07 October 2015

The Pros & Cons of IVF


So humbled to address today one of the most difficult/emotional decisions a woman ever has to make. And this decision sadly affects lots of women - too many of us. And based on many researchers, it will only affect more of us in the very near years ahead. I had to make this decision twice and it was difficult both times.

The decision is this: Should I do an IVF?

The other related questions usually are:

Should I wait and do nothing and see what happens? (and for how long?)
Should I first try more natural ways to heal my body? (and for how long?)
Should I first save some money for the procedure?
Should I keep trying clomid and IUIs?
Should I find a new job at a company that covers IVF?
Should I wait until my relationship feels more solid or until my spouse is more involved?
Should I find a new doctor who will investigate my health more before recommending IVF?
Should I skip IVF altogether and research adoption?

Oh, the complexity.

(photo from one of many IVF appointments)

In case you're facing this decision, here my PROS and CONS and the same from 7 readers who have generously shared their thoughts:

From Mara:

Pros:

-You get to see if it works! The curiosity is a hard one to pass up.

-Likely if IVF is on the table, one has already invested financially and emotionally in the medical route (tests, diagnosis, finding doctors, etc.) So IVF may feel like the easier next step. At that point, it feels like known territory in a way and it can feel like you should see those investments to the finish line.

Cons:

-IVF is rampantly recommended by doctors. So very often, underlying health issues are not addressed and the procedure is more like throwing a dart to see if it will work for you. The problem is, if the underlying issue is not addressed, it's very likely that IVF won't work or the pregnancy will not be healthy.

-For me, IVF affected my hormones for an extended period after the IVF (the trailing off was close to a year, I'd say.) I normally have extremely stable cycles without PMS. Though I noticed a bit of it in the many months following the IVF. It was a sad thing to me to feel like I'd messed with my body so unnaturally.

-I mentioned once that I noticed some hair thinning and my curls have gone limp (compared to what they used to be). I noticed this happening after the IVFs and I later read that hormonal changes are one of the biggest causes of hair changes in women. There's a very good chance it was all related.

-Adding so many drugs to your body is just gross. I did about two hundred injections in two IVF cycles (I did have extras compared to a standard cycle, though.) Yuck!

-There is a lot at stake. It leads to a lot of stress for people's marriages and lives unless you go into it with a healthy mindset (if you want coaching on this, I offer mentoring sessions). IVF also greatly affects finances and can have a negative affect on your employment.

-You have to stay put for a very long time: doctors appointments galore; timed injections; refrigerated drugs. Travel for business or pleasure is pretty much out of the question. Don't even think about moving or changing jobs/insurance while you have your team of doctors in place for however long it takes.

-Infertility and IVF is a lifestyle. It dominates your life so much that other goals and pursuits are very much on the back burner.

-It's very expensive and it's more likely that it won't work on the first cycle. Having the procedure not work is one blow. Draining funds is another. Depending on your financial and health situation, financing an adoption may be more likely to lead to a child.

From Anon:

Pros:

-It gave us a chance to have a biological child. Adoption wasn’t the right choice for our family, and so if we wanted a child, this was the last chance.

-It’s pretty common these days, so a lot of people knew what it was and were supportive.

-We got to choose when I got pregnant! I fit it in between school semesters! Obviously, we were lucky that the first try “took”, but still!

- I was lucky and got to freeze a few extra embryos. Now I feel less pressure to pop out another when I am focusing on completing my degree right now. At 31, this quieted the biological clock for me a bit.

- It was actually (in retrospect) pretty cool to get such a close-up look at the miracle of life. I have a pic of my daughter at 5 days post fertilization. We got to watch them plant her as a tiny embryo on a big screen.

Cons:

- Yucky drugs

- $$ and more $$

- Time and effort – constant appointments, research, taking time off work, etc., etc. It was a marathon, but after 4 years, we were used to it.

- Mental stress, life being in “limbo”, feeling like I couldn’t make plans because of this huge mountain we were climbing.

- Lack of privacy. Let me explain. I’m not talking about the invasive medical procedures and constant “undress from the waist down” appointments; I’m talking about lack of privacy from friends, family and coworkers about what is usually a very private experience (the planning and conception of a child). Now, we CHOSE to tell the people in our life about our fertility troubles and IVF plans, and I don’t regret that – we got so much awesome support – BUT it came at a high cost. I never got to really announce a pregnancy to my spouse. My mother-in-law called the morning she knew we would be getting the HCG results back asking for the news. Everyone knew exactly what appointments were going on (because they asked, and we didn’t hide it), and at some point I began to feel that the experience wasn’t “mine” anymore. Many other people who loved us were very invested in the outcome and it left me feeling very exposed and pressured. I hope that makes sense. I know it seems crazy, but I found this aspect to be harder than the injections and the hormone swings, etc. I told my husband that the next time around we are telling NO ONE. I want to experience this in private next time.

- One final con. I feel pressure from people, (even myself sometimes!) that because it was so much work for me to get pregnant, and it was such a miracle that I did, that I am somehow being ungrateful because I don’t (and never did) want to be a full time stay-at-home mom. My own grandmother said to me when I told her my school plans “after all the trouble it took to get her here – you’re going to leave her?” I was crushed. I had a hard time reaching out and getting help when I suffered from post-partum depression because I felt so guilty for being so unhappy when I was supposed to be so happy. I still struggle with this guilt.

From Michelle:

Cons:

-I've thought about this a lot. The biggest cons I can see are the cost and the toll on my body, as well as the possible emotional letdown. I feel like I would put a lot of pressure on myself for it to work out if we put so much money into this chance.

Pros:

The pros, of course, would be the possibility of having a child. (It might be worth noting that these feelings are often mixed and convoluted.)

From Vilulind:

Cons:

-The only cons I could think of when I started preparing for IVF was that this procedure would be my last resort for getting pregnant. That there would be no hope left in case this last, ultimate measure failed. And yet, here we are, still hoping after 5 failed IVF cycles.

-Now, having gained the "failed IVFs" experience, I can wholeheartedly confirm it's totally devastating to get non-pregnant HCG results.

-Ten days after embryo transfer are crazy but still somehow pleasantly emotional. I feel pregnant, not pregnant, never-gonna-be-pregnant, all at the same time. I secretly talk to my embryos, search for non-existent pregnancy signs, even feel false pregnancy cravings--only to get crushed by the test in the end.

-And the week or so after that is just plain horrible =)) Crying jags, feeling sorry for myself, wanting to have kids SO MUCH, being desperate. Definite cons. But this week comes to an end, and somehow hope emerges again. So yes, emotional letdown is by default in the cons column, but you know, sadness will pass, tears will dry, life will go on.

Pros:

We are happy that we had tried.

From Jaime:

Cons:

-We did IVF to get baby #3. I think if you want a baby enough to do IVF, at that point, the "cons" just feel like another hurdle for you to get through. The expense, the daily monitoring appointments (especially difficult with older children at home) and the weeks of twice-daily injections.

Pros:

-The pro? Your very best chance of conceiving! The elation of knowing you're pulling out all the stops and doing the best science can offer at this time. And it may be possible to have embryos to freeze so that you are able to have more children if you wish.

From Sarah:

Cons:

-Solely from reading about your experience (ok, and a few other posts) the cons are the costs, the taxing regime on the body/injections, the exhaustion.

Pros:

-The pros are obviously: A CHILD and one that's likely biologically linked.

From Sonal:

Part of the issue is that many people have preconceived notions about IVF that are hard to shake. No, it's not something that only desperate rich people do. No, it will not make you Octomom. No, it does not (to anyone's knowledge) cause lasting issues for the mother and baby. But the hardest one is no, it does not always work.... people in general have a vastly inflated idea of how well IVF works.

Cons:

-Expensive.

-It's a big commitment of time for appointments which involve transvaginal ultrasounds over a period of (depending on the protocol and how you respond) up to a couple of months per cycle.

-It's a lot of injections, every day, most of which are hormones so side effects are highly variable.

-It's not a sure thing--there is a huge amount of guesswork and trial and error involved, so most people have to go through multiple cycles which can be a big shock if no one told you.

-If it goes well, you will probably be very uncomfortable, for a few days to a few weeks. Egg retrieval is minor surgery.

-There are a large number of decisions that have to be made, often somewhat blindly because there is not much solid information.

-The process itself is very unpredictable and there are a huge number of things that can go wrong which makes it an emotional roller coaster. You spend a lot of time not knowing.

-Most couples go through a lot of other methods before getting into IVF, so at this point, a lot of them are emotionally (and perhaps financially) burned out before having to face IVF, which makes the decision that much harder.... you always wonder, in infertility, if maybe nothing will work and you should stop while you still recognize yourself. The fear of the physical effects is probably the biggest concern before starting. The emotional up and down is probably the hardest part of actually doing it.

Pros:

-It's by far the most successful treatment available for using your own eggs/sperm.

-IVF can reveal more information about why you aren't conceiving, although there's often not much that can be done about it.... still, infertility is a process with a lot of unknowns, so there is some comfort in just knowing.

-By the time you get there, it may be your last option... when the choice is IVF or no children, IVF doesn't seem so unreasonable.

From Jefra:

At this point, other than a miracle, IVF is the only way I can get pregnant again. We chose no...or rather, no for now. But we will probably revisit the idea again at some point.

Cons:

-Financial cost was a big factor because our insurance at the time didn't cover IVF.

-Aside from that, I knew I wasn't ready to deal with the emotions. It's already too much to deal with years of infertility and then to have a doctor tell you you won't be able to have anymore children. I wanted to get myself to a place where I wasn't obsessed with having a baby because I knew that getting pregnant wasn't going to magically heal the hurt. I've had to learn to be ok with the fact that my son will probably be an only child.

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I know a lot of our readers here have had experiences with IVF. What would you all say would be the pros and cons of IVF for you?

If you liked this post, please share it with others or leave a comment, below! xo

20 comments:

  1. Oh boy. This post struck a cord... I live in Canada where IVF if basically free (up to 3 transfers). I had 12 cycles. Yep... 12! Twelve cycles that.all.failed. The cons for me are mainly related to the damage it did to my body. The injections gave me 3 large polyps (4'') on my uterus that the doctors won't remove until menopause; Weight gain that is terribly hard to get rid of; That feeling of being a stranger in your own body (or the reverse); The emotional let down. The only pro I can think of is the fact that we tried.

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    1. I also worry about the weight gain, among other reasons. I recently worked really hard to lose 60 pounds and finally be in a normal weight category, so the thought of putting that back on and not being able to get it off scares me. It sounds vain, but it is a legitimate concern for me.

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    2. Where in Canada are you living?!?! Because on my Canadian street, the three houses where people had trouble conceiving had to fork out $10,000 for IVF. Only one person I know had insurance that covered $4500 of that.

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  2. My pros are my son and my second child on the way. They are my miracles. But I know it often doesn't work that way. The pain and stress of infertility was incredible. IVF was, in some ways, more bearable than what had proceeded because I felt that we were doing everything we could to see if this would happen for us. Financially, it was the path of least resistance. Really.

    I live in a state (IL) that has mandatory infertility coverage. This makes IVF a more affordable option than adoption, surrogacy or any other family-building option out there. Financially, it was no more costly than any other major medical procedure. It was our co-pay. Emotionally, IVF is brutal.
    It's an incredible shame that the aid we received for IVF isn't made available for other viable options in family building for those of us not fortunate enough to get knocked up after a margarita or two.

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  3. What a timely post! Just found out yesterday that IUI #4 didn't work, and now my doctor is giving me three options:

    1) Do more IUI's with a new heavy duty drug, which has been shown to cause birth defects (letrozole/Femara)

    2) Pursue IVF

    3) Have an investigative surgery to see if I have endometriosis

    I'm petrified of all three option because I do horribly with added hormones in my system (I was a total nut case while on birth control), and I'm also scared of the surgery since I had life-threatening complications during a "minor surgery" in the past. I'm so overwhelmed, and don't know what to do. The internal clock ticking away doesn't help either. I'd love to hear your readers weigh-in, especially those who have been down this road.

    Luckily, I also live in IL, so my treatments are covered as any normal insurance claim would be - I just have to pay my deductible. A little tip for your readers - both Costco and Bank of America cover fertility treatments 100% for even part-time employees, so if that's an option, it may be worth pursuing,

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    1. I'm assuming that if your doctor is recommending Femara, your IUI cycles were already with Clomid? Did they monitor you with an ultrasound to see how many eggs you were producing? In my case, we knew that I was producing a good number of eggs with the drugs, so after 4 failed cycles of various combinations of Clomid/Femara/IUI, our feeling was that it was likely that the eggs weren't making it where they needed to go, and it was time to switch to IVF, because it would solve that problem.

      I had surgery for endometriosis, and in retrospect, I'm not sure I would do it again. Of course, that's only because hindsight is 20/20, and I know now things that I couldn't have know then. But in your case, I would suggest seriously questioning your doctor on the what would be gained from the endometriosis surgery. It is real outpatient surgery (full general anesthesia, intubation, catheter, etc.) with a recovery time of several days, as opposed to IVF, which is just sedation and taking it easy for a few hours. My understanding is that it is fairly rare that surgery for endometriosis allows a woman to succeed in becoming pregnant. So the main advantage to the exploratory surgery is knowing that drug, IUI, etc. treatments likely won't work for you, and you should go straight to IVF. If you're already turning to IVF, then I don't see the surgery being useful for you.

      Of course, this is all based on my personal experience, and everyone's journey and bodies are different.

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    2. I agree with what was said above. I had endometriosis surgery just to find out that I have very mild endometriosis, they gave me an antibiotic and I still have to pursue IVF. I did not gain anything with this, it was a waste of money, time, taking off work, feeling miserable after surgery. Afterwards my doctor did a biopsy to see if the antibiotics worked and everything was fine. I will never understand why she did not do the biopsy in the first place, instead of insisting on surgery.

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  4. After four years of infertility, including one major surgery that removed both of my fallopian tubes, kept me in the hospital for four days and recovering for six months, we went down the IVF road, twice. I was on a drug regimen that required a pill every eight hours for three months. I worked two hundred miles from home, so there were countless injections done on freeway on ramps. Weekly counseling for nearly two years and acupuncture treatments were on the table as well. In one year alone, we spent $25,000 out of pocket on my medical expenses. This was covered by credit cards completely maxed out and entire paychecks going just to keeping that debt somewhat under control, sacrificing payments to student loans. Forget buying a house or even repairing a car.

    In the end, we had beautiful twins. But I held my breath my entire pregnancy, couldn't take maternity pictures, and ended up in the hospital for monitoring on a couple occasions. IVF takes those moments of surprise away. My announcement to my husband was over a phone call, saying "it worked." To complicate matters, my beautiful baby boy has cerebral palsy, a likely effect in his case of being a twin and conceived through IVF.

    I would not trade one dime, one heartache, or one hair on either of my kids' heads to avoid any of this. I am so incredibly grateful for everything it taught me. It is challenging, not right for everyone, and the long-term effects on your body, your kids (if you are lucky enough) and your parenting style can be quite jolting. Depression and anxiety often become synonymous with fertility treatments and the team approach to family building can be overwhelming.

    It is simply the best decision we could make knowing what we knew then. It changed our lives, left some scars, and opened us up to a world we both loathe and love. We became more empathetic, more cynical, and more committed to living the life we wanted. Even though it is still sometimes difficult, I wouldn't change any of it. I consider myself to be a brave person, something I would not have believed prior to IVF.

    On another note entirely, have you read The Hidden Messages in Water by Masaru Emoto? I thought of it when I read your post on the River Ceremony. I go back and read that post often. My mom always says when you are stressed, you should "get thee to a stream."

    Thanks for allowing me to post some thoughts on this very complicated issue.

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  5. At the end of pregnancy#2 right now, reading all this is really making me grateful that I am here right now. There is so.much to complain about in pregnancy (especially with a high strung 18 month old) but ultimately I should just remember to be grateful for the.miracle of life. So much respect for women who have to go through so much.

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  6. We did 3 IVF embryo transfers: 1 fresh, then 1 frozen, then another fresh. In the end, we did come out with our daughter (although only barely - I developed an SCH at 10 weeks, instead of shrinking, it grew, and eventually led to my water breaking -PPROM- at 21 weeks. Somehow, against the odds, I remained pregnant for another 7.5 weeks and baby came at 28.4w). I love my daughter and am so glad she's here (of course).

    But oh, there are definitely huge drawbacks to IVF. First, like one of the women quoted in the post says, people think it works more than it actually does. It's so easy to get sucked into the idea that it *will* work, and of course, it can take several attempts if it even does work at all in the end. And yep, it was wicked expensive for us. We spent our savings (enough for a down payment plus some on a nice house) to do it.

    Then there's the emotional part. Our first IVF ended with miscarriage. I started out pregnant with twins, lost the first one at around 5-6 weeks (could see gestational sac and something in it, but no heartbeat) and then lost the second one after seeing a beautiful heartbeat twice at 9 weeks. The second IVF I had an ectopic loss. It was horrible - I had always sort of envisioned IVF being a "yes/no" situation. Either I'd be pregnant or I wouldn't be. With the ectopic in particular, I knew based on the low beta and bleeding that this probably wasn't a viable pregnancy, but had to continue with hormone shots and acting like I was pregnant for several weeks. So I had this awful in between situation where I was pregnant...but not really, not with a pregnancy that had a true shot at being a take-home baby for us. Between the hormones and the stress of the situation, it was absolute hell.

    IVF also interfered quite a bit with work. It really is an all-in procedure and during those weeks of stimulation/retrieval/transfer, there is simply no ability to predict or control the schedule no matter how inconvenient.

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  7. We did two rounds of IVF that didn’t work and then one that did, but I ended up miscarrying. It’s hard to say if it’s worth it or not. If we would’ve ended up with our child, I imagine it would’ve been. Since we didn’t, it’s hard to say it was worth it. Personally, I don’t regret it as I feel like we did everything we could to try to have a kid (biologically anyway) and there’s some sort of solace in that. I think I would’ve always wondered “what if” if we hadn’t tried. But it’s put my marriage through the wringer. My husband has had a really hard time with the ups and downs and hopes and loss and his infertility tied to it all through the whole journey. We’ve talked about separating and even divorce and are still on shaky ground. And it’s all stemmed from the infertility but I think the IVF even more so than the infertility. He’s said that if we would’ve never tried IVF he thinks he could’ve accepted our situation and been okay. But the whole ‘being so close’ thing and seeing me dive into a depression for a while after the miscarriage has really done a number on him. IVF messes with your head. Big time. I saw a statistic once that said couples who go through infertility treatments without having it work are three times more likely than other couples to break up. So is it worth it? If it works, sure. If it doesn’t? I don’t know. It’s a massive gamble. I think clinics and doctors often have the best interest of their patients in mind, but it’s also a business for them and of course they want to make money. I think sometimes they play on peoples’ desperation. The biological, cultural, and personal drive to want to produce your child is HUGE—and most people will do anything they can to get that. The good news in all this is that infertility and treatments, if you go that route, come with loads of life lessons and growth . . . and you can still be happy through and after it all. :)

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  8. So inspired by you all. I have had many family member struggling with similar things and it is nice for me to read different perspecives to more fully understand. I am not married and was wondering if you (Mara) could write a post for the single ladies on being success/succeeding in college/careers/ or just figuring out what to do/ how to me financially independent. I admire your work ethic and think we could all learn from you! Just an idea!

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  10. I don't yet have the words to articulate my feelings and experiences in the world of IVF but reading this post and these comments fills me with such a sense of peace and sadness knowing I was not alone. Love and light to all

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  11. For us, in addition to what has been said above:
    Pro:
    Having only one child (not multiples). We knew having a baby at all was going to be way past our comfort zone, and more than one at a time terrified us. We only transferred a single embryo, so our chances of more than a singleton were quite small. (We could have still had identical twins.) This was one of our primary reasons for switching to IVF, and not trying injectable fertility drugs. We knew that transferring only one embryo would decrease our chances of success in any given cycle, and we were willing to make that trade off. If this is important to you, make sure you tell your doctor.

    Con:
    For me, the main hormonal side effect of the drugs was anxiety. It was pretty intense, and not something that the clinic had prepared us for. Even once they admitted it was a possible side effect, we got a lot of, "Yes, this is a very anxiety-producing time for many people." Well, yes, but I've struggled with anxiety for many years, and I know the difference (in my own body) between when I am anxious ABOUT something, vs. when I am anxious because of biochemistry. First trimester was similarly difficult for me, and I couldn't say whether it was my own biochemistry, or the supplemental progesterone (probably both). We are preparing to do IVF again, and this time, I am expecting the anxiety, and preparing ahead of time--e.g., establishing a relationship now with a therapist.

    And as mentioned in the article, there are a lot of misconceptions about pregnancies/babies that started out with IVF. Because of this (and some religious objections), we have not shared our daughter's origins with my husband's family. My MIL already has diagnosed numerous "delays" in our daughter's development (even though her pediatrician and day care teachers say she is average or ahead of the curve in those same areas)--we are certain that if she knew the origin story, she would find even more "problems," and lay all the blame on the IVF.

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    1. There are a lot of people in our family as well that don't know that our babes were conceived via IVF, mostly because of religious concerns. It sort of breaks my heart because what we all went through is a pretty remarkable story. I have embryo pictures on my fridge as a reminder of how far we have come. On the flip side, I want to protect my kids from folks who think they are somehow less than. Thanks for sharing your story. Stay strong.

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  12. I'm looking at this topic from 21 years out. We chose IVF because it was the last option and we felt we needed to try everything. Our first try produced triplets. A tough, anxiety filled pregnancy. They were born premature at 35 weeks. The first few years were hard but fun. One of our daughters was small for her gestational age and had a lot of physical and developmental issues in her early years. That was very, very hard. At 20, she has overcome many of her challenges but not all and it is still a question on whether she will ever be completely independent. My other two girls are doing great. They probably could give you a long list of why they wish they were born singly, but I'm sure they are all IVF proponents. When they were 2 the doctor said now or never so we did try another cycle. I became pregnant with twins who I miscarried at 12 weeks. Sad and upsetting but I was too busy to dwell on it. I think of those two at milestone times, graduations, big birthdays and alternately mourn the loss and give a little sigh of relief.

    The pros are clearly my three loves.
    The cons, well since I was successful there aren't any lasting cons. Yes, the process was expensive, time consuming and stressful but like most things, time softens those edges. Looking back, they were just tiny blips.

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  13. Mara,

    Thank you for sharing what is often such a private experience, with so many of us. My husband and I are in the very early stages of starting to consider conceiving and we are going into it knowing that we will need some sort of intervention (as I have Polycystic Ovarian Syndrome).

    From everything I have read and the generosity of everyone sharing here, I don't think IVF is something I want to go for if all other routes prove unsuccessful. However, I also realize you can never say never...especially when it comes to such an emotionally charged decision as this one.

    I have found that I have never allowed myself to really want a child to the degree that I probably do deep down. It is sort of 'protection mode' I think, not giving myself permission to get my heart set on something that may not happen. I wonder if others have had similar experiences?

    Much love to everyone who has been or is going through this journey.

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  14. Thank you for sharing this, both the discussion today and the previous posts about your experiences with IVF. I stumbled across your blog a few years ago when I was planning my wedding, and yours was featured on the JCrew website. (We wore the same dress!) It seems only fitting that you would be talking about IVF the day after I took my first Lupron shot.

    I’m still making my own pros and cons list, even as we take our first steps. We are definitely moving forward, but I’m so conflicted.

    The pros: It makes sense financially, even without insurance coverage. I have HA, and I don’t cycle on my own without injections. We were spending about 1/3 the cost of IVF each month with significantly lower odds. It makes sense emotionally, because I’m about at my limit. It appeals to my very driven personality. I’m not sure that I can fully quit the RE and move on without feeling confident that I tried everything I could.

    The cons: I feel guilty about the cost of IVF. I feel guilty that I’m choosing this path over adoption. I’m so blown away by the science, but I still feel odd about the unnaturalness of an embryologist creating my baby. The odds, while they are better, are still not amazing.

    The loss of privacy is huge. (I loved that mention by your anonymous contributor!) I used to be very open with my friends and family about each round of treatment. The sadness and shame I felt with each failed treatment was compounded every time I shared the news with a hopeful friend or parent. We aren’t telling anyone about IVF, and I’m grateful. It’s led me to confide in and lean on my husband more than before, and I think it’s been good for us both.

    Sending so much love to everyone in the struggle.

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  15. HI Danny and Mara! I LOVE your blog. I follow it all the time. I’ve never been through infertility but a lot of my best friends have and are going through it. I read your blog for them, but also for myself because I apply your principles to ANY trial I face. But something I’ve come across recently is that when my best friend is doing IVF or fertility treatments she turns into another person. She is completely unreasonable with EVERYONE around her. You can’t even reason with her at all. She gets mean to strangers even. I’ve tried to talk to her about it and she won’t have any of it. And with me her personality changes every single day. Some days she texts me all day long and then other days I don’t hear from her days at a time. It’s just super hard as her friend to go through this. I miss my real friend and it’s SO hard. I never know if she is mad at me and if it will last or not. DO you have any tips for FRIENDS of those going through infertility?! Thank you!!!

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