Thalia's fertility journey

Always more questions than answers

I have several bigger 'issue'-type posts brewing, but mostly when I'm nowhere near the computer, so sadly not making any progress on getting my thoughts clear and written down. In the meantime I thought I'd answer some questions on protocol and other science-y stuff from the comments. Because you know how I'm a geek about that.

Why won't you trigger til next Tuesday?
We don't know yet whether or not it WILL be Tuesday, it might be Monday, but either way I seem to stim so damn slowly. They didn't do retrieval til Monday (day 15 of stims) last time, and Tuesday will be day 16 of stims this time - the equivalent retrieval day to that of cycle 1. They will discount the follicle that was 16 yesterday as it is too far ahead of the others. What they want is a crop of similarly sized ones. Dr Condescending (did you notice how the three docs I see most at the clinic all got C names? Do you think I should be busy psychoanalysing myself on that one?) is estimating that they will grow between 1 and 2mm a day, so hopefully on Friday they will be around 16-18mm. I guess that might mean Monday retrieval, we'll just have to see. Last time on the Friday (day 12) there were 13 of them between between 11 and 20mm, and on the Monday we got 9 eggs, so I guess the little ones were too little still by the Monday, and I know two were empty.

Why did Dr Condescending ask if I was happy with her wanding
See, that wasn't exactly what I typed. What I typed was that she asked if I was happy for her to wand me instead of Dr Casual doing it - seeing as how he wasn't there. It was a permission thing - she was being respectful of this special continuity-of-care thing I was supposed to be getting. Yes, I didn't exactly have loads of choice, but at least she asked. And I wanted to be clear - because clearly it didn't read that way to some of you - it wasn't like she wanded me, then asked if I liked it. That would have been weird. Maybe there's some English phrasing I used that doesn't make sense in American?

Does Dr Condescending have short skirts to go with the high (red) heels?
Nope, she was wearing a tight-ish but reasonably modest calf-length dress. Which was different from when we saw her from afar last week when she was wearing a very short, tight, flowery wrap dress, again with the red high heels. Perhaps part of her maternity leave involved shoe shopping? And she's got no bloody stomach left from her pregnancy, the cow. No seriously, I do actually rather like her now. But it's funnier to be snarky.

Why does symmetrical embryo development matter?
I think the answer to this is that they don't know WHY but they do know THAT symmetricality relates to better pregnancy rates. It was one of the studies I quoted from the ESHRE meeting. In addition, I found this article. There isn't a lot of agreement here, but some factors do seem to be helpful - and not always the ones that clinics tend to score for. Just to be clear, symmetry doesn't mean going 2 cells, 4 cells, 8 cells, it means that the cells that the embryo has are spaced symmetrically within the embryo - the right relationship to each other. This is such an imperfect science that I wouldn't worry too much about it. However, given I got pregnant last time from a nice symmetrical 4-cell, I hope I'll be forgiven for feeling a bit superstitious about this.

Why is E2 not reliable on an antagonist cycle?
I'm hungry so am not going to spend the time right now to get this right, but basically in an antagonist cycle you are affecting directly the LH level (the antagonist turns it off), and that affects the oestrodiol level directly. In an agonist cycle, you've shut down the pituitary and hence LH etc indirectly by over-stimulation, so the oestrodiol level is independent. I know, that doesn't make great sense. I will read more and get back to you.

And they're off! (please oh please)

You remember how I was supposed to be getting more continuity of care? You remember how Dr Candour said that Dr Casual would be around and would make a special effort to scan me, do the retrieval etc.? Well, this morning we got in to an unusually quiet clinic at 0710, only for Dr Condescending (yes, she is back from maternity leave) to come up and let me know that Dr Casual would be away for this week and part of next week. Huh? How come he didn't mention that to us when I spoke to him on Friday? I don't want to be too negative about him, I do like my doctors to stay on their respective pedestals, so I'm thinking that perhaps it's a family emergency, although Dr Condescending's manner didn't really indicate that. She was wearing some extraordinary fuck-me red patent leather high heels. Now she always wears high heels - she says she's small and she does it to feel confident - but red patent leather? At 7am in an infertility clinic? And she doesn't half stomp in those shoes.

Anyway, she was very nice - in the way that she is nice although still remaining condescending - and asked if I was happy to get scanned by her instead. Which I was as actually she gives good scan, not to mention being a cracking egg retriever. And the alternative was Dr ICU. Nuff said. Oh the relief when she said - "I'll just show you what's going on - it's good news - before I measure the follicles." So it is good news. Two 10s and two 11s on the right, two 12s, two 10s and a 16 (where on earth did that come from??) on the left. Sounds like we will get fewer eggs than last time (we got 9, but only 5 fertilised) and I'm trying not to freak out too much about that, but just keep on hoping that we have 2 good ones to put back. I do want this cycle to give us at least the same chance of getting pregnant as we had last time.

The slightly less good news is that E2 is only 725 (203 American). Gaah. It's not accurate given the protocol, but it's an indication. It was only 247 on Sunday, so at least it's climbing, but still. Dr Condescending thinks it will be retrieval next Tuesday. Perhaps I'm just getting harder to stim as I get older? The docs aren't worried, and I'm not really worried, I'm just irritated. It would be so nice to be an IVF superstar and get 20 follicles, be able to do blastocyst transfer and have lovely frosties. But I guess that's like saying it would be nice to win the lottery and not have to do this job any more and be able to pay off the mortgage. Just.not.going.to.happen.

Two embryos please. Just two, lovely, symmetrical four cells with fragmentation below 5%. That's not too much to ask, right? That's just like asking for the bus to come along in the next few minutes rather than when you've been waiting for 20 minutes. Or that you look into the fridge and magically find that your husband went to the supermarket and remembered to buy blueberries. Not a miracle, and not a lot to ask. Just a little ask. Please?

Slow? This is funereal...

Not a particularly encouraging morning. The follicles haven't grown AT ALL. Still five less than 8mm on the left, four less than 8mm on the right. That doesn't feel good on day 7 of stims. Dr ICU didn't seem too worried, but he did tell me to put up the dose to 400. The good news is the endometrial growth - to 8.1mm from 6.1mm on Friday. If that has happened, then it means the E2 must be rising. I asked Dr ICU if he'd ever seen the E2 rising and the follicles not growing, and he said no. So we must just be patient, I guess, and assume that when we go in again on Tuesday morning things will have started moving. Tomorrow we'll get the E2 result from today and that will give us some indication. I'm certainly not going to be underestimating the length of my stim - I've booked the week commencing 4 Sept off work, assuming that I'd stim for 15 days as I did last time. If anything I'm going to go longer this time, so it was a good bet.

Problem for me in making sense of this is we've never been scanned on day 7 before. Let's compare anyway, because it's a distraction

• On cycle 1, on day 5 my E2 was 82, and I had 9 follicles under 7mm. On day 9 the E2 was 482 (132 US units) and I had 12, 14, and two under 10 on the left, and four under 10 on the right. We ended up with eight possible, but only six collected due to the endometriomas. Six out of six fertilised
• On cycle 2, on day 5 the E2 was 253 (68 US units), and I had nine follicles under 8mm. On day 9 I had eleven follicles between 10 and 13mm, and the E2 was 1253 (341 US units). (NB this was an antagonist cycle, so the E2 number is not very indicative of what's going on). We ended up with 9 eggs, 5 fertilised.

So I think I should be staying calm. If they all grow between 2 and 4mm by Tuesday, we'll be in a similar place to where we were last time, and that turned out ok. But of course I am stuggling to do that. I'm freaking just a little bit. No, quite a big bit. What I should be doing is being all Zen and calm and remembering Ovagirl's mantra from the first cycle, picturing my follicles: "like coloured balloons, blowing up into beautiful rounded globes of goodness." I'll go and work on that now.

Slowly slowly slowly

It's been quite a week on the work front, hence no posts. Although I am very proud of myself for having caught up with most of you on the 'still trying' list on various slow connections from cars and trains. I seem to have missed out on a couple of blog storms while I was away, plus several people deciding to go password protected for various reasons, and my dear internet friend Kay has quit blogging completely, which is a huge loss to our community. I have to confess, it's made me a bit frightened that at some point someone will dooce me, or I'll get spotted by the trainwreck guys (they already took one of my comments on Mare's site and trashed it, but that's not quite as invasive), or something similar. I'll have to think more about this.

Today was day 5 of our cycle, and, as is my wont, I attended the clinic for a wanding and blood tests. I find it amusing that on each cycle since the first I've had to insist on being monitored on day 5. They don't usually do it. Despite this my treatment has changed on day 5 on both previous cycles. My E2 has come back low, and they've put up my dosage somewhat - from 150 to 200 on cycle 1, and from 250 to 300 on cycle 2. Surprise surprise, today my E2 is low. Really quite low - 205 to be precise, that's 55.85 in American. I do have nine follicles appearing - for a change five on the left and four on the right (usually my left ovary is a little slacker) - all under 8mm. I produced a little spreadsheet to make sense of this. I tried to post it but it looks stupid in the column format, so you'll just have to trust me on the data.

Since today was also the day of our appointment with Dr Candour to talk about the miscarriage, Dr Casual when he called with the test results asked me to check what Dr Candour wanted to do - i.e., did he want to put up the dose or not. So we discussed it with Dr Candour. He says that above 300mIU of recombinant FSH (i.e. not the stuff purified from urine but the stuff produced in culture), there is very little improvement in response. The clinic docs had suggested putting me up to 400mIU. Dr Candour said that if I wanted to increase the dose, he'd be fine with it, but that he thinks it would have no effect so it would be mostly just to keep me happy (he said this with a smile!). When I challenged him on that, he said that he was trying to think from our side of the desk. That if he was sitting where we were, he would want his wife scanned every day, and he'd want the most responsive treatment, despite the fact that a study from Bristol has shown that it makes no difference in success rates when women are scanned just once during a cycle compared to scanning every other day (for scanning read scan plus bloods).

So he suggested a compromise. That we come in for a scan on Sunday, and see how things are going. If the follicles haven't grown (they don't get blood work at weekends) they will up the dose then. I confessed that I was tempted to self-medicate and up the dose to 350 as a compromise, anyway, and he told me straight that in his clinical experience there would be no impact of me doing so. We'll see what my instincts tell me tomorrow morning.

We had a great conversation for the rest of the consultation.

• We talked about the miscarriage and it didn't really change anything but confirmed that we should not be pessimistic. The chance of another miscarriage is less than 1%. Yes, we all know we can be on the wrong side of the statistics, but this is an ok number to go on.
• He does not think we are under-treating the MTHFR - in fact he thinks we are over-treating it, although he's not suggesting changing it.
• We talked about transferring three embryos. He said that he just could not override the HFEA's rules on this, despite the fact that in his clinical judgement it would be a good idea, and that I will be 39.75 by the time we do transfer (for those not in the know, the HFEA say that you cannot replace more than 2 embryos in a woman under 40, and that you can't put back more than three in a woman over 40).
• We talked about exercise and IVF. He said studies show it's a good idea to do some exercise, but that you must not let your core temperature become elevated, nor should you become dehydrated, so to exercise at a more moderate pace than you might usually.
• We talked about UK statistics and why one clinic always looks much better than the others. The answer is they have another clinic next door, and when cycles go badly they do the transfer at the next door clinic, and so they don't have to report those numbers. Apparently the HFEA say they can do nothing about it - it's completely legal.
• We talked about the fact he's taking the week off next week, and he had the grace to comment that he seemed to often be away when we had critical things happening. I told him that those of you who read my blog think he takes a lot of holidays. That you like him, but think he's quite lucky with his time off. He didn't really know what to make of that! He did say that we could email him at any point next week and he would get back to us.
• We talked about PGD and he said it's not indicated for us. That he can see a future (say 3-8 years out) where they will screen embryonic DNA against the total human genome on a chip to look for abnormalities, and where they will biopsy the uterus during the cycle to see if it is receptive. But that we aren't there yet, and he doesn't know whether any of us now in treatment will get to benefit from those kinds of advances. This is for all of you in your 20s now - perhaps some of this can come true for you if treatment isn't working for you right now - or maybe by the time it is available you will have moved on to other paths.

I do really appreciate having a doctor like him, who is prepared to discuss the issues with us, to take our concerns and our questions seriously. We are lucky.

So onwards to Sunday. Let's hope my body is just taking a while to get going.

Lighter, tighter, and ready to go

I am back, I am scanned, my ovaries are quiet, my lining was thin,my FSH is at 2.3 (2.3?? Must be the zoladex), and I have injected 300mIU of Puregon. Along with all that excitement I've been to the launderette (our basement laundry room is currently being rebuilt due to extreme leakage whenever it rained previously), been to the supermarket in the pouring rain, and made my husband a delicious lunch of cheese and pickle sandwiches with a beefy cup of builder's tea (just what he wanted), myself a watercress and rocket salad with cottage cheese, spring onions and tomatoes, done some work, been to the gym and am awaiting supper (a takeaway curry, H has been pining). Not bad given we only landed back at Heathrow this morning at 705am.

So there you go, that's my news, that's all you came for, right? No, really? Ok, I give in. Yes, we had a lovely holiday, thank you. It had good points and bad points, but all in all it was worth the extortionate amount of money we spent. I've been to this hotel twice before, as a single woman. To be honest, H was a bit nervous that it would all be a bit girly, as it has a reputation for being a place to go and recuperate, with a spa, a focus on healthy mind and a healthy body, and a considerable amount of spiritual therapy as well. In the end H had a great time, doing lots of Thai boxing and throwing himself into punishing workouts in the gym, as well as attending a stretch class every morning and swimming in the afternoon.

He even enjoyed the food, which is all delicious but also designed to be low-fat and low-calorie. To be honest, some of the food is more successful than others. Wheat-free pasta just isn't that nice and why a chef with all the skill of this guy, with all the wonderful Thai flavours he has to hand, even bothers to serve it up for a main course lunch choice once a week is beyond me. Buckwheat pancakes at breakfast, though, are delicious, as were his chocolate sponge cake, and the passion fruit sorbet - some western-type foods do work well in his cooking. Best of all, though, were the more eastern-based dishes, such as the Thai-inspired salads available at lunch, the pad thai, the salmon glazed with red curry, and a miraculous gingered lentil dahl, served with a lid made from naan. The dahl plus naan offered a total of 289 calories (all the food is marked for nutritional content) - I have no idea how he did that, but have asked for the recipe so if I learn anything interesting I will share.

As you know, my back has really been painful over the last year - since I basically started sitting on my butt during IVF#1. The physiologist I saw on day 1 suggested a programme of water fitness and pilates, so I did that along with my daily massage, as well as some sessions in the gym, lots of swimming, and the daily stetch class. They warned me off yoga because of the focus on forward bends, which are very hard for me and could strain the back further. I was relieved to find that I was able to exercise hard despite the Zoladex. I had thought that the fact I got migraines previously on this drug when I got dehydrated would mean that working out hard would have the same effect. It didn't. My guess is that the migraines were more related to lack of sleep than to lack of water, and sleeping was something we did well. I also read lots of books, had some good (ish) nookey, and met some very interesting people.

The consequence of all this exercise plus the healthy eating is that I am MUCH more flexible, although still in some pain (it's going to take more than 2 weeks to cure a lifetime-long back problem), and I am 3 kilos lighter, as well as 2 inches smaller on my waist. My hips, of course, have hung onto most of their fun coating of lard, but I am now only just under 1 dress size larger than when we got married and about 8 pounds heavier. Given I lost about 25 pounds during the year before we got married, and dropped 2 dress sizes, I feel a lot better about where I am now than where I was before we went away - it was so frustrating having shaped up so well and then let it all go to seed again. I had fun trying on clothes when we got back from the clinic this morning, and found I could fit into all but one pair of jeans comfortably, and two suits I haven't been able to wear for a while. There are still a few suits I bought just after the wedding that are too tight, as well as some of the clothes I wore on honeymoon, but this is a bit positive change. I wish I could keep up the losing weight and shaping up, but I feel that trying to work at that through a cycle won't be a terribly good idea. Not to mention there is of course no way I can do that much exercise while working! My aim therefore is to not gain weight or lose any flexibility during this cycle.

The physiologist gave me a pilates-based routine to do every day to continue to build strength and flexibility. The one thing I am slightly nervous of is that I remember various discussions about how strengthening your abs during stims is not really a good idea - anyone kept up a good exercise regime during a cycle and want to comment?

I have lots of ideas of things to write about, but am already getting stressed about work where all hell is breaking loose, just because I've come home. It's like they saved it all up for me, just to welcome me back. Oh how I long for that lottery win.

It will take me a while to catch up with all of you, so please forgive me while I do so.

Thalia is out of Blogworld. She will respond to your message when she returns

So sorry to leave in the middle of this interesting discussion, your thoughtful comments have given me much food for thought. I may or may not post something from holiday if I feel the urge, but don't expect anything til I get back on 21 August. I'm going to the suppression scan straight from the airport! I'll miss you all desparately, and apologise in advance for all the milestones I'll miss while I'm away. I wish you two joyous weeks.

Communities, or what to do about pregnant blogging

I promised that I'd return to this topic, but haven't had the chance to do so. I've been thinking about this post a lot, which is a mistake because I had lots of interesting thoughts (I promise) but I didn't write them down and now they may be lost to posterity. No matter, I will do my best to recreate. Just bear in mind that there was another, much better post, written in some parallel universe.

It seems I touched a few nerves with the whole pregnant blogging thing. Poor Beth, for example, felt it was directed (at least partially) at her. So while it had the joyful effect of getting her to update us on how she was, it had the negative effect of making her feel got-at, and making me then feel guilty for having got-at her. What a fun cycle we do subject ourselves to.

My thoughts have led me to the conclusion that there are two angles to this. The angle of the pregnant after infertility blogger, and the angle of the continuing infertile blogger. And then there is the question about the combination of the two. Let's think about the newly pregnant first.

Several pregnant bloggers commented on why they slowed down or stopped once they get pregnant. The reasons seem to be:

• Guilt, often combined with Fear
• Boredom
• Just feeling too bloody ill to get to the computer
• All your readers go away so it's very hard to motivate yourself to post

The guilt one is the one that I do empathise with, although I don't buy it completely. I did feel guilty, and even have the post to prove it. Then my dear friend Ms Pamplemousse wrote me a 'get over it' email and I got the message. Apologising for being pregnant is not the point. None of us should apologise. Even our fertile friends shouldn't apologise. We all deserve it. Our fertile friends, I think, owe us a bit of sensitivity in how they break the news (but oh how so few of them manage that), but treating us as damaged people who cannot handle the information is so much worse - patronising and controlling. But for those of us who have struggled together, the blissful pregnancy announcement, accompanied by a picture of a peestick if appropriate, is entirely fine. You don't have to wind up to it or pitch it carefully, we've probably been reading along with breathless anticipation (although not as breathless as yours) for the last four weeks or so. And mostly, we don't wind up to it. We are not embarrassed to announce that pregnancy. It's what to say after that first post, or perhaps the first few posts, announcing rising betas, that we find hard. How can we rejoice when so many friends are left behind? Or, alternatively, how can we post about how bloody awful we are feeling when so many friends would give anything to be feeling this disastrous?

Then comes the fear. How can we rejoice when we are so scared? How can we not rejoice when others are desperate to be in our position? We're damned if we do, it feels, damned if we don't. And it's all very well saying that once we get to 13 weeks or so the fear should go away. This community has seen too many awful things happen after 13 weeks for most of us to relax, even then. And worse, we probably feel that we SHOULD be relaxing, but yet we can't. And we can't complain that we're so tense, because our friends would love to be where we are, yadda yadda yadda. So it must be incredibly hard to know how to pitch your posts. Joy/fear? Guilt/Joy? Happiness/Sadness? All so very complicated.

On the guilt and fear side, I am not going to tell anyone how to feel. The fear I think will never go away, goodness knows if I knew how to banish it I could make a million. But how about changing the guilt to empathy? You know that where you are is a great place to be, you wish all your internet friends could be here, but for now you are just going to remember how they feel, and connect with that in your writing. At a minimum, I would love it if more people felt able to write through it. Follow the advice I give a lot of my junior colleagues. Acknowledge the emotion you're feeling (I'm feeling so guilty, it's really hard to write about how happy I am), then figure out how to deal with it so it doesn't become a problem for the other person in your conversation (I wish you were all here too. I know that may never happen, but remember that I feel that way. At the same time I'm so happy for where I am/we are). So that's it for the guilt side...

The boredom one seems like a reasonable reason for struggling to write. Many of us struggle sometimes with what to post when the infertility stuff is taking a back seat for a while. So when a pregnancy gets past the 'oh wow, I'm pregnant, but I might lose it, oh wow, oh shit, oh great, oh shit' stage, and just goes on going, then I can see that it might be hard to post. Some people, like Jen, just keep posting regardless. Jen has shared about her family, how her pregnancy is progressing in great detail, and all about her preparations for the Beasties. And now she's even sharing from the labour suite! So it works for some people, but not for others. Perhaps it depends how good you were at just posting before you got pregnant. Some of us seem to be in the habit of updating regularly, regardless of whether big things are happening. Others take extended breaks from time to time. I guess writing regularly is one of those disciplines, like making time to exercise, that some of us are good at and some not. Not that I'm equating blogging with the health benefits of exercising, you understand. Oh, if only - but that's another post. So on the boredom front, just a little bit of telling us how you are will work wonders, even if you don't feel you have anything very exciting to say.

The too sick to come to the computer makes perfect sense and no one is ever going to hold that against you. Just let us know when you can how you are. That's all.

The demotivation of losing your audience is hard, too. I know that my audience has gone from about 800 a day when I was about to miscarry, to more like 350 a day now - just above where I was before this last cycle. It was hard looking at those dropping figures, but it doesn't stop me wanting to post. I understand that if you're getting down to the 1-2 comments per post level, perhaps it feels that you aren't appreciated any more. Your reading figures may be higher, but you're not getting any validation. You know why we aren't visiting as much as we did, you've been there too. And without validation, why keep posting? I'm going to come back to this point below. Hold on, another point has to come first.

Before that killer point, we need to look at things from the perspective of the infertiles left behind. As far as we are concerned, we are part of your support group. We helped you get here, emotionally. Not to mention that we are desperate to be where you are. So we are all a bit emotionally invested in you being happy, and in sharing that happiness with you. It's a little bit like when you think really carefully about a lovely present you want to give someone. Then you make the present, wrap it up, and present it, and they say: "Oh thanks." And put it to one side and get on with what they are doing.

Let's be clear we KNOW that you are incredibly grateful for the support you've gotten. But it just doesn't FEEL that way when you immediately bugger off and don't tell us how things are going. And, as described above, we KNOW there are all sorts of good reasons why you might feel bad about continuing to share. But dude, we are the ones who are left here, still infertile, no happiness to share around without your input. See how that works?

So really, what this comes down to is whether or not we have any responsibility to each other or not. This argument has been had many times before, and from what I can gether from sideways comments, there was a big furore in blogland sometime in 2004 which touched on this point. The arguments seem to be that

1. A blog is your blog, and whether someone reads or not is up to them, so you say whatever you like.
2. A blog, particularly one with comments enabled, is everyone's blog. Yes, you are the author, and it's up to you what you write, but you are clearly writing with at least one eye on your audience. This has the upside that you get supportive and encouraging comments, but the downside that in return for the readership and the commenting, your audience expects something from you. A certain frequency of posting, or a certain kind of post, or a certain obligation to update. You are, of course, free to ignore these obligations, and then you might irritate or even anger people. In the pregnancy case, we'll just feel hurt but probably not say anything if you stop posting. In other cases, people have had to deal with angry comments about something they've said, because they've offended community sensibilities.

This second point of view assumes that we are a community. I've seen people debate this before, so I thought I'd go and get a definition so we've got something to debate from. Here is the Wikipedia point of view:

A community is a collection of living things that share an environment, so forming a recognizable group. These living things can be plants or animals; any species, any size. Communities are characterized by interaction in many ways. The definitive aspect of community is that each subject in the mix have something in common that allows an identification. ...[In] human communities, intent, belief, resources, preferences, needs, risks and a number of other conditions may be present and common, affecting the identity of the participants and their degree of adhesion.

The word ''community'' comes from the Latin ''communis,'' meaning "common, public, shared by all or many." German sociologist Ferdinand Tönnies presented a concise differentiation between the terms "community" (gemeinschaft) and "society" (gesellschaft). In his 1887 work, Gemeinschaft and Gesellschaft, Tönnies argued that "community" is perceived to be be a tighter and more cohesive social entity within the context of the larger society, due to the presence of a "unity of will." He added that family and kinship were the perfect expressions of community but that other shared characteristics, such as place or belief, could also result in gemeinschaft.

Sounds like us - no? "A tighter and more cohesive social entity, due to the presence of a unity of will". I'm buying it. So if we are a community, doesn't that mean we have some obligations to each other? I believe that in a healthy community, there is some sense of responsibility for each other, some give and take. Perhaps in any community there will always be free riders (I'm not going to divert into economics now, don't worry), but for a community to survive, those who form it have to have some sense of its value, and of their role within it, and to continue to contribute to it, although that contribution may vary over time.

So I'm coming down on the side that says

1. We are a community
2. When you write your blog, you are writing mostly for yourself, but also with your audience in mind
3. Your audience therefore has a vested interest in your story
4. And you therefore have some - perhaps minor - obligation to your audience
5. This means that when you get pregnant, we need to know how you are from time to time

I'm not entirely thrilled by where I've come out, since another way of saying the above is that you owe us something. Maybe you do. Just a little thing, the gift of sharing whatever it is you are going through, good or bad. If you are able. And you know, even if you can't or won't, we aren't going to forget you. Everyone leaves an imprint on this community. Some bigger than others. But the moment you hit 'save' on that first post, or left your first comment, you made your first step into the community. So whether you like it or not, you're part of us.