Episode 20 SN: Take Love and Determination, Add Science: Emily

P: Hi, why don’t you tell us your name and where you’re from.

Emily: I’m Emily Anderson. I currently live in Los Angeles, California, we moved out here in May, after the 

P: oh, wow 

E: from New York City. 

P: G-d, that must have been an adventure. 

E: It was yes, especially with my six month old and a three and a half year old at the time so, wow. Yeah. 

P: Are you feeling a little more settled now?

E: Definitely, yeah, more fresh air and easier outdoor access during everything that was going on,

P: God, no kidding. That is, in some ways that’s really well timed right to not be.

E: Yeah,I mean it wasn’t planned it was pushed up by a year after the pandemic hit. 

P: Yeah, so it sounds like you have two kids. 

E: Yes, I do have a daughter who now is almost four and a son who just turned one year.

P: Oh wow, nice. 

E: Yeah. 

P: So, before you got pregnant, I’m sure you had ideas about what it would be like, what did you think it would be like,

E: I don’t know if I had really clear ideas of what I thought it would be like but I knew it’d be like a very interesting experience. I knew it was something I wanted to do, I didn’t know how it made me feel but I always wanted to have kids so I knew whatever it was that would be worth it. 

P: Well, that sounds great. And did you get pregnant easily?

E:  No, I was a little bit older at the time I got married 36 I just turned 36 When we got married, we started planning I had a feeling that maybe it was going to take a long time or we would need to get help and my husband was like, Oh, I’m sure it’ll be fine. You’re not old, you’re so young and I’m like well, biologically, can’t really say that, and so I wanted us to just get checked out after a few months just to see if everything was looking normal and if it was, we would keep trying and if not you know we would explore other options and that’s when we realized that there was an issue that was likely going to require IVF. 

P: Oh wow, so I had trouble getting pregnant too but it was like hard to identify our problem.

E: So ours was pretty clear as it. 

P: Oh, okay. Yeah, 

E: I had had, I’m blanking on the name right now but one of those tests to just see what sort of shape my ovaries were in it was a blood draw, so it wasn’t, you know, if you had a good result that didn’t necessarily mean it was going to be easy to get pregnant, but it meant that you know, sort of, everything was looking kind of normal so I had a good result for that, it turned out when my husband just did, you know, a sperm sample that he had low sperm count and low motility. So it seemed like that was probably the problem, 

P: and so they tell you right away that the way you approach that is IVF. 

E: They said it was, it was probably likely there were a few things they wanted to try in the meantime, and so they started by having my husband. I think it was like first stop a medication had been taking, and then, you know, every time you have to wait 90 days, to see how the sperm regenerates. So 

P: Oh, wow, 

E: you know, I was definitely feeling a little impatient and Lego I’m just getting older, as this is going on, then they had an, try and taking a medication to see if that helps. So that was another 90 days. At that point we had been living in San Francisco and we knew we were going to be moving to New York, and so it seemed pretty likely that we were going to have to do IVF since nothing really helped, but we couldn’t start until after we got to New York and that was going to be another several months down the road so you know we just kind of put it on hold for the time being.

 

P: So let’s talk a little bit about IVF tell us about like what do you have to do for IVF and my only powerful impression is that it’s expensive.

E: Very. So, different people can do it in different ways depending on your age, your history, you know what your doctor recommends and it is still a relatively new practice, 

P: The first live birth of a “test tube baby” was in 1978 in England. The mother had a normal cycle, physicians grabbed one egg, fertilized it in a petri dish, and implanted the eight cell embryo in her womb. 3 yrs later, in 1981, after 41 failed attempts this experiment was successfully repeated for a couple in Massachusettes . Now, IVF accounts for between 1 and 3 percent of all births in the US and europe. The doctor who pioneered this approach almost 40 years ago won the nobel in 2010 for 

E: As far as things go so kind of amazing they’re learning new things, each time so even between my first and my second, There were some really big differences. So for my first I had to do the actual egg retrieval, so for that you have to take medication, usually in the form of injection or maybe only in the form of injection I had to inject myself with a needle with a medication for I think it was for two weeks, I had to go in frequently to the doctor’s office between seven and 9am I think, and if you got there too late, there was usually a very long wait so I tried to get there, you know, set my alarm for 530 and get there early, I also started a new job and I wanted to make sure I was there, you know by 9am It was an hour commute.

P: good lord

E:  I had to end, and ever react to the medication in different ways and I had actually I was fortunate that very healthy looking ovaries, but it meant I was having big production so I was actually reacting too strongly to the medication and then they give you one to slow things down so you don’t ovulate prematurely. So that was another injection I had to start doing a few days in, I had to go in for very frequent monitoring. So then, what they’re doing is trying to figure out how follicles are growing, how many you have one year going to ovulate so they start tracking very closely, and then they have you do a trigger shot, they call it that forces you to ovulate within a certain number of hours and it’s very specific, I had to stay up or set my alarm for midnight, so that I could give myself a shot with within a 30 minute period or even shorter a 10 minute period and that was a big shot. Even bigger than the other needle I was a little nervous for all of it. I also just felt terrible doing IVF because I’m a pretty like thin person and I just, it made me like so bloated and I just didn’t have a lot of room to expand and so yeah it the whole thing was very uncomfortable physically, and I had a really hard time with it, so that was a couple weeks worth of my life you know I knew there was going to be and ending. They then you go in and they also give you a very specific time to come in for the egg retrieval, and they go in they put you under it was actually the first time I had ever been put under in my life. I started crying right beforehand I got so nervous and you’re all alone in there, your partner isn’t allowed to come in and say I got a hug from a nurse and then passed out, and then woke up something like 45 minutes later, and then you know it’s pretty painful. It is kind of like a minor surgery, I guess, so you can take some pain meds and recover but then I have something called hyperstimulation where, because I had a very large egg production. I actually started feeling worse and worse for a few days afterwards, and sometimes it can get so bad that people have to go to the hospital. Fortunately for me, it stopped just short of that, but a little rough. I couldn’t go into work and I was making up excuses like I had the flu. I just started this new job.

P:  What does it feel like? 

E:  I was very sore, like in my lower region, you know, I think I was using either ice packs or heat packs, I can’t remember now taking Tylenol or Advil, the hyperstimulation though it feels like. It felt like I was so incredibly bloated like it was just it was less painful more uncomfortable, but like, extremely uncomfortable I could barely walk, I mean I was basically lying on the couch I could barely eat, but you’re supposed to eat and there’s certain things to eat or avoid and you’re not supposed to drink too much liquid and they get worse and so it was just feelings like that I think I had some shortness of breath, I mean, it was pretty miserable, but I was happy that you know, had a lot of eggs. So that was the upside, but then, you know, it continues to just be a very stressful process emotionally so even after the physical side is over, and you’re feeling better, you know there are a lot of phone calls that come in from the doctor to let you know how many eggs you got and how many fertilized and how many grew over the course of four to five days and then we had decided to do PGS testing, pre genetic screening. So neither my husband nor I showed up for any genetic disorders but because of my age, the doctor said, the average would be about one in three would be a normal, normal embryo so a healthy embryo without any potential birth defects or, you know, major illnesses, so we decided to go ahead and do that as it turned out I had something like 35 eggs with a lot of eggs, so probably three times as many at least for a woman of my age normally would have had

P: I brought some IVF questions to Dr. Patricia Robertson, a perinatologist at UCSF who specializes in high risk pregnancy. Hi Dr. Robertson, thanks so much for being on the show. Here’s a basic question. The surgery to harvest eggs how exactly does that work, and why is it painful?

Dr. Robertson: well they take it, they usually stimulate the ovaries, there’s something called natural cycle but usually patients take medications ahead of time, and have lots of follicles and little cysts so they can harvest as many eggs as possible because then they have to fertilize them and not all will fertilize, and then some patients will get them tested ahead of time before implantation so each step of the process you can decrease the number of potential embryos. So they either do it through the vagina, and you know that’s painful having a needle go in to the vagina into your ovaries under ultrasound guidance, or if it’s done it, let’s say a laparoscopy because they’re looking for other things at the same time, they’ll harvest them through a needle through the abdomen, 

E: the doctor thought, ixsi which is when they forced the sperm into the egg, would be the best way to go about it since the sperm did have low motility, we had extremely low results from that that batch of eggs I was really disappointing, but then the eggs that were left to fertilize naturally actually did better than the doctor expected so we still ended up with, I think 15 fertilized embryos and then 12 grew over the course of five days to what looks like a good size and shape and so then we did the PGS testing where they take some cells samples, and then they test to see if it’s you know for normal or not it’s not 100% accuracy but, you know, based on what we learned from our doctor it definitely seemed like it would be worth it instead of just blindly trying 12 embryos with the risk that two thirds or more could be non viable.

P: right

E: So as it turned out we did get exactly 1/3 back that were considered normal for, which at the time felt very disappointing, we thought we would have more than that and we weren’t sure if we should go ahead and do another round or not but all in because of the whole round of egg retrieval and the embryo fertilization the PGS testing and then the fact that when you do PGS testing you actually have to do a frozen transfer, they have to freeze your eggs while they’re testing everything and then you have to wait until your next cycle, and then you have to pay for the frozen transfer it costs almost $30,000

P: wow

E: and it’s not covered by insurance,

P: this was my feeling when we had trouble getting pregnant was, I was instantly a science project. 

E: Yeah, 

P: which was weird to me because I guess I hadn’t anticipated it would feel like that. 

E: Yeah, you’re both kind of amazed about all the information they can gather and everything that you can do and at the same time, there’s a lot of gray area right where you just don’t know 

E: Yeah, yeah, 

P: the limit is hard on in terms of what they know.

E: Yeah, it’s really hard and we had a doctor who was very experienced, he had been doing this for many years very smart knowledgeable but not, not the warmest bedside manner which it was okay for me I didn’t feel like I really needed hand holding I just wanted you know I wanted the results I wanted the numbers but he just said everything like very matter of factly you know like, there’s no guaranteed like you. You could have zero embryos, the guy was very straight with us. Yeah, it is hard since there are no guarantees and I think I felt very, very nervous about the whole process very stressed because I knew, you know I had always wanted kids for my whole life I knew this was something I would have had kids in any way possible, you know, even if it meant adoption in the end, but my husband didn’t necessarily feel that way and you know I’m a planner and I always think of contingency plans and here I am:  I’m like five steps ahead like what if this doesn’t work. What if he’s not willing to give a sperm donor whether he’s not willing to consider adoption, what would I leave him, I mean literally this is where my mind is going during this whole process. It was very stressful for sure and very emotionally taxing,

P: it’s also like basically being evaluated on your stats and so I definitely felt like my fitness was being examined and potentially challenged, which is a weird feeling also 

E: that it’s hard, yeah I know so many women who have gone through IVF and so hard because if I’m friends who barely produce any eggs and I really feel like there’s something wrong with them like why is their body just doing what, what their body should do and why are they only producing a few or why are all their embryos bad, and, you know, they said like I was very fortunate to have a lot of eggs and to produce pretty good embryos but I even felt that way at times like, Oh, two thirds of mine are bad, it’s probably because of my age you know and that definitely was hard.

P: yeah

E: I think it was certainly the hardest on my husband, you know, because it more frequently is an issue with the woman and my husband’s not like even a macho kind of guy, but it really does take an emotional toll on them too, especially when you just assume you won’t have a problem and this is something that you’re supposed to be able to do with a man, you know, as you always think just going to go the natural way and that’s not like is how we made babies in this petri dish. 

P: Yeah yeah

E: and it definitely feels a bit impersonal at times, which is hard, I think, but yeah but I knew we were so fussy, we did the PGS testing had four good embryos we decided we should go ahead and try them instead of thinking up more. And the only reason we consider doing more is we knew we wanted to have two children, and I didn’t want to have to go through IVF again, I couldn’t imagine doing it with a young child since I was like, off my feet for basically for three weeks. And so but we decided, you know, given the cost the time the, you know, physical toll, for me, we would try implanting an embryo, and we thought we probably could implant to up to two if two don’t work, we’ll go back to the drawing board and try to bank up some more embryos, but if it works first try, we have three left that’s pretty good odds. And so, as it turned out it did work, the first try, and that was amazing

P: That’s amazing. 

E: Yeah, and we actually another unusual thing is we knew the genders because we had done this pre genetic screening, you can choose not to find out if you don’t want to but we’re like, find out you’re kind of like to know if I’m definitely not going to have a girl you know or what the options are, and it is a turned out we have to have two of each gender. 

P: Oh wow!

E: Yeah, so for the first one, I didn’t want it I really wanted to girl, but I didn’t, I didn’t want to try to plan it in case it didn’t work out so we just told the doctor put the best looking one in, and we’ll find out, you know, a 20 week ultrasound of everything’s been looking good up till that point and so that is what we did, but yes, that you know it’s so exciting to find out that you’re pregnant, but from a call from the nurse but it also is just so scary. I think there’s so much more at stake when you go through IVF and you’ve had trouble. And so, you know, many, many women go through miscarriages and it’s always hard I’m sure in every single case for the woman, you know, I felt like it was that was even so much more heightened of the possibility when you go through IVF and, you know, have done so much to try to get to that point it’s not as easy as being like, Oh, that was terrible, but we’ll try again, it’s like, oh my god, now we’re down one embryo and, you know, 

P: yeah, yeah

E:  $30,000 

P: as of today, the most common cause of early miscarriage seems to be chromosomal abnormalities of the embryo, given that you think that pre implementation genetic screening with Dr galery of miscarriage for women who undergo IVF, but it seems that a lot depends on the ability of the pre genetic screen to accurately assess the quality of the embryo. This process is complicated as you can imagine, but more recent research from 2017 and beyond, suggests that in fact, pre genetic screening can dramatically reduce the rate of miscarriage, 

E: until really I made it. The 20 week ultrasound I was, I was really nervous about a lot of things and every appointment going in, hoping there was still a heartbeat, you know, very nerve wracking 

P: if you do IVF Are you high risk or you just go to regular OB practice

E:  different consider it in different ways, I think, I think the default is to consider it high risk, but I didn’t have to go to a special high risk practice, although I also was over 35 already so you know it’s probably considered high risk anyway, You know I’ve heard some things that with IVF there could be an increased risk of birth defects but I don’t know the numbers behind that my doctor did not mention it to us.

P: So are there more cases of birth defects, among couples who use IVF. It looks like the answer to this is yes, the rate is slightly higher, but Is this because of something about the IVF process that’s unclear, people using IVF have fertility issues and tend to be older, and both of those factors fertility and age also lead to higher rates of birth defects, but with the constant improvement of PGS testing, potentially the difference between IVF and natural conception may be eliminated in the future. 

P: So given all that you had to do to get to 20 weeks after that, did you get to enjoy the pregnancy or what was it like,

E: I enjoyed it a little bit I think I always joke that I felt really awful during the first trimester, you know, nauseous, pretty much like all day morning sickness and tired and everyone would say oh wait till you get to the second trimester, you’re gonna feel so great and I got there and I was like well, I feel less bad, but I don’t feel great. 

P: Yeah, 

E: like I was not like going to spin classes during my pregnancy I mean I don’t know how anyone was doing that but I think some people feel amazing. Some people feel very feminine and they look amazing and they’re glowing, I did not really feel like that during any point of my pregnancy. I think probably during the second trimester, I was the least worried about anything. Oh, and one other hiccup that had happened in the first trimester was with the, the nuchal ultrasound, which we had, I think around 12 weeks that looked good, but there was a blood draw, they did this fingerprint right at the end of the test, and the Oh what’s this for, and I was so confused on like is it just like identification or something and they didn’t really tell me and then later my doctor called and said that they weren’t supposed to give me that blood draw, it had been discontinued but out of habit they did it by mistake, and now she’s obligated to tell me the results which showed there was an increased risk of downs, and she said she wasn’t worried at all since we had done PGS testing and she thought it was just my age skewing it but I of course was very worried and suddenly can do and an amnio if you want to I don’t think you need to but you can think about it, you can talk to a genetic counselor, and that was so stressful because I mean I know the risk is very small, during an amnio that you could lose the baby but after going through so much, I mean I didn’t want to take the risk if it was just me being nervous about it. So, that was tough. We did meet with a genetic counselor and once she went through all the numbers. Oh, because also we had done that DNA blood draw. The nipt, NIPT test.

P: Real quickly, the nips are non invasive prenatal screening is a blood test that looks up placental DNA fragments placental DNA is usually identical to the baby’s and effort to determine the risk of the fetus will be born with certain genetic abnormalities like downs and Trisomy 13 and Trisomy 18 Because it’s a screening test it can only tell whether the risk of a certain condition is increased or decreased,

E: and that had shown good results with nothing concerning and that also had a much higher accuracy rate than the new goal, blood draw. So that’s why the doctor and the genetic counselor said they really weren’t worried went through all the numbers we decided not to the amnio tightening during the second trimester, I kind of enjoy the pregnancy like I wasn’t feeling great physically but emotionally I was fine in the third trimester that and I think not only does it get more uncomfortable physically, but I started getting very nervous about, you know, the possibility that the baby wouldn’t be healthy when she was born and I should have done the amnio, but it’s too late now and they’re a little bit stressful. And then, other than that I mean it’s, it was a fine pregnancy, I did get some really bad SI joint pain and I couldn’t really walk for about a week, and that was tough was my last week of work an hour away, commuting and my husband had to drive me a couple days and I had to take Uber shares a couple of days because I just couldn’t manage commuting, but then it, it went away, so that was good.

P: So take us through the birth, you know, what were you doing did your water break like how did you know, it was time,

E: so I for some reason was convinced I was going to be late and have to get induced a week after my due date my thing my mom had been a week late, and I wasn’t showing any signs of, you know, being a face or dilated or anything. And then one day before my due date, I woke up at 4am felt this little rush of water and thought oh my god who knows my water breaking, and I called the doctor and they said, come in when their office open so I kind of paced around for a couple hours woke my husband up at 6am and said okay we have to go in. And at first they couldn’t confirm it and then they, they did confirm that it should. The nurse kept saying are you sure you didn’t pee your pants? you’re like I’m on 100% Sure, I actually haven’t done that at all during pregnancy and I know it did not feel like that. So they finally confirmed it and then they sent us straight to the hospital, and that don’t even stop to get your bags just go check in his New York City and it can get really crazy so they said it can take a few hours and since I still wasn’t dilated at all they wanted to start me on induction medications, since they do have goals of trying to get the baby out within 24 hours once your water breaks. So we went straight to the hospital they got a room they started me on induction meds, I got the epidural, very early, like at one centimeter so I was already in so much pain, and then it just turned out my epidural didn’t work that well, which I did not even know was possibility. But I guess with some people, it just doesn’t work that well for some reason, 

P: what’s that mean? You could feel below your waist?

E: I was in a lot of pain, so I was still feeling really terrible contractions. At one point it was just on half my body so they said, Turn, turn this way and let them in, kind of drain it and I was like, is that how this unscientific and they’re like yeah pretty much so I did that and it helped a little bit, I still could feel like contractions, they weren’t pleasant, some of them were getting pretty painful and then I started to tell the nurses I was in a lot of pain like down there and they’re just like, really are you sure, what’s the feeling and I was like, just so much pain like I you know we’re trying to play a card game and I really couldn’t even focus on it, and they try not to check you that much after your water breaks because they don’t want to introduce the possibility of infection but they had the doctor come in and check me and they were like, oh you’re eight centimeters dilated already and, 

P: wow, 

E: this had gone much faster than I expected. They had said, you’re gonna have this baby till tomorrow and so then they were like, you’re gonna be ready to push in the next half an hour and I was like oh my god, and so the doctor when it felt like I was ready to push the doctor came in and then I don’t know, I thought I was pushing. Like, are you even pushing, like I don’t feel anything happening and I was like, Excuse me, are you kidding I don’t know what I’m doing. and I kind of realized that that point the birth class we had taken through the hospital didn’t really cover pushing in much detail and I thought well that was kind of a big oversight. So I was trying my best not really knowing what I was doing, and it was hard because they had tried to increase it, but they’re a little bit of a, you know, it sounds like kind of numb but also still feeling a lot of pain and at this point I mean it was like nine or 10pm I had been up since four I’d barely eaten anything all day I was so exhausted and I think I just started like begging for a C section at some point, it seemed like I was not making a lot of progress so it turned out I ended up pushing for two hours, and the baby had made its way down the canal and everything goes as a matter of getting her out and then at one point I heard that a doctor nursing at the heartbeat, you know, kind of in hushed tones and I was like, oh my god they’re talking about the heartbeat and they’re like frantically pushing. Finally she came out, she had had the thing, when the meconium where the baby poops in during labor and so on and so they had to have a pediatrician there and whisked her away immediately and and you’re crying right away right just like she helped me because I’ve been very nervous at that point that maybe, you know there’s going to be something wrong and the doctor said yes she looks great. So they sucked her lungs she  cried, everything was good, but then my placenta wouldn’t come out. So, it had to be manually extracted, which, since my epidural still wasn’t working that well I really could feel a lot more than I was supposed to and it was, it was unpleasant so the doctor basically says like reach up and, you know, pull it out in pieces,

P: wow

E: was it like it was still stuck to your uterus? 

E: or like, yeah, it was like stuck to the wall of the uterus. 

P: In Emily’s case the baby is born, but the placenta seems like it’s stuck to the wall of the uterus, it will not come out what’s going on there,

Dr. Robertson: so we call that a retained placenta and it’s actually more common than people could imagine the usual style with birth are to wait until the placenta sells itself or gentle traction on the umbilical cord that depends on the provider and, but everybody does agree that once said he hasn’t delivered after 20 to 30 minutes, it’s probably a good idea to get that placenta out even if you have to go up and actually with your hand, create a plain grab the placenta and pull it out, because mom’s that’s a big risk factor for hemorrhage, if you ever retained placenta. It’s painful so there isn’t any anesthesia, usually, unless the mom is a hero and has a huge pain tolerance you wouldn’t do this with a little bit of anesthesia in the operating room, and once you

have retained placenta you’re at risk for it happening again with the next birth so you just need to educate your provider, and know that you may need to have extra care. 

E: I was reading this article in People at one point later or Kim Kardashian was talking about how traumatic her birth was because her center wouldn’t come out and the doctor believes there are mouth and pull it out and she was crying her mother was crying and that’s why she decided to use a surrogate for the next birth and I was like, that’s funny. That’s what happened to me. I was like I want to describe you that’s so dramatic. I mean it was very unpleasant, but yeah so basically that’s it, pull it out and afterwards and I said you want to see and I was like, I guess so. And you know She held it up, it was like roadkill and I was like, put it back, get rid of it I don’t see it anymore. Yeah, it was pretty terrible and then one of the risks with that is they don’t get it all out, because they’re they’re trying their best, but a piece could still be stuck there which could cause problems, then you have to go back to the hospital and sometimes surgically removed. It’s also too late, no production, the doctor thought she got it all out, and we were just hoping for the best at that point I didn’t have any hemorrhaging or anything that was fortunate to, I did tear in four places, the doctor said, Good news, you only have minor tearing, but it’s in four places. How is that considered minor. So then I could feel like every stitch going in and out which are worse because you know I still wasn’t none down there like your supposed to be, I mean while my husband was doing skin to skin with the baby since I still couldn’t hold her yet. He kept telling me to be still and I was like, writhing in pain, but finally it was over and I just, like, kept looking at the baby and being happy she was healthy and happy that I had a partner there with the skin the skin with her and then eventually got to hold her which was wonderful and she latched straight on to breastfeed and so it’s great. And then I really didn’t dwell on the bad birth experience at all, just, you know, very happy at that point that everything went well and I have a healthy baby. 

P: yeah, I think, to some degree, your entrance into pregnancy gives you a lot of perspective.

E: Yeah, maybe it’s like, I’ll get through whatever I have to do like, yeah, this alternate child. 

P: Yeah, it just sounds also like it was a little bit faster for a first time mom 

E: yeah I leave that the labor was a bit fast, so that that was probably the one outside. And how was it when you brought her home. It was great. We ended up leaving the hospital for about 36 hours which was very quick, but because you only stay two nights in New York, and I had her at 1030 in the evening, we didn’t get our room till 130 in the morning but that counted as our first night. It’s kind of weird, they’re just like good luck. My parents were coming to visit a week after my due date. We really thought I was gonna be late. And so we had no help for the first week, which I actually really liked, and I think I might have thought about getting some help, but my husband was like, oddly confident about caring for a baby, I think I had never changed a diaper before and really had no experience with, with new babies but was like, We can do this and make our one big hiccup was the first night we had our home, that there was an emergency heat shut off, And it was late January in New York City, and I had lent, our space heater out to someone because our apartment was usually very warm, so you know I realized this at like 930 in the evening that was freezing cold and I start freaking out and like, this tiny baby that’s less than two days old, like, you know, we need some heat in his apartment and so I like sent my husband out in the middle of the night to find a space heater. So, that was fine. And then, yeah, she was like a really amazing easy baby especially for the first couple weeks my parents came to visit, which was nice for an extra pair of hands and eyes, and yeah it was it was great. 

P: That sounds like a very good ending to uncertainty.

E:  Very very good. Yes.

P: And what is she into now. Well, she’s almost four, she’s into, let’s see unicorns and princesses and dresses very girly things that I was not into as a child and I don’t know where this came from but she’s a very girly girl that’s very sweet. She loves to dance. She loves gymnastics, she goes to preschool and, you know she’s, she’s in a really good kid, I mean she has a strong personality so there are some, some lows with the highs and highs with the lows, there’s definitely strong opinions and tantrums, but she’s also I think it means very independent very confident. She’s so so so funny like she makes us laugh out loud and has been the time she was, she was a baby, pretty much, it’s really wonderful to see her personality develop. 

P:Sounds adorable for is a very funny age, like you, my friends were going to get me like black onesies for my newborn because I only wore black and I’m not girly at all, and my daughter is super primo girly, it is fun to see some aspect that that does not come from you and this little individual that you have created 

E: definitely…it’s a lot of fun. 

P: So let’s talk about your son, was that process smoother because you had been through before 

E: It was a lot smoother. At the time I, I was getting pregnant with my daughter to do a frozen embryo transfer, they had to take progesterone shots for weeks and weeks and weeks so it was something more shots and this time in your butt and I made my husband do every single one because I couldn’t even see back there I was like, you’re going to be involved with and posing, so they have you started can’t remember but maybe a week or a few days before doing the transfer and then if the transfer is successful, to continue for several weeks I think I did it maybe for nine or 10 more weeks. By the time I was trying to get back on my son, the doctor said, Well, we’ve learned in this time, that it actually doesn’t make much of a difference. So, he said well it worked for you the first time if you feel more comfortable doing it again you can but we haven’t seen numbers wise to change and I was like well I’m, I’m a numbers person I believe in the science and if I don’t have to inject myself with shots for weeks on end I will definitely skip that part, they just have you do a progesterone suppository for a few days I think or maybe a week which was a piece of cake, you know, compared to the shots, and, and then the transfer was successful again. So first try, and this time we did actually choose the gender, which was a little weird, you know, I think, the doctor said your three remaining embryos are all the same quality. Seems like you should just pick, you know, and just pick what you want, and we had always talked about how nice it would be to have a boy and a girl, and we had the girl first thing I would have been happy they’re having two girls or a boy and a girl but and I probably would have just said to the doctor just put in whatever looks like the best one and we’ll find out again at 20 weeks but my husband thought we should try for the boy and so we did say, you know, put in the best looking male embryo and that turned into our son. So, yeah, 

P: that’s kind of amazing, and that there was that there was so much learning between your first and your second which aren’t that far apart. 

E: Yeah, I mean that’s that’s talking about earlier, just being still a relatively new science and technology it’s amazing that they’re still learning. Another major thing is mosaic embryos when they do the PGS testing, there are some embryos that look like they have clear birth defects but there are some that are called Mosaic or some cells look okay and some don’t. And they don’t know what that means. And that’s actually a really crazy thing which I think, you know, in the next few years, they’re probably going to learn a lot more about it.

P: So it looks like previously in IVF pre genetic screens. Doctors identified either totally normal embryos, and those with chromosomal abnormalities, but new technologies make it possible to make this into a spectrum, which includes mosaics embryos that include both normal and abnormal cells, looking only at research from 2020 and beyond. It looks like some of these mosaics can be used as embryos, but mosaic embryo transfers have a higher rate of miscarriage and a lower rate of live births a fraction of cells that are normal relative to those that are abnormal may be an issue in the viability of mosaics.

E: Typically they recommend you don’t use a mosaic embryo just because they don’t know what’s going to happen with it, but some people don’t have a lot of embryos and they’ve had a very hard time and that’s all they have, and I do have two friends who ended up using it and their kids are perfect, and out of our eight that tested not normal three or four were mosaic so you know it may it may be that those were perfectly fine 

P: so with your second pregnancy, what do you get to enjoy that one or were you equally nervous 

E: I’m so lucky. I don’t need more than one child, and the second one is I actually, you know, when we were talking about trying for the second I started having some reservations, I’m an only child and I always wanted a sibling and that’s why I always wanted that more than one, And whenever I asked my parents why they didn’t have more than one so we had the perfect child we didn’t, we didn’t run any more out of it, like, whatever, that’s not a reason to do, and then I, like, actually I get it now like I you know I felt very close with my daughter and I was a little worried about adding a second you never know how it’s gonna go if they’re gonna get along or not, and I was a little worried about, you know, ruining our relationship and also we could feel life starting to get a little bit easier and I was like oh my god, are we going to do this again and go back to the drawing. And you know, I was 40 I was already I think, you know from like, I’m getting older. This is more challenging than if I were 10 years younger, but you know we did decide to go for it, but I think, you know, because probably in both those things I was just much, much, my anxiety was not there the second time, which is great, physically I think it was harder, you know, just having a toddler at home I was so, so tired, and you know get to the end of the day and just have like no energy left by bedtime, so that part was difficult. I also got bigger, faster and just bigger overall and it just like I have a very small frame so it just felt pretty uncomfortable for most of the time, I felt like I had like a lot of pulling like I was certainly not going to any spin classes. So like all I can do the walk around normally, at least in New York. Did you get a lot of blockings, but yeah, then by the end I mean, it’s just so uncomfortable all the time, so that was, that was pretty much what second pregnancy was for me. 

P: And was that birth, fast also, like the first one, 

E: yeah, it was much better, I had made it very clear that the epidural did not work the first time and I really wanted to try to get it to work the second time it worked better I think. Toward the end I was having really painful contractions so it still didn’t work quite to its full extent but that was hard but the whole thing was much faster so I think I had been asking to get induced at 39 weeks, partly because of my age, I thought, well there’s, you know, a study had just come out saying it was really no different than 40 weeks.

 

P: So Emily’s talking about the ARRIVE trial that tested the consequences of induction at 39 ish weeks when they only looked at births with one baby for a first time mother who had no risk of fetus was in the right position for vaginal delivery the study found that there were fewer complications and a lower frequency of respiratory support and these newborns at lower rate of C section, it’s not clear if this generalizes to all births,

E: and a lot of doctors were inducing women over 40 at 39 weeks. Also I was due on October 30 And I didn’t really want to have a baby on Halloween. So I thought, well I can do this one week earlier was just being so uncomfortable I thought, you know, I’d rather just not be pregnant one extra week if I don’t have to be at my practice they weren’t doing that and so I really had to try to fight to get that request in and finally one doctor, you know who strongly believes that it should happen helped make it happen so we had an induction time set up, we’re supposed to go in at 9pm one evening, my parents had flown in to help watch our daughter, and then my water, coincidentally broke a couple hours before that. So it was very unusual but it was, It was getting we were going in anyway I still needed the induction medications since I wasn’t very dilated, it was kind of the same as last time but you know since we went in, in the evening, the New York hospitals can get so crowded sometimes so we were in this triage area for a while and you know that took a few hours to even get our room I think we didn’t get a room till after midnight and then it was another hour or two before they could even get there with the induction medication so you know it happened pretty late, but then labor moved along quickly enough and so I ended up having the baby at 10am that morning. Yeah, other than the painful contractions, I only pushed for for 30 minutes or something, and that was much easier, and it was it all felt much more calm, like I don’t know it was morning not evening like that just felt kind of better as a doctor, it was supposed to be the doctor for my practice that I liked a lot. I was at a good practice, you never know who you’re gonna get and I was very happy it was gonna be this one doctor, and then the reason she wasn’t available so there was supposed to be this other doctor and I was like, Okay, well, like her, that’s fine. And then if she wasn’t available I prefer like being a second time mom was good because I was like, whatever whose delivering me I don’t care. And so it was like this other doctor from like a sister practice who I’d never even heard of before but she, she was great and she was very calm and it wasn’t that busy at that time so she kind of just stayed in there with me the whole time and she gave me more tips about pushing than my original doctor had so that was actually helpful. It was weird, it felt like I was making no progress and then all of a sudden the baby was out so I had no tearing the second time which was miraculous. The babies is a little bit bigger than my first, they immediately put him on my chest, and that was a weird experience, my husband was much more calm and present the second time and, and he started taking a video and I’m like paid through this like naked purple crying baby on my chest and I was like, like sounds kind of funny, my face in the videos like bewilder and I’m like was avatar, but it was really nice and I think you know both of us were just a lot more kind of calm and present too, and then the baby looked great, 

Both my kids I think from the start were like, oddly calm and also making eye contact from like minute one which was amazing, you know, and so they, they were both cool just like hanging out. My husband went to get breakfast and I had like a truck drivers breakfast and it was amazing and a giant latte from Starbucks and, and I felt like I was fine and you know send the baby with the nurses to the nursery overnight, I get a little bit of sleep and yeah it was it like weirdly felt like a little bit of a vacation because I had actually never spent a night away from our daughter, before that, and at one point in the hospital I was like, eating ice cream, they had brought me and reading a magazine and watching a TV show on my iPad and the baby’s peacefully sleeping in the bassinet and I was like, This is amazing. Relaxing was nothing to do right. 

P: That sounds like a great experience. 

E: Yeah it was. And our daughter was great when we brought the baby home, we had done a lot of prep around that and we had her come to the hospital to meet him it was really wonderful and we were able to time it with the hospital photographer so she got like the first look, you know my daughter seeing her little baby brother for the first time and holding him for the first time, kissing him is really really sweet. 

P: That’s cute.

E:  Yeah. 

P: What is he doing these days,

E:  he started walking. It took his first steps on his first birthday. Oh, it was really about yeah it was about a month until he really started walking. He’s being very cautious for a little boy, which I was not unhappy about and so yeah now he’s like walking everywhere and starting to try to run a little bit. He loves to climb. He’ll do things that he thinks are funny and then look at us for a reaction and like really good natured. Yeah, yeah, although like my daughter is extremely chill until one year and then it’s almost like a switch flip for both of them where they just started developing much stronger personalities, so it’ll be interesting to see how that emerges,

P: yeah that sounds fun. Yeah, yeah it is the well that’s a completely triumphant story after you know an uncertain start right where yeah, you have no idea how it’s gonna work or if it’s gonna work and all the waiting and, yeah, testing and so that’s an amazing story to share and very hopeful so thank you. 

E: Yeah, thank you.

P:  If you could go back and give advice to your younger self, what do you think you would tell her. 

E: You know, it’s funny, one thing I think I would tell her is to just freeze your eggs when you’re like 20 years old. You know, 25 or something like that i A friend had asked me when we were 30 If I was thinking about freezing eggs. I was like no, are you crazy we’re so young, you know, but I think knowing what I know now you just you never know how it’s going to work. Worked out and you know when you’ll meet somebody when you’ll be trying to have kids how that will go how your body will react at that point, so that’s probably one thing I would have done, and other than that I mean I don’t know like I think, you know I always say it would be nicer. It would be nice to be a little bit younger at times just to maybe have a little more energy, but that’s just how my life went, you know, 

P: yeah, 

E: I wouldn’t have chosen to be, you know, 40 years old, having a baby but I’m, you know, that there were no other options and also when I look back on, you know, when I was 30 I mean I was nowhere near ready to have kids yet I was having the time of my life I just moved to San Francisco I was making tons of new friends it was like, I mean I can’t imagine already being settled, I would have I would have missed out on such a big chunk of my life. So, you know, I think you just kind of go with it and, and that’s how it works out.

P: Yeah, it kind of all comes in its own time right you can’t 

E: Yeah, yeah. 

P: Do you want to tell us a little bit about it sounds like your business is related to your experience with pregnancy. 

E: Yeah, 

P: tell us a little bit about that.

E: Sure. Basically I, we had just moved back to New York, not long before we were trying to do IVF and get pregnant and I had lived in New York twice before so I did still have a few friends but a lot of people had moved out of the city and the friends that remained were all scattered so we literally all lived in different quadrants of, you know the city or the boroughs, I just wanted to meet some new people that, that were having babies around the same time and live near me, I figured once I had the baby I probably wasn’t really traveling very far to see people. So I started a Facebook group and I called it winter babies 2017 and I posted it in a couple of the local moms groups I was in on Facebook and said Oh If anyone’s having a baby around this time, I just started this new group you want to join us. It was started slowly and then it kind of started snowballing. I planned. I think one meetup for coffee for those of us who were pregnant, and there were probably like, maybe eight or 10 people who came so that was really nice just to meet a few people and then once the babies were born more and more people are joining and telling their friends and I started planning weekly lunches and we would all be chatting on this Facebook group all the time and at all hours of the day, you know, post a question at 3am and like 10 Do I answer, usually, you know, and I started planning some mom baby happy hours and after the baby’s got to mobile I started planning mom’s night out at night and I planned a Halloween party for our first Halloween and I sold tickets so that I could help purchase them, you know, share food and, and everything and it’s sold out and I you know it’s like trying to get more space with the restaurant, it was really crazy and so then people started asking if there were any other groups like this because they had friends having babies and I wanted them to have the same experience, they felt like it has really transformed new motherhood for them, and, you know, that kind of gave me the idea for this business, 

And I thought well you know a lot of expectant moms and new moms, it’s a lot of people feel very isolated, they don’t know how to make new friends as adults or are nervous about it and they don’t, maybe don’t have a lot of friends that have kids or at least who live near them, and so I based the business around the idea of just providing opportunities for social connection among expectant and new moms, so I run Facebook group for moms do every six months in New York and then I just recently changed it to be by year, and then I just launched groups in a few new cities as well, and in New York where I launched it I was planning monthly mom to be meet up weekly new moms happy hours in different neighborhoods. So, you know, people could connect to the Facebook group, they could connect in person they could make their own friends set up their own playdates, you know it’s really what you want to get out of it but the happy hours, and they were amazing, I, I would get a 40 to 60 moms coming to these things with their little babies and I mean this was obvious help pre COVID Yeah and it was so much fun, and people, you know a lot of people made like real genuine friends from these experiences, and it’s, it’s unique because there are other mom groups that happen, new mom groups but they’re usually a much smaller group they’re more like a support group, you know, there’s, there’s maybe eight or 10 other women with you and if you happen to connect with someone in that group that’s great if you don’t, you know, you know, they’re also usually very expensive so it’s like okay well I spent a lot of money into this for six weeks and that and then people move on, whereas, you know what I was trying to do is provide like a little bit of like a 360 experience with like even come to the happy hour you can meet people in person, you can keep chatting on Facebook or vice versa, start chatting on Facebook, then put a face to a name, you know, and it was, it was really great they were unstructured, they were free for the moms of getting sponsored by businesses, and so it’s kind of low pressure too because I think you know I found it is hard to commit to a certain date and time with a newborn when you just don’t know how your day is going to go and I was reluctant to sign up for anything that wasn’t drop in because I didn’t want to waste my money and I didn’t want to feel pressured if it was a bad day, you know, And so, so these were low pressure fun, it was every three weeks in the same neighborhoods that would rotate neighborhoods, and they were really great usually people would would come and just start chatting because I’d have name tags and you have a baby, which is almost like your little wing man and kind of a natural icebreaker, but I think you know I’m someone who will pretty much just talk to people will talk to anyone and I’m not shy if I connect with someone I don’t know I’m not shy about saying they should hang out sometime here, let’s exchange numbers, you know, but most people won’t do that. So I think, setting up an environment where it’s very friendly and supportive and everyone’s just coming in their own works really well. and, you know anyone who did look a little bit shy or was hanging back I’ll usually try to talk to and make some introductions. But, yeah, they’re really nice events, and a lot of people made their, their closest mom friends,

P: that’s awesome and it is. I was surprised by how isolating it is in the beginning but you are exhausted and running round and you sort of don’t have control of your day at all, and that sounds like an awesome opportunity

E: yeah, yeah, they were a lot of fun. Everyone looked forward to them so hopefully I’ll be able to log them again at some point. So how do people find it what’s the name. It’s called mom crew, my mom crew, com. and yeah so people some people go find it just by searching for mom groups in their area. I do post on local Facebook groups and other moms like neighborhood mom groups just to let them know if there’s an event coming up, and then some people it’s spread through word of mouth so people tell their friends and invite their friends to join, and a lot of people have been asking for a while if it’ll be in other cities because they’ve moved or they have friends there and they’re interested so I decided, you know, just to, since this is the time I can’t plan any in person events I would just see if I can start new social communities in other cities.

P: That’s very cool. Thanks so much for sharing your story. 

E: Yeah, It was so nice to talk with you.

P: If you didn’t catch that, it’s mymomcrew.com. Thanks to Emily for sharing her story and thanks also to Dr. Robertson for her insights. If you liked this show, feel free to like and subscribe. We’ll be back soon with another inspiring story of overcoming.