Monday, July 18, 2011

Guest post:: Trying to conceive

Twice a day, during my typical 5am - 7pm style day, I sneak away to the bathroom with a little sealed packet.  In that little packet is a small white test strip.  I have a small plastic cup in my hand.  You can buy these little packets online -- 50 of them for about $10.  I  pee in the little cup and dip the stick, waiting to see what lines develop.  One dark line and one lighter line; nope, no LH surge.  Still not ovulating.  Then I wonder, for the hundredth time: is it my irregular schedule?  Is it the q3 call, even though it's home call, still tends to extend my work hours to the 80/week boundary?  Is it the stress of running an Orthopaedic Surgery trauma service?  Is it my complete lack of sleep?  I bury the little stick in the trash, hoping nobody notices it, and I rinse out the cup, dry it off and palm it, heading back to clinic.

I'm disappointed again today.  I do this twice a day -- looking for my LH surge, looking for a sign that I'm ovulating.  On my OR days, it's harder to test in that daytime window.  I usually manage at least one pee-in-a-cup time a day, though.  My cycles aren't regular enough for me to just count calendar days.  My basal body temperature pattern isn't consistent enough just to test around "expected ovulation" time.

When the two lines are the same color, I'll get home at around 7 or 8pm and try to coax some energy into my body in order to get some lovin' from my husband and work on this conception business.  Small windows in time where gettin' busy really matters.  Small windows of time in my life where I want to catch up on sleep.  In the 6 months we've been trying, there have only been one or two cycles where I was pretty sure I had an LH surge and I ovulated.  After those cycles, it was hard not to get hopes up.  Each time, blood in the underwear heralding menstruation left me disappointed.

Each morning, around 5am, I take my basal body temperature before getting out of bed.  All the temperature/charting folks say 3 hours minimum of uninterrupted, good sleep are necessary for a reliable basal body temperature measurement.  HA!  Have they ever met a surgery resident before?  My chart looks like a saw blade ... up down up down up down ... it's no wonder I can't figure out whether or not I've ovulated.  My OB/Gyn doesn't really know what to make of my temperature charts.  He tells me: "Sure, I'd love to say 'get more regular sleep,' or 'try for a more normal schedule,' or 'work on your stress levels,' but I was a resident once, too, and I know how ridiculous that sounds to you.  He's right - if I had a "normal" job, or a "normal" life, those would be reasonable suggestions.  I do what I can with the life I've chosen.

All of this is difficult, even though I've been off hormonal birth control and we've only been officially "trying" for about six months.  What compounds the difficulty, though, is that all this has to be kept under wraps.  Most women who start down the path of trying to conceive are, understandably, quiet about their journey, unless they have a kindred soul (who may also be trying) with whom to share their experiences.  Being a surgical resident just adds another level to the need for secrecy.

In my program right now, there are several male residents whose wives are pregnant.  All of those announcements were met with a lot of "way to go, man!"  "Congratulations!  When's she due?"  "Not much longer until she'll want #2, eh?  Too bad we've got residents' salaries!"  In my program, we average one woman for every 5 or 6 men -- and that's actually a good number, for an Ortho program.  There have been two women before me who had children during residency, and one woman in the class below me.  When they got pregnant, there were significantly fewer "YEAH!  Way to go!  Congrats"-type responses.  Instead, it was a whole helluva lot of "how much time are you taking off?"  "Wait, you're due during a rotation where you're q3 call -- who is going to cover your call?"  "We're going to have to book down that clinic for a month, aren't we?"  And while they were away on maternity leave - most of them took 4-6 weeks - there was definitely a fair amount of grumbling.  I found myself defensive for them: "If this were YOUR WIFE, I'll bet you'd be fighting for every single day of her leave," I'd tell the complainers.  The double standard still gets me.

And so I continue to sneak away to pee in my cup and look for signs that I might be ovulating, despite this ridiculous schedule and stress I put on my body, my mind and my spirit.  I'll deal with the double standard when I get to that point; right now, I'd just like to see two lines of the same color, and my husband and I will keep hoping.

-I'm an orthopaedic surgery resident on the west coast. No children yet.


  1. Fantastic post. Great illustration of the double standard. I still remember my somewhat lazy male colleague referring to my maternity leave as extended vacation. Due to two maternity leaves in residency (8 weeks each - my program allowed me to start a month early in order to accomplish this), I did not get vacation for three years.

    Good luck to you. One of my best friends in residency told her OB she had been trying for a year after six months of frustration so she could start fertility work-up. Turned out she had polycystic ovaries - she was a marathon runner and did not fit typical picture. She started in vitro and has two beautiful kids now - second one conceived naturally when she was done nursing her first.

  2. Ack. I'm now nervous about that comment. A truth, but I certainly don't advocate being dishonest with your doctor. I simply wanted to portray her frustration and desperation to express empathy. It all turned out well in the end.

  3. Great post -- I hope that by the time I make it to residency that this double standard will dissolve into something of the past... sadly, I doubt it'll be the case.

    Good luck!

  4. When my daughter was about 6 months old, I made a joke at work that I was pregnant again, and I could literally see the blood drain out of everyone's faces before I said, "Kidding!"

    Good luck to you! Pregnancy during any residency is rough, but surgery I'll bet is going to be really hard. Don't let anyone bully you into doing more than you can handle. Practically every pregnant resident I know (including myself) had a first trimester threatened miscarriage.

  5. I hear you about not being able to tell anyone. It's true even if you're not a resident. If you've had any miscarriages and (god forbid) tell ANYONE, you will get one of the following reactions. 1) You must be doing something wrong. Let me tell you what those things are. 2) I had 15 miscarriages and it took me 10 years to get pregnant. You don't have it bad at all and therefore you don't deserve to be anxious and should shut up. 3) You can't get pregnant? What are you, some kind of failure?

    Anyway, not exactly the same thing as you're going through, but I think many women can relate.

    BTW -- If the men in my program reacted that way to my pregnancy announcement (oh. who's going to cover your call?), it would make me want to punch them in the face. So, it's ok to feel that way if that's how you feel.


    Hang in there. Things will work out for you and this too shall pass. I really admire your will to make yourself have sex with your husband when you haven't had much sleep. That's dedication right there!

  6. I can see myself in your less than 2 years. I'm a Foreign Medical Grad, working FT in Clinical Research and studying for my boards. I tried all that you did, but finally I decided I needed a break. It is very frustrating dealing with all these...I understand you. It is unfortunate how you get the same response from all co-workers and colleagues...male AND female...they only care about their "extra" work when you're out. don't need that people...
    I wish you the best in your journey to be a Mom. Don't give up!

  7. I made the "mistake" of getting pregnant when our first child was only 9 months old. It had taken such a long time to conceive with the first, so we didn't think we could have another. I was so scared of telling anyone, but had to tell my boss. The look of shock and dismay on her face told it all. I'm a postdoc and things are not as difficult as it is for residents. The attitude and double standard, though, seem to be universal.

  8. I wish you success in conception. I'm a lot older than you - my baby is 30 - and I'm in finance not medicine. I was told at the time, and still believe to a certain degree, that you can't have it all. My pregnancy was disruptive to the running of the business and my daughter's early years were fraught with the tension between the demands of my career and her upbringing. In retrospect, her upbringing has brought me much greater fulfillment!

  9. thank you for sharing!

    i'm a second-year medical student, and my husband and i have been TTC for 3 months now, i think.

    i want SO DESPERATELY to be able to share this experience with another woman...but, like you say, everything has to be kept under wraps.

    school, at least the dean and faculty that i've told, are supportive. they say it'll make my career harder, but my life more fulfilling. but family, and classmates, can't understand, and so can't know. i already seem like a collection of foolish decisions, incapable or disinclined to pull my own weight...

    hate the double standard. love to hear your voice on it. thank you for sharing!

  10. I definitely relate to the heartbreak of trying to conceive. I was age 29 when we started trying and month after month of getting of my period. After 7 mos of trying last year (during my OB/Gyn chief yr), I was on my REI (reproductive endocrinology and infertility) rotation and my attending and I struck up a conversation in which I revealed our lack of success. My REI considers work-up after 6 months of trying. I thought I was ovulatory (fairly regular periods), but he suggested confirmation with ovulation kits or a day 21 progesterone and also he offered to perform a semen analysis on my husband for free. I figured I had nothing to lose since it was free. My husband was nervous about the semen analysis, but reluctantly agreed. We found out that my husband's sperm count was extremely low (severe oligospermia) and that our chance of success in getting pregnant was very low unless we did IVF. We repeated the semen analysis a month later and also had my husband checked out by a urologist. I am now 1st trimester pregnant with twins because we started the work-up and treatment early (we had IVF a few months after we found out the diagnosis). Many REIs and OB/Gyns consider more than 6 mos a time when you consider starting some work-up or treatment. I would recommend totally skipping the basal body temperature measurements because that is extremely stressful and my REI no longer recommends doing them due to lack of reliability. It seems like you have put a lot of work into the ovulation kits without success. Sounds stressful and a pain in the butt. I personally thought they were hard to do accurately. I wouldn't suffer too much longer on your own, but form a plan with a OB/Gyn or REI. If your current Ob/Gyn doesn't seem helpful, try a different one or curbside your OB chief on labor hall. Even if it's just trying on your own a few more months and then some work-up, then you have a game plan. If it's really just a ovulation problem, then some clomid (fertility pills) could really do the trick. Or maybe you will get lucky this month and won't need the above advice! Either way, good luck! -New OB/Gyn

  11. 6 months is average for conception and an 80+h work week ain't average, but here's a tip:

    Those cheap ovulation kits off eBay suck. I bought them, too. An REI just shook his head when I mentioned them. If you can afford proper ones like the clear blue easy fertility monitor, at least they'll be more accurate.

    Good luck! I wish you many babies and understanding colleagues!

  12. Thank you for sharing your secret pee checks. Maybe your husband could surprise you for a quick burst of private fun when you are in between surgeries. I know, it sounds like I've never been a resident, but the sheer craziness of it might just do the trick. Okay, forget that, but I'm just hoping for some joy in trying and wishing the very best for you.

  13. It's not a double standard, though, if the consequences for your colleagues is different, is it? Assuming everything goes well

    Male resident's wife gives birth; He misses one or two days of work.

    Female resident gives birth: She misses 4-6 weeks of work.

    Unless the males are taking paternity leave (which it doesn't sound like they are), it's hardly a mystery that your colleagues aren't thrilled with having to take on extra work.

    It's not about gender. It's not about fairness. It's the fact that the consequences are very, very different.

  14. hmm... it sounds like the maybe double standard the author is talking about is that the people who are complaining about the author (or her peers) taking maternity leave would put up a fight for their (also physician) wives to have their full maternity leave.

  15. or maybe the double standard being that where the people complaining, should they be the ones to need maternity/paternity/other medical leave would expect to get all the leave that was legally allowed, but when it comes to someone else taking that leave, they complain?

  16. The issue is this: When someone tells you they're pregnant, your first out loud response should not be, "How will this affect ME???" It should be congratulations! I am so happy for you! Period. Details can be worked out later as necessary. It's not sexism, it's selfishness.

  17. Suzanne Lucas is obviously assuming that all of the colleagues wives do not work, which is a dangerous and highly unlikely ASSumption.

  18. I am not assuming the wives do not work. I do assume that the wives do not work in the same group as the husbands. Therefore, their maternity leaves don't affect the husband's coworkers.

    Look, you cannot expect people to be excited about more work being thrust upon them. It just doesn't happen. Not in medicine. Not in any other situation. And, as a general rule, men care a heck of lot less about babies than women do. (You find birth forums all of the web, where women whose youngest child is 22 still talk about their birth experiences. Most men don't participate in that kind of stuff.) Men just don't care as much.

    So, when you take into consideration that a. your pregnancy means more work for them and b. they don't care much about other people's babies in general you can't expect overjoyed reactions to a pregnancy announcement.

    If you'd like to read more, I commented on this topic here: Is Your Sense of Entitlement Ruining Your Career?.

  19. SL -- Expecting people to be polite is not the same thing as being entitled. What a sad world you live in where you think it's ok to respond to a pregnancy announcement with, "Am I going to have to cover for you while you're out." And if someone does respond to you in that rude way, it's only natural to feel a level of resentment, just as you might about someone who was rude about something NOT pregnancy related.

    I feel sorry for your colleagues.

    And FYI -- I'm not a doctor.

  20. Old MD Girl, I'm sorry for assuming you were a doctor. The fact that this is a "mothers-in-medicine" site and you have MD in your name, confused me. I edited my article to reflect that you are a commenter, and not a doctor.

    I don't think it's okay for anyone to do anything other than offer congratulations on someone's pregnancy. However, if you spend your life being angry because people react the way you expect them to act, then you're only hurting yourself.

    You cannot change other people. You can't compel them to be happy for you. So no, you're not entitled to their happiness.

  21. Awww.. I understand.. May You Get what You are wishing for.. soon.. :) Wishes..:)

  22. SL -- When did I ever say you were entitled to other people's happiness? It's called a filter, lady. You say something polite even though you're thinking something else? Maybe you've heard of it.

    I don't think anyone who commented here has "spent their life being angry" because people haven't reacted the way they wanted to their pregnancies. That's just you reading into things. Just because someone blogs about being disappointed in something doesn't mean that they have a giant cross to bear about it, and are stomping around work whining constantly.

    Not sure what YOUR issue is, but you certainly have a lot of them.

  23. Please come back when you are pregnant and get your CONGRATULATIONS from these wonderful women, especially if you aren't getting in real life.

  24. Ya, the ebay kits from the internet SUCK! So do the store bought ones, according to an REI guru that I just finished rotating with. He basically tells his patients (without a clear medical indication to their infertility) to throw the kits out and just have lots of sex. He said ..many times ..the problem is just that people aren't having enought sex! Especially the otherwise healthy Type A's ..doctors, etc. that are working to the bone., q2 starting Day 8 from LMP... take a sick day and stay home and hit it!!

  25. Anon -- Re the sex: they say every other day can be better than every day. But yes, the most useful thing I learned from my Ob/Gyn rotation was to have sex during your "fertile period" every other day. Which means basically day 7- day 17 or more if your cycles are longer. It's hard work!

  26. yes, I meant q2 days..not hours!! ha ha !!

  27. I'm done with residency now, but I feel your pain. My advice is, eat LOTs of fruits and veggies, if you can juice for 7-10 days even better. Detoxify your body, and your fertility will increase... I have 4 kids, had 2 in med school and 2 during residency, and conceived everytime (while contracepting) when I did a high, high all veggie diet (I am now vegetarian, but was not at the time). Good luck!!!

  28. umm. . . not sure if you are still trying or if it even matters, and you probably know that consistency of any discharge you may have changes to a egg white consistency when you are ovulating so you could try to look for that. Not a doctor yet, just what my doc told me so that I wouldn't get pregnant when I didn't want to. Well sort of. Not the best way to not get pregnant but anyway. Good luck to you!

  29. Thank you so much for this's something I really needed to hear. I am 27 and my husband 31. I will be starting a residency in ortho next year (if match goes well). We are planning on a baby for my third year. Being a total Type A I have though of everything from how to arrange my rotations and research time, to buying a bigger home, to the safest vehicle to get when it's time for a new one, to which neighborhoods have the best daycare get the point. The thing I didn't consider is that things don't always go to plan. I need to accept a little uncertainty in our family planning. Thank you for opening my eyes. I wish you the all the best.


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