Month: February 2020

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Favorite Products for TTC

Amanda Hannan

Here are some of my favorite products for TTC

I must have used over a thousand tests, both ovulation and pregnancy tests. I tried every brand out there and I found over time I preferred Wondfo. They are simple, straightforward and accurate. They are also a great price. There are some copycat versions out there but you want the genuine thing. You can get the real ones at the link below:

Some people prefer the digital ovulation and pregnancy tests. The ovulation tests make it super clear whether or not you are at peak, there is no evaluating color. The general instructions on how to do OPKs is a little different with some digital ones as they measure both estradiol and LH, so instead of testing once or twice in the afternoon, you test only one time a day in the morning. Pay attention to the instructions. The pregnancy tests are also very straightforward but they do require higher levels of HCG to get a positive so keep that in mind you early testers! Below are links to my favorites in the digital category.

Let’s talk lube. You may not need any, but there are some that claim they help sperm swim. If you have any issues with not enough cervical mucus, it doesn’t hurt to try one of the following. Remember, many lubes kill sperm. I know some people have used regular egg whites or coconut oil. That sounds messy to me. I would buy the stuff in a tube with an applicator.

I will disclose that as an Amazon Associate I earn from qualifying purchases. I am not recommending these for that reason, rather these items were my favorites, and I used a ton, during my 8 year TTC journey. If only I had a dime for every pregnancy test I took!

Mommyhood

Plagiocephaly

Amanda Hannan

When my first son was born, the first thing I heard before I saw him was the nurse asking “was this baby breech?” When you have a C section you expect the perfect little round head over the cone shape you often get with vaginal births. Well, didn’t happen here. My baby’s head was squished under my ribs forever. They had to twist and turn to get him out! I could feel it. His little head was crooked. His lips didn’t even line up when he closed his mouth. They told me in the hospital it would get better.

At 12 weeks we had a lactation consultant come in to check for ties. She mentioned torticollis to me. That took us down a path of twice weekly PT for about 9 months. At first I wasn’t super worried about his head shape. At about 5 months old or so, the PT asked if I had considered a helmet. I hadn’t really, I still expected it to get better as he started moving and sitting up. Still I ended up making an appointment at one of the big cranial helmet companies.

As I was in the waiting room, I heard the entire consult with another family in a room right beside me, through the closed door. The man was telling them how the back to sleep campaign has caused so many bad shaped heads and that they should have done more tummy time, etc. It was close to blaming the baby’s head shape on the family. Then he went on to talk about how they don’t have to worry because he can fix what they have done. It didn’t sit well with me. When it was our turn, as soon as he came in, he started giving me the same speech. I interrupted at one point to tell him about how the baby was breech and his head had improved a ton and he gets tons of tummy time, but he wasn’t having it. He just continued on implying it was my fault. Before he left the room, he mentioned my neighborhood and how it is expensive but a helmet is not that much money for my child’s entire life.

I was so turned off I wanted to vomit. They measured him at 16mm asymmetry, severe in their opinion. They loaded me down with tons of documents and quoted one study that said heads don’t improve on their own. I left there feeling almost taken advantage of. I only want what is best for my kid, I love him with all of my heart, and I felt like they were playing off that. I went home and did a ton of research. I found the study they mentioned and I don’t recall specifics but it was a super small study. I couldn’t find a lot to support their claim that he would have jaw problems and ear infections and helmets would never fit him right. But I also couldn’t find any posts from parents who chose not to helmet or a lot of data to show what happens if you don’t.

I went to the pediatrician to get an opinion. The caveat is that my pediatrician had left that practice and for other reasons related to where he went, I wasn’t going to go with him. The person I saw that day seemed confused about why I was there and basically said, if they think you need a helmet, get a helmet. I asked for a referral to a neurosurgeon or someone who can provide an opinion. They literally looked at me like I was crazy, rolling their eyes between two of them and gave me a brochure for the same helmet place I had just been to. I went home steaming mad (and btw went back to my original pediatrician who I love to this day).

As soon as I got home I started researching. I live in the NYC area, and it turns out, there are neurosurgeons who have plagiocephally clinics! I wasn’t so damn crazy afterall. I went to Cornell’s plagiocephally clinic, ran by their chief of pediatric neurosurgery, and saw a wonderful female doctor. She checked out my son, explained that heads grow like a deflated basketball when you add air back, filling out one area then another. She wasn’t wishy washy at all, said absolutely No you don’t need a helmet. My son is now almost 4 and looks great. I will add pictures to this post eventually to show the difference.

To be clear, I have nothing against helmets and I think everyone needs to make the best choice for them. I chose not to helmet for my son. I joined some Facebook groups and saw that many babies have rashes, dry skin patches and other complications from the helmet. Some don’t adjust well. You must go often to get it adjusted, and remember we were already doing PT 2 times a week. I just didn’t want to put him through all of that. He may have had to wear it 8 months, maybe 12 months. It was a lot. Also, I saw so many moms who were unhappy with the helmet’s result. Maybe they went from 16mm to 12mm and that wasn’t enough for them. I didn’t want to put him through all of that for a result that is that slight. Also there was a lot of data suggesting that helmeting exacerbates torticollis, which I knew had to be the focus of treatment.

The icing for me was the obsession. I saw so many moms who were not satisfied when they went from 16mm to 3mm. They were chasing absolute perfection and always being let down. I saw some take their second child for a helmet as a given, even when that child measured only 8mm off at 3 months. I didn’t want to become obsessive about the head shape. I wanted to enjoy my son and I trusted the doctor at Cornell, though to be honest, it was hard. It was very hard to let it go and have faith that it would be Ok. That is because we all want the best for our kids and making a decision is scary – it is either the right or wrong choice every single time.

If you are in the situation where you are deciding whether to helmet or not, I feel for you. It’s a hard choice. I really believe it will be OK no matter what choice you make. Some kids do great in helmets, don’t even mind them and their results are fantastic. Some kids helmet with little result but by age 3 look fantastic. And some kids don’t get the helmet and also look fantastic by age 3.

What I learned was overall it wasn’t worth the stress and agonizing I did over the decision.

Mommyhood

Breast pumps

Amanda Hannan

What I wish I had known before having to order my insurance provided breastpump.

  • You may or may not respond well to any particular pump.
  • Spectra and Medela are the most popular home pumps, which can mean it may be easier to find parts locally for them.
  • A battery is wonderful. Even if you are home with baby, being able to move around and pump in different areas without finding a plug is huge. I pumped in the car, airports, everywhere. If it is an update for a small amount of money, definitely consider it.
  • Parts can be provided through your insurance. I honestly didn’t know this till towards the end of my breastfeeding journey so never got to take advantage. Not sure how to get the process going, but worth it to enquire.
  • Your baby will be more efficient than a pump at transferring milk. If your milk supply seems low from pumping, don’t assume your baby isn’t getting enough.
  • Fancy bags designed for pumps are nice but I found it most helpful to have simple stuff, a bag large enough to include my pump, extra parts in a Ziploc, and an insulated lunch bag and the hardsided ice packs.
  • Breast Milk Soap – one of my favorite products. Makes cleaning parts so much easier.
  • You can ask for a pump while in the hospital. Some say wait till your supply is established, but both my kids spent a little time in NICU and I wasn’t able to latch as often. They will provide you a hospital grade pump and parts and you can likely rent that pump from your hospital or local pharmacies if you prefer.

I liked the Medela Symphony rental and also my Spectra S1. What pumps did you love and what other advice do you have?

Mommyhood

Exclusively pumping

Amanda Hannan

So what I wish I knew about breastfeeding before my baby was born is huge! I focused so much on getting pregnant and after so many losses, including my second trimester loss, I was so afraid to even use the P word, I really didn’t start thinking in Mommy mode till I was on the C section table. To be fair, I did take one breastfeeding class, but I definitely didn’t realize it was not just going to be easy peasy. In fact, I didn’t even buy a single bottle cause why would I need a bottle? I was going to breastfeed. It will just naturally happen.

But it didn’t. Here’s what actually happened.

Around 32 weeks or so they thought they saw a knot in my son’s cord. Remember, I had several early losses and lost my twin girls due to incompetent cervix. I firmly believed in my transabdominal cerclage, but I was acutely aware through the whole pregnancy that things happen. So hearing there is possibly a knot and reading that they can result in a stillborn some percent of the time – even though a super small percent, it is still a percent – I was holding my breathe and getting scared I may lose another baby. I was told to do kick counts and I was doing stress tests weekly or twice a week, can’t recall now.

At 36 weeks, I had gained about 20lbs quickly, like in a week. I had a headache. I knew what this meant. I went to my OB appointment telling my new puppy (yes, I had a puppy while I was having a baby – do not recommend but more on that later), I would be right back but knowing I would not. My BP was 146/86 or something – not super high but very high for me. They sent me to labor and delivery and did some blood work and urinalysis. My doc came in a few hours later and basically told me that there may be a knot, my BP is going up probably cause they scared me with the knot, the fluid looks a little low and I am 36 weeks and 2 days. She was suggesting we take the baby. It was May 5th. I totally agreed but was glad when she said tomorrow. (I was picturing trading my Cinco De Mayo Margaritas for Paw Patrol and popsicles).

The next day, my beautiful son was born, 7lbs and 5oz, big for his gestation, with no knot in the cord! It was the most wonderful sound I had ever heard, him crying. The hospital had prepared me for NICU, as their policy is all babies born before 37 weeks must go to NICU for at least one night. I was fine with it of course, but that meant he was whisked off after just a couple of little kisses from me and I was carted to recovery. In recovery my BP bottomed out, dropping super low then half an hour later went up super high. It was all over the place. I finally got to see my baby when they stabilized me and wheeled me into NICU. This was the first time I had a chance to try to latch him. He had already sucked down 15mL of formula like a total champ. He wasn’t super interested, but latched for a second or two.

Once I got to my room, instead of being able to go back to the baby in a wheelchair, and later as my legs woke up, by foot, I was put on magnesium due to the crazy BP fluctuations. That meant I spent 18 hours locked to the bed, away from my baby. Once I was off of it, I was moved to the regular maternity ward and he was allowed to come to my room, finally. By now, he was loving his formula and bottle and my milk hadn’t even begun to come in. I started pumping and tried to latch him a few times. I had no idea what I was doing and although the lactation consultants offered to help, I wasn’t sure what I needed help with.

Eventually I was pumping on the Symphony at the hospital and rented one as soon as we got home. I tried latching him when I could but then also had family over to help and was super exhausted. I always thought I could work on that later, if the milk would come in good then he would latch. It was also painful for me. I couldn’t stand the pain if he latched more than 2 or 3 times in a day. I expected it to hurt a little at first but then get better. It never got better. Overtime I started reading up on breastfeeding issues and read about tongue and lip ties. I had a lip tie myself that had to be fixed before I could get braces on. I could clearly see he had one too. I called in a lactation consultant to help me confirm.

The LC walked in and mentioned torticollis right away, then confirmed the ties I suspected. I went and had them laser revised that same week. But this was week 12. I got him to latch maybe 2 or 3 times after that. I didn’t try very hard. I was afraid he would be hungry and unsatisfied, that he wouldn’t grow well, that he was too upset when trying. I basically gave up. I exclusively pumped for him for 10 months. And that was awful! Would never recommend.

Exclusively pumping means for most of us, a constant battle with supply. It was impossible for me to ever make enough to feed him without supplementing. I pumped every 3 to 4 hours, around the clock for awhile, to “establish supply” as they say. All it ever established for me was being in a complete stupor. I could make at most 18oz a day as my baby was eating 26oz a day and then later up to 30oz a day. I finally scaled back and pumped about 5 times a day only during daylight, meaning I allowed myself to sleep for 6-8 hours. I decided to freeze some milk and feed some milk so over time I could space it out and he could always have 10oz a day till he was a year old. It was hard as can be. I used an app called Pump Log, and as soon as I had enough frozen to feed him till his birthday, I was so glad to hang up the flange.

During the process, I spent about $90 a month on pump rental, as well as who knows how much in pump parts (I didn’t know insurance will often cover these), different size flanges till I found what worked, and even more on things like pumping bras, freezing bags, etc. I am doubtful I saved any money overall since I still had to buy formula too. Did it make him healthy? I don’t know how much I believe in all the hype. But in case it is real, he had breastmilk.

What I learned with baby #2 and wish I had known with baby #1, is nipple confusion isn’t really real. You absolutely can get a baby back to the breast after having a bottle. A baby really can remove milk way better than a pump and help with your supply. If you don’t “establish supply” right away, it’s ok, you can still increase it over time. The best tip I can give anyone who is thinking of exclusively pumping is to offer the breast, with a smile and soothing words, don’t push, be playful, try it when they are sleepy, try it when laying in a warm bath with them, make it a nice option, and when they refuse, don’t take it personally, don’t let them see you upset, don’t sweat it, at all.. just give them the bottle and try again the next time. I firmly believe most babies can be coaxed back to the breast in these ways. And if you find you can’t get them back, exclusively pump if you want but do not feel bad at all for saying heck with it. It’s such a hard path and ultimately, it took so much time away from my baby that overall I wish I hadn’t done it.

Mommyhood

Torticollis, my kid was crooked

Amanda Hannan

For 12 weeks I struggled with son #1 not latching. After some research I suspected he had a lip and tongue tie. I called in a lactation specialist and the first thing she said to me was, “oh looks like a little torticollis”. I had never heard that word.

But turned out there was an actual name for my baby’s head tilting to one side. We started physical therapy and went 2 times per week from 12 weeks to almost one year old. At the time we had a nanny and she and I would also do the stretches at home.

My best advice for dealing with tort is to treat it as early as you can. Eventually they fight the therapy. You can do just about if you use a silly song or a toy when your baby is 4 months old, but by the time they are getting around on their own, good luck!

Torticollis is from a stiffened muscle in the neck. It’s too short compared to the other side and needs stretched. It can be caused by laying one way too much or one of the now off the market baby apparatus. My son was smashed under my ribs and even though born via C-section, his head was a squished up mess. His lips didn’t even meet top to bottom at birth. I am pretty sure his tort started while tucked in the womb.

Most tort it seems can be treated by PT and stretching exercises. I did see in some groups I joined that sometimes they use surgical release or injections to help treat the tougher cases.

Sometimes tort goes hand in hand with plagiocephaly, a condition with a flattened area on the head causing asymmetry. Yep, we had that too. It often goes with tort because of the tight neck muscle. The baby doesn’t tend to move the head to the other direction and therefore the one side gets flattened. In our case I think the torticollis definitely exasperated plagiocephaly, but I think it was all there from him being breech and under my ribs. (More on plagiocephaly and helmets coming in another post)

One other point, occasionally the child may be tilting due to eye muscle issues. They do it on purpose to make their vision better. I have double vision when looking up and had a couple of surgeries to fix that in my 20s. For this reason, I did take my son to an opthalmologist to be sure, especially before spending 2 hours a week in PT.

Overall, in the big scheme of things, it turned out to not be a huge deal for us. We got therapy, stretched him out and he is totally normal now. At the time though it was overwhelming. I think anytime you have a baby who needs help in any way it can be overwhelming. There are decisions you must make for your child. It was the first time I was in that position, navigating my way through making the best decisions for him, this person I love more than life itself.

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Incompetent cervix

Amanda Hannan

In May of 2014 after a failed IVF cycle, we were super lucky on an IUI. It was a new protocol for me, low dose meds. My response was bad, like always, but fine for IUI. I had 3 mature follicles at trigger, two others not too far behind. We got the big BFP, big fat positive, and a beta of 92 on day 12 post IUI.

It was the first time I had ever had such a great number and was so reassuring. Even better, I knew it was a positive before seeing the pink lines just due to the overwhelming brain fog that swept through me. I remember the moment it first happened. We were in the grocery, I couldn’t recall what I wanted to buy and was way too tired to walk three aisles over to the dairy section.

Over the next couple of weeks we watched my beta skyrocket and finally got to a scan. We saw one sac and nothing much else. It was early though. We were leaving on a cruise and I wanted to be sure it wasn’t tubal. Sac in uterus, check. Once back we got another scan and saw 2 sacs in the uterus along with two beautiful heartbeats.

I remember thinking that surely I would get one baby out of this. I feel guilty about that thought sometimes, but after multiple miscarriages, somehow I felt like 2 meant my chances for actually having one was higher.

Things progressed and we finally announced around 16 weeks. I was showing already as I am very short waisted so nowhere to go but out. I was feeling pretty relaxed and like we were not only pregnant, but done with the whole fertility world. This was perfect, two in one. Life really had worked out so perfectly.

At my 13 week scan she was pretty sure they were both girls. We picked names over the next few weeks. I planned a nursery and started building a registry. I expected them to be born early, being twins, so picked a date for a shower.

At my anatomy scan, 18 weeks along, we looked over baby A and then baby B and then after all was so perfect, the technician turned white. She had seen my cervix was short. The doctor came in and explained everything to us but it didn’t matter, it was all a haze, like an airplane motor was outside my ears. I didn’t accept that I would or could lose my girls. I was put on bedrest and told to come in weekly.

That was a Wednesday. The following Wednesday I was leaving the hospital, so empty, no longer pregnant.

On Sunday night I woke up to sharp pains in my back, electric shock type of pains. I realized I was laboring. My cervix was open, baby A’s sac was bulging out. I called my OB whom I hadn’t spoken to since the MFM appointment and she told me to go to the hospital. I asked “is it over.” She said yes.

I went by ambulance to the hospital with the highest level NICU. It was the paramedics idea. I knew it didn’t matter, I was too far away from viability. Still I stayed there in bed, head down, for two more days. Eventually my water broke for the first baby and I was bleeding. My bloodwork showed infection. I was told I needed to induce or I risked losing my uterus or my life.

I fought it as long as I could but finally gave in. I took the meds and labored and delivered them. It was painful, my IV had infiltrated and they didn’t get organized enough to give me anything. My girls had heartbeats when they were born, but passed in our arms.

This is what my incompetent cervix story is. This is so similar to so many others. It happens fast, shocks you, and with no warning it takes your babies. If you are lucky, maybe you can make it long enough to make it to NICU. Maybe a cerclage can be placed. But often, the first pregnancy for us fails.

While still in the hospital I was researching all I could. I read about different types of vaginal cerclages, TVC- shidrocker, McDonald, TVCIC, and the TAC. I read about being on bestest after and success rates, some defined as getting you to 24 weeks on tons of restrictions. That all sealed the deal for me. I knew leaving there I would get a TAC, transabdominal cerclage.

So this isn’t a totally sad post I will end it with a quick update. I got my TAC in 11/14 (more on that in another post) and it has brought me two beautiful, full size, healthy little boys with absolutely zero restrictions. Actually really easy pregnancies. My doctor for this is a pure angel, Arthur Haney. I will forever know that he saved my life. He gave me hope when I was at my lowest. He showed me light when all was dark. He gave me my life back when he fixed me so I could have my boys. I hope everyone who goes through these losses finds someone like him.

Here is a link to my angel, Dr. Haney. https://www.uchicagomedicine.org/find-a-physician/physician/arthur-f-haney

And here is an FAQ on the TAC https://www.uchicagomedicine.org/conditions-services/pregnancy-childbirth/high-risk-pregnancy-maternal-fetal-medicine/conditions/incompetent-cervix-cervical-insufficiency/transabdominal-cervical-cerclage

In a follow up post I will be bringing more info about different cerclages and options for incompetent cervix, as well as the wonderful AbbyLoopers group, found here https://abbyloopers.boards.net/. And https://m.facebook.com/AbbyloopersforTAC/

Abbyloopers is the perfect place to start for support through IC, no matter where you are in your journey.

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Low AMH and the depressing news

Amanda Hannan

You got the news your amh is low.  Maybe you heard some stats that sounded awfully bad. Maybe you weren’t following everything that was said, but words stood out. Words like donor. Titles like DOR, or diminished ovarian reserve.  It’s one of those conversations no one ever wants to have and be sure, whoever is delivering the news isn’t happy to do so either. 


What happens next is typically a period of despair and depression until we finally get the strength to fight back.  It’s now when you need to focus more than ever.  
AMH levels are thought to correlate to how many follicles you have left. Some women take this so seriously that they believe that means it’s only going to go down, and in theory it should. The fact is, if you hang out in infertility groups long enough you’ll see women whose  AMH fluctuates, some even from low back to normal.  
In the fertility world low amh truly only means you are less likely to respond well to fertility meds.  It means the tools the doctors’ use to get women pregnant are likely going to be less effective.  Low amh makes the doctor’s chances of giving you success lower.  It does not mean you can’t get pregnant the old fashioned way. 


Think of it like this. IVF works to overcome infertility caused by male issues or no tubes.  It works by pulling out a lot of eggs, say 15, giving them the best shot at fertilizing by leaving them in a dish with a ton of good sperm or injecting with ICSI, putting a sperm directly into the egg.  Some will fertilize and some will not, some will grow and divide as expected.  Some will make it to day 5 and turn into beautiful blastocysts, a ball of cells of hope.  Maybe out of 15 eggs, the woman gets 2 or 3 blasts and the rest die off.  She has one of her blasts transferred or goes on to test them with PGS.


For women with DOR, that very same process can happen, but due to low response to meds, maybe they need to retrieve eggs 4 times to get the same 15 eggs.  It may take even more.  On all different types of protocols, I can make a maximum of 3 follicles.  Going through 5 cycles to get the 15 eggs for me would be too expensive.  And of course, even after all of that there is a chance it won’t work.  Overall, the first cycle works for all women only 35% of the time. 


For this reason, doctors often offer donor eggs.  Donor eggs are a tool to fix the issue of not being able to get the 15 eggs in one cycle.  It is a tool in their arsenal, the same as stimulation meds, or ultrasound machines, or embryo labs are tools.  When they offer them, they are not saying you can’t get pregnant with your own eggs, naturally or with assistance.  They are saying that there is a tool available that can overcome a hurdle.


The good news is that AMH does not speak to quality.  Everything I can find and all my years in my groups points to age as the best correlation of quality.  If you are 25 and have low amh, the eggs you do have should be as good as a 25 year old with good amh.   Low AMH itself is usually not a cause of infertility.  IVF is typically not the answer to low AMH. 


If your tubes and sperm are good and you aren’t getting pregnant, I always suggest people consider having a natural cycle monitored.  This means getting bloodwork and ultrasounds throughout your cycle and looking for anything abnormal.  I did this once and I surged to ovulate with a small follicle and just barely ok lining, and I already knew my luteal phase was 5 to 8 days.  Would IVF fix that? Sure, but it’s overkill. Like getting IV antibiotics for a sinus infection. 


My main point with this post is that low amh is not the end.  I have met a ton of women who have had babies with low AMH, many naturally, many with help of some sort.  It feels devastating but it isn’t the end.  Remember, women over 40 have been having babies forever and their AMH is low naturally.  


Take the amh value for what it is, one indicator of how you are likely to respond to stimulation meds.   Still, if you need IVF due to your partners sperm or bad tubes, remember it is just an indicator. Some women with low AMH respond well, some women with normal AMH have poor response.