Family reunion

Yesterday, K, E and I attended an event that’s hosted by the reproductive endocrinologist who helped us conceive E. It was held in a park with a bouncy house and free ice cream from an ice cream truck, and was meant to be a sort of family reunion for families who have expanded because of the staff’s loving expertise. K and I wanted to attend because our lives had gotten busy and we had never gotten the chance to take E into the office and thank the staff.

It was a lovely park that we didn’t even know existed, and the weather was perfect for the event. Staff members ooed and ahhed over E and other babies in attendance. The oddest part was an unofficial receiving line of sorts where parents and babies waited to speak to the doctor. It felt a little bit like an unintended “meet your maker” sort of moment, but likely only because there were so many thankful parents (like us) who wanted to say hello to the doc.

The doctor’s practice is located in a very upscale nearby community, so K and I weren’t sure what sort of crowd to expect at this gathering. I was pleased that so many of the families seemed down-to-earth and friendly. We chatted with some of the parents about each other’s babies, milestones, etc. K and I confessed to each other later that we each spent time wondering about each of these family’s experiences with infertility. Thoughts of, “I’ll bet you were a cycle monitored, fertility med sort of family,” and, “IVF with egg donor for sure,” kept swirling through my head.

There was one family that was among the demographic I expected to see at this event: a privileged blond woman with her equally privileged mother and baby. They were, as K put it, a spectacle. The baby’s grandma clearly had a lot of plastic surgery and the entire family was decked out in a wide array of upscale clothing brands. The baby was cruising in a $5 bajillion stroller and had no short of seventeen toys dangling in front of her glitter beret topped head. I imagined that the mother had been married to a very wealthy older gentleman and, upon his death, had a doctor harvest his sperm so that she could conceive her miracle baby and secure a larger part of his estate for her and his postmortem spawn.

I wondered what others assumed our fertility journey was, and mused that they were all likely very far off from the accurate story.

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A day of pure work win!

I have a standing weekly meeting with our new director and yesterday was our day to meet. At the end of our meeting, she said, “So tell me more about this baby!” I had previously mentioned that K and I were expecting but didn’t have an opportunity to speak to her more about the details. It has also been really difficult to bond with her and develop a sense of trust. I decided to take the plunge with her perfect opening and just told her the rest of the story. She reacted wonderfully, asked really thoughtful and sensitive questions, and seemed genuinely excited for me! This was a breakthrough in our very new work relationship and I think I learned a lot more about her in the process.

Later that day, when I was processing and acknowledging donations, I saw that our reproductive endocrinologist had renewed an annual gift from him and his wife, and added a $1,000 donation from his clinic. When sending out major donor appeals about a month ago, I made the decision to write a note on his letter:

As survivors of domestic and sexual violence, one of the reasons why K and I felt inspired to come see you for our care is your generous support of [organization], where I work. We greatly appreciate your commitment to the women and families we serve! Best, C, Mama-to-be BECAUSE OF YOU!! 🙂

My supervisor was so excited to hear about such a major donation and directly attributed his increased generosity to our relationship with him. She even joked, “Falco is already engaged in philanthropy while still in utero!”

Also on the topic of winning, while not entirely work-related, I had an epically good hair day yesterday. Those who know me well know just how exciting this is for me!

Fertility Preservation in the Trans Community

At work I have a bunch of different searches set up to email myself different journal articles related to queer bioethics, LGBT research ethics, transgender stuff, etc. Lately I’ve come across a number of different articles on the ethics of fertility preservation in the trans community (particularly with any type of body modification)

I’m probably less interested in the ethical debates and more interested in the implementation.  Things like providers having conversations with their trans patients/clients and establishing clinical guidelines and protocols for these discussions.  It’s nice to see that some places include fertility, like UCSF’s Center of Excellence for Trans Health’s “Primary Care Protocol For Trans Health”.    

Thinking back to the time (about 7 years ago now) when I started taking testosterone no physical or mental health providers ever discussed fertility issues with me. Granted, I may laughed in their face.  I was around 25 or 26 at the time.  I wasn’t ready to think about kids.  I was totally absorbed with surviving day-to-day and jumping through hoops so I could finally begin my transition and feel more comfortable in my body.    

 Things get even more important/interesting/complicated as youth begin to transition at earlier ages.  I know there is quite a bit written about having discussions about fertility in the oncology field, with teenagers who have cancer, but I haven’t found much of anything about teens and transition and fertility.   

Some of the research I currently work on is related to patient education and risk communication related. Specifically we look at improving ways of presenting risks and benefits of different treatments to help patients make better decisions. I often think about the decision to begin hormone therapy for trans folks….but I wonder how effective even the best designed health education materials could really be.  I’m sure everyone has their own unique experiences but personally my drive for self-actualization was so strong that I paid little attention to the risks (or just minimized them). 

In my case I think I would have responded similarly if a provider would have tried to discuss fertility with me back then, yet now I really wish they would have.

Falco’s second ultrasound

Yesterday afternoon, K and I went to our final visit at our reproductive endocrinologist’s office, where we went for our second ultrasound. It was so phenomenal to hear Falco’s strong heartbeat (on the high range of normal at 180 bpm) and see the little one moving all around. It’s so amazing to see how much Falco has changed in a few short weeks. Our baby is finally looking like a BABY, albeit one with alien-like translucent skin.

Our doctor took videos with his iPhone of Falco’s heartbeat and of Falco moving all around, which he emailed to us after our visit. It’s this thoughtful nature, coupled with the doctor and staff’s sweet, supportive demeanor, that we’ll miss the most about their practice. It’s sad to be leaving them, even though it’s for a very happy reason. We look forward to referring many other hopeful parents-to-be and, perhaps, we’ll be back there for help conceiving our second kid! (Right now, K’s rolling his eyes at me and telling me that we’ll see.)

Now, some close-ups of our now FETUS (no longer an embryo!) named Falco:

All nestled in

The heartbeat

A sideways view of Falco

Now, because we’re opting out of some of the diagnostic tests like the NT scan, we likely won’t catch a glimpse of dear Falco again until our sex scan at 16-20 weeks. At least K can continue to watch that video on loop like he did last night.

Path to pregnancy, a retrospective

The journey to become pregnant for the first time has been a roller coaster for the past 9 months. Since we started our blog just recently, I thought I would share some of the highlights month-by-month to tell the story of how we got to this place.

December 2011
Took my final shot of testosterone on December 23, 2011.  C and I talked constantly about baby making and our plans for 2012!

January 2012
Started charting with Fertility Friend and felt obsessed and empowered by all of my bodily data.  We also began researching sperm donors and narrowed down our choices to our top 2 or 3. Our friends tease us about a Google spreadsheet we created to track pros and cons of each donor option.

February 2012
Still waiting for my cycle to return.  Waiting and waiting, and was getting scared that it would never come back.  On Valentine’s Day, I went to my regular OB/GYN and discussed my plans for getting pregnant.  The doctor and nurse practitioner are excited for C and I and are more than willing to work with us for my pregnancy.  C teased me about showing my bits some love on V Day.

March 2012
March 4 2012–my period returned.  I was overjoyed and grouchy at the same time.

We also had our first consults with reproductive endocrinologists (RE) this month.  We selected one RE based on the fact that they advertised in a LGBT local paper and the other based on good word-of-mouth feedback.  Before scheduling the appointments, C and I drafted long, detailed letters explaining our situation and identities.  They both sent me 30-40 page packets of forms to complete ahead of time, most of which I had to respond with “does not apply.”

The prices were really somewhat shocking, especially that of Dr. W, which were about $750 more per cycle than Dr. MB.
We both felt really excited about going with Dr. MB between his better pricing and REALLY compassionate and nerdy personality. This is somewhat surprising because we both anticipated liking Dr. W more, based on some good experiences we’d previously had with her staff. However, she seemed very judgmental toward C. For example, when I asked directly how queer/trans friendly she was, she responded, “I’m sitting here talking to you, aren’t I?”  Ummmmm….What?!
Looking back, I can honestly say that we couldn’t have made a better choice.  Dr. MB’s staff are so kind and I feel very relaxed and safe at their practice.
April 2012
First month of testing at the RE’s office.  I was introduced to the joy horror of the cycle day 3 vaginal ultrasound.  If I had any issues with being a bleeding man, I was going to have to get over them quickly.  We also had tons of blood work to check hormones, thyroid, FSH, and a bunch of other things.  I had a HSG, which is uncomfortable both physically and emotionally, as it turns out the resident performing the test was in my degree program and remembers me—-as a different gender.  At the end of the testing cycle, we met with the RE who diagnosed me with Hashimoto’s and refers to me another endocrinologist.  Other than my slightly elevated thyroid, all other systems were a go.

May 2012
I was disappointed because I was hoping May would be our first month to try.  Instead, I met with the new endocrinologist, Dr. B.  He’s young and did his residency at the medical school where I do research.  Somehow this makes him more approachable. He prescribed synthroid and wanted to see my TSH levels below 2 before we began trying to get pregnant.

C and I took a trip to Philly to visit our best friends and attend the Trans Health Conference. We attended a half-day intensive workshop on trans-masculine pregnancy and it was amazing! I was still charting this month and also practicing with ovulation predictor kits (OPKs).  While on the drive to Philly, we stopped somewhere on the Ohio turnpike so I could pee on a stick.  I got one of my first smiley faces in a men’s public restroom!

June 2012
My thyroid levels were good and were finally ready to start trying!  This month, we had our first IUI attempt.  We decided to try one natural (un-medicated) cycle.  We did OPKs and went in for back-to-back (24 hours apart) IUIs once we received a positive OPK result.  The first IUI went great, but the second one was physically and emotionally uncomfortable.  We had a nurse we didn’t like as much, she mis-gendered me and spoke about me in the 3rd person.  Plus, she had difficulty inserting the catheter through my cervix and I had a lot of bleeding, camping, and backaches afterward.

We tested after 2 weeks and a got a very faint positive.  After going in for blood work we discovered my HCG (beta) had dropped and I wasn’t pregnant after all.  I was unprepared for how crushed and disappointed I would feel.

July 2012
Because I don’t want to be off T for longer than I have to, and was hoping to be hugely pregnant during the winter months, we decided to move ahead with a medicated cycle for our second attempt.  Doing the medicated and monitored cycle made me feel like we were at the doctor’s office every other day (and we were for two of the weeks).  I did a baseline ultrasound and blood work, took Femara, did 4 or 5 additional ultrasounds (with blood work each time) to check on how my follicles were growing.  We ended up with two mature follicles and did a trigger shot of Ovidrel to initiate ovulation.  Again, we went in for back-to-back IUIs, 24 hours apart.  4 days later, I had another follow-up appointment to confirm ovulation. Two weeks after taking the Ovidrel shot, we got our good news! 🙂

Product Review: What Makes a Baby book

K and I were very excited when we saw a Kickstarter campaign to fund the publishing of an inclusive book that would teach children about reproduction. Below is a description of the project, in the words of the author, Cory Silverberg:

What Makes a Baby is my response to the fact that books about where babies come from leave many of us out.  They tell a nice story (mommy + daddy + intercourse = you!) but the truth is that more and more of us are acknowledging the help we get to bring children into our lives.  That help might be a doctor, fertility clinic, adoption or foster agency; it might be a turkey baster and a friend; it might be a sperm donor or a surrogate.  What Makes a Baby helps parents tell children a story about where they came from that isn’t just true for them, but true for everyone.

Crafted for children roughly from pre-school to 8-years-old, What Makes a Baby is written and illustrated to include all kinds of kids, all kinds of adults, and all kinds of families – regardless of how many people were involved, what the orientation, gender identity, or other make up of the family is, or how it came to be that way.  It’s a social justice approach to sex education.  Like all picture books, it’s meant to be read to a child and gives the adult reader the opportunity to fill in as much detail as they would like.

What Makes a Baby Book Trailer from Cory Silverberg on Vimeo.

What’s not to love about this project? As a transguy who is the gestational parent and a queer woman who is an adoptee and non-gestational parent of Falco, K and I are obviously going to one day need to answer the question of our children’s conception and we plan to teach them about this in inclusive and age-appropriate ways. What Makes a Baby, written by certified sexuality educator Cory Silverberg and illustrated by Fiona Smyth, seemed like a logical and exciting resource for young kids, and we happily backed the project at the “Flash Mobber” level, which came with the benefit of receiving a first edition, hard-cover copy of the book.

We were elated when the Kickstarter campaign exceeded their funding goal and even more so when we received our copy of the book. It is vibrantly colorful and appropriately addresses the concept of conception and birth for young children.

Cory Silverberg accurately professes that What Makes a Family is “a book for every kind of family and every kind of kid.” I personally loved that the people all appear to be happy, gender neutral beings and that the language follows suit with treasured sentiments like, “Not all bodies have sperm in them. Some do, and some do not.” Silverberg includes questions such as, “Who was waiting for you to be born?” which leaves room for caregivers to provide additional or personalized information about the child and family’s stories, and to celebrate the unique ways in which families come together.

In a nutshell, K and I love this book and can’t wait to read it to our little Falco. We hope you’ll consider purchasing What Makes a Baby to read to the children in your life!

Confirming the confirmed & moving forward

K just got a call from our reproductive endocrinologist’s office with our first HCG beta number: 102! A nice, normal number for a gestational parent who’s anything but. We’ll be headed to their office, bright and early every Monday and Thursday mornings for the next several weeks, then we have a couple of ultrasounds, and are released to the OB office. K scheduled our first OB visit for late September when we’re right around 10 weeks.

In my quest toward mommy-to-be perfection (I’m certain I’ll examine this further in a future blog), I have this overwhelming sense of panic about the ever-growing list of tasks we need to accomplish in the next 35 or so weeks. I’ve already scheduled us for some classes and have begun investigating others. When it comes to classes, the one I’m most nervous about is the birthing class. The last thing we need is a heterosexist, judgy environment inflicting stress on my love and little Falco. Using a similar strategy as K and I did when finding a reproductive endocrinologist who’d be respectful to our “unique situation,” I decided to reach out via email to some nurse educators at our hospital. I introduced myself, explained our identities and concerns, asked some questions and thanked them in advance for their help. Now, we wait. Worst case scenario: K and I persevere by finding our own resources and path (something we’re quite used to) and a medical provider learns something new about the gorgeous diversity in our world.

K apologizes for his lack of posting thus far. I suppose we were ambitious when we thought that his first trimester would still allow him to feel up to accomplishing even his regular tasks, let alone starting a new project like this baby blog.

Finally.

It’s been such a long journey already. At times, it was hard to let myself imagine that we’d finally be at this place and, truth be told, I’m still a little stunned by the reality of it.

It took months for K’s period to make its reappearance, then two cycles involving a wait for ovulation to occur and then agonizing waits to test for pregnancy. Our first attempt at insemination (IUI) involved a long delay between inseminating and K finally getting his period. We were completely overwhelmed by a constant sense of anxiety and took several pregnancy tests during that wait, one of which was a very faint positive. Unfortunately, by the time we went to our reproductive endocrinologist (RE) for blood work to confirm the pregnancy, we must have lost the baby. It’s what many refer to as a “chemical pregnancy.” It was a horrendous feeling of loss and sadness for us both.

Because K was finding it increasingly difficult to be off of testosterone, we decided to work with our RE to take fertility medication and a trigger shot with ovulatory monitoring to enhance our chances at conceiving during our second cycle. Our RE almost exclusively prescribes Femara to his patients on fertility medication because it has many of the benefits of Clomid without the potential side effects such as anxiety and depression. The monitoring involved endless early mornings to have K’s estradiol level checked and ultrasounds to monitor the size of his maturing follicles, most of which wasn’t covered by our insurance plan. We started to heavily stress about money as we watched the savings we’d manage to scrape together for this journey quickly diminish with each monitoring visit. We knew that if the second try didn’t end with the result we’d hoped, we would have to take at least one month off from trying in order to replenish our savings for another attempt.

We went into the second try with so many reservations. We were terrified to get any hopes up. Still, this time, we felt much calmer and a lot less anxious about our two week wait until we were able to test for pregnancy. During the beginning of the second week, when K brought home french onion dip from a routine tip to the pharmacy for refills, and then said he felt too yucky to eat the food he’d purchased on a craving-based whim, I felt a glimmer of hope. On Friday, at 2:30 a.m., K turned to me in bed and announced that he had to pee and wondered if we should test. I, having just ingested my second dose of sleeping medication for the night, followed K into the bathroom and sleepily waited. I wasn’t even paying attention when K announced, “I think I see a second pink line!”

It's a faint second pink line!

It was faint, but much more prominent than the previous month’s result. Still, after our previous month’s heartbreak, we were tentative and frightened. I went back to bed in my zombie-like, already asleep state, while K stayed up ruminating about the result. In the morning, we called the RE’s office and they congratulated us, assured us that a second line, no matter how faint, means that we are pregnant and that we should come in on Monday morning for the first of our bi-weekly HCG beta tests. We began to feel a glimmer of hope, but we were still somewhat skeptical.

That evening, I had picked K up at work and we proceeded to make an hour long trek to visit out-of-town friends for dinner. I brought a digital pregnancy test with me, just in case, so we stopped at a Speedway gas station to see if we could potentially confirm the result. We crammed into a single-stall restroom to test and created quite the line for the women’s room. People, of course, gave us dirty looks when we both poured out of a single restroom, but it was worth it to be able to confirm this joyous news.

We confirmed with a digital test.

On the evening before the 34th anniversary of when my mom learned that she was becoming a mom, I learned that I was about to embark on the journey toward motherhood as well. It was a meaningful and treasured day to receive such momentous news.