Heather Kirn Lanier’s article on raising a daughter with Wolf-Hirschhorn Syndrome might seem removed from my life experience, but it home for me, as I’m sure it will for many of you.
Too often, I feel like I am to blame for being sick, for having Rheumatoid Arthritis. Like somewhere along the line, I did something wrong. Had the wrong diet, was too stressed out, was too hard on my joints.
And on the days I am strong enough to not believe that I caused my disease, I have to live with the fact that other people do believe it. They think that I wasn’t [insert fun adjective here – fit, healthy, happy, mindful] enough. That if I’d [insert condescending verb here – taken vitamins, run more, meditated], I wouldn’t have RA.
Well you know what? Fuck that.
The article isn’t about RA. It’s largely focused on motherhood, something I’ve yet to experience. But it doesn’t matter. It resonates just the same.
I’d believed I could control the body because I could not stomach the truth: that the body is fragile, ephemeral.
Here’s the thing. If you buy into a false narrative that the body is controllable, that illness can always be prevented, then by proxy you are left with a disturbing, damaging, erroneous conclusion: the belief that a person’s disability is their fault.
Perhaps the point of life was not to achieve some kind of perfection. Perhaps illness was an integral part of life’s dance. Perhaps fragility was built into our very design. Perhaps fragility was also strength.
So the affirmation-uttering woman might more honestly say into your ear: It will not be easy, and it will not be comfortable, but it will be, and you will become.
Here’s a challenge: love your body.
I mean it. Dance in front of a mirror and tell yourself your beautiful.
Love your tall, your short, your skinny, your fat. Love your freckles, your dimples, your birth marks. Love your hips, your boobs, your butt.
Love your joints that don’t quite straighten. Love your rheumatoid nodules. Love your body’s quirks and imperfections.
I mean, why not?
Next time you catch yourself “if only-ing” about your body…. If only my eyes were blue. If only I lost 10 pounds. If only my face was perfectly symmetrical. And I was taller, thinner. And I could run without sweating. And eat without gaining weight. And stand on the beach as though salt water were a hair product.
Breathe. Love. Embrace.
So, this is how it was supposed to go! Two painless weeks of hormones and 9 mature eggs now in the freezer.
After my canceled round a couple of months ago, I was feeling pretty discouraged. I took a month “off” to prep my body for a second round.
Of course, “off” in the world of fertility meant a month of testosterone gel, progesterone, estrogen, and blood thinners. So, the month off was taxing, but it let my brain take a break and forget about eggs.
Then, day one of my cycle came. The ultrasound brought news of another cyst. Last round, the cyst had been a showstopper and I chose to spend money to have it drained so I could continue with the hormones.
This time, the cyst was small enough that they gave me a choice: wait another month for it to go away, have it drained (for yet another $600), or continue with the hormones and risk the cyst growing as well.
My nurse told me to listen to my gut, and my gut was telling me that it had been a waste of money draining it last time and obviously my body is prone to cysts, so waiting it out didn’t seem rational. I opted to begin the hormones: Menopur, Omnitrope, Gonal-F and Clomid, this time at higher doses than the last round.
And this time around, in spite of the extra shots each day, I found it relatively easy. Giving myself shots wasn’t as emotionally taxing as last round and my body wasn’t bruising anymore (in spite of still being on blood thinners).
I eagerly awaited for day 6 when I could find out how my eggs were growing and whether the cyst was messing everything up. Last time the news on day 6 was that I only had four eggs growing, but two were so far behind, only two would be mature by my retrieval date. This time, I had 11 good-looking possibilities and my cyst was growing slowly enough not to be a concern.
After that, it was continued hormones, daily morning ultrasounds and bloodwork, and daily afternoon calls from the nurse. To my surprise, everything was growing right on schedule. My body was responding well and things were looking good.
Finally, I got the news that it was time to take my trigger shot. The shot had to be taken at exactly 8:30pm so that surgery could take place exactly 36 hours later. It was my fist time giving myself an intramuscular shot (versus subcutaneous) and I was super nervous. To my surprise, it was relatively painless (though I was pretty sore afterward).
My partner drove me to surgery 36 hours later and that went smoothly. No pain during or after and I didn’t even get sick from the anesthesia! I am very happy that we got 9 mature eggs (so much better than the 2 from last round!).
Seriously, after all the complications my body has thrown me, I was shocked that things just went well.
One major bonus of this whole process: I’m still off of methotrexate and my RA symptoms are under control. I still take Enbrel (and I will never complain about one shot per week again!), but my rheumatologist and I are going to try to keep me off methotrexate. I’m so excited to be down to one RA drug!!
Day 1 (Thursday) – The day I wonder why everything is so hard.
I would have started this whole process last month, but I had a totally normal, randomly occurring cyst form in my ovary. I opted to wait a month to see if it goes away on it’s own.
I’m not really in a time rush after all, but I am very eager to get this show on the road. My “chem lab” and “pharmacy” have taken over my apartment, my vacations have been perpetually put on hold; let’s grow these future babies!
Well, one month later, I found out my cyst is still there. I couldn’t help but start to wonder if I’m destined for literally every medical thing to be more complicated than expected. Tried to push the thought away.
Day 2 (Friday) -The day the hardest part is just the beginning.
I opted to get my cyst aspirated versus go through another month or more of waiting to see if my cyst decides to go away on its own.
This was a hard decision because it was an extra $650, a three hour round-trip drive to the clinic in rush hour, and a needle-in-the-ovary procedure.
Met some friends for dinner who tried to encourage me…
Them: “You’ve had a needle pushed into your ovary – you’ve already been through the hard part!”
Me: “But I haven’t even actually started yet…” (cue appropriate use of crying/laughing emoticon)
Day 3 (Saturday) – The day I start hormone injections.
Luckily, being the RAD person I am, I have plenty of experience with injecting myself. The thing I don’t have experience with is mixing my own drugs… which I managed to mess up.
In my defense, it was early, I was running late, and I was a caffeine-addict avoiding coffee. So I grabbed 1ml of sodium chloride from the first vial and pushed it in the menopur vial without paying much attention. I took a look and it looked the same as it had before. Conclusion: the menopur vial must have been empty!
I pull the 1ml of liquid out and combine it with a second menopur vial, noting that this one most definitely has drug in it. The resulting liquid looks identical to before. Oops.
I troubleshoot and add an additional ml of sodium chloride to dilute it back to the required dose and then take half of it.
But then the internet scares me by saying you can only store it this way for 15 minutes.
Frantic call to the emergency nurse line and she told me I could store it for 24 hours and use it tomorrow morning — phew! Disaster (or really wasted money) diverted.
The nighttime shot went more smoothly.
Day 4 (Sunday) – The day I become an injection pro (and a living, human pin cushion).
Sunday happens to be my Enbrel day. Combine that with a genetic disposition of blood clots, which means I need blood thinners when messing with estrogen, and I had a whopping four self injections today. Go me!
Here’s what I’ve learned:
- Hormones have the smallest needles and don’t sting
- My blood thinner (Lovenox) has the widest needle which makes the injection site bruise and makes it hurt (seriously, who designed these things?)
- Enbrel has the longest needle of the bunch. WTH, Enbrel?
I also learned that brewing up eggs is hard work – my body is in RA flare fatigue status.
Day 5 (Monday) – The day I perfect my inner pep talk (aka talking to myself).
“You got this! Feed those future babies! You’re a needle ninja!”
– me, to myself
That’s right, I’ve started talking to myself before injections. And maybe my cat.
I was late for my nighttime injection because IKEA is like a black hole time suck, but other than that I’m feeling like I finally have a handle on this.
Hormones? No prob.
Day 6 (Tuesday) -The day this becomes tedious and I question everything.
This morning I went in to get blood work and my ultrasound. Then it was the waiting game.
You go in the morning to get labs, then they get sent across the city and you have to wait until the afternoon for results.
But I had a feeling the news wouldn’t be good. The ultrasound nurse counted five follicles that had shown growth. Five!
This is down from a resting follicle count of 21 and a hope for 15-20 eggs to come out of this.
I couldn’t help but cry in my car on the way home. Why is my body constantly making things more complicated? Why am I doing this to myself? What if I’m never supposed to have children?
That afternoon I broke the golden rule and hopped on Google and discovered that some people start out slow. I felt hopeful.
My nurse was pretty encouraging as well, telling me to wait a day or two to see my progress.
So I distracted myself with Pitch Perfect and ice cream and hoped for the best.
Day 7 (Wednesday) – The day my disappointment is crushing.
The news at this morning’s ultrasound wasn’t great. Five follicles, one not growing at all, two growing out of pace with the two biggest.
Tears. Lots of tears.
And talks with a supportive partner and supportive friends.
And, finally, talks with my nurse in the afternoon who left it up to me, but suggested I could cancel this round and try again next month with more aggressive hormone treatment.
My doc says that what he would advise his wife to do, so that’s what I’ve decided to do.
So goodbye to this month’s possible future offspring. Goodbye hundreds of dollars of drugs. Hello bruised stomach and thighs. Until next month….
Perhaps this could be relevant to other autoimmune disorders, such as rheumatoid arthritis, as well?
Does rheumatoid arthritis effect fertility?
My fertility doctor thinks so, citing this study, but my rheumatologist disagrees. This lack on consensus means women aren’t counseled on this possibility by their rheumatologists and there is a general lack of information out there on the subject. But where does this uncertainty leave women like me, who are diagnosed with RA in the prime of our reproductive years.
In fact, women like me, who are diagnosed with RA before giving birth to their first child, have fewer children, possibly due to being on medications like methotrexate, which is linked to birth defects and therefore can’t be taken while trying to get/being pregnant or breastfeeding. It could also be because we’re choosing not to reproduce, fearing the burden of childbirth or raising a child with RA or passing our genes to our children.
It wasn’t until I was prompted by a gynecologist to test my ovarian reserve levels that I even gave this matter any thought. But now after being told my ovarian reserve is low, potentially due to RA, I do wish my rheumatologist would have told me to consider the possibility that my fertility might be effected by my RA earlier.
Had I considered this, I may have aligned my path to coincide with getting pregnant earlier or perhaps chosen to freeze my eggs earlier, a journey I’ve just set out on at age 33.
There are very few studies on the topic. This one, focusing on Systemic Lupus Erythematosus (SLE), found a higher correlation of SLE in infertile women than the general population, but the small sample size rendered the study inconclusive and its unknown if it would translate to women with other autoimmune diseases.
Others suggest that the higher incidence of inflammation which comes hand-in-hand with many autoimmune diseases could make it more difficult to carry a pregnancy to term. Autoimmune ID, a condition where your body’s immune system might attack an implanted embryo, resulting in a miscarriage, is more common in women with rheumatoid arthritis and other autoimmune disorders.
What’s more, it may take women with RA longer to get pregnant, perhaps due to trying to coordinate disease flares with needing to get off medications that would be harmful to the fetus.
Another thing to consider: autoimmune diseases may cause irregular ovulation, which can lead to more difficulty getting pregnant.
I don’t want to be too negative though, because many women with RA do successfully get pregnant and give birth, both naturally and through IVF. And one thing my rheumatologist and fertility doctor agree on is that, if anything, RA symptoms should lessen during IVF treatment as they do in pregnancy.
So what does this all mean? Does rheumatoid arthritis effect fertility? And what can we do about it?
Unfortunately, the answer is as unclear for me as when I started my research. I’ve taken all this inconclusive science, along with my own bloodwork showing low ovarian reserve, and my age (33), and have chosen to freeze my eggs with my partner’s support.
You’d think someone with RA would be used to their apartment being overrun by medications, but IVF takes it to a whole new level.
Here’s what my linen closet now looks like:
And here’s my fridge (my Enbrel now has company!):
And my kitchen counter:
I’m nervous about taking all the medications and what they might do to my RA symptoms, but I’m also feeling empowered about living in a time when I have the opportunity to freeze my eggs and get a bit of a fertility boost from science.