Kara

Infertility is depressing, even if depression isn't something you've experienced before. The whole process of infertility treatments, between the medications and the procedures, can often make it worse. On rare occasions, it can even quite literally take someone to the edge.  And it nearly did...

Please check our resources page for places to connect to should you be struggling with the same issues. Finding a mentor, connecting with other women struggling through a Resolve group, or finding a therapist and/or acupuncturist can be tremendously helpful. 

Transcript

Today, we're going to start with a simple sentence. Infertility is depressing. I don't just mean, the whole thing is a sad state of affairs. I mean, the women and men going through it are more prone to clinical depression and anxiety than more fertile folk. Multiple studies have shown that women struggling with infertility are two to three times more likely to meet the criteria for a major depressive episode than the average woman. Another showed that women with infertility feel the same level of anxiety and depression as those just diagnosed with cancer just had a heart attack or were diagnosed with hiv. Up to fifty percent feel infertility is the most upsetting experience of their lives for men, research shows. It seems to be more dependent on where the infertility diagnosis lives, if it's firmly on the shoulders of the woman there, definitely more clinically depressed than other men, but not nearly as much as women are. But now, if you shift that diagnosis too male fertility, suddenly it starts to mimic the same rates of depression, anxiety, scene and women now take that baseline and add to it the effects of the many physical and hormonal treatments involved in trying to conceive, and it can get even worse, and in some very rare cases, even worse, can become downright scary and that's how we get to today's story. I'm Steven Mavros, this is waiting for babies where we take a deeper look into the very human side of the world of infertility. Today's story comes from an old patient of mine. I'm Kara Kobetitch, thirty two years old, thirty two that goes for thinking, dropped a few years. I like cat, i'm character vantage, thirty six years old. Normally, someone's job doesn't directly impact the state of their fertility, but cara had a unique position. That meant she could never really get away from other women being pregnant. I am an ultrasound stenographer for maternal fetal medicine department, so i scan pregnancy is all day long. How was that ? While you were going through all ? This, um, good and bad, it definitely helped me respect a lot of the ivf girls. Um, and i've seen a lot of success stories in them have also seen women with frozen i'm sorry donor embryos, sarah cassie's all that stuff. And so i knew that there were other options out there, and that does kind of give you that hope. Um, but on the flip side, you also see a lot of people that are on grateful, um, people saying they want to give their baby up for adoption because it's a certain gender that they didn't want that kind of stuff, some of that stuff was a little bit hard to swallow professionally, though i think that i had been at that job probably about ten years by the time i was really trying to have a baby, and so i remember not wanting children a cz i started that job too. Now all of a sudden wanting children, and it was easy to kind of tune that off as i went to work. The personal life was a lot harder. The people getting pregnant in my personal life definitely triggered some sadness and jealousy if shoes in may. Kara and her husband started trying and after a few months she realized that her periods were nous regulars she thought they'd been they were coming every thirty two to thirty six days which technically still falls into the normal category so she started using ovulation predictor kits to help her determine when the best time to try to conceive was and anxiety quickly seeped in the moment she started the kids i mean, once you start being on a knob relation kid every morning it puts you on a whole another level oh my gosh. Why did i do it right ? Did i forget you know that kind of stuff what did it do like what were the anxieties ? Um when we when you went away you had to bring the right amount of sticks with you and the kid and all that kind of stuff you know, i got this really expensive one thinking oh, this will get me toe get pregnant this little work you know, you go from being very optimistic like this is this is exactly why i wasn't getting pregnant and then you know, a dozen and you're like ok, well, change things around after some quick testing they found that carries husband had a sperm count that was a little low but close enough to normal but still recommended moving on toe y or inter uterine insemination although that wasn't quite how was presented to cara he said, listen, if you want the easy button, like the staples easy button, if you want the easy button, just go and get a night. You i you'll be pregnant in a flash, and and so when they said, you know you have unexplained infertility is so great, let's, do it, i, you guys, this will be perfect, even with that, maybe minor male infertility factor will get an iou, island one and boom, that will be our easy button, and then seven or eight rounds of easy buttons later, it wasn't so easy anymore. Did you have words with the person again ? Yeah, didn't become the easy button anymore, but, yeah, way thought i you. I was the trick, right ? Yeah. During the first few otherwise, carol is to hand drug called clomid or clomiphene, an estrogen modulator, which can help ensure a strong population and sometimes even leads the ovaries, developing more than the single follicle that normally develops per cycle. Unlike injectable medications that work on the ovaries directly by flooding the body with stimulating hormone clomiphene a bit more elegant and that it actually tricks the brain to send more signals to the ovary to keep recruiting and grow more follicles. Now, all medications that modulate your hormones are going to make you feel different different, of course, being a kind of way to portray what most of my patients describe this feeling just plain crazy as someone who's personally watch, many people go through the emotional and physical ups and downs of fertility medications. I've always felt clomid was the most egregious offender, both while they're taking it, and often the week or two afterwards, my patients report, feeling intensely emotional have a propensity for physical symptoms like hot flashes, night sweats, headaches and nausea, among other things. Now, in the past, cara had a history of being a pretty even keeled, optimistic person but was prone to headaches. The clomid, though, hit her harder and in different ways than she thought it would. So i forget which days it's my husband doing dishes you forget which days you actually take clomid but when i was actually taking the medication, i felt awful. I did get headaches, i'm a little bit irritable. Um, and as soon as you stop taking it, i felt fine again, but i think maybe a week or two now, maybe a couple days or a week later, you would get your cycle on dh while i was on my cycle, it was such a bad drop of of of feelings that it was a little bit alarming. I remember saying to somebody, gosh, i just feel so blue right now, do you feel like that was something you were from, you know, very unfamiliar with it ? Um, and then i mentioned tio, my doctor, that i wasn't really nuts about clomid, is there any other options ? And she brought up let's resolve, so i think i had three or four cycles with let's resolve, and that was a lot better of a medication didn't have nearly as many side effects, they didn't have the headaches. I felt fine taking it, and and i didn't have that emotional drop during my cycles, um, but by what seven or eight u i cycles, they said, it's time to move on so, as is the classic progression, when a few all you guys aren't, in fact, the easy button, and they're still stuck in the unexplained category, the next plan, people are often presented with his ivf. Most people have a lot of fear and trepidation around ivf, especially when they don't really know what they're in for from her work care actually knew pretty well what the process entailed was still pretty hesitant about it, though i was the girl that said i was never gonna do ivf, um, because i didn't think i needed it when it actually came down to the conversation with my reproductive endocrinologist. It was devastating to me because i couldn't believe that i was actually going down this route. At this point, i think i knew knew more than most people what it actually entailed. Um, my husband was pretty supportive, and and, yeah, let's, do it, you know, if that's what she says that we need to do, then let's do it, i support it, and you guys didn't get into many fights about no, no, not about that decision. Now, when you say, like, you weren't going to be the girl who did ivf like who's, that girl in your mind, was that girl in your mind, back that someone a lot older than me, um, because you're someone who actually had problems on with pco as that kind of stuff. I mean, again, i guess because i was labeled as i should say, we were labeled as the unexplained infertility, i just assume nothing was wrong. I didn't realize that it could be bigger issues that they can't diagnose for you. The process of ivf is really easy for no one, even if you're in the medical field and know what to expect. Remember the first time i put a needle in me ? I was shaking, but after it was done, i thought, well, it's not so bad, like i wasn't nervous about the actual needle itself. I think i was just nervous about me starting this, and so i actually ended up documenting the whole story that that day that was my first journal entry ever. I never did journals when i was growing up, and that was my first journal entry on my cell phone, and i remember taking a picture of the whole entire kitten caboodle all laid across my kitchen can't like, ok, here we go through this is it, um, you still have that idea it so i made it actually, you know, look back on it, which is pretty interesting. So Kara started the process of ivf, doing her multiple injections of stimulating hormone per night. Now carol was a good candidate for ivf, meaning her hormone levels before starting looked great, and she had many an drool or pre follicles toe work with. Remember follicles of the little sex that have the eggs inside, always looking really good, and she was a few days away from triggering. Now, triggering is giving an injection, usually of a hormone called hcg, that starts the process of population so that retrieval can occur at a very specific time. But as she was about ready to do that, something happened that she still can't explain. Oddly enough, she was in my waiting room, reading a magazine about to see one of my colleagues, for some acupuncture way, often do a number of acupuncture treatments. During the stimulation phase, i was one or two days away from being triggered and i don't think if they don't think it was the article that i read in the waiting room that that did anything to me but interestingly enough i was reading an article about NICU babies or something like that and i went in and i um i got like acupuncture and i was laying there and i just started thinking and something came over me and i just started immediately hysterically crying and i had to ring the bell and your partner came in and i i begged her to be done she took the needles out she had me rolling the one side just can you do me a favor don't read anything more like that again and i said yeah sure but that's the weird part was is that i couldn't laugh off what happened um and that was a friday i think it came home that weekend and i was supposed to see my family was supposed to be a nice event and i couldn't shake off what had happened to me, I i just didn't know what was wrong with me so much so that my husband i think that saturday morning he was supposed to go to a golf outing overnight and i said to him and my mom i don't care who's staying with me but i don't want to be left alone and i remember my husband looking at me like one of my crazy, because i loved when he would go away for a night or two, you know, i'd like to my alone time and ah, what i didn't tell them at that time was when i was resting a few hours before i had a fantasy about hanging myself with an extension cord down the back alley of my house, and it just kind of like popped up in my head and freaked me out that i saw that vision of me doing that. It was like i witnessed my body doing it wasn't me actually doing it saw myself doing it like an out of body experience had anything like that ever happened and your change, your changers never and i never even really had depression. You know, you get you go through those ups and throws float flows of your life, but i never seek denny care for depression. I never took any medication for it. You know, from time to time, you get sad and you talk to people about it, but i never felt like i ever wanted to end my life over how i was feeling. That way the day after this happened carris follicles were ready to go and she did her trigger shot after that her feelings of sadness and thoughts of suicide seemed to disappear as if they never happened when she did the trigger shot she didn't have to do any more injections of the stimulating hormone which she thinks may have been what stopped all the thoughts in doing research for this episode i found no record in any of the literature about suicidal thoughts being a side effect of this type of medication i also spoke with several reproductive endocrinologists in the philadelphia area to see if they'd ever heard of this and they all basically said they'd never seen it happen before. Thankfully for Kara it seemed to have passed by the time i showed up for my retrieval on monday i had no thoughts of suicide or lose or anything like that i was pumped and right to go had you talked to any of the doctors that were brought up that this is a really person that knew that was your colleague like was this something did you like read through the leaflets off the medication to see if that was like a side effect now i should have i mean i should have said yeah i e if i remember right you were also pretty well stimulated that first time around so i was actually on and hyperstim protocol because they thought you would happen because they thought i would hyperstim, dave, the retrieval. They said it was. It was it success. We got twelve eggs, or i'm sorry, twelve eggs, and my husband said to me in the recovery room, there was women who had already had their retrievals. They were laughing, having a good time, joking around, and i look at my wife and she's sitting there shaking, um, post post recovery in the recovery room shaking and the shakes didn't go away until okay, a diet coke or something like that. And i remember walking to the bathroom in so much pain, and he just thought it was so odd that i handled it the way i did that. It seemed like you were in a lot more pain than those women were, and that was weird to, um, but i just thought, well, maybe they only took one eyed from her, and they took twelve for me, so you never know. I want to take a quick break to talk about hyper stimulation or as it's medically known ovarian hyper stimulation syndrome or OHSS so when a woman is going through ivf and injecting stimulating hormones into her body, the ovaries are producing a lot more follicles than normal and our this growing a lot bigger than usual they're also reducing a lot more estrogen than they normally would now OHSS isn't fully understood, but the basic concept is that if the ovaries and follicles are growing really big thie estrogen is really high and you do a trigger shot and add the presence of hcg something happens that makes the blood vessels in the ovaries start being for lack of a better word leaky and spreading fluid to a place into the abdomen where it really shouldn't be now for most women going through follicle stimulation, this either doesn't happen or they experience it as very mild and is simply a filling of bloating. But a more moderate and severe forms of o h s s fluid keeps leaking into the abdomen leading toe a pocket of fluid that can build and build to the point that the abdomen actually expand it's in very severe cases the patient gained so much fluid they end up looking almost like they're six months pregnant, which is possibly the foolish joke i can think of in this field and it's not just the swelling women also can experience nausea, vomiting, shortness of breath and in extreme circumstances if the fluid doesn't stop kidney failure women going through this severe oh hss often end up in the emergency room and if it gets bad enough doctors will actually physically drain the fluid out of their abdomen or tap the abdomen now if that sounds like the same thing you do a maple treating getsem sear about your scarily not that far off since i'm sure i'm freaking some people out right now especially as those doing ivf now or about to keep in mind severe oh hss is very rare and fertility doctors have gotten much better at preventing it sadly for cara they weren't quite so successful i remember walking home in so much pain um and they said i could go back to work actually the second day and i thought to myself like i can't go backto work this is this is crazy and all of a sudden i started feeling pressure in my upper right dia fran and so i said you know what ? This isn't really normal they said i should be going back to work today or tomorrow i better give the doctor on call of course it was after hours and i got a phone call right back and that resident wanted me to come right in first thing the next morning in the meantime she said oh drinks and gatorade has some soup all that kind of stuff so it almost sound like she knew i was already hyper stemmed, but we went in and they did an ultrasound. And so, since i do ultrasound, um, they kept the screen away from ray. Had they done that before ? Know someone, read the church. Yeah. Oh, yeah. She would not let me look at that screen. And my husband watched it and i could see in his eyes something's not right. And he doesn't even know ultrasound all that well, but he could just tell, i guess, by seeing all the other ultrasounds that all those black isn't normal. And i said, scan right here where my ribs were, where i felt this pressure and actually, i should say skin right here because it's my liver, um and i knew in school that that that's where a lot of a society's sits is, you know, right below your liver and that's where i was feeling that pressure and my husband's eyes bugged out. When when i guess they saw the amount of fluid there. So again, i never saw how much fluid i actually had in my belly. But i looked about six months pregnant. Um, and my blood values said i was point one unit away from named to be hospitalized with have heparin treatment. Thankfully, for carrie, they didn't have to attempt to get the fluid out of her. They put her on bed rest and had her drinking more gatorade than she ever wanted. No, remember, she just had retrieval and the plan had been for her to do a transfer afterward. But if there's one thing that makes hyper stimulation worse it's getting pregnant. We talked about how this all started with the trigger shot or hcg. When a woman becomes pregnant, the hormone that starts to be produced by the body in ever increasing quantities is each cg that's, actually, what those p sticks were looking for and since hcg is what started this whole fiasco, the last thing we want to do is add fuel to the fire. So cara had to freeze all the embryos so they could be transferred another day. When interesting results of the hyper stimulation, though, is how it countered how she was feeling all of two to three days before, when she had those scary, terrible thoughts. But i remember when i was hyper stemmed feeling like i needed to thrive physically on be healthy. I wanted this ability, tio liv. I really wanted to feel healthy again because i was so sick, and so it was interesting that that yeah, that, um, that union yang, um over the course of the next week or so carries body started returning to normal her abdomen went down in size back to normal her body figured out how to process all the fluid and luckily for her she got a few good embryos that made it to freeze that she could get ready to transfer back once her body was in the right stage. The nice part about transferring an embryo that's been frozen is that you don't need to go through stimulation anymore all you need is a uterus with an appropriate thickness and phase of lining and a certain amount of estrogen and progesterone in the body the ovaries don't have to do anything and many physicians actually like them to be quiet to the point that they start this process by putting women on oral contraceptives or birth control. This also allows them to control the timing of the cycle so they can set the transfer up on a day that's convenient for everyone and that's exactly what Kara's doctor did started her on birth control to get her ready to do a transfer at the same time this was going on cara found out that her sister in law was pregnant. Normally this would have been a joyous occasion when you've gone through everything cara has finding out someone no matter who they are could just go have sex and get pregnant can feel terrible and just make worse that feeling of brokenness that so many women feel dealing with infertility, something about this combination of the birth control pill and the news of her sister in law started bringing back those blues that cara had experienced before. I started to go downhill really fast, and the conversations that i had had with my sister in law, i think, were the catalyst to it. But i'm pretty sure it would have happened regardless of me being set off with whatever just happened to be that it was her. I ended up getting those thoughts of suicide again, and i remember crying to my husband, saying, we just bought this big house. I can't fill it, um, i don't know what i'm going to d'oh, i'm so hopeless. Remember the word hopeless coming into my head a lot, and again, the fantasies of hanging myself, strange that it was hanging myself, but it was always hanging myself, same imager, different. Um pretty much the same image just different different places yeah but always always the orange extension cord and not quite sure why um and i ended up leaving the leaving new york early that weekend to go home because it wasn't good for me to be around his family and i left him there and i drove i took the car and you decided to take the train home that night and remember driving over the varies on a bridge and i saw a sign that says your life is worth it and at that point i had another vision of me pulling the car over the verizon a bridge would you can't dio and jumping off because that would be better than what i'm feeling right now and it freaked me out i mean shocked me to the core um and so the next day at work i decided to call my reproductive endocrinologist and i left and a message with the nurse saying that i feel hopeless if you're depressed and i'm having thoughts of suicide and i remember saying that so flat with no emotion to it i just kind of sound like a robot when i said it and she patch me through to my reproductive endocrinologist and i said the same exact thing to her and she said that when you stop your birth control right away i don't want you or the e r and tell them what you told me so the air at the hospital that i work for has a separate building for behavioral health so i went to the e r i told them my whole story and they called made called somebody made a phone call and a security guard picks me up at the e r and walks me over to the behavioral health center like i think i told i told my husband i called my husband and i said they told me to go the e r okay at this point it didn't call my husband i walked in they took my bag they took my cell phone everything away for may they didn't give me a chance to make any phone calls and they put me in a room with another security guard watching me and cameras all around me um and i go through a metal detector i think too and i sat there and waited for one of the residents to come and talk to me for probably about forty five minutes and i remember crying when she brought me in and she said well what's wrong and i'm like i don't know why you treat patients like this i'm sitting here telling you that i'm having problems and you're treating me like i'm a criminal or a prisoner no wonder people don't come teo to seek help when they're this depressed or suicidal because this is this is so bad and she said well tell you what you're actually not that sick if you're feeling that way because a lot of people who were really really sick don't care about the security measures that are that are placed in front of them the doctor told her what she had already surmised, which is that she's, extremely sensitive to hormones. They were going to refer her to a group of therapists who specialize in infertility. And if she didn't get better, once the birth control was out of her system, they would put her on an anti depressant. It took six weeks before she could get an appointment with the specialized group, though so luckily, she was able to see a social worker at her fertility clinic to help in the interim. Once off the birth control, she started feeling better pretty quickly. But a fertility doctor still wanted to pause and wait before going forward for the embryo transfer. Until the therapist signed off there's. So much stigma around mental health that it acts like a barrier to people who even think they should reach out for help. And for karen, it was hard to share what she was going through, even with her husband. When my husband picked me up from the e r that night, he was frantically looking for may because i didn't call him, and he went to the e r and i wasn't in the e r that i said, i wass, um and the look on his face was the most embarrassing moment in my life for me because you kind of looked at me like a little lamb, like this sad little person and it's, not his fault. Hey, he obviously was extremely worried about may um, but it wasn't me that that that was sitting there in front of him in his eyes, this strong, vivacious person. And so when i was, you know, kind of just like a puddle of emotions and looking like the like this little lamb, it it was highly embarrassing, i don't know why, but so i didn't want to share that, obviously with a lot of people, because it was really hard. Teo teo, even tell my own husband that i had been having these feelings did you ever think about, like a hotline or i don't know why, but now ? Three months later, caress therapist signed off on her to move forward. There's such an interesting catch twenty two here. On the one hand, everyone wanted to wait for care to mentally be ready to move forward and for depression toe lift. Yet at the same time, aside from the effects of hormones, the thing that was adding to this depression was the waiting so much waiting, trying to conceive or in this case, even to be able to try with the embryos that she already had. Frozen as you've seen in past episodes, it's not always easy on a marriage. To be fair, i'm glad it was only a three month period because it was not an easy three months for our relationship. And, um, i can't imagine couples that go through this for years for several cycles because it almost killed us in one cycle. Um, and and and it was really the depression that it was really the worst. Did you feel like you had support in your community at large ? Yes, and and actually that's. Probably my biggest advice, tio. Women who want toe do the ivf route. Um, i never felt like i needed a team of supporters when i was just trying or doing the iaea wise. But all of a sudden, when i decided you ivf, i kind of developed this team of supporters in my life. And there were a couple friends that knew everything. I mean, i'm most friends knew that i was trying to get pregnant, but there are a couple of friends that knew everything that was happening. A couple family members and i had an acupuncturist, and i had a chiropractor, and i had this, you know, the therapist and the social worker and my reproductive endocrinologists and the nurses there, and i really felt like i developed a great team of people that were highly qualified and understanding what was going on with me. Um and so that's my advice, you just just grab a team, you know, grab people that understand what's going on and it's kind of one of the also the reasons why i'm doing this, just getting it out there that you're not alone. So, finally, after all she'd been through, kerra was ready to have her embryo transferred, knowing how sensitive she was. Two medications her doctor did was referred to as a natural frozen cycle. Instead of manipulating the body to produce the right conditions to implant the embryo, they simply followed her regular cycle waited for her to copulate and five days later, which is the stage of development the embryo was frozen in. They could transfer the embryo back in. So i went back to population kits and one side populated. They did an ultrasound to see if my corpus liam was popped yet. And once it popped that's. When you started the day five, you counted a fives five days ahead of that. And that was your friend's number your day reason why they don't like doing this is because my frozen embryo transfer was on these saturday of labor day weekend. Yes, not convenient at all. Um, so the first embryo that they picked, which was the best one, um was my son and i had a very wonderful pregnancy. Not complicated. Um, i had those feel good estrogen's and my body, and interestingly enough, i didn't develop postpartum depression, um, i was prepared for it, it never really happened. Cara son anthony was born about three years after she and her husband first started trying, as with many fertility patients, once they finally get pregnant there's still so much worry and disbelief they spent so long waiting for this moment that sometimes it just doesn't feel real and infertility you you you learn not to hope for anything because the planner that i am, i planned all these amazing things, like, ok, well, if i well this out, i'm going to have the baby this month so we can do this this and this in our it after we have the baby, and that was so sad for may, and so i stopped hoping for anything, including a positive pregnancy test at one point, you know, and and even during my pregnancy, even though i loved being pregnant with him, i was always waiting for the other shoe to drop. I never washed anything until he was home from the hospital, i remember sitting at home from the hospital and saying to my mom, well, we have a lot of work to do, and she said, what ? Don't wash anything ? She looked at me like, are you insane ? So well, i don't really know if i was to be bringing a baby home, what is wrong with that you were just questioning of, yeah, yeah and you know that that jewish tradition of i'm not having a baby shower until after you have had a baby. I needed that. I should have had it that way. With anthony. I was not opening up anything. I felt like i needed to return it, if if if need be. Um and so you know, i regret not not truly, truly enjoying it, too. The sense where i was, i never saw it past the pregnancy and never saw me actually having a baby. I just was so happy to be pregnant that the baby thing didn't come until after he was out of me. Oh, no, mom. Okay, all right, cool. I got this. About a year and a half after anthony was born, karen, her husband decided it was time to start trying for their second. Many of my patients throughout the years tell me that once you go through infertility, it sticks with you. Even after they have their child. Cara started trying again, and many of those anxieties and thought she had before came flooding back right away. So the second go around was not nearly as bad as the first, but it's. Funny how the same sort of demons and fears come back out within the first population kit pee test that you that you bring out, um, i don't think i think that, like ptsd or that that that fear all came roaring back for me. And i think also the second time, i wanted it more. I think i very much protected myself the first time around. But the second time, i really had envisioned a family of four, and, um, there, i think there was a little more at stake. I don't know why, but it just seemed like there was a little more at stake the second time around. Carol was lucky enough to have a number of embryos left over from her first cycle that she actually decided to do genetic testing on them to figure out if there was a good one there that she should be putting back. And sure enough of the bunch that she had. There was one. So after preparing her body for a transfer again mindful of how sensitive to medication she had been in the past, that one good embryo did the trick and she conceived for the second time. Her second son, will, was born last year. She had a lot of concerns about her mood and whether if it any point, those blues would return. But luckily, when they started, she didn't have that stigma to reach out, and she had a team. So she was quick to seek out help during the pregnancy, and it never got to the scary points. It had the last time around after giving birth. The mood changes she got afterwards were a little stronger than the first time, and she was given an anti depressant to help with the transition. Interestingly enough, this postpartum course my husband just started a new job there's a little bit of anxieties of having two children all by myself what if he's really busy and i can't handle it and ah very unlike me to have any kind of anxieties and on that aspect and so i did and filling that zoloft just to kind of get me through that hump of the confidence that i need to take care of two children but do you feel like it's been helpful ? Yeah, i dio what's different um i'm not laying in bed worrying about having two kids and what if one cries or what the other one you know, just i'm just kind of like ok, well hurry and put your big girl panties on and let's do it you know ? Um yeah, i think that's helping it's such a low dose it could just mean the placebo effect too, but whatever it is it i think it is helping and i don't know when i'm goingto go off of it. But again postpartum depression is kind of a sneaky thing and i'm highly aware of it and i just kind of wanna just make sure that that's not gonna happen to me because i'm a mom of two now i need toe you take care of it yeah do you feel like it's a lot easier now knowing that you have this relationship with the therapist and and that that's there, yeah, um, seeing what i, saul and what i've been through and going through what i'm the anxieties that i'm having now, they pale in comparison. So i'm not scared to ask for help now, um, and i'm not embarrassed about it now, and i'm talking about it now. Um, but it's, a little bit sad that it took tio three years to do that. Do you think there are things you could have heard along the way ? They would've held no least not from my providers. No, not talking about you, but do you feel like there is anything any advice you would give to other people who, like, what do you what do you feel like you you now navigated that you now could tell someone else, had a navigate. I just i want people to know that it's ok tio be sad it's okay to be jealous of other people um and it's okay don't want the things that you want and it's okay to want the family that you want however it happens there's undoubtedly somebody that's gone through this that you know pretty well one in eight couples suffer from this if you talked to enough people someone's going to be out there that is going through the same thing interestingly enough, i had a friend who was literally going through ivf the exact time that i was with my son with with my first son and i got pregnant and she didn't she has a great story in the end but to take another round for her um but i remember we knew exactly which days was what and my pregnancy test was a few days before hers and mine was positive terms wasn't and i know that that was probably hard for her, but i think that that camaraderie of us doing it together at the exact same time was extremely helpful for least for may. I don't know about her, but at least for may and so wouldn't it be great if there was some kind of forum minus hippa where you could get people who were going through the exact same thing at the exact same time t be able to talk through certain things ? Oh, you have another blood draw today didn't drink enough water. So it was a really hard stick, that kind of stuff, the things that other people just don't understand because it's not happening to them. Once you start sticking needles in your body, it's a whole, another it's a whole other ball game, do you feel like you have a different view of what that ivf girl is now ? Absolutely. Do you feel like you are ? I'm totally the eye of ivy s girl now, yeah, i'm her, um yeah, i mean, i wouldn't wish it on anybody, but, hey, i'm here and wants some advice. Yeah, thanks. To sarah for sharing her story in researching this episode i tried to find data or case studies on ivf medications leading to similar feelings that carry experienced and i came up very empty handed as i did when reaching out to the many fertility specialists i know there's research over the last few years showing a link between hormonal based birth control and an increased incidents of suicidal thoughts and attempt though the number of cases air still relatively small if you or anyone you know had a similar experience would love to hear about it if you're so bold you can do so in the comments for this episode or just email us through our contact page and waiting for babies dot com and tell us what it was like for you and how you got through it we've also updated the resource is page on our site to include a number of ways you can seek help if you or your partner are experiencing similar issues if i learned anything since starting this podcast it's that there is a vast community both on social media twitter, facebook and yes absolutely even in real life of people who have been where you are and want to help get through it with you together waiting for babies is produced by me Steven Mavros welcomes what i'm calling our second season sorry about the break we have a lot of interesting interviews in store for you over the next few months but we're looking for more so if you have a story you want to tell please reach out via the web social media or find me on twitter @smavros they're also more live podcast events in the works for later this year that i'll have details for soon so keep an eye out on our site the our facebook or instagram pages till then i'm Steven Mavros see you next time.