I do not need to take Lovenox and that Methylated Folate and a Baby Aspirin should work fine for me. Please speak with your doctor about your specific treatment plan, don’t just follow mine. My geneticist talked to me about my particular MTHFR gene mutation, C677T heterozygous single variation, and said, “It’s fairly benign” and “it’s actually pretty common, with as many as 50% of the population having this kind.” I’ve heard this statistic about a large part of the population having it, but it was the first time I was told it was “fairly benign” which I guess is a good thing, but if it’s the main contributor to all my miscarriages I would not categorize it as “benign” at all. One of the definitions of benign is “not harmful.” I’d say this is pretty damn harmful. I guess we will find out for sure whether my Methylated Folate and Baby Aspirin is what finally makes the difference with this pregnancy.

 

img_20190906_203329-1

First ultrasound from week 9 of pregnancy. Looks like a little blob, but ultrasound tech showed me the head on the right side. Heart is beating strong at 155 bpm.

 

I have my ultrasound this Friday and I am kind of stressed about it, most of my past ultrasounds are always bad news. I feel like I will absolutely be blown away if my pregnancy is still continuing to be healthy. I’m still shocked that I’ve made it to week 10 without any issues other than feeling nauseous. This is the first pregnancy where I’ve been incredibly nauseous which I hear is a good thing. One other difference about this pregnancy is I haven’t spotted at all, which I did in all my other ones I miscarried.

 

I decided to let my two supervisors and HR know about my pregnancy. It’s a little earlier than I was planning to do after the first trimester. But because I’ve been feeling so cruddy and it’s been somewhat affecting my work performance, I thought it would be better to speak up about it. I’m glad I did because shortly afterward one of my coworkers confronted me about not helping with a cleaning project. I felt like every smell in the building was about to make me projectile vomit. I figured by the end of the shift I’d start to feel better but I didn’t. So my attempt to clean would most likely have ended up with me also cleaning up my vomit. I figured some people would be grumpy with me not doing everything I normally do, but I’m not ready to announce my pregnancy. It just feels too early for me. Part of me wants to explain why I can’t lift heavy things and why I seem very immobile these days, but I want to protect my privacy a little longer from my coworkers. 

 

Even if this ultrasound on Friday shows that everything is perfect, I’m still hesitant to share the good news. Although I originally planned to announce to everyone at the end of my first trimester, I kind of like keeping this to myself right now. If I lose the baby I’ll have to explain to so many people about it. And even if everything goes well, I don’t really want people asking me a lot of questions about the pregnancy. For now at least, I’m just not ready for that. I’m considering keeping it to myself until I start to show. I even had the idea to wait long enough until I’m clearly showing, then place my bets on who will ask me if I’m pregnant first. I think I might find that kind of entertaining, plus it will buy me some time to keep it to myself a little bit longer.

 

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Week 9 of Pregnancy: Top Secret

Week 9 of Pregnancy: Top Secret

(Entry written prior to posted date)

Date written: 9/3/19

 

PLEASE READ FIRST: Although this pregnancy ended in a miscarriage, I still wanted to share my experience of this pregnancy. I wasn’t ready to talk about my pregnancy as it was happening, so I wrote this entry prior to the date it is posted.

 

I’ve decided this pregnancy needs to stay a secret from pretty much everyone until I at least pass my first trimester. This is proving to be difficult while I continue to write posts about other things going on simultaneously. For example, while I was waiting to get tested for the MTHFR gene mutation and when I got my results what I didn’t tell you all is that I was mostly there for testing my HCG levels because I was pregnant. Sneaky, sneaky. I so wanted to share the news because I was so happy but I ultimately chose to wait because I wanted to not deal with the questions I would get. I tend to be OCD at times and I overly research the s**t out of things enough as it is with this pregnancy, almost to the point of neurosis. So I really didn’t want to have the added stress of other people’s questions and worries on top of my own. For this pregnancy it was more of a strategic stress management decision. I wanted to reduce my stress as much as possible. I’ve decided to keep this news to myself until I feel comfortable to share it, which in all honestly will probably be sometime during my second trimester.

 

I just got off the phone with the office of my geneticist. My OBGYN doctor referred me there since I was found to be positive for the MTHFR gene mutation. So my geneticist’s office has been playing phone tag with my OBGYN office and apparently didn’t have a clue why I was referred to them. So I had to explain to them that I was pregnant, had the MTHFR gene mutation and needed to find out ASAP whether I should be taking Lovenox or not. So I’m still waiting to hear back. My OBGYN didn’t seem too sure whether I should be taking a Baby Asprin or not, so I decided to continue taking it since I’ve read that it probably wouldn’t do any harm if I took it but didn’t need it. 

 

As far as how I’m feeling, well imagine that every ounce of life has been zapped from your body and that’s pretty much what I’m feeling. I have zero energy, and I mean zero. It takes a decent amount of energy just to get up and get something to eat. I’ve been parked in front of the TV so much my body aches until I force myself up and stretch while I reach for a small snack. I’ve been eating like a bird, very small amounts but frequently. I’m eating frequently because my nausea has been absolutely terrible and the only thing to keep it at bay is to have a little snack in my stomach. I don’t eat full meals much, and if I do it takes me forever to eat it all. I definitely have morning sickness when I wake up. Needless to say Saltine crackers have become my new best friend. We bought a Costco sized box of twelve sleeves of crackers which will probably last me just a couple weeks. 

 

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Positive Pregnancy test on July 26th.

 

A couple years back I was eating a snack at work and my coworker’s face lit up and she said, “Oh my God! You’re pregnant!” I was so confused how the comment came seemingly out of nowhere. “Uh, no, just hungry. I haven’t eaten yet today” I said. She pointed to my snack as if I should have known I was pregnant just based on what I was eating. I was so confused and asked her why she thought I was pregnant. She explained that I must have been because I was eating Saltine crackers and that no one eats Saltine crackers unless they are pregnant. I explained to her that I like salty snacks and that I figured it was better than potato chips. It took a while to convince her that I was not pregnant. Knowing that some people so strongly associate these crackers with pregnancy is going to be a problem for me while I try to keep my current pregnancy under wraps. They are the only thing keeping me from being barfy. Granted I no longer work with that person, but I am a terrible liar and need to figure out how to maneuver around this possible question. Mamma needs her Saltines! 

 

As far as emotionally, I’m excited that this pregnancy has been going well so far. I’ve had no problems at all other than some random sharp pains. But my baby’s heart is beating well and it’s measuring perfectly on track with the ultrasound. Kurtis had to work that day so I’m hoping he and I will be able to actually see the heartbeat the next time we are there. And maybe we can actually make out some body parts instead of it appearing like a blob where it’s hard to even tell where the head is. I’m counting down the days. We are doing the appointment and ultrasound on Friday the 13th. I hadn’t really thought that one out, but I figure with the terrible luck I’ve had in the past maybe I should play the “opposite game” and stick with that appointment date. Maybe our little one will be just as healthy and strong as it was with the first ultrasound but bigger. 

 

I’ve been using the Ovia Pregnancy app on my phone. I love that app because it gives an adorable cartoon rendition of what the baby looks like at each week of the pregnancy. It also tells you what size the baby is, mostly in fruit, but this week my baby is the size of a southern pecan according to the app. It even shows you the actual size of the baby’s hand which really adds to the cuteness factor and will make anyone go “awww.” 

 

As much as I want to be in the moment I also really want this first trimester to fly by, so I can feel some sense of security knowing the miscarriage risk is lower. I know you can lose a baby at any point during the pregnancy. But to get past the first trimester would be amazing and surreal, because I’ve had that chance. Even now, when I think about how this time next year I could be cuddling with my baby, it seems very surreal. The best way I can describe it is when you have such a strong dream in your heart, but you’re told it will never happen, and then way later down the road it suddenly becomes a possibility. It’s hard to fully embrace that reality when you feel like it can be ripped out from under you at any point. But I still carry on and try to stay optimistic.

 

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