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" In the first installment of The Fertility Diaries, we met three friends from the Cleveland area, all planning families. Jenny Taylor, 27, and Jody Urbas, 33, have faced challenges and heartbreaking losses in their journeys to motherhood, while Carrie Brainerd, 31, easily became pregnant the first month she tried to conceive. As we revisit this close-knit group, Jenny anxiously awaits the birth of her daughter after the loss of a newborn son to sudden infant death syndrome (SIDS) only a year earlier, while Jody starts reproductive treatment after enduring a miscarriage and being diagnosed with impaired fertility.  Jody was feeling cautiously optimistic. She had already undergone her first round of intrauterine insemination (IUI) in July 2006: Her husband&amp;#039;s sperm were concentrated and injected into her uterus, timed to coincide with ovulation. Even though she was too far into that month&amp;#039;s menstrual cycle to take the medications that would boost the odds of success, she&amp;#039;d been eager to move ahead with the process. As Jody put it: &amp;quot;It was just a cycle to see what happens \u2014 nothing to lose, only to gain.&amp;quot; So she wasn&amp;#039;t entirely surprised when that first attempt at IUI failed.  The next month marked the start of her merry-go-round of fertility medications to stimulate egg production and precisely time ovulation. Initially, she injected these drugs into the fat of her stomach. When that method didn&amp;#039;t help her conceive, her doctor decided that the injections should go directly into a muscle, which would increase egg production; Jody&amp;#039;s husband, Scott, 32, gave her those shots, in her rear end. &amp;quot;They call it the hip, but I don&amp;#039;t see how that&amp;#039;s your hip,&amp;quot; she says. These injections were punctuated by regular blood tests, sometimes as often as every day, to monitor egg development and ovulation. Although Jody was excited at the prospect of finally starting her family, the seemingly endless rounds of tests, syringes, doctor&amp;#039;s visits, and bruising were more stressful than she had imagined.  Jody: I started with a drug called Repronex, to create more eggs \u2014 so you have more targets for the sperm to hit. Then, when the time was right, I took a drug called Ovidrel to stimulate ovulation. I didn&amp;#039;t get pregnant that first month on medication, and then, when I went to the doctor to make sure I&amp;#039;d ovulated, they saw that there were egg cysts \u2014 the sacs that hold the eggs \u2014 left over. We couldn&amp;#039;t do another cycle of insemination the following month because we had to get rid of the leftover cysts first. They put me on a drug called Lupron to do that. It suppresses your ovaries and puts you in false menopause \u2014 you get hot flashes and everything. I&amp;#039;m usually very cold, and I was sweating 24 hours a day. I hated it! And then each cycle, there&amp;#039;s barely time in between for the bruises from blood draws and injections to heal before I&amp;#039;m being poked again.  A Second Chance As Jody waited to see if IUI would help her conceive, her friend Jenny&amp;#039;s own long and very anxious wait for a child was thankfully coming to an end. After the devastating loss of her son, Andrew, to SIDS a year earlier, Jenny was due to give birth in August. Both she and her husband, Sean, 37, could hardly wait to get their daughter safely into the world and to bring her home. Jenny prayed that she wouldn&amp;#039;t have to leave the hospital with empty arms once again.  Jenny: I was four days overdue when I went into labor. I&amp;#039;d already been sent home from the hospital once, the evening before \u2014 I&amp;#039;d been having contractions all day, but my cervix wasn&amp;#039;t even a centimeter dilated. Then at about 4:30 a.m., I woke Sean with all my moaning as I tried to work through the contractions. He insisted that we go to the hospital, but I said I wouldn&amp;#039;t go there until my water had broken. I didn&amp;#039;t want them to send me home again! Then just as the six o&amp;#039;clock news was coming on, I heard a pop, and I knew. When we got to the hospital, I was between four and five centimeters dilated.  Labor and delivery were still fresh memories for Jenny, but she was relieved to find that the experience of giving birth was much different this time. With Andrew, the process had been long and difficult, ending in a cesarean section. This second labor was much easier \u2014 Jenny had an epidural at around 11 a.m., and two hours later she was almost fully dilated. After just two or three pushes, Eleanor Grace Taylor was born at 1:26 p.m. on August 10, weighing in at a healthy 7 lbs., 9 oz., and with a very full head of dark hair. The relief was overwhelming as baby &amp;quot;Nora&amp;quot; was placed on her mother&amp;#039;s chest and parents and daughter cuddled close. Jenny: We hadn&amp;#039;t found out the sex ahead of time with Andrew, but this time we did. Knowing that we were having a girl was a relief in a way. If we&amp;#039;d had another boy, I think that there would have been a lot of comparisons with Andrew, which would have been hard. But Nora can be her own little girl. We were able to celebrate her birth as opposed to reliving what had gone on before. That was so important for our first child after Andrew&amp;#039;s death. We both want more kids, and Sean wants another boy, so, of course, we&amp;#039;ll still have to deal with the loss \u2014 but I think having Nora first helps.  Still, Jenny and Sean knew all too well that delivering a healthy baby wasn&amp;#039;t the end of the story. When the family went home two days later, it was with Nora hooked up to an apnea monitor. A band around Nora&amp;#039;s tiny chest was connected to a remote alarm unit that beeped \u2014 loudly \u2014 if her heart rate dropped or her breathing stopped. (Although research offers no clear answers as to whether subsequent siblings of babies who&amp;#039;ve died of SIDS are at higher risk for this disorder, many parents like Jenny and Sean choose apnea monitors for peace of mind.) &amp;quot;The first night we had her home, it was going off nonstop,&amp;quot; says Jenny. &amp;quot;It petrified us. The first time it went off, I&amp;#039;d just dozed off on the couch and I lurched up so fast I think I ripped a stitch. You don&amp;#039;t know if it&amp;#039;s a false alarm or not.&amp;quot;  The couple later learned that they&amp;#039;d put the band in the wrong place on Nora&amp;#039;s chest, which is why the alarm kept going off that night. Over the next few months, the monitor&amp;#039;s recording device indicated only a couple of real &amp;quot;apnea episodes,&amp;quot; in which Nora&amp;#039;s breathing stopped for 20 seconds or more. &amp;quot;Most babies have these episodes, though,&amp;quot; says Jenny. &amp;quot;But because these babies aren&amp;#039;t wired, most parents don&amp;#039;t realize that it&amp;#039;s happening. After what we went through, I couldn&amp;#039;t have another child without the monitor. I wouldn&amp;#039;t have been able to sleep!&amp;quot;  With Nora feeding as often as every hour on the hour, Jenny soon found herself caught up in a whirlwind of breast-feeding, day/night confusion, cracked nipples, and sleepless nights. Her delight in her daughter sustained her, but it didn&amp;#039;t leave her immune to the stresses of new motherhood. &amp;quot;There&amp;#039;s no sainthood that descends on you when you&amp;#039;ve gone through infertility or losing a child,&amp;quot; she says. &amp;quot;I&amp;#039;m human just like everybody else and I&amp;#039;ve sometimes cried right along with Nora when she&amp;#039;s been crying for four hours straight. But even during those difficult times, I&amp;#039;m just so incredibly grateful for her. I don&amp;#039;t want to say that other parents aren&amp;#039;t, but I just have this incredible love for her because of what we&amp;#039;ve lost.&amp;quot;  An Easy Pregnancy  In light of her friends&amp;#039; difficult quests for parenthood, Carrie found herself sometimes embarrassed by how completely uneventful her pregnancy continued to be. &amp;quot;I&amp;#039;ve been lucky. Apparently, I have one of those pregnancies that they write about in books or something,&amp;quot; she says. &amp;quot;At all of my doctor&amp;#039;s appointments, they keep telling me that I&amp;#039;m just average for everything \u2014 I&amp;#039;m right down the middle.&amp;quot;  As of her second trimester, Carrie and her husband, John, 32, still hadn&amp;#039;t decorated the nursery or settled on a short list of boy and girl names (they wanted the baby&amp;#039;s sex to be a surprise to them). They had, however, bought a fluffy elephant baby chair, which their dog deemed an excellent toy.  &amp;quot;We&amp;#039;re not froufrou people \u2014 the nursery isn&amp;#039;t going to have a theme or a mural on the wall,&amp;quot; says Carrie. &amp;quot;We&amp;#039;re going to paint the walls a color and put in a crib and a dresser and call it a day. And we&amp;#039;ll go into the hospital with small lists of names we like, and then decide what seems right.&amp;quot; Carrie admits that after seeing the painful losses her friends had experienced, she might have been procrastinating on the baby preparations a little because she knew how unexpectedly things could go wrong. But for the most part, she says, taking the onset of parenthood in stride is just in her nature; as one of six children, and having seen seven nieces and nephews come into the world, she&amp;#039;s very used to babies.  Her conversations with Jody and Jenny didn&amp;#039;t revolve exclusively around babies, pregnancy, and fertility, either. &amp;quot;When we had lunch at Friday&amp;#039;s right before the holidays, for example, most of our discussions were about things like Jody redoing her house and Jen getting ready to host Christmas,&amp;quot; Carrie says. &amp;quot;We all ooh and aah over Nora because she&amp;#039;s so happy and so much fun, but we&amp;#039;re busy women with full lives, and we do have a lot to talk about other than pregnancy and babies.&amp;quot;  Still, watching all the difficult experiences that her friends were going through definitely gave Carrie a new perspective on her pregnancy.   Carrie: I&amp;#039;ve learned a lot. Until you know someone who&amp;#039;s gone through something like this and have seen how it affects them, you don&amp;#039;t realize how it totally changes your life. I&amp;#039;ve had what might be considered an easy pregnancy, but for somebody who&amp;#039;s normally a very active person, to not be able to do the things you normally do, or to sleep through the night, or to feel like yourself \u2014 it takes a toll. If I had a rough pregnancy, I know that Jen and Jody would be understanding and listen to me complain and give me suggestions to help. But as smoothly as things are going for me, I&amp;#039;d never complain about my pregnancy to them. When I get in a bad mood, knowing everything they&amp;#039;ve gone through reminds me how lucky I am.  Another Disappointment In early November, Jody received some sad news: Her third round of insemination with medication had failed. &amp;quot;Jenny e-mailed me, saying, &amp;#039;Did you get your baby yet? C&amp;#039;mon, tell me!&amp;#039;&amp;quot; Jody recalls. &amp;quot;I had to tell her no. But the truth is, I had always known that the chances weren&amp;#039;t all that good with intrauterine insemination. You have a fairly small chance of getting pregnant when you&amp;#039;re using that method.&amp;quot;  Jody could have done three more cycles of insemination before using another fertility method, but she and Scott decided to try in vitro fertilization (IVF) immediately. This more invasive approach has a higher success rate. The type of treatment she&amp;#039;d receive is known as IVF with intracytoplasmic sperm injection, or IVF with ICSI.  Jody: My chances of getting pregnant with in vitro are anywhere between 45 percent and 65 percent. I like those odds. The drugs you take are mostly the same, so I&amp;#039;ll still be getting all those shots in my butt, which Scotty will give me. Then they take all the mature eggs out with a laparoscopic needle and then find the best sperm under a microscope and inject it into the best eggs. Normally, they&amp;#039;d just mix all the eggs and sperm together, but in situations like ours, where there&amp;#039;s male factor infertility, picking out the best sperm gives you a better chance of a successful pregnancy. I&amp;#039;ve been reading posts in online forums about so many people who have all the same issues we have \u2014 abnormal sperm, a blood clotting disorder \u2014 and have gotten pregnant with IVF. That gives me real hope, and I think the fact that we had already agreed that IVF would be our next step made it easier when we found out that the last round of insemination didn&amp;#039;t work. I&amp;#039;m comforting myself with the thought that at least I can have beer and wine this month!  As December arrived and the holidays drew near, Jody would start a round of fertility medications for IVF. She&amp;#039;s lucky to have health insurance that covers infertility treatments up to a preset annual limit, and with some of that amount still untouched for the year, the costs of the latest round of drugs were covered. A few days before Christmas, Jody would meet with her reproductive endocrinologist \u2014 a physician who specializes in reproductive disorders \u2014 and begin her IVF journey.  All of this was racing through Jody&amp;#039;s mind on December 13, when she joined a group of Carrie&amp;#039;s work friends for a baby shower (which Jenny had to miss for a church event). Instead of buying gifts for Carrie, Jody made them: handcrafted baby announcements, intricately decorated with baby feet, with quotes like &amp;quot;sweet baby,&amp;quot; &amp;quot;welcome,&amp;quot; &amp;quot;precious,&amp;quot; and &amp;quot;new arrival,&amp;quot; and a place for Carrie to attach a newborn picture. &amp;quot;I make all my own cards, so I thought this would be special for her,&amp;quot; says Jody. Carrie was surprised \u2014 and touched \u2014 by Jody&amp;#039;s thoughtful gift. &amp;quot;The cards are so beautiful, and so personal,&amp;quot; she says. &amp;quot;I know how much time she put into making them, and that means a lot.&amp;quot;  Jody has been to more than one baby shower since her miscarriage, and these gatherings have often been painful and awkward. &amp;quot;We don&amp;#039;t talk about our struggles to have a baby with our whole family, and so at family showers, everyone always wants to know, &amp;#039;So, when are you going to have kids?&amp;#039;&amp;quot; she says. &amp;quot;I&amp;#039;m so tired of answering that question, or avoiding it.&amp;quot;  But Carrie&amp;#039;s shower was more of a relief \u2014 many of the women there didn&amp;#039;t have children yet, and the talk wasn&amp;#039;t all about babies. &amp;quot;I didn&amp;#039;t know anyone except Carrie, and no one was asking me those kinds of questions,&amp;quot; says Jody. &amp;quot;I could just enjoy it and talk to people, watch Carrie open her presents, and be happy for her.&amp;quot;  Jody has also kept a strong, positive attitude by being very realistic about her situation.   Jody: Scotty and I have set a deadline for ourselves. If we&amp;#039;re not pregnant after two cycles of IVF, we&amp;#039;re going to take a break and then talk about adoption. I&amp;#039;m simply not going to let my life be engulfed by this. I don&amp;#039;t think that I could keep taking all of these medications and doing this to my body over and over. I can&amp;#039;t imagine just trying and trying and trying. There&amp;#039;s got to be a point where you stop.  Fertility Treatment: First Steps After your initial round of diagnostic tests, &amp;quot;90 percent of the time, your doctor will have a good idea why you&amp;#039;re not getting pregnant,&amp;quot; says reproductive endocrinologist David Adamson, M.D., president-elect of the American Society for Reproductive Medicine. If your diagnosis is clear, your doctor will determine which of the following steps are appropriate for you. But if the cause of your infertility remains inconclusive, she may try these treatments one by one, or suggest going straight to in vitro fertilization (IVF) if you&amp;#039;re 37 or older. Medications: If you&amp;#039;re not ovulating regularly \u2014 caused, for instance, by menstrual irregularities or polycystic ovarian syndrome, a hormonal disorder \u2014 your doctor may prescribe oral fertility drugs, like Clomid or Serophene, which induce regular periods and stimulate egg production; they help 20 percent to 30 percent of women conceive within six cycles. If that doesn&amp;#039;t work, you may undergo injections of gonadotropins, hormones that stimulate the ovaries to develop multiple eggs, for eight to 12 days; this helps 30 percent to 40 percent of women to conceive.  Surgery: Anatomic problems such as blocked fallopian tubes or fibroids in your uterus may require corrective surgery using a laparoscope (a thin tube with a tiny camera that&amp;#039;s inserted through an incision) or lasers. &amp;quot;But surgery is less common now because IVF can be a quicker and more cost-effective way to bypass the problem area,&amp;quot; says Adamson. Success rates of different surgical procedures range from 10 percent to 80 percent, depending on the problem&amp;#039;s severity.  Intrauterine insemination (IUI): If you have cervical problems such as infection, or if your partner has a low sperm count, your doctor may suggest IUI, a straightforward outpatient procedure in which highly mobile sperm are injected directly into the uterus. Pairing IUI with fertility meds that precisely time ovulation doubles the pregnancy rate for the procedure, to 10 to 20 percent.  In vitro fertilization (IVF): In about 5 percent of infertility cases, especially those involving blocked fallopian tubes and male infertility, couples proceed to IVF. After fertility meds are injected to stimulate egg production, the eggs are removed with a thin needle and combined with sperm in a laboratory dish for fertilization. Three to five days later, the resulting embryos are placed directly into your uterus via a catheter that&amp;#039;s passed through the vagina. About 30 percent of women who try IVF will have a baby.  How to Find the Right Fertility Doctor  Choosing a specialist that you trust can make all the difference in your comfort level \u2014 and therefore, the outcome. &amp;quot;It&amp;#039;s not just money and time at stake \u2014 it&amp;#039;s your hopes, your dreams, your life,&amp;quot; says David Keefe, M.D., chair of ob/gyn at the University of South Florida. Start by checking a clinic&amp;#039;s success rates on the Society for Assisted Reproductive Technology (SART) Website (sart.org). Even if rates are high \u2014 above 45 percent for women under 35 \u2014 don&amp;#039;t stop there. &amp;quot;The clinic may not be highly skilled in the procedures you need,&amp;quot; Keefe says. Here, what to ask:    Are you board certified as a reproductive endocrinologist? A &amp;quot;yes&amp;quot; means she&amp;#039;s had four years of training in ob/gyn and three in infertility procedures, plus she has passed rigorous national exams.   Does your clinic belong to SART? Member clinics must follow strict ethical guidelines and use up-to-date procedures.   What is your success rate for women my age with my diagnosis? Clinics can push up their overall numbers by accepting women with more treatable conditions and by over-implanting embryos (which can lead to multiple births), so pin down the numbers that apply to you and ask for recent data.   What is your twin and triplet rate? If these numbers are higher than the national clinic averages of 31 percent and 3.2 percent, respectively, they may be implanting unnecessarily high numbers of embryos \u2014 increasing your odds of a risky multiple birth.   What days and hours are you open? You&amp;#039;ll be at the clinic regularly for blood work and sonograms, so convenience matters.   When I have questions, can I call you directly? &amp;quot;Your doctor&amp;#039;s accessibility and communication style can determine your outcome,&amp;quot; says Keefe. &amp;quot;You&amp;#039;ll be relying on her to help make complex decisions for which there are no simple answers. Follow your gut when selecting a doctor.&amp;quot; If you&amp;#039;re still uncertain, check out what the doctor&amp;#039;s previous patients say about her on the online bulletin boards of RESOLVE, an infertility consumer group (resolve.org).   What will it cost? Prices can vary by up to 20 percent between clinics. Make sure yours offers a payment plan that fits your budget.  Read the first installment of The Fertility Diaries. "^^<http://www.w3.org/2001/XMLSchema#string>
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