August 31, 2024 • 36 mins
Mandy Nielsen, an expert in infertility, shares her experience and insights on infertility and IVF. She emphasizes the importance of seeking help from a specialist early on and highlights the role of reproductive endocrinologists in diagnosing and treating infertility. Mandy discusses the various factors that can contribute to infertility, including male factor infertility, egg health, and uterine issues. She also talks about the different procedures and treatments available, such as ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF). Mandy addresses the emotional impact of infertility and the need for mental health support. She provides advice on how to support friends going through infertility and emphasizes the importance of being open and compassionate. Mandy also discusses the financial aspect of infertility treatments and shares resources for financial assistance. She touches on the topic of pregnancy after infertility and the unique challenges and anxieties that come with it. Finally, Mandy shares her experience as an older mother and the joys and benefits of being an older mom.
CHAPTERS
00:00 Introduction to Mandy Nielsen and Infertility 03:17 Causes and Treatment of Infertility 06:58 Understanding Secondary Fertility 08:51 The Emotional Impact of Infertility 13:07 Supporting Friends Through Infertility 23:18 Financial Assistance for Infertility Treatments 28:53 Pregnancy After Infertility 31:17 The Joys and Challenges of Being an Older Mother
RESOURCES Female Fertility - Toni Weschler Book Quote - "The strongest women become the strongest mothers before their children are even conceived." PCOS SOS Fertility Fast Track - Felise Gersh Book Quote - "Healthy babies start with healthy mothers. Instead of rushing into fertility treatments, Dr. Gersh shows how you can use diet and lifestyle to get truly, deeply, wonderfully healthy and how this naturally restores female fertility."
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Transcript
Episode Transcript
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(00:05):
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The Best Birth [00:02]
You're listening tothe Best Birth Podcast.
We are here today on the show withMandy Nielsen, an expert in infertility.
Mandy Nielsen is a mom of three wonderfulchildren who all came to her in unique
ways, including battles with infertility.
She loves spending time with her husbandand kids, girls nights out, reading
(00:50):
and spending time in the mountains.
If she can't get to the beach whenshe isn't being a mom, she works in
marketing and social media management.
She loves having a career thatsupports her creativity and
passions for helping others.
Mandy worked with the Utah InfertilityResource Center and Utah Fertility
Center during her years of infertilityto help support her community.
Now she works with mentalhealth clinics, specializing in
(01:11):
postpartum mental health support.
Thank you, Mandy.
It's so good to have you here.
I'm excited to be here.
Well, what do you wish you hadknown before IVF and infertility?
What would you go back and say?
I think the first thing I wish Iwould have known is how common it is.
Actually one in eight individualswill struggle with infertility during
their years of trying to conceive.
And I wish I'd known that I wasn't kindof an anomaly, especially in Utah and
(01:35):
the area where people seem to pop outbabies just like one after the other.
You hear all the time, theremust be something in the water.
When are you gonna giveyour kid a sibling?
All those kind of commentsare really commonplace.
And I wish I had known that infertilityis very common and it's very isolating.
I also wish I had knownto get help sooner.
The standard recommendation is ifyou are over 35 that you should be
(01:57):
seeing a professional doctor whospecializes in infertility within
six months if you haven't conceived.
And if it's been a year and you're under35, then that's when you should seek help.
I wish I just sought help sooner.
Found resources, found support, and gottento see someone who was a specialist in
infertility instead of just going to myOBGYN, which is what most individuals do.
And sometimes that's helpful,but it's like, imagine if you
(02:20):
need your shoulder replaced.
And you just went to your general carepractitioner and you're like, my gosh,
I think my shoulder really hurts.
I'm like, yeah, that sucks.
Here's some ibuprofen and a sling.
And maybe we could just put someice on it and see how it does.
That's kind of what going to anOBGYN with infertility is like.
well, we can do a couple of things,but this is an area of expertise.
(02:44):
Someone who is a reproductiveendocrinologist has had an additional
almost six years of training.
in the field of infertility, that'shormones, that's male infertility,
female infertility, unknown infertility,like all these different factors.
And so I wish I'd known to see someonewho was a specialist much sooner.
Do you feel like those specialists canthen help you specifically find out
(03:05):
why your infertility is taking place?
Yes.
I mean, they're the ones thatrun all the specialized testing.
They're the ones that have allof the kind of the tests set up
to kind of determine why there isinfertility within your partnership.
And then they also have more refinedmethods of treating the infertility.
So I kind of describe it likewhen you go to an OB -GYN,
they'll usually prescribe Clomid.
(03:26):
And that's almost always to the woman.
But it takes multiplepeople to create a baby.
You need a healthy uterus, ahealthy egg, and a healthy sperm.
So those are three factorsthat you need to consider.
And if you're just doing Clomid, allyou're doing is increasing ovulation.
You're just making more eggs.
And so if those other two factorsaren't even addressed, you could
be wasting months of precious time.
just kind of, and a lot of emotionalheartache doing something that is, it's
(03:50):
just kind of like a shotgun approach.
Like, well, maybe this will fix it.
Sometimes it does, but a moretargeted approach with a reproductive
endocrinologist allows you toreally hone in on what the issue
is and then work with whatever thatissue is to help you have a family.
So if those three things areneeded for pregnancy, you know,
the uterus, the egg and the sperm.
(04:10):
What are the main causesof our infertility?
gosh, there are so manydifferent kinds of factors.
You have male factor infertility andthat's an issue with the sperm, right?
So that could be the sperm leaving thesperm, finding the egg, it's motility.
there's any genetic factorsthat can be a really big issue.
functional factors.
Sometimes men aren't ableto ejaculate properly.
(04:33):
There's retrograde ejaculationwhere the sperm goes back in instead
of coming out the way it should.
Lots of different factors there.
With the egg, so there's egg health,how the egg is doing if you have
endometriosis, sometimes that canattach to your ovaries and impact
the health and quality of your eggs.
So that means they're lesslikely to form a healthy embryo.
There can be the egg leaving theovary and traveling down the fallopian
(04:57):
tubes, sometimes the tubes are blockedthrough scarring or endometriosis.
There can be an issue withcreating healthy eggs with PCOS,
polycystic ovarian syndrome, whereyour ovaries are producing cysts.
and that impacts the quality of the eggsand your ability to ovulate regularly.
With uterus, there can be adhesions,there can be septums, there
can be a host of other factors.
I'm not a doctor, I can just tell youwhat I learned in helping different
(05:20):
couples and in my own experience.
And so those are all kindof the different factors.
And then you have avariety of couples, right?
Some people have a healthy egg and ahealthy sperm, but no uterus, or you
have same gender couples where they needextra support to create their family.
or you have single individuals thatneed more help to create their family.
And so a reproductive endocrinologisthas resources to do all of that.
(05:40):
Things like sperm donation, egg donation.
The term commonly used is surrogacy, butthat's not really an accurate description.
It's a gestational carrierbecause the person is only hosting
the baby through their uterus.
They don't contribute the egg as well.
So those are all kind of thedifferent factors that a reproductive
endocrinologist can look into.
In your experience,
(06:02):
You experienced secondary infertility.
That was a term that Iwasn't familiar with.
So secondary fertility is when you have arelatively easy first or second or third.
Secondary fertility is kind of amisleading name because it can be
any time after you've already had apregnancy trying to have another child.
So I had had one pregnancy and Iused Clomid to have that pregnancy.
(06:23):
So some infertility there,but pretty low grade.
And then I wasn't able to getpregnant again, even after Clomid.
multiple rounds of intrauterineinsemination where they, you know, place
the sperm directly like closer to the eggand they stimulate your ovaries and they
monitor you and do all these injections.
And so I did that for about threeyears, three years after when I
(06:46):
was trying to have my next child.
So my oldest and my second oldest,there was a nine year gap there.
So it was a bit of a, bit of anadventure and a bit of a wait.
But yeah, so secondary fertility isjust when you have kind of that gap.
And it can be, you know, after you'vehad, you use it less frequently
if you've done reproductive,assisted reproductive technology.
(07:09):
So you've done IVF, IUI, anyof those kinds of things.
If you've done that kind oftechniques, you don't really just
say secondary fertility againbecause you're just struggling
with infertility in general, right?
Like it doesn't start new.
But many couples find that theyhave one successful pregnancy or
two successful pregnancies and thenthey're unable to conceive again.
And that is secondary fertility.
It sounds like your journey ofinfertility, a long journey, a lot of
(07:32):
different options that you were utilizing.
How did it affect youmentally and emotionally?
It was really, really hard.
it's very difficult to feel likeyou're doing the right thing or that
you want something that's a good,healthy, normal thing and something
that comes easily to other people.
It was really hard to watch multiplesister -in -laws get pregnant.
(07:53):
it was difficult.
to see my husbandstruggle with it as well.
And it's just hard to want somethingso much and have so little control
or being able to achieve it.
And that it's very much a rollercoaster because you get your
hopes up every month, right?
Like, okay, we're gonna trysomething new this month.
This is gonna be the month.
This time it's gonna work.
I'm doing all the things.
And then to have it be unsuccessful isvery emotional and it's very difficult.
(08:17):
It's also very isolating becausethere's not a lot of people
you can talk to about it.
I was lucky because I had found theUtah Infertility Resource Center.
I ended up with a lot of friends that hadeither gone through fertility or going
through it, that had experienced losses.
And so I had a really strong supportgroup of women around me to kind
of help me navigate that time.
And I just had to keep believing thatsomething good would come, that eventually
(08:41):
I'd be able to have another child,whether that was through IVF, through
adoption, that there was another path.
There was always goingto be a path forward.
It just would take me timeto find what that path was.
And so if you're not lucky enoughto have the support group as part of
your system, are there different waysthat you can find those families?
You can get the support that you need.
(09:02):
There is a national support group calledresolve and resolve has chapters all
over the country and internationally.
And so you can find an effort tosupport group almost anywhere.
And online there's lots ofsupport for women out there.
And I think something thatI have found is being open.
about my journey was really helpful to me.
People were quick to reach out,quick to be understanding, and
(09:23):
then because I was open with it,I was able to support others.
After I had hope, a couple years laterone of my friends was going through
infertility and she called me inthe middle of the night one night.
It was probably, not the middle, itwas was 10 pm She's like, my gosh.
She goes, I know it's really late.
She goes, but my husband isn't backyet and I have to do my trigger shot
at 10 pm Will you give it to me?
I was like, of course.
(09:44):
And she's like, I knew I could call youbecause you've talked so much about it.
And so I think that it'sdifficult to be open and transfer.
It was something that's so intimateand personal and heartbreaking and
hard, but when you are, it allowsa community to be built around you.
Is this what sparked yourpassion for mental health or
did that come before or after?
(10:06):
it kind of all happened at thesame time because there's a lot of
overlap between, postpartum mentalhealth and infertility mental health.
going through infertility increasesyour risk of a perinatal mood disorder.
And so I worked very closely witha lot of clinics that addressed
mental health and that had mentalhealth based support groups.
Utah Infertility Resource Center,that's one of the things that they do.
(10:28):
It was founded by a therapistwho had done infertility, who had
experienced infertility herself.
And that was one of the big causes thatwe raised money for is free to sliding
scale fee mental health care for peoplethat were struggling with infertility.
Because you just need,
a lot of support and there's also a lotof losses associated with infertility.
The loss of the way you thought yourfamily would look, the loss of how
(10:50):
close your children would be together,how many children you would have.
A lot of times you have tocope with the loss of having a
genetically related to you child.
And so understanding thoselosses and having the appropriate
space to grieve them, I thinkis really important and helpful.
The attitude of, well, at leastyou have one child or at least
this or at least that is very...
(11:12):
unhelpful to say it charitably tosomeone that has tried with infertility.
And so being able to see a qualifiedmental health professional that
especially has experience inreproductive loss in infertility,
I think it'd be really worthwhile.
And they have the tools, theyhave the training, you know,
to help you along your journey.
For those of us who are not experiencingit and want to support our friends,
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what do you recommend that we say or do?
I think the most important thing is to
Be open about it.
If they've shared with you that they'restruggling with infertility or you suspect
that they're struggling with infertility,I think there's two different paths.
So if you suspect and they haven'tshared with you, maybe you can just
say something like, just, you know, ifthere's ever something you're struggling
with, I'm always here to listen.
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I want to support you wherever you are.
I've noticed that you've beena little extra down lately.
Is there something youwant to share with me?
I'm a safe place to share.
If they've shared with you the experienceinfertility, ask them how it's going.
Be like, Hey,
How's it going?
Are you doing any treatments this month?
What day is your treatment?
Can I bring you dinner that night?
Can I bring you a treat?
(12:16):
It's hard to see all of your friendsget new baby meals and there you are
after having your fourth or fifthprocedure or surgery or loss and
just kind of feeling very isolated.
And so I had a lot of friends dothings like they would keep track of
when I was going in for an appointmentor when I had a blood test and they
would be like, hey, we're just, ifyou don't want to share, that's okay.
But no, I'm thinking about you.
(12:37):
I'm sending you positive vibes.
How's it going?
Like, hey, I know you haven'tshared publicly where you are
on your journey yet, but I'msending you some cookies today.
Like, just let you know that I'm here,I'm with you, like you're not alone.
And be sensitive to how theyrespond to your own announcements.
It has nothing to do with their lovefor you, their love for your children.
It is just very painful.
(12:59):
And so the losses you experiencewith fertility are as impactful.
as any other loss that youwould experience in life.
And so if they can't come to your babyshower, let them know that that's okay.
That it doesn't impact your friendship.
If they feel like they can't holdyour new baby right now, it doesn't
mean they don't love your new baby.
It doesn't mean they don't love you.
And that's a really hard space tobe in because you're also dealing
(13:20):
with your own hormones and yourown emotions and your own feelings.
You want everyone to be happy andit's hard to have someone else be
really sad when you're really happy.
But I think just seeing that andfinally like, hey, you know what,
however you want to participate,I totally understand and respect.
That's, I think the biggest thing isoffering support and then have compassion,
understanding when they maybe can'tshow up for you and your happy moments.
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They're just not in aplace where they can.
They would love to.
I mean, I, I would loveto, but it was really hard.
Hmm.
I have a friend who went throughcancer a few years ago and this
was before she was married.
And so before radiation, she had hereggs frozen and now they are working
on trying to implant those eggs andthey've had a few rounds and, and are
(14:02):
still working on it.
So that's great advice for me personallyto know how to help and talk to her.
What are some other things thatthey do with fertility, like
freezing eggs or those processes?
So that's called fertility preservation.
So that's when you freeze either eggs orsperm so they can be used at a later time.
This is just my personal experience.
So some of the fertilityprocedures, the first one is
(14:24):
going to be ovulation induction.
That's like,
Clomid or Fomara where they encouragea woman's body to create more eggs.
So that you have a higherlikelihood of implantation.
Because you release one egg amonth, with Clomid or Fomara
you might release three or four.
So that just increases your odds.
The next step onto that is intrauterineinsemination or IUY and that is where
(14:45):
they take the sperm and they kind of spinthem around so that the highest quality
ones are separated out and then they...
induce ovulation so theydo the same procedure.
Clomid for MARS, sometimes they useinjectable hormones to help create eggs.
And at this point, this iswhere it's really important to
differentiate between an OB -GYNand reproductive endocrinologist.
Because if ovulation inductionis not monitored, you can run the
(15:08):
risk of high order multiples, likequadruplets, quintuplets, things
that really negatively impact thelikelihood of success of a healthy baby.
The goal of any infertility treatmentis healthy mom, healthy baby.
One healthy baby.
If you have to, I mean that's exciting,but the odds of all those things being
healthy start to go down when youstart to induce higher order multiples.
(15:31):
And so in a reproductive endocrinologistsetting, they monitor how many eggs are
growing and how fast they're growingso that they can make sure that they're
not putting sperm up next to seven eggs.
You don't want that tohappen, that's very dangerous.
And it's unlikely that wouldresult in a healthy pregnancy.
So that's the next step.
So usually it's like three or foureggs and then they do the insemination.
(15:55):
So they go to the office, theyuse a thin catheter to put the
sperm closer to where the eggswill be released and they time it.
So you do it, it's called a trigger shotand it induces ovulation within 24 hours.
So you do it at a very specific timeand then 12 hours later you go into
the office and you have the procedure.
Okay, so that's intruderinsemination or IUI.
(16:17):
So if you've heard your friendsdoing that, that's kind of
what that procedure looks like.
The next level up from that youstart to get into the more advanced
reproductive technology or art.
So that's why you want touse a SART certified clinic.
That's Society for SisterReproductive Technology.
It basically means that they'vepassed all these tests and they're
monitored to make sure that they'redoing things in an ethical way.
(16:39):
There are people, there are surgeondoctors that are not SART certified
and they tend to do things that arenot in line with ethical values.
That's where you end up seeing peoplethat are having seven kids at a time or.
high order pregnancy, they're notusually following the guidelines for
assisted reproductive technology.
That's why you want a certified clinic.
IVF, in vitro fertilization.
(16:59):
So at that time they take the spermand the egg, and there's two different
ways to do the fertilization.
One is where you take one sperm andone egg and you put them together.
The other one is where you take anegg and then a bunch of sperm and
you see kind of how that one goes.
in glass in a petri dish, that's why it's
called invitro.
(17:20):
So that's how that starts andthey could do that with as
many eggs as they've harvested.
So that is ovulation induction,but at that point they do
it at a much higher level.
So you're doing injections.
When I did it, I think I had threeor 400 injections for one round.
And they try and induce your body tomake as many eggs as it healthily can.
So you want a high quantityand a high quality.
(17:41):
So it's that constant balance.
Like you don't want 200 eggs and thenyour egg reserve is wiped out, right?
I think I have like 12 or 15.
So then they induce kind of thatovulation, and then they don't
necessarily trigger it in the same way.
They trigger it so the eggs start to form,but then you go in much earlier and the
eggs actually retrieve, so they use avery thin needle and they retrieve each
(18:05):
individual egg from the ovary, so you'reunconscious mercifully for that procedure.
You're conscious for the restof them, but that one you're
mercifully unconscious for.
and they retrieve all of the eggs.
And at that point then theytry and fertilize the eggs
and they watch them grow.
They see which eggs fertilizeand how those blastocysts grow.
(18:26):
And then usually they watch them forfive days and at five days they freeze
them, depending on how they're growing.
And they either freeze them fora future transfer or as we do
it's called a fresh transfer.
And that's where you go back infive days later and they transfer
the egg into the woman's body orthe gestational carrier's body.
Is there a greater chanceof success if it's fresh?
There is mixed research on that.
(18:46):
It just depends kind of on the personand their situation and the quality
of their eggs and their blastocysts.
Like sometimes if you have a low qualityone, you might opt for a fresh transverse.
They won't survive thefreeze in the thought.
But then on the other hand,frozen, you could do things like
what I chose to do was a frozencycle so I could genetically test.
(19:07):
So I would have a higher likelihoodof each route of not implanting
a blastocyst that wasgenetically malformed in a way
that wouldn't create a baby.
It's not saying like, I want like agirl or a boy or blue hair, brown hair.
I think people confusewith genetic testing.
This is like, is this likelyto form a healthy pregnancy?
And so that's kind of what you test for.
(19:27):
And so that's one of the optionsfor frozen cycle and also it
gives your body time to recover.
So if you're doing a fresh cycle, you dothe egg retrieval, which is a surgery,
five days later and at the same time ofgrowing your eggs, you're also trying to
thicken the lining of your uterus, right?
So then five days later, you're back inthere and trying to sustain a pregnancy.
And so it's a lot foryour body to go through.
(19:48):
So a frozen cycle, you do the retrievaland then you usually wait a cycle or
two depending on your body and dependingon your doctor's recommendations.
And if you're choosing to do genetictesting, all of these things take time.
Then you would go back in.
So the next focus is creating ahealthy uterus, creating a healthy
lining that's thick, that willbe optimal for implantation.
(20:09):
and then they place the little blastocyst,they thaw it out and they place it
in the uterus and it's really cool.
When they do a transfer, it's likea little like flash of light when
they put the little blastocyst in.
It's a really cool experience.
I've done two of them.
So yeah.
I've heard from others that theyfeel like it's a very spiritual
experience to witness that.
(20:30):
I thought it was a veryspiritual experience too.
I don't.
think that it's, and so you're probablylike, it's the beginning of life here,
the beginning of life there, becauseit starts to get real murky and tricky
when you're in the waters of IVF.
But it is a very spiritual experienceto find kind of, to get to that point
in your journey because of everything,like everything that's led up for it.
Because it's also very, it's kindof like, this is your chance.
(20:53):
You've spent probably easily like25 to $35 ,000 at this point.
It's been years and years of workand a lot of procedures and a lot of
heartache.
So it's very much kind of likethis, like very intense moment.
It can be very spiritual.
It can be very exciting.
It can be very scary.
It can be very, it's just, it'sjust kind of a lot of things.
(21:13):
Also you're taking a lot of Valium.
So it's also a lot of things thatyou're feeling at that time too.
Can we talk about theexpense a little bit?
Yeah.
So expensive for, for peopleto, undergo these procedures.
What have you seen forindividuals who aren't able to,
afford this themselves.
(21:34):
I think there are a lotof really good resources.
So what I worked with the infertilityresource center, something we really
focused on is helping people find loans.
We will find, there's a lot of scholarshipoptions, a lot of nonprofits that are
around now that offer partial treatments.
There are studies that clinics do.
There's a lot of ways thatyou could reduce the cost.
(21:54):
you can take on extra work if you can.
Like it's just, it's, thecost is not insignificant.
I mean, my daughter all told probablyin the neighborhood of $40 ,000 before
she, we spent before she was born.
And many people spend that much and don'thave a healthy live baby afterwards.
You can, it takes, we were verylucky that our first transfer
(22:17):
with her was successful.
Our next transfer was unsuccessful,but with her, with that first
transfer was successful.
And that's before allof the birth expenses.
That's just the very beginning.
That's just to get pregnant.
That's not staying pregnant.
That's not giving birth.
That's not.
postpartum care, new baby expenses,that's just to get pregnant.
And so it's very expensive.
(22:38):
I've worked with resolveand the interpreters to
campaign for better coverage.
So the state of Utah,actually, I testified with
fellow infertility warriors.
We went before Congress and wetestified about our experience dealing
with infertility and the expense.
And they passed a bill that forstate employees, they covered, up to
$5 ,000 of treatment, which isn't.
(23:00):
Everything.
But I mean, it, it's a big difference.
You could also ask your employer ifthey have a specific policy or I don't
know if it's a grant or a loan or agift, but some employers, a lot of
health insurance programs have that.
And you can ask your employer like,Hey, I'm sorry, this can, we opt into
this for our health insurance program,or is there anything we can do?
Some people do matching.
I have found that if youdon't ask, you don't know.
(23:23):
And that's part of theopportunity of being open with it.
Something that happened to me.
is when I had a secondcycle, we lost the baby.
We lost a little boy baby at 10 weeks.
It was a little before 10 weeks.
And that was our last embryo, so wewould have had to start all over again.
And at that point, we were definitely notin a place where we could do it again.
(23:45):
And so I was kind ofsharing on social media.
I was like, this is the end of our road.
Thank you to everyone who supported us.
We really appreciate you.
Everyone has been cheering us on andpraying for us and sending us good wishes.
We're closing this chapter because of...
and time and all of that.
And I had a private donor reachout to me and offer to help
support me in another round.
(24:06):
I wanted to do another round of treatment.
I ended up having a spontaneouspregnancy six months later
when I was about to start.
So yeah, I had a private donor.
So I think when you're open aboutyour journey and your heartache,
it provides opportunities.
People want to help.
I think that's what I learned most.
People are anxious to help.
Your doctor's offices probablyhave some kind of program or they
know someone or they'll have...
(24:28):
a list of grants to apply for.
If you have a nonprofit support group inyour area, they'll have grants to apply
for or different loans you can take out ordifferent things or they'll know people.
And I think as you start to open upabout those experiences, then you'll
find more options, more pathwaysopen up for you in my experience.
(24:49):
And what a beautiful wayfor those people to share.
Yeah, it's definitely somethingthat's been impactful and meaningful
to me and that I always hopeto to pay for it as I'm able.
You spoke about losinga baby boy at week 10.
We talk about week 12 as kind of the weekof viability and moving beyond what can
we do or say, or how, do we handle themiscarriages that are around in that time?
(25:16):
So I think something that's difficultis most people choose to not announce
pregnancies until they're further along.
With IVF, you know you're pregnantand you're watching your baby
grow starting very, very early.
So you're starting week five.
You're starting to like look andsee, okay, is everything's happening?
And then at week seven,things looked okay -ish.
(25:36):
And then, I mean it was week eight.
It's all kind of a blur now.
Week eight and then the next week wewent in and they're like, I'm sorry,
there's no heartbeat, but you know,maybe just maybe next week it'll be okay.
And then next week there was not.
And we ended up havingto do a DNC at that time.
I think something that's important is whensomeone chooses to share a loss to offer
(25:57):
them grace at that time, just because youchoose to keep something private doesn't
mean that's the right path for everybody.
And I can't imagineexperiencing that loss alone.
Like that was the time where I felta lot of support from my community,
where a lot of friends reached out.
I had a good friend who had had a coupleof miscarriages over the course of her.
years of childbearing, she had olderkids now and she, her husband actually
(26:20):
reached out to my husband, he's like,look, I know everyone's there for your
wife, but if you ever need a friend,man, like, you're hurting too, like
you're a dad and it's hard and it hurts.
And so, and having friends drop offdinner or ask me like, what does
your plan look like so we can supportyou, offer to help with the other
children if there's other kids.
All those things were reallymeaningful and impactful to me.
And I think being honest that a lossis a loss, a loss that happens at
(26:44):
10, 12, 13, 14 weeks, likethose are real losses.
You have already developed attachments andplans and love for this baby and allowing
people to grieve how they want to grieve.
The term rainbow baby, isthat appropriate to use?
Or I think it is usually if you useit or rainbow baby, it's something
(27:04):
it's a miracle after a storm, right?
Or a loss.
And so I have a rainbow baby.
I have a little boy.
Like I said, we had a loss and then sixmonths later after, I don't even know
how many years of never having a, I'venever had a spontaneous pregnancy before.
And so we had a spontaneous pregnancy.
It was a little boy.
And so he was definitely a rainbow baby.
And it was definitely a brilliant.
(27:25):
bright spot of hope after a very darktime, but it was also very difficult.
I was surprised how much anxietyI had during my pregnancy.
I had very, very high prenatalanxiety, like being pregnant.
Like every day I wasjust like, am I bleeding?
Is everything okay?
Can I feel a move?
I swear I went to my doctorso many times, I was like, can
we have another ultrasound?
I'm just really nervous.
(27:45):
You just have such a heightenedfeeling of anxiety after a loss.
I think that's something to watch for.
because a perinatal mood disorder can cropup during pregnancy, not just postpartum.
And if you've experienced loss orinfertility, then you're more likely to
experience those perinatal mood disorders,like postpartum anxiety, postpartum
depression, postpartum psychosis.
(28:06):
And so if you're starting to feelthose feelings in pregnancy, that's
definitely something to address duringthe pregnancy and not wait until after.
So I was surprised.
And the contrast between how happy you areand how happy everyone is for you, like
all of my friends and family were like,
my gosh!
And we were too, I was thrilled.
But it was very hard to just be fullyjoyful because in the back of your
(28:28):
mind there's always that stupid anxiety
voice.
I refused to name mybaby until he was born.
I couldn't, I was too afraid.
I told my husband, my husbandwanted me to read all these names.
I'm like, I can't, I can't do it.
I can't.
And being honest about that andhaving mental health support during
that time was really important to me.
So I think if you're experiencing thejoys of a rainbow baby, it's okay to also
(28:52):
allow yourself to have the both and tohave the anxiety and the sadness for your
lost time, all those kinds of convergingat once and to get help and support.
especially before you havethe baby, because it doesn't
just miraculously go away.
So that'd be my advicewith a rainbow baby.
When you think about, an actualrainbow and oftentimes the rainbow
can show up while it's still raining.
Yeah.
And so balancing both emotions,recognizing that someone experiencing
(29:16):
this is going to have the rangeof emotions and to support them in
everything they're going through.
So important.
Can I ask you a littlebit about the pregnancy?
So when you were pregnant,after your IVF treatment,
Were you automatically shuffled to amaternal fetal medicine specialist or
what does that pregnancy look like?
How does it differ?
It's terrifying because like whenyou're doing IVF, the first 10
(29:37):
weeks of your pregnancy, it's likeyou're in there every single week.
They're drawing your blood.
They're doing ultrasounds.
You're just right.
You have a doctor monitoringevery sip of the wind.
They're like, okay, good luck guys.
And you just go straight to yourOBGYN unless you have a previous
condition that makes you high risk.
So after your endocrinologist kind of like
affirms the pregnancy and clears you.
Yeah, that's usuallyaround like 10 or 12 weeks.
(29:59):
They'll move you on to your regularOBGYN and then you're totally fine.
You sometimes with an IVF pregnancy,they'll do extra monitoring
towards the end of pregnancy.
You might have some non -stress testsin the last several weeks because
there's some associations with frozenembryo transfers and incidences of
cord mishaps or stillbirth or those kindsof things, but they're very, very rare.
(30:20):
So it just depends on your OBGYN.
Most IVF pregnancies, once you'repast that 10 or 12 week mark,
continue just like a normal pregnancy.
I've heard from some individuals,they'll say, well, I have to get induced
because this was an IVF pregnancy or,you know, like I have to deliver early.
And so I guess just each OBGYNis going to navigate those cases.
Yeah.
A lot of that is just goingto depend on the individual.
And like I said, because the reasonsbehind infertility are so broad.
(30:45):
there might be a need fordifferent medical interventions.
But many women that I have spoken with,
go on to have completelynormal pregnancies.
They choose a variety ofchildbirth methods and all of
them valid, all of them wonderful.
It just really depends on the individualand what their doctor recommends
because there's no set, you'vedone IVF, then you have to do this.
(31:07):
There's no set protocol after that.
Your pregnancy is just a normal pregnancy.
You're just throwing up andtired, just like the rest of them.
Waddling around, justlike the rest of them.
What has been your experience
being an older mom Cause I knowsome friends weren't able to have
children until later in life.
And so then it's kind ofa different age dynamic.
(31:28):
It's totally different age dynamic.
I mean, I had my first baby inmy mid twenties and then my last
baby was an advanced maternalage because I was almost 40.
I was 38 when he was born.
Yeah, I was 38 when hewas born, almost 39.
And I think the difference is I was a lotmore settled on who I was as a mother.
The harder part is Ihave a lot less energy.
(31:51):
I mean, my oldest is12, 13, 13 years older.
than my son.
And so the difference in kindof the world and me as a person
and our life is very different.
So in that way being an oldermother is harder and you're not in
the same place as a lot of peers.
A lot of my friends that have children,I'll go to kindergarten, you know,
(32:12):
with my daughter and they're like,like I'm having my third baby.
And I'm like, yeah, me too.
And you're in a different spotthan your peers, but I found it's
been wonderful for me personally.
As a new mom in my 20s, I felt veryinsecure with who I was as a mother.
I'm kind of insecure with who I was asa person, and it was really difficult.
(32:34):
But as an older mother, I havefelt more secure in who I am, and
having my oldest son is a bit ofa challenge, to say the least.
And so having a kid that is a littleneurodivergent and has a lot of
things going on, I've been ableto let a lot of other things go.
Like today, my daughter'swearing some kind of hideous long
-sleeved dress with flowers on it.
(32:55):
and polka dot striped pants and her hairlooks like a bird flew in it because she
did it herself and I was like, you lookgreat dear, have a great time at daycare.
The things that I would have been soanxious about as a brand new mom, I'm
just gonna be like, that'll be fine.
And with my last baby, Ethan, when hewas born, I really just didn't want it.
(33:17):
to go by fast because Iknew how fast it goes.
Right at that point my son was turning 13.
I was like, wow, I blinked, I blinked.
And so I just really leaned intothat fourth trimester of just.
Laying in bed a little bit longer,holding him a little bit more, wearing
him a little bit more often, notworrying so much about getting my body
(33:38):
back, whatever that's supposed to mean.
Your body doesn't go anywhere,so you don't need to get it back.
And just enjoying the experience forwhat it was and not wishing it away,
not being like, my gosh, I can't waitto walk, I can't wait to do this.
Just gonna be like, I loved.
where I was and where my babies were.
The nice thing about being a geriatricmom is it keeps you young longer.
(33:58):
Allegedly.
That's what they say.
My gray hair is beg to differ.
You get to retire beforeyour kids graduate.
That's true.
I didn't think about that.
I'll probably never retire, but it is,it is nice being a, being an older mom.
And it, I've been surprised how manyof my friends have had outside of Utah.
It's very normal to have babies inyour late thirties and early forties.
(34:21):
And in Utah, that'svery, that's less common.
And so I've been, it's been interesting tokind of find friends that are in similar
phases of life and be able to talk aboutthe different ups and downs of that.
And then I have friends acrossa wide spectrum of ages and
experiences, which is wonderful to me.
Well, we love to share resources onthe podcast and I am a huge book nerd.
(34:44):
I just love reading.
I love listening.
And so I had a couple of quotes from.
from some books, the firstwas from female fertility.
This is by Tony Weschler.
And she said the strongest womenbecome the strongest mothers before
their children are even conceived.
We want to thank you for being thatstrong mother and sharing all of these
tender and precious moments with us.
It's been so delightful.
(35:05):
Do you have any resources that you'dlike to share with our listeners today?
yeah, definitely the resolve.
is a wonderful national resource.
If you're in Utah, the Utah InfertilityResource Center, and just really finding
those resources within your own community.
So good.
Thank you.
Cheryl has our mom squad secret.
She says, having to pee all the timein pregnancy is not just at the end
(35:29):
of pregnancy when your baby is doinga P90X workout on your bladder.
It's your hormones.
So be prepared to pee night and day,even at the start of your pregnancy.
Such a great reminder.
I feel like you can seewhen you need to go pee.
That's, that's definitely true.
Or if you're doing a hormone treatmentsand then that can impact it as well.
Get prepared ladies.
Mandy, thank you so much forbeing on the podcast today.
(35:50):
Thank you so much for having me.
It's been a joy.
Thanks for joining us on today's episode.
We hope you've been elevated andinspired by this week's expert.
Subscribe today so you never missan episode and please share our
podcast or post on your socialmedia so that other moms and dads
to be can also have the best birth.
Please note that the informationprovided is based on the expert's
(36:13):
insights and personal experience.
It is not intended as medical guidance.
Please seek the advice of yourmedical provider as it applies
to your specific condition.
It's the Best Birth Podcast, wherewe interview experts that elevate
you as you prepare your heartand mind to have the best birth.
Each episode will interviewprofessionals so you are prepared
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This audio is takenfrom videos on YouTube.
(00:27):
Watch the entire episodes onYouTube at Birth Made Mindful.
The Best Birth [00:02]
You're listening tothe Best Birth Podcast.
We are here today on the show withMandy Nielsen, an expert in infertility.
Mandy Nielsen is a mom of three wonderfulchildren who all came to her in unique
ways, including battles with infertility.
She loves spending time with her husbandand kids, girls nights out, reading
(00:50):
and spending time in the mountains.
If she can't get to the beach whenshe isn't being a mom, she works in
marketing and social media management.
She loves having a career thatsupports her creativity and
passions for helping others.
Mandy worked with the Utah InfertilityResource Center and Utah Fertility
Center during her years of infertilityto help support her community.
Now she works with mentalhealth clinics, specializing in
(01:11):
postpartum mental health support.
Thank you, Mandy.
It's so good to have you here.
I'm excited to be here.
Well, what do you wish you hadknown before IVF and infertility?
What would you go back and say?
I think the first thing I wish Iwould have known is how common it is.
Actually one in eight individualswill struggle with infertility during
their years of trying to conceive.
And I wish I'd known that I wasn't kindof an anomaly, especially in Utah and
(01:35):
the area where people seem to pop outbabies just like one after the other.
You hear all the time, theremust be something in the water.
When are you gonna giveyour kid a sibling?
All those kind of commentsare really commonplace.
And I wish I had known that infertilityis very common and it's very isolating.
I also wish I had knownto get help sooner.
The standard recommendation is ifyou are over 35 that you should be
(01:57):
seeing a professional doctor whospecializes in infertility within
six months if you haven't conceived.
And if it's been a year and you're under35, then that's when you should seek help.
I wish I just sought help sooner.
Found resources, found support, and gottento see someone who was a specialist in
infertility instead of just going to myOBGYN, which is what most individuals do.
And sometimes that's helpful,but it's like, imagine if you
(02:20):
need your shoulder replaced.
And you just went to your general carepractitioner and you're like, my gosh,
I think my shoulder really hurts.
I'm like, yeah, that sucks.
Here's some ibuprofen and a sling.
And maybe we could just put someice on it and see how it does.
That's kind of what going to anOBGYN with infertility is like.
well, we can do a couple of things,but this is an area of expertise.
(02:44):
Someone who is a reproductiveendocrinologist has had an additional
almost six years of training.
in the field of infertility, that'shormones, that's male infertility,
female infertility, unknown infertility,like all these different factors.
And so I wish I'd known to see someonewho was a specialist much sooner.
Do you feel like those specialists canthen help you specifically find out
(03:05):
why your infertility is taking place?
Yes.
I mean, they're the ones thatrun all the specialized testing.
They're the ones that have allof the kind of the tests set up
to kind of determine why there isinfertility within your partnership.
And then they also have more refinedmethods of treating the infertility.
So I kind of describe it likewhen you go to an OB -GYN,
they'll usually prescribe Clomid.
(03:26):
And that's almost always to the woman.
But it takes multiplepeople to create a baby.
You need a healthy uterus, ahealthy egg, and a healthy sperm.
So those are three factorsthat you need to consider.
And if you're just doing Clomid, allyou're doing is increasing ovulation.
You're just making more eggs.
And so if those other two factorsaren't even addressed, you could
be wasting months of precious time.
just kind of, and a lot of emotionalheartache doing something that is, it's
(03:50):
just kind of like a shotgun approach.
Like, well, maybe this will fix it.
Sometimes it does, but a moretargeted approach with a reproductive
endocrinologist allows you toreally hone in on what the issue
is and then work with whatever thatissue is to help you have a family.
So if those three things areneeded for pregnancy, you know,
the uterus, the egg and the sperm.
(04:10):
What are the main causesof our infertility?
gosh, there are so manydifferent kinds of factors.
You have male factor infertility andthat's an issue with the sperm, right?
So that could be the sperm leaving thesperm, finding the egg, it's motility.
there's any genetic factorsthat can be a really big issue.
functional factors.
Sometimes men aren't ableto ejaculate properly.
(04:33):
There's retrograde ejaculationwhere the sperm goes back in instead
of coming out the way it should.
Lots of different factors there.
With the egg, so there's egg health,how the egg is doing if you have
endometriosis, sometimes that canattach to your ovaries and impact
the health and quality of your eggs.
So that means they're lesslikely to form a healthy embryo.
There can be the egg leaving theovary and traveling down the fallopian
(04:57):
tubes, sometimes the tubes are blockedthrough scarring or endometriosis.
There can be an issue withcreating healthy eggs with PCOS,
polycystic ovarian syndrome, whereyour ovaries are producing cysts.
and that impacts the quality of the eggsand your ability to ovulate regularly.
With uterus, there can be adhesions,there can be septums, there
can be a host of other factors.
I'm not a doctor, I can just tell youwhat I learned in helping different
(05:20):
couples and in my own experience.
And so those are all kindof the different factors.
And then you have avariety of couples, right?
Some people have a healthy egg and ahealthy sperm, but no uterus, or you
have same gender couples where they needextra support to create their family.
or you have single individuals thatneed more help to create their family.
And so a reproductive endocrinologisthas resources to do all of that.
(05:40):
Things like sperm donation, egg donation.
The term commonly used is surrogacy, butthat's not really an accurate description.
It's a gestational carrierbecause the person is only hosting
the baby through their uterus.
They don't contribute the egg as well.
So those are all kind of thedifferent factors that a reproductive
endocrinologist can look into.
In your experience,
(06:02):
You experienced secondary infertility.
That was a term that Iwasn't familiar with.
So secondary fertility is when you have arelatively easy first or second or third.
Secondary fertility is kind of amisleading name because it can be
any time after you've already had apregnancy trying to have another child.
So I had had one pregnancy and Iused Clomid to have that pregnancy.
(06:23):
So some infertility there,but pretty low grade.
And then I wasn't able to getpregnant again, even after Clomid.
multiple rounds of intrauterineinsemination where they, you know, place
the sperm directly like closer to the eggand they stimulate your ovaries and they
monitor you and do all these injections.
And so I did that for about threeyears, three years after when I
(06:46):
was trying to have my next child.
So my oldest and my second oldest,there was a nine year gap there.
So it was a bit of a, bit of anadventure and a bit of a wait.
But yeah, so secondary fertility isjust when you have kind of that gap.
And it can be, you know, after you'vehad, you use it less frequently
if you've done reproductive,assisted reproductive technology.
(07:09):
So you've done IVF, IUI, anyof those kinds of things.
If you've done that kind oftechniques, you don't really just
say secondary fertility againbecause you're just struggling
with infertility in general, right?
Like it doesn't start new.
But many couples find that theyhave one successful pregnancy or
two successful pregnancies and thenthey're unable to conceive again.
And that is secondary fertility.
It sounds like your journey ofinfertility, a long journey, a lot of
(07:32):
different options that you were utilizing.
How did it affect youmentally and emotionally?
It was really, really hard.
it's very difficult to feel likeyou're doing the right thing or that
you want something that's a good,healthy, normal thing and something
that comes easily to other people.
It was really hard to watch multiplesister -in -laws get pregnant.
(07:53):
it was difficult.
to see my husbandstruggle with it as well.
And it's just hard to want somethingso much and have so little control
or being able to achieve it.
And that it's very much a rollercoaster because you get your
hopes up every month, right?
Like, okay, we're gonna trysomething new this month.
This is gonna be the month.
This time it's gonna work.
I'm doing all the things.
And then to have it be unsuccessful isvery emotional and it's very difficult.
(08:17):
It's also very isolating becausethere's not a lot of people
you can talk to about it.
I was lucky because I had found theUtah Infertility Resource Center.
I ended up with a lot of friends that hadeither gone through fertility or going
through it, that had experienced losses.
And so I had a really strong supportgroup of women around me to kind
of help me navigate that time.
And I just had to keep believing thatsomething good would come, that eventually
(08:41):
I'd be able to have another child,whether that was through IVF, through
adoption, that there was another path.
There was always goingto be a path forward.
It just would take me timeto find what that path was.
And so if you're not lucky enoughto have the support group as part of
your system, are there different waysthat you can find those families?
You can get the support that you need.
(09:02):
There is a national support group calledresolve and resolve has chapters all
over the country and internationally.
And so you can find an effort tosupport group almost anywhere.
And online there's lots ofsupport for women out there.
And I think something thatI have found is being open.
about my journey was really helpful to me.
People were quick to reach out,quick to be understanding, and
(09:23):
then because I was open with it,I was able to support others.
After I had hope, a couple years laterone of my friends was going through
infertility and she called me inthe middle of the night one night.
It was probably, not the middle, itwas was 10 pm She's like, my gosh.
She goes, I know it's really late.
She goes, but my husband isn't backyet and I have to do my trigger shot
at 10 pm Will you give it to me?
I was like, of course.
(09:44):
And she's like, I knew I could call youbecause you've talked so much about it.
And so I think that it'sdifficult to be open and transfer.
It was something that's so intimateand personal and heartbreaking and
hard, but when you are, it allowsa community to be built around you.
Is this what sparked yourpassion for mental health or
did that come before or after?
(10:06):
it kind of all happened at thesame time because there's a lot of
overlap between, postpartum mentalhealth and infertility mental health.
going through infertility increasesyour risk of a perinatal mood disorder.
And so I worked very closely witha lot of clinics that addressed
mental health and that had mentalhealth based support groups.
Utah Infertility Resource Center,that's one of the things that they do.
(10:28):
It was founded by a therapistwho had done infertility, who had
experienced infertility herself.
And that was one of the big causes thatwe raised money for is free to sliding
scale fee mental health care for peoplethat were struggling with infertility.
Because you just need,
a lot of support and there's also a lotof losses associated with infertility.
The loss of the way you thought yourfamily would look, the loss of how
(10:50):
close your children would be together,how many children you would have.
A lot of times you have tocope with the loss of having a
genetically related to you child.
And so understanding thoselosses and having the appropriate
space to grieve them, I thinkis really important and helpful.
The attitude of, well, at leastyou have one child or at least
this or at least that is very...
(11:12):
unhelpful to say it charitably tosomeone that has tried with infertility.
And so being able to see a qualifiedmental health professional that
especially has experience inreproductive loss in infertility,
I think it'd be really worthwhile.
And they have the tools, theyhave the training, you know,
to help you along your journey.
For those of us who are not experiencingit and want to support our friends,
(11:33):
what do you recommend that we say or do?
I think the most important thing is to
Be open about it.
If they've shared with you that they'restruggling with infertility or you suspect
that they're struggling with infertility,I think there's two different paths.
So if you suspect and they haven'tshared with you, maybe you can just
say something like, just, you know, ifthere's ever something you're struggling
with, I'm always here to listen.
(11:55):
I want to support you wherever you are.
I've noticed that you've beena little extra down lately.
Is there something youwant to share with me?
I'm a safe place to share.
If they've shared with you the experienceinfertility, ask them how it's going.
Be like, Hey,
How's it going?
Are you doing any treatments this month?
What day is your treatment?
Can I bring you dinner that night?
Can I bring you a treat?
(12:16):
It's hard to see all of your friendsget new baby meals and there you are
after having your fourth or fifthprocedure or surgery or loss and
just kind of feeling very isolated.
And so I had a lot of friends dothings like they would keep track of
when I was going in for an appointmentor when I had a blood test and they
would be like, hey, we're just, ifyou don't want to share, that's okay.
But no, I'm thinking about you.
(12:37):
I'm sending you positive vibes.
How's it going?
Like, hey, I know you haven'tshared publicly where you are
on your journey yet, but I'msending you some cookies today.
Like, just let you know that I'm here,I'm with you, like you're not alone.
And be sensitive to how theyrespond to your own announcements.
It has nothing to do with their lovefor you, their love for your children.
It is just very painful.
(12:59):
And so the losses you experiencewith fertility are as impactful.
as any other loss that youwould experience in life.
And so if they can't come to your babyshower, let them know that that's okay.
That it doesn't impact your friendship.
If they feel like they can't holdyour new baby right now, it doesn't
mean they don't love your new baby.
It doesn't mean they don't love you.
And that's a really hard space tobe in because you're also dealing
(13:20):
with your own hormones and yourown emotions and your own feelings.
You want everyone to be happy andit's hard to have someone else be
really sad when you're really happy.
But I think just seeing that andfinally like, hey, you know what,
however you want to participate,I totally understand and respect.
That's, I think the biggest thing isoffering support and then have compassion,
understanding when they maybe can'tshow up for you and your happy moments.
(13:42):
They're just not in aplace where they can.
They would love to.
I mean, I, I would loveto, but it was really hard.
Hmm.
I have a friend who went throughcancer a few years ago and this
was before she was married.
And so before radiation, she had hereggs frozen and now they are working
on trying to implant those eggs andthey've had a few rounds and, and are
(14:02):
still working on it.
So that's great advice for me personallyto know how to help and talk to her.
What are some other things thatthey do with fertility, like
freezing eggs or those processes?
So that's called fertility preservation.
So that's when you freeze either eggs orsperm so they can be used at a later time.
This is just my personal experience.
So some of the fertilityprocedures, the first one is
(14:24):
going to be ovulation induction.
That's like,
Clomid or Fomara where they encouragea woman's body to create more eggs.
So that you have a higherlikelihood of implantation.
Because you release one egg amonth, with Clomid or Fomara
you might release three or four.
So that just increases your odds.
The next step onto that is intrauterineinsemination or IUY and that is where
(14:45):
they take the sperm and they kind of spinthem around so that the highest quality
ones are separated out and then they...
induce ovulation so theydo the same procedure.
Clomid for MARS, sometimes they useinjectable hormones to help create eggs.
And at this point, this iswhere it's really important to
differentiate between an OB -GYNand reproductive endocrinologist.
Because if ovulation inductionis not monitored, you can run the
(15:08):
risk of high order multiples, likequadruplets, quintuplets, things
that really negatively impact thelikelihood of success of a healthy baby.
The goal of any infertility treatmentis healthy mom, healthy baby.
One healthy baby.
If you have to, I mean that's exciting,but the odds of all those things being
healthy start to go down when youstart to induce higher order multiples.
(15:31):
And so in a reproductive endocrinologistsetting, they monitor how many eggs are
growing and how fast they're growingso that they can make sure that they're
not putting sperm up next to seven eggs.
You don't want that tohappen, that's very dangerous.
And it's unlikely that wouldresult in a healthy pregnancy.
So that's the next step.
So usually it's like three or foureggs and then they do the insemination.
(15:55):
So they go to the office, theyuse a thin catheter to put the
sperm closer to where the eggswill be released and they time it.
So you do it, it's called a trigger shotand it induces ovulation within 24 hours.
So you do it at a very specific timeand then 12 hours later you go into
the office and you have the procedure.
Okay, so that's intruderinsemination or IUI.
(16:17):
So if you've heard your friendsdoing that, that's kind of
what that procedure looks like.
The next level up from that youstart to get into the more advanced
reproductive technology or art.
So that's why you want touse a SART certified clinic.
That's Society for SisterReproductive Technology.
It basically means that they'vepassed all these tests and they're
monitored to make sure that they'redoing things in an ethical way.
(16:39):
There are people, there are surgeondoctors that are not SART certified
and they tend to do things that arenot in line with ethical values.
That's where you end up seeing peoplethat are having seven kids at a time or.
high order pregnancy, they're notusually following the guidelines for
assisted reproductive technology.
That's why you want a certified clinic.
IVF, in vitro fertilization.
(16:59):
So at that time they take the spermand the egg, and there's two different
ways to do the fertilization.
One is where you take one sperm andone egg and you put them together.
The other one is where you take anegg and then a bunch of sperm and
you see kind of how that one goes.
in glass in a petri dish, that's why it's
called invitro.
(17:20):
So that's how that starts andthey could do that with as
many eggs as they've harvested.
So that is ovulation induction,but at that point they do
it at a much higher level.
So you're doing injections.
When I did it, I think I had threeor 400 injections for one round.
And they try and induce your body tomake as many eggs as it healthily can.
So you want a high quantityand a high quality.
(17:41):
So it's that constant balance.
Like you don't want 200 eggs and thenyour egg reserve is wiped out, right?
I think I have like 12 or 15.
So then they induce kind of thatovulation, and then they don't
necessarily trigger it in the same way.
They trigger it so the eggs start to form,but then you go in much earlier and the
eggs actually retrieve, so they use avery thin needle and they retrieve each
(18:05):
individual egg from the ovary, so you'reunconscious mercifully for that procedure.
You're conscious for the restof them, but that one you're
mercifully unconscious for.
and they retrieve all of the eggs.
And at that point then theytry and fertilize the eggs
and they watch them grow.
They see which eggs fertilizeand how those blastocysts grow.
(18:26):
And then usually they watch them forfive days and at five days they freeze
them, depending on how they're growing.
And they either freeze them fora future transfer or as we do
it's called a fresh transfer.
And that's where you go back infive days later and they transfer
the egg into the woman's body orthe gestational carrier's body.
Is there a greater chanceof success if it's fresh?
There is mixed research on that.
(18:46):
It just depends kind of on the personand their situation and the quality
of their eggs and their blastocysts.
Like sometimes if you have a low qualityone, you might opt for a fresh transverse.
They won't survive thefreeze in the thought.
But then on the other hand,frozen, you could do things like
what I chose to do was a frozencycle so I could genetically test.
(19:07):
So I would have a higher likelihoodof each route of not implanting
a blastocyst that wasgenetically malformed in a way
that wouldn't create a baby.
It's not saying like, I want like agirl or a boy or blue hair, brown hair.
I think people confusewith genetic testing.
This is like, is this likelyto form a healthy pregnancy?
And so that's kind of what you test for.
(19:27):
And so that's one of the optionsfor frozen cycle and also it
gives your body time to recover.
So if you're doing a fresh cycle, you dothe egg retrieval, which is a surgery,
five days later and at the same time ofgrowing your eggs, you're also trying to
thicken the lining of your uterus, right?
So then five days later, you're back inthere and trying to sustain a pregnancy.
And so it's a lot foryour body to go through.
(19:48):
So a frozen cycle, you do the retrievaland then you usually wait a cycle or
two depending on your body and dependingon your doctor's recommendations.
And if you're choosing to do genetictesting, all of these things take time.
Then you would go back in.
So the next focus is creating ahealthy uterus, creating a healthy
lining that's thick, that willbe optimal for implantation.
(20:09):
and then they place the little blastocyst,they thaw it out and they place it
in the uterus and it's really cool.
When they do a transfer, it's likea little like flash of light when
they put the little blastocyst in.
It's a really cool experience.
I've done two of them.
So yeah.
I've heard from others that theyfeel like it's a very spiritual
experience to witness that.
(20:30):
I thought it was a veryspiritual experience too.
I don't.
think that it's, and so you're probablylike, it's the beginning of life here,
the beginning of life there, becauseit starts to get real murky and tricky
when you're in the waters of IVF.
But it is a very spiritual experienceto find kind of, to get to that point
in your journey because of everything,like everything that's led up for it.
Because it's also very, it's kindof like, this is your chance.
(20:53):
You've spent probably easily like25 to $35 ,000 at this point.
It's been years and years of workand a lot of procedures and a lot of
heartache.
So it's very much kind of likethis, like very intense moment.
It can be very spiritual.
It can be very exciting.
It can be very scary.
It can be very, it's just, it'sjust kind of a lot of things.
(21:13):
Also you're taking a lot of Valium.
So it's also a lot of things thatyou're feeling at that time too.
Can we talk about theexpense a little bit?
Yeah.
So expensive for, for peopleto, undergo these procedures.
What have you seen forindividuals who aren't able to,
afford this themselves.
(21:34):
I think there are a lotof really good resources.
So what I worked with the infertilityresource center, something we really
focused on is helping people find loans.
We will find, there's a lot of scholarshipoptions, a lot of nonprofits that are
around now that offer partial treatments.
There are studies that clinics do.
There's a lot of ways thatyou could reduce the cost.
(21:54):
you can take on extra work if you can.
Like it's just, it's, thecost is not insignificant.
I mean, my daughter all told probablyin the neighborhood of $40 ,000 before
she, we spent before she was born.
And many people spend that much and don'thave a healthy live baby afterwards.
You can, it takes, we were verylucky that our first transfer
(22:17):
with her was successful.
Our next transfer was unsuccessful,but with her, with that first
transfer was successful.
And that's before allof the birth expenses.
That's just the very beginning.
That's just to get pregnant.
That's not staying pregnant.
That's not giving birth.
That's not.
postpartum care, new baby expenses,that's just to get pregnant.
And so it's very expensive.
(22:38):
I've worked with resolveand the interpreters to
campaign for better coverage.
So the state of Utah,actually, I testified with
fellow infertility warriors.
We went before Congress and wetestified about our experience dealing
with infertility and the expense.
And they passed a bill that forstate employees, they covered, up to
$5 ,000 of treatment, which isn't.
(23:00):
Everything.
But I mean, it, it's a big difference.
You could also ask your employer ifthey have a specific policy or I don't
know if it's a grant or a loan or agift, but some employers, a lot of
health insurance programs have that.
And you can ask your employer like,Hey, I'm sorry, this can, we opt into
this for our health insurance program,or is there anything we can do?
Some people do matching.
I have found that if youdon't ask, you don't know.
(23:23):
And that's part of theopportunity of being open with it.
Something that happened to me.
is when I had a secondcycle, we lost the baby.
We lost a little boy baby at 10 weeks.
It was a little before 10 weeks.
And that was our last embryo, so wewould have had to start all over again.
And at that point, we were definitely notin a place where we could do it again.
(23:45):
And so I was kind ofsharing on social media.
I was like, this is the end of our road.
Thank you to everyone who supported us.
We really appreciate you.
Everyone has been cheering us on andpraying for us and sending us good wishes.
We're closing this chapter because of...
and time and all of that.
And I had a private donor reachout to me and offer to help
support me in another round.
(24:06):
I wanted to do another round of treatment.
I ended up having a spontaneouspregnancy six months later
when I was about to start.
So yeah, I had a private donor.
So I think when you're open aboutyour journey and your heartache,
it provides opportunities.
People want to help.
I think that's what I learned most.
People are anxious to help.
Your doctor's offices probablyhave some kind of program or they
know someone or they'll have...
(24:28):
a list of grants to apply for.
If you have a nonprofit support group inyour area, they'll have grants to apply
for or different loans you can take out ordifferent things or they'll know people.
And I think as you start to open upabout those experiences, then you'll
find more options, more pathwaysopen up for you in my experience.
(24:49):
And what a beautiful wayfor those people to share.
Yeah, it's definitely somethingthat's been impactful and meaningful
to me and that I always hopeto to pay for it as I'm able.
You spoke about losinga baby boy at week 10.
We talk about week 12 as kind of the weekof viability and moving beyond what can
we do or say, or how, do we handle themiscarriages that are around in that time?
(25:16):
So I think something that's difficultis most people choose to not announce
pregnancies until they're further along.
With IVF, you know you're pregnantand you're watching your baby
grow starting very, very early.
So you're starting week five.
You're starting to like look andsee, okay, is everything's happening?
And then at week seven,things looked okay -ish.
(25:36):
And then, I mean it was week eight.
It's all kind of a blur now.
Week eight and then the next week wewent in and they're like, I'm sorry,
there's no heartbeat, but you know,maybe just maybe next week it'll be okay.
And then next week there was not.
And we ended up havingto do a DNC at that time.
I think something that's important is whensomeone chooses to share a loss to offer
(25:57):
them grace at that time, just because youchoose to keep something private doesn't
mean that's the right path for everybody.
And I can't imagineexperiencing that loss alone.
Like that was the time where I felta lot of support from my community,
where a lot of friends reached out.
I had a good friend who had had a coupleof miscarriages over the course of her.
years of childbearing, she had olderkids now and she, her husband actually
(26:20):
reached out to my husband, he's like,look, I know everyone's there for your
wife, but if you ever need a friend,man, like, you're hurting too, like
you're a dad and it's hard and it hurts.
And so, and having friends drop offdinner or ask me like, what does
your plan look like so we can supportyou, offer to help with the other
children if there's other kids.
All those things were reallymeaningful and impactful to me.
And I think being honest that a lossis a loss, a loss that happens at
(26:44):
10, 12, 13, 14 weeks, likethose are real losses.
You have already developed attachments andplans and love for this baby and allowing
people to grieve how they want to grieve.
The term rainbow baby, isthat appropriate to use?
Or I think it is usually if you useit or rainbow baby, it's something
(27:04):
it's a miracle after a storm, right?
Or a loss.
And so I have a rainbow baby.
I have a little boy.
Like I said, we had a loss and then sixmonths later after, I don't even know
how many years of never having a, I'venever had a spontaneous pregnancy before.
And so we had a spontaneous pregnancy.
It was a little boy.
And so he was definitely a rainbow baby.
And it was definitely a brilliant.
(27:25):
bright spot of hope after a very darktime, but it was also very difficult.
I was surprised how much anxietyI had during my pregnancy.
I had very, very high prenatalanxiety, like being pregnant.
Like every day I wasjust like, am I bleeding?
Is everything okay?
Can I feel a move?
I swear I went to my doctorso many times, I was like, can
we have another ultrasound?
I'm just really nervous.
(27:45):
You just have such a heightenedfeeling of anxiety after a loss.
I think that's something to watch for.
because a perinatal mood disorder can cropup during pregnancy, not just postpartum.
And if you've experienced loss orinfertility, then you're more likely to
experience those perinatal mood disorders,like postpartum anxiety, postpartum
depression, postpartum psychosis.
(28:06):
And so if you're starting to feelthose feelings in pregnancy, that's
definitely something to address duringthe pregnancy and not wait until after.
So I was surprised.
And the contrast between how happy you areand how happy everyone is for you, like
all of my friends and family were like,
my gosh!
And we were too, I was thrilled.
But it was very hard to just be fullyjoyful because in the back of your
(28:28):
mind there's always that stupid anxiety
voice.
I refused to name mybaby until he was born.
I couldn't, I was too afraid.
I told my husband, my husbandwanted me to read all these names.
I'm like, I can't, I can't do it.
I can't.
And being honest about that andhaving mental health support during
that time was really important to me.
So I think if you're experiencing thejoys of a rainbow baby, it's okay to also
(28:52):
allow yourself to have the both and tohave the anxiety and the sadness for your
lost time, all those kinds of convergingat once and to get help and support.
especially before you havethe baby, because it doesn't
just miraculously go away.
So that'd be my advicewith a rainbow baby.
When you think about, an actualrainbow and oftentimes the rainbow
can show up while it's still raining.
Yeah.
And so balancing both emotions,recognizing that someone experiencing
(29:16):
this is going to have the rangeof emotions and to support them in
everything they're going through.
So important.
Can I ask you a littlebit about the pregnancy?
So when you were pregnant,after your IVF treatment,
Were you automatically shuffled to amaternal fetal medicine specialist or
what does that pregnancy look like?
How does it differ?
It's terrifying because like whenyou're doing IVF, the first 10
(29:37):
weeks of your pregnancy, it's likeyou're in there every single week.
They're drawing your blood.
They're doing ultrasounds.
You're just right.
You have a doctor monitoringevery sip of the wind.
They're like, okay, good luck guys.
And you just go straight to yourOBGYN unless you have a previous
condition that makes you high risk.
So after your endocrinologist kind of like
affirms the pregnancy and clears you.
Yeah, that's usuallyaround like 10 or 12 weeks.
(29:59):
They'll move you on to your regularOBGYN and then you're totally fine.
You sometimes with an IVF pregnancy,they'll do extra monitoring
towards the end of pregnancy.
You might have some non -stress testsin the last several weeks because
there's some associations with frozenembryo transfers and incidences of
cord mishaps or stillbirth or those kindsof things, but they're very, very rare.
(30:20):
So it just depends on your OBGYN.
Most IVF pregnancies, once you'repast that 10 or 12 week mark,
continue just like a normal pregnancy.
I've heard from some individuals,they'll say, well, I have to get induced
because this was an IVF pregnancy or,you know, like I have to deliver early.
And so I guess just each OBGYNis going to navigate those cases.
Yeah.
A lot of that is just goingto depend on the individual.
And like I said, because the reasonsbehind infertility are so broad.
(30:45):
there might be a need fordifferent medical interventions.
But many women that I have spoken with,
go on to have completelynormal pregnancies.
They choose a variety ofchildbirth methods and all of
them valid, all of them wonderful.
It just really depends on the individualand what their doctor recommends
because there's no set, you'vedone IVF, then you have to do this.
(31:07):
There's no set protocol after that.
Your pregnancy is just a normal pregnancy.
You're just throwing up andtired, just like the rest of them.
Waddling around, justlike the rest of them.
What has been your experience
being an older mom Cause I knowsome friends weren't able to have
children until later in life.
And so then it's kind ofa different age dynamic.
(31:28):
It's totally different age dynamic.
I mean, I had my first baby inmy mid twenties and then my last
baby was an advanced maternalage because I was almost 40.
I was 38 when he was born.
Yeah, I was 38 when hewas born, almost 39.
And I think the difference is I was a lotmore settled on who I was as a mother.
The harder part is Ihave a lot less energy.
(31:51):
I mean, my oldest is12, 13, 13 years older.
than my son.
And so the difference in kindof the world and me as a person
and our life is very different.
So in that way being an oldermother is harder and you're not in
the same place as a lot of peers.
A lot of my friends that have children,I'll go to kindergarten, you know,
(32:12):
with my daughter and they're like,like I'm having my third baby.
And I'm like, yeah, me too.
And you're in a different spotthan your peers, but I found it's
been wonderful for me personally.
As a new mom in my 20s, I felt veryinsecure with who I was as a mother.
I'm kind of insecure with who I was asa person, and it was really difficult.
(32:34):
But as an older mother, I havefelt more secure in who I am, and
having my oldest son is a bit ofa challenge, to say the least.
And so having a kid that is a littleneurodivergent and has a lot of
things going on, I've been ableto let a lot of other things go.
Like today, my daughter'swearing some kind of hideous long
-sleeved dress with flowers on it.
(32:55):
and polka dot striped pants and her hairlooks like a bird flew in it because she
did it herself and I was like, you lookgreat dear, have a great time at daycare.
The things that I would have been soanxious about as a brand new mom, I'm
just gonna be like, that'll be fine.
And with my last baby, Ethan, when hewas born, I really just didn't want it.
(33:17):
to go by fast because Iknew how fast it goes.
Right at that point my son was turning 13.
I was like, wow, I blinked, I blinked.
And so I just really leaned intothat fourth trimester of just.
Laying in bed a little bit longer,holding him a little bit more, wearing
him a little bit more often, notworrying so much about getting my body
(33:38):
back, whatever that's supposed to mean.
Your body doesn't go anywhere,so you don't need to get it back.
And just enjoying the experience forwhat it was and not wishing it away,
not being like, my gosh, I can't waitto walk, I can't wait to do this.
Just gonna be like, I loved.
where I was and where my babies were.
The nice thing about being a geriatricmom is it keeps you young longer.
(33:58):
Allegedly.
That's what they say.
My gray hair is beg to differ.
You get to retire beforeyour kids graduate.
That's true.
I didn't think about that.
I'll probably never retire, but it is,it is nice being a, being an older mom.
And it, I've been surprised how manyof my friends have had outside of Utah.
It's very normal to have babies inyour late thirties and early forties.
(34:21):
And in Utah, that'svery, that's less common.
And so I've been, it's been interesting tokind of find friends that are in similar
phases of life and be able to talk aboutthe different ups and downs of that.
And then I have friends acrossa wide spectrum of ages and
experiences, which is wonderful to me.
Well, we love to share resources onthe podcast and I am a huge book nerd.
(34:44):
I just love reading.
I love listening.
And so I had a couple of quotes from.
from some books, the firstwas from female fertility.
This is by Tony Weschler.
And she said the strongest womenbecome the strongest mothers before
their children are even conceived.
We want to thank you for being thatstrong mother and sharing all of these
tender and precious moments with us.
It's been so delightful.
(35:05):
Do you have any resources that you'dlike to share with our listeners today?
yeah, definitely the resolve.
is a wonderful national resource.
If you're in Utah, the Utah InfertilityResource Center, and just really finding
those resources within your own community.
So good.
Thank you.
Cheryl has our mom squad secret.
She says, having to pee all the timein pregnancy is not just at the end
(35:29):
of pregnancy when your baby is doinga P90X workout on your bladder.
It's your hormones.
So be prepared to pee night and day,even at the start of your pregnancy.
Such a great reminder.
I feel like you can seewhen you need to go pee.
That's, that's definitely true.
Or if you're doing a hormone treatmentsand then that can impact it as well.
Get prepared ladies.
Mandy, thank you so much forbeing on the podcast today.
(35:50):
Thank you so much for having me.
It's been a joy.
Thanks for joining us on today's episode.
We hope you've been elevated andinspired by this week's expert.
Subscribe today so you never missan episode and please share our
podcast or post on your socialmedia so that other moms and dads
to be can also have the best birth.
Please note that the informationprovided is based on the expert's
(36:13):
insights and personal experience.
It is not intended as medical guidance.
Please seek the advice of yourmedical provider as it applies
to your specific condition.
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