Sunday, October 28, 2012

The 10-10-10 Rule

About a year ago, my mom came to St. Louis to go to a PEO convention.  She told me about a speaker she saw who talked about the 10-10-10 rule for decision making.  It's pretty simple.  Whenever you have to make a difficult decision, you consider a choice and ask yourself how you will feel 10 minutes after making that choice, 10 months, and 10 years.

Last September, I was desperate to get pregnant.  It hadn't happened yet, and I was starting to think that it never would.  I'd had all kinds of bloodwork done and everything came back normal, and I had an HSG test at the end of July to make sure that nothing was blocked up (it wasn't).  We couldn't find any specific problem, but I wasn't getting pregnant.  I was sure that just as Eliza's cause of death remained unknown, that I was now experiencing unexplained infertility.  I was convinced that my body was no longer able to do this.

By August we had been trying to get pregnant for four months, which I know does not sound like THAT long.  But it was.  From the moment we decided we were ready to get pregnant again, we were READY to get pregnant again.  And when it didn't happen right away, it felt like an enormous failure (which I wrote about here).

I didn't want anyone to know that we were trying again because I didn't want to feel the additional pressure of others' expectations.  In retrospect, that wasn't necessarily the best idea, because people didn't know how sensitive I was.  When a friend commented in July that she thought I'd be pregnant again by now, I cried for days.  It didn't occur to some people that news of other people's pregnancies might be difficult for us to hear, but it was.  Really difficult.  I felt old and sad and like I was falling so far behind where I'd wanted to be in my life.

It even got to the point where it was hard to hear about other bereaved parents who were pregnant again.  I was truly happy for them, but announcements started to make me feel envious and panicky.  Especially when people whose loss happened after Eliza were announcing pregnancies before I was.  GET IN LINE AND WAIT YOUR TURN, PEOPLE!

So I spent last summer doing everything I could to get my body ready for another pregnancy.  I ate healthy, adding more protein to my diet.  I upped my omega 3's.  I kept taking prenatal vitamins.  I didn't drink caffeine and I had alcohol only on rare occasions.  I walked the dogs regularly and started going to yoga again.  I did meditation CDs (halfheartedly, but still) and tried acupuncture.  I subscribed to Amazon's ovulation kits (the subscription means it's a reduced price and they mail them to you automatically each month until you cancel).  I peed on sticks and waited for smiley faces and tried for a while to track my basal temperature and basically obsessed.

And month after month of doing things "perfectly," I still wasn't pregnant.

I heard the "20% chance to get pregnant any given month" so many times that I wanted to throat punch anyone who started telling me not to worry.

Logically, I knew that all of my testing had come back normal.  I knew that I had gotten pregnant with Eliza with relatively little effort, but now everything felt different.  Something. Had. To. Be. Wrong.

After my HSG scan came back with nothing to report, I decided I had to take things to the next level.  I called a reproductive endocrinologist that my friend Angie had recommended.  And I lied and said I'd been referred by my OB.

Then I freaked out, thinking maybe the RE would check on that?  So I called my OB and left a message for him explaining what I'd done and saying I hoped that was ok.  (He called back and said that was fine.  I'm sure he was just going with whatever would keep me from losing my shit.)

I saw the RE for the first time in September of last year and he did a monitored cycle.  Meaning that I came into his office for ultrasounds so that he could watch me ovulate.  (Not as sexy as it sounds.  Also stressful to schedule around teaching, as this was the first month at my new job.)

What he discovered was that the follicle was developing normally.  It looked like all things were in working order.  But once the egg was mature and ready for release, my body wasn't releasing it.  So instead of traveling down the fallopian tubes to meet a sperm and make a baby duck in my ute, the egg was just hanging out and then... nada.

The RE explained to me that this was a hormonal issue. Basically, my brain wasn't communicating with my ovaries and there was no way to pinpoint the cause (stress? anxiety? grief? check and check and check).  He considered this good news, because for him it was an easy fix.  But as he was explaining this, I burst into tears.  All I could hear was that I couldn't get pregnant because my brain was broken. Which seemed fitting, given my state of mind at the time.  Anyway, he was slightly taken aback by me crying, but he very patiently explained that all he needed to do was inject me with an extra dose of hormone (the "trigger shot") that would tell my body to release the egg.  He felt confident that the rest would take care of itself.

So we tried that.

But I didn't get pregnant in September.

In October, he suggested putting me on Clomid so that we could time ovulation more exactly, and know precisely when to give me the trigger shot.  But I'd just had a pre-conception meeting with my MFM who put the fear of God in me re: Clomid and the risks associated with multiples.  So I freaked out and asked the RE if I could do Femara instead.  He agreed like it was no big deal, which then had me second guessing everything (Why is he letting ME make these decisions?  I don't have a medical degree!) but in the end we went with a very, very low dose of Femara.

Well, it was just enough to whack out my body.  Instead of the normal rate of egg maturity, things were like a week behind schedule at my next ultrasound.

As you can imagine, I was totally calm and I took all of this in stride, assuring David that everything would be fine.


Of course I completely freaked out.  But my RE had an "easy" fix for this "problem."  He said I should just use Follistim (another drug) to get my follicles growing in a timely fashion, then check back in to see when I needed to do the trigger shot.

I was flipping out because I wanted to know why.  Why were my hormones still whackadoodle?  Why did my body respond like this to the Femara?

My RE didn't really care why.  He wasn't interested in getting to the root of the problem; he was interested in solving the problem and getting me knocked up, and although he was really nice about everything, he seemed puzzled by my reaction.  He knew how to fix this!  Why was I being spastic?

So I left his office and drove to Walgreens with a prescription for the Follistim and the trigger shot (neither of which are especially inexpensive).  I called David on my way there, crying (because of course), and asking him what I should do.  He figured I should listen to the doctor.

But then I started worrying (out loud to David) about whether these drugs would be forcing my body to do something it wasn't ready to do...  whether this would somehow increase our chances for another loss...  whether I was just having an "off" cycle and maybe next month we wouldn't need any intervention and we'd get pregnant...  Plus the total cost of the medication would be like $300 and it wasn't like it was guaranteed to work.  Why was this so hard?  Why couldn't I just get pregnant like I had before?  So then David seemed to think maybe I should wait and we should see how next month went.

(We had already decided if I wasn't pregnant by November that we were going to stop trying until after the new year.  I didn't want to go through Eliza's birthday and Christmas with the anxiety and potential disappointment of a negative pregnancy test).

But when he started agreeing with me, I realized that by talking him out of it, I'd talked myself into it.

Or had I?

I decided to drop off the prescription and in the twenty minutes or so that it would take them to fill it, I continued to freak out and wonder what I should do.  That meant there was only one thing left to do:

Continue freaking out and call my mom.

I walked out to the parking lot and called my mom.  I went through the same pros/cons argument with her, and she suggested I use the 10-10-10 rule.

So, in the parking lot of Walgreens, I considered how I would feel in 10 minutes after picking up this prescription.

That was easy.  Cash poor.  And worried about the needle situation (oh yes, Follistim is administered through tiny needles in the belly, not to mention the big needle trigger shot!).

How would I feel in 10 months?

This one made me catch my breath.  Forget needles and prescription drug costs.  OMG.  In 10 months, I could have a baby.  A baby that would be worth every single needle poke and dollar spent.

And in 10 years?  In 10 years, I could be parenting a fourth grader.  What the WHAT?  Mind blown.

It felt like a HUGE leap of faith, deciding to fulfill that prescription, but the potential pay off was just too good to pass up.

So I did it.  Bought the drugs, did the needle sticks, did the trigger shot, and we waited.

Two weeks later, on October 23, 2011 (my brother's birthday), I peed on a stick and got two pink lines.  I had a positive pregnancy test.

And almost 10 months after that 10-10-10 decision day at Walgreens, I had this.

my 10-10-10 baby
I think we can all agree that this was the best decision I ever made.


  1. I just hit publish on a post about freaking out over waiting about an answer to something. The posts are WAY different but it cracks me up that I clicked over here and immediately felt better about putting it all out there. Again.

    And I'm so glad you made your decision.

  2. Best 10-10-10 decision, ever. She's such a little darling in that picture.

    I so remember the desperation to become pregnant again... the waiting, the (excessive) pee sticks... The tears when it just didn't happen.

    The fear of "what if my body's not ready?" were tempered by "I need a baby now, f&4k my body". I'm so thankful for Clomid, even though it did upset me and make me 10x as sad, it brought my the egg which brought me Grace. I'm thankful for that.

  3. Gah, this takes me back to those freak put days. Bleh. But great 10-10-10 decision!! ;)

  4. Beautiful post. Simply beautiful. Good writing can be like soul food and this entry felt like it.

    10-10-10 rule, I adore it! I have never done that before but I love that sweet Caro is your 10-10-10 baby.

  5. That's a great rule to remember. And what an awesome reward! <3

  6. When we emailed back in Aug, about getting pregnant...or TRYING to get pregnant rather, was the first I heard of the 10-10-10 rule.

    I just love it. And I love where it got you.

    Getting pregnant after a loss is anything but fun...but it sounds like it was its own personal little hell with the bag of tricks you were dealing with.
    Hope you never have to be in that place again...but Caroline certainly made it all worth it.

  7. Oh! And I wanted to say, I HATE it when a doctor so casually agrees to a suggestion or question I have!! Like, "yeah, go ahead, do it that way if you want...". It's like I'M NOT A DOCTOR BUDDY! Don't listen to me! Tell me what the "right" thing to do is!!

    Ah, doctors...don't get me started...

  8. Your mom rocks!
    I love the 10-10-10 rule...
    I have never taken any reproductive enhancers but I do know about freaking out about getting pregnant. I knew before I had even delivered Camille that we would try agian. Of course I had to wait until I had my period which took 3 months...We tried to get pregnant for 3 months. I had never tried to get pregnant before and every month I didn't get a positive result was agonizing. 3 months of trying is not very long but add that to the wait for my cycle to come back and it was 6 months post loss when it happened. But look at what we have now? Aren't they amazing?

  9. I'm going to have to try that 10-10-10 rule! Great post!

  10. Freak Out and Call Your Mom.

    Amen to that, sister!

    Great 10-10-10 decision, needles and all.

  11. Seems like a totally warranted name-the-baby-after you kind of a decision you made because of your moms sound advice :)

    Also, my sisters birthday is October 23rd. She's single. Have we discussed this yet? We should play matchmaker with her and your brother. And then be related! Well, sort of...

  12. Thank you for sharing this. I did the Clomid and got crazy, but for both of my full term pregnancies the magic trick seemed to be the HSG. Apparently, it cleans out the tubes or something. It took us over a year of trying this, that, and everything else before I finally begged the Fertility Doc to do it again. Best $500 vaginal procedure ever. I've never heard of the 10-10-10 rule. But I have committed it to memory. ~Missy

  13. Thank you for this! We're been in the trying-to-conceive phase for eight months. I feel like I'm sliding backward on all the grief work I've done. Isn't stillbirth enough? I have to go through infertility too? I have a prescription for Clomid in my hands now, but I'm scared to start down this road.