Tough Talk about Crazy Pills.

About 8 years ago, I went through a really deep, dark and scary depression-anxiety combo platter. It was not my first bout with depression but it was the first time that anxiety rattled my brain and left me a house-bound mess. I dutifully went to therapy and practiced yoga on the rare occasion when I could peel myself off my couch. I tried my damnedest to get through it without medication. I couldn't do it. Believe me, I gave it the good old college try.

After truly suffering for about 8 months, I finally succumbed and started anti-depressants (SSRI). Within weeks, I felt as though somebody had flipped on a light switch in my body. The fog began to lift. Dramatically. I laughed, I enjoyed myself, I stopped constantly crying hysterically for no real reason. I had felt like horrendous doom was around every corner and then POOF! doom disappeared. It felt like nothing short of a miracle. It still does. Three years ago, I tried to go off of SSRIs to prepare my body for getting pregnant. We weren't yet trying and I wanted to see if I could do it. Under the care of a psychiatrist that specializes in women's health and pregnancy, I slowly weaned myself off. It didn't take long for the light to switch back off and the fog to descend. Once again, I fought for over half a year before it dawned on me that it would be pretty hard to get pregnant if nobody wanted to sleep with sad, angry me. And so, I went back on. It was hard. I struggled significantly with that decision. Shed a whole lot of tears. At the end, I knew that to be a good mother - both while pregnant and after - I needed to be a healthy, sane and happy person. For better or worse, anti-depressants are part of what help me feel like me instead of a sluggish, hateful zombie. They don't work for everyone. I'm lucky that there's a solution out there for me.

I know that SSRIs carry risks to babies. The most well documented risks include PPHN (persistent pulmonary hypertension of the newborn) and heart defects. These risks are very low but they do exist. Depression during pregnancy also carries risks: pre-term labor, low birth weight and elevated cortisol levels at birth.

What's a crazy girl to do? I can only remark on what I've chosen. I'm on sertraline (Zoloft) - the SSRI considered the "safest" during pregnancy. While I still occasional doubts about my choice, I know that my mental health is critical to the physical health of me and my future baby. There are no awards given out for abject suffering and one must deal with the demerits.

As a fertility patient, I've been making choices about my own "greater good" for some time now. Since I started on medications designed to hyper-stimulate my ovaries one year ago, I've knowingly been ingesting and injecting drugs that increase my odds of getting ovarian cancer later in life. I see this as part of the difficult trade off of modern life and medicine: we have access to drugs, hormones, and procedures that we never had before. We can survive cancer, get pregnant despite a slew of otherwise debilitating factors, test for genetic predispositions, eradicate diseases that once killed thousands, transplant organs and implant devices that make our hearts beat. On the other hand, we pickle our food with hormones and pesticides and cloud our skies and water with pollutants, some of which may cause the very conditions we work so hard to cure. I realize that my choice to stay on anti-depressants while trying to limit my gluten, dairy and caffeine intake is in some ways ridiculous. Infertility makes you nuts, what can I say?

This was all brought on by an email I received this morning from my father-in-law. He sent this link regarding anti-depressant use during pregnancy to me, J, his daughter (also struggling with infertility, also on anti-depressants) and son-in-law. A professor at the National Institute for Health and Care Excellence (UK), states in the article that the risks inherent to SSRI use during pregnancy for women with mild to moderate depression "are not worth taking." I don't believe that my depression is mild or moderate, though who is to say? It's a deeply personal, subjective assessment. It is very easy to say that there are no risks worth taking when it comes to pregnancy and the health of your child. The decision is far harder when the "safer" road presents the risk of mental illness for the mother and a set of different, perhaps less precarious threats to the baby.

My father-in-law meant no harm. He wants us to be safe and his future grandchildren to be healthy. Believe me, so do I.  My first reaction to the email was rage, then sadness and now, calm rationalism. Here is the informed choice I made after many years of anguish and research. I do what I can and pray that my choice will one day matter at all. 

The last real day - 8dp3dt

I am considering this the last real day before my blood test. (I honestly can't bear using the words "pregnancy test." Perhaps I'll pretend I'm being blood typed or something as I sit in the chair with my favorite salsa dancing lab technician. I don't know his name, he probably knows mine or my patient ID. All day he listens and sings out loud to old school salsa. I love it. It's much easier to distract myself while he croons.) I say the last real day because A) I am a child and have a warped sense of time and B) tomorrow is Good Friday and I have the day off of work. Tomorrow will be a fun day to simply fritter away. I might get my bangs trimmed and visit my grandma. It might be that wild and crazy. That is, after I complete the Stations of the Cross. Um, not really. I don't actually even know what that means in a practical sense. I figure it would require prayer and walking on my
knees on stone flooring.

My single goal for today is to be productive at work (good start, eh?). This is a formidable task since I spend much of my day sitting in front of the sickly glow of Dr. Google. Don't google today. There is nothing to be found. There is no magical combination of search terms to tell you if you're pregnant or not, or what medications you should be on next time if there is a next time.

Is it horrible to admit that I think there will be a next time? And that I'm not all that upset about it? Not really. I just expect it. When you've been on such a long road, it's very hard to imagine that you'll ever get to pull over and take a nap. Long distance trucking is an absolutely apt description for infertility.

On this last real day and last real blog post before my blood donation, I wanted to do a little product placement. Here's to you, Tylenol! The only drug I can take during IVF and pregnancy. Cures about 7% of what ails ya. Seriously though, this fertility haul has made me look a lot at my diet. I never ate particularly unhealthily but I have made a few real changes to my diet. First, I scrapped my dependence on caffeine. It hurt. Terribly. But just for a little while. I went from 2-3 cups of strong coffee a day to zero with an occasional cup of decaf to get me through the shakes. I weaned myself slowly going from full blast to half-caf to decaf and then nada. I drank green tea for a while, mostly decaf, but got really tired of it. It is an uninspiring hot beverage and, according to my acupuncturist (yep, I've gone all crunchy granola these days), too cooling to the body. These days I'm allowing myself black tea or homemade chai with almond milk in the morning. It's caffeinated but pales in comparison to a grande dark roast. Product placement #1 - Lipton Yellow Label and Twinings English Breakfast.
Another change has been my full acceptance of the fact that I'm lactose intolerant. No more grilled cheese sandwiches with creamy soup. Worst of all, no more ice cream (well, a very occasional treat). It's remarkable how grateful my digestive system is. Product placement #2 - Almond milk. Any brand. Thank you.
The most difficult change has been avoiding gluten. I don't eat completely gluten free. I don't have the patience nor the ill-effects of a true gluten intolerance to inspire me. While I'm certainly not any shade of Celiac, I have learned that gluten is an inflammatory and is thought to affect fertility. And since my fertility is certainly affected, I thought I'd give going gluten-free (or gluten-limited) a whirl. I don't know if it's affected much of anything. If anything, it's kept me from being so carb dependent. I know that this is not a change I'll incorporate into the rest of my life but it gives me a sense of control for now. One of the hardest things about infertility is the feeling that you can't control your treatments and the outcome. Diet is one productive thing to grab hold of. And with that, product placement #3 - a shout out to Ancient Harvest quinoa spaghetti, Udi's Gluten-Free breads, Pamela's cookies, herb bread from Marie Catrib's of Grand Rapids, MI and rice crackers. Ok, looks like I'm just as carb dependent as before.
Finally, phyto-estrogens. This is sort of a minefield and one I choose not to drive myself crazy with. I've got plenty of crazy. Soy is a phyto-estrogen and can negatively impact your hormonal balance when consumed in large amounts. So I simply limit my tofu and soy milk intake. That's it.
Is any of this making a difference? Who knows. All of the changes I have made simply feel like healthy ones. I haven't lost any weight and have only seen digestive benefits. I'll spare you the details. Much of this won't all stay with me when infertility is behind me. I miss coffee and bagels too much. Together and separately. Coffee and bagels, I will come back. Just not yet.

What diet and lifestyle changes have you made to reach a goal, fertility related or otherwise?