Eco-tip, and questioning ingrained habits

potato
Not an excellent photo, but they sure were delicious!

The eco-tip is simple: when cooking baked potatoes, skip the foil.

I’ve had many meals of baked potatoes* but only recently have I been cooking these without the use of aluminium foil. It’s kind of surprising that it took so long to realise this. I recall that I even googled ‘do you need to use foil when baking jacket potatoes?’ before I was willing to risk it. Yes, wrapping up a potato in foil and throwing it into a hot oven is easier than using a dish, which has to be cleaned afterwards. But aluminium (or aluminum) foil is something that doesn’t break down in landfill and we have a pretty nifty and efficient dishwasher so I’m not worried about the small amount of water and detergent usage with the new method. It wasn’t the sustainability considerations that was stopping me previously though, it was that I thought that was the way you baked potatoes, and therefore that the foil had something to do with achieving the tasty end product.

As it turns out, I think they’re even tastier without the foil. I do parboil the potatoes for 10 min or so before the oven. This helps prevent the outside of the potato cooking before the inside during baking, but also has the benefit of getting potato into your belly sooner. Don’t forget to splash a bit of olive oil and salt onto the potatoes before baking them.

*Yes, I consider baked potatoes a satisfying and healthy meal option, even with butter, cheese and sour cream added. It’s all about balancing out the starch and fat with a good salad/other veg such as broccoli and any other imaginative topping you can think of/have at hand. We always end up having baked potatoes in winter when using up the last of a big batch of chilli, for instance.

I bet there are plenty of other wasteful practices that we do out of habit around the house. It’s almost become a game for me to stop and consider where I can create less waste/use less resources, and every small change in behaviour therefore feels like a win.

I will concede that wrapping a few potatoes in foil is something that I will continue to do whenever we go camping, so that we can cook them in the ashes of a camp fire. Hmm, that makes me wonder… there are no banana trees around here but perhaps there is a similar type of leaf that would stand up to that pressure…

Messy lettuce

It’s summer in Australia, the predicted weather for today is 37 degrees C (98 degrees F). Also, we are not getting much rain. We did get a little the other night, for the first time in a month, but the water tanks are still practically empty. So it’s not surprising that my lettuces have bolted.

mauve_lettuce_flower
The red lettuce in the back still has some tasty leaves, even though these have bolted too. The green ones are too bitter at this stage.

lettuce_bolt.jpg

I guess this looks a little messy, a little weedy, but i’m happy to let these go to flower. Up close, the flowers are very nice actually:

yellow_lettuce_flower.jpg
perfect little yellow circles form, even though the petals are square-edged

And after all, none of these lettuce plants were actually planted by me, they all came from seed after the last ones put out flowers. That’s how a couple of them even managed to escape the wine-barrel bed and grow between the pavers.

brick_lettuce
back when it was just baby lettuce… and tasty 🙂

Hooray for self-sowing edibles!

Second opinion

I haven’t been blogging much, I’ve been too busy with the new job, buying gifts, etc. For the sake of continuity though, I wanted to write this update about what happened when we got a second opinion about my chances of reproduction.

I’ll start with the short version first: The second doctor didn’t give me any hope either. He didn’t recommend trying any assisted reproduction, although he did acknowledge that it was a very personal decision, and an emotional one at that. His medical opinion, based on the medical history we gave (which boils down to a few hormone tests really) and his not-insignificant experience, was that I wouldn’t be releasing any eggs.

I’m not at all bummed out by this, even though some might expect that reaction. I’m also not surprised by the response of friends when we briefly mentioned that we were perhaps, maybe, considering IVF/ART, with the first step of obtaining this second opinion. Their response was excitement for us, or thinking they were ‘joining us in excitement’. I can’t speak for my husband, but I was anything but excited at this prospect. Part of that was that I expected this answer from the doctor. I’ve read the scientific literature surrounding this situation. Over the years the message has slowly been changing from ‘premature menopause’ to ‘Well, there are a lot of similarities to peri-menopausal women, although we don’t really know why that is. The outcome, however, for these two groups of women is usually the same (nearing the end of their reproductive life stage). Usually…’

One of the reasons I chose the doctor that I did was that he came highly recommended by the ART provider that he is affiliated with. There are two major IVF/ART providers in Australia (although there seem to be more and more smaller companies getting involved…). My last doctor was affiliated with one of them, and this new doc is affiliated with the other. I figured this could give me an idea of how these organisations deal with women like me, with ovarian insufficiency. The answer is that they don’t. Not really. There is not much point getting upset about that, the state of the technology is just not there. We don’t understand ovulation well enough. Ovarian insufficiency occurs for 1% of women under 40, and we rarely know why, let alone if it can be ‘fixed’.

Getting back to our interactions with the new doc, I could tell that he wasn’t across the newest findings in relation to ovarian insufficiency. I was probably an annoying patient, asking highly technical questions and interrupting his explanations because I didn’t require the long answers he was giving (we only had 30 mins for our appointment and I wanted to get our moneys worth!). But he used the term ‘ovarian failure’ (which is what my previous doc had written on her records), rather than ‘ovarian insufficiency’ (which I had written on the medical history form). I could also glean that he believed that ovarian failure essentially meant menopause, done and dusted. And I know that’s not quite right.

One quite useful thing was that he convinced me to not be concerned about endometriosis. I’ve previously worried that endometriosis could be an underlying factor in my subfertility, and that in turn makes me wonder that I should perhaps do something about it (but equally perhaps not). The reassuring explanation for the data in Nieweglowska et al 2015 is that these types of endometriomas are the easiest to image via ultrasound, therefore I would know if I had those on my ovaries (I’ve had them scanned a few times in the past few years).

There were lots more thought-provoking things that came out of our doctors appointment, but that will do for this little update. I think we left it at ‘This perhaps requires more thinking, and a resolution of emotions before any final decisions are made’. I’m generally pretty terrible with decisions, especially any that require figuring out emotions! So any further thought on possible ART attempts can definitely wait till after Christmas, if not longer. I suppose if the decision process takes too long, then that is a decision in itself. And that is totally fine.

hill_scene

Feelings about assisted reproduction

My posts are not normally written in ‘real-time’ but last Monday I wrote down what I was feeling at that moment:

Today, right now, all I’m feeling is defeatist. I can’t be bothered, I’m over it. I think I see now why other infertile women live in seemingly endless hope, because you have to have something to keep you going. I’m trying to be pragmatic about the whole thing but it’s not enough. I would like to have children but I don’t want to have to put that much effort into it. Is that a terrible thing to say? I can imagine the responses I would get if I actually said this out loud to someone. “The decision to have children should not be taken lightly, so it should always involve mental/emotional effort”, “Once you have children they are going to be a whole lot more hassle than organising these medical appointments, so you should get used to it”, “having children is the best thing ever, all of this will be worth it”. But I just can’t get over the fact that conception for us is just that much more difficult and a financial and emotional strain.

I’ve got the appointment later this week for a second opinion. I start my new job tomorrow, so today is the perfect opportunity for me to write down carefully worded, precise, succinct questions for the doctor so that we can get maximum value out of our $250; 30 minute appointment. It’s now 5 pm and I haven’t done that yet. There have also been a few admin hurdles to jump through (referral letter not quite right, previous clinic won’t release my results), which might cost me money and time. No biggie right? Especially if you consider that all of this is supposed to lead to our firstborn.

Right now though I’m fuming, frustrated and despondent about the fact that it’s not easy. These feelings are justified somewhat by the knowledge that all of this might not result in our firstborn. The chances of success are not great (according to Seifer et al. we only have about a 50/50 chance of obtaining an embryo for transfer after stimulating my ovaries and a less than 1/10 chance of an actual baby being born). And the last thing I want is to be chasing after something that is unlikely to happen. Maybe I don’t deal well with failure. Maybe I don’t deal well with hope.

Mostly what it boils down to is wanting to yell out “why do I have to deal with all this crap! When other people just had to have sex?!”. It seems the modern fairy tale these days is that we all try and build a life we like while delaying the more ‘grown-up’ activities, most of all the ultimate responsibility of parenting. We delay because we don’t feel ‘ready’, but then one by one we take the plunge and find it’s wonderful, really. If it was up to me I’d be happy to delay a bit longer, but instead I’m being told that I probably should have done it yesterday and now there are a bunch of forms to fill out and fines to pay. Ugh. A large part of me would like to throw up my hands and just leave it all to ‘the will of the gods’ (if only I was religious). There are times when I think “it’ll only be a few short years before I’m 40 and then I can give up all hope”, and this with some relief. But then there is the hope that I do feel, the pregnancy tests that I take ‘just in case’ and I guess it would be silly to not put a little effort in. I really shouldn’t be concerned with the money, we can throw a little at this issue (even if I would sometimes prefer to give any extra to charity!). The administration/legal issues regarding medical records really do make me angry and rightfully so, this stuff should be easier. People with more serious diseases have to deal with this bureaucratic mess all the time, and I feel for them.

***

Now it’s a week later (after quite a busy one, hence the lack of blogging). We’ve had the appointment, and obtained our second opinion. I’ll write again soon to share how I feel about all of that, which I’m still processing to be honest.

P.S. I generally try to keep this blog upbeat, because life is marvellous, infertility notwithstanding. Writing my feelings down has always been therapeutic for me, and I felt a whole lot better after writing the above paragraphs last week. At first I wasn’t sure if I was going to share, but if this brings comfort to another infertile woman/couple then that’s worthwhile. This postscript is to reiterate that the last thing I want is anyone’s sympathy.

desert_flower
I could say something cheesy about blooms in a desert… but really this is just a random photo

Back in the game! And a word on identity

Which game? The game of life! That might sound a bit dramatic but that was how I felt last Friday when I heard I have a new job. Being unemployed and also not a mother had left me a little adrift. It’s been more than a year since I had a paid job. It took quite a while to become comfortable with the situation, and even quite a while to figure out why I was uncomfortable. I should have been happy, my last job sucked* so now I was free. My time was my own, I had the luxury of starting all those rainy day projects that I had been meaning to get around to. And I had time to figure out what the next steps in my life were going to be, instead of rushing into something that I wouldn’t really enjoy.

*The job itself wasn’t that bad, it was however, a terrible fit for me at the time and certain aspects of it drove me crazy no matter how hard I tried to not worry about them.

hobo_clothes
gone are the days of dressing like a hobo…..well, reduced, anyway

Instead of enjoying my time and exploring new exploits I spent many days in a funk, bummed out and generally not feeling very inspired. Even though I’m an independent spirit it can still be hard to be self-motivated. At the same time I was recovering from the knowledge that my ovaries were no good. I’m truly sorry if this offends anyone, but even though I’m in my mid-thirties, having children still seemed like a fall-back option to me. This is not a sentiment that I’ve come across on any other ‘infertility blog’! It’s not that I’m specifically looking for a child-free lifestyle, rather that I wanted to find my own sense of purpose before becoming a mother. I never saw myself as the ‘mothering-type’. Some friends have actually commented that this would work in my favour as I would not likely turn out as a ‘helicopter parent’.

When I was a teenager I struggled with the question of ‘what do you want to become?’. I was good at school so my choices should have been many, but for whatever reason I had trouble visualising becoming any particular profession. In the end I chose science because I was looking for something useful and interesting. Fast forward a few years (or decades?!) and I found myself with a failed science career, the inability to cope with a well paying yet mind-fuck of a 9-5 job and infertility. The infertility seemed like another nail in the coffin. I wanted a really stimulating science career, but that didn’t work out so I compromised and got a more standard job, but that didn’t work out so I thought ‘at least I can provide my family with children’. My feelings of failure were not so much along the lines of ‘I am built to bear children and that is my role as a woman’, as ‘I tried to have a career before I had children and now I don’t have either!’. I found myself back in the same place, mentally, as when I was a teenager, wondering what my place in the world was and doubting what I had to offer.

And it’s hard when your friends are busy with their own stuff. Their own careers and their own family-building. All of my friends are wonderful women (the lads are OK too), and many of them maintain an interesting job as well as looking after their children. I’m sure it’s not easy, and I guess I could be an object of envy, living a life of leisure, without the ‘hassles’. However, life isn’t all beer and skittles, at least not my version of life. In fact, if you had a chance to try it (living a life of leisure), you’d see as well. We all need a sense of purpose. For some, building a loving family can be enough, and I pass no judgement on that, really. For me, I want something else, and then I’d love to have children so that I can help them find their something else too.

The funny thing is, that this job has come along at a time when I’d brushed aside my doubts and insecurities and was starting to feel quite purposeful in the many little activities I have going on. I’ve learnt to stop saying “oh, nothing” when someone asks me what I’ve been up to lately. Even if I’ve just been pottering in the garden since they’ve seen me last; it’s learning, and smile-inducing, and definitely ‘growing something’! And hubby and I have been talking more and more about our dream of having a small business, so we’ll keep growing that too. And I no longer have days where all I have done (apart from housework, which is definitely too boring to mention), is mope about my various failures or shortcomings. Maybe who I am and what I choose to do is a little more difficult to explain to people, but that’s ok too.

It took some time but I learnt to love my lifestyle of continual learning, and efficient resourcing, and music and good friends and new things every day. Now I get the chance to contribute to science once more with this new job (hurrah!) and the best thing is that it’s part-time, so I can keep the other dreams and me-affirming activities going too 🙂

leaf_garland
Now I can say what I ‘do’ for a job, as well as telling people about my hipster craft efforts such as this leaf garland

Endometriosis and Anti-Mullerian Hormone levels

I’ve mentioned in a previous post that I have wondered in the past if I might have endometriosis. Endometriosis seems like a really tricky disease in that many of the symptoms can be vague (bloating, fatigue) and it can be present even when there are no symptoms at all. The most common symptom is period pain but we are told (by doctors and everyone else) that period pain is normal and just part of being a (reproductive) woman. Lately when I’ve had a period (irregularly) the pain that has come along with them has been stronger and stronger. Last time I was kept awake at night because I couldn’t sleep through the pain. That’s the first time that has happened. Another reason I have dismissed this pain in the past is that I know a certain drug works like magic on the pain (I didn’t have any naprogesic last time, but I’ve now stocked up for the next one!). So there has never been a reason to ask a doctor about endometriosis, because if I do have it, it doesn’t seem to affect me too much. But perhaps it has? Is it possible that endometriosis has engulfed my ovaries to such an extent that they can’t release any eggs? I really don’t know if that is a possibility but last week a new hint of evidence in this direction was published (Nieweglowska et al. 2015).

First of all, I love a study that publishes the raw data! Figure 2 in Nieweglowska et al. shows the AMH levels of all of the women in their study, plotted against the women’s ages. The women with ‘low functional ovarian reserve’, that is, low AMH levels for their age, all seem to have endometriosis. And the women with lowest AMH levels have endometriosis growing/present on both ovaries (bilateral ovarian endometriomas, BOE). So maybe these women are like me? There are other similarities too, half of the women with BOE had pain-free periods and most of them did not have heavy periods (mine are light/normal). So, while I do not know if it is a contributing factor in my subfertility it is certainly possible that I do have endometriosis.

Another factor that makes me wonder is my small uterine cervix. Before I had my anti-mullerian hormone tested I went for a HSG test, a hysterosalpingogram. This is the test where they squirt dye up through your cervix and into your uterus. The idea is it flows through your fallopian tubes and this is all watched via x-ray. If the dye doesn’t flow all the way through then perhaps your tubes are blocked or some other such problem that may be preventing conception.

I went in for a hsg, and paid the 400-odd dollars for the procedure, but I didn’t find out anything about the state of my tubes. The doctor couldn’t inject the die into my uterus. I had been warned that this procedure can be painful, and it sure was. There were repeated attempts by the doctor/radio technician at finding my cervix, by sticking the sharp needle and various other implements in the region, but nothing opened up. The nurses in attendance (yup, there were at least 3 people peering up into my vagina looking for my cervix) were really nice about the whole thing saying things like ‘don’t worry, I’ve seen this before, it doesn’t mean you’re abnormal’. I was mostly peeved that I still had to pay out of pocket for the test even though I didn’t get to find out about my tubes. The fertility specialist had ordered this test and she seemed to think it was odd too. So she asked me to open my legs in her consulting rooms so she could have a look too. She had just as much trouble finding the cervix, and even asked me more than once if I was sure that I had periods (yes, there are no mistaking those!). Eventually she did find it, and similarly reassured me that it was just small because “I had never used it” (obviously I have used it to menstruate, she meant I hadn’t passed a skull through it).

Now, about a year later, I wonder just how abnormal my teeny cervix is? And if it means that my uterine lining finds another path? There are plenty of questions, so it’s apt that I have an appointment with another doctor soon for a second opinion. Fingers crossed for some answers!

ref: Nieweglowska, D., et al. 2015 ‘Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery’. Reproductive Biology and Endocrinology 13:128

magnoliafairy
The magnolias are blooming but my ovaries aren’t and I’d love to know why not