# anti-depressants during IVF



## deedee_spark (Aug 6, 2014)

Hi,

Does anyone know whether you can take anti-depressants during IVF? I am not on any at the moment. I am just very tired of the infertility journey. Sleep is not that great, I suffer from anxiety, but mainly I feel permanently flat - not happy. I have suffered severe depression and post traumatic stress in the past so I know what really bad depression is, and I'm not at that stage or anywhere near. I feel like a need a pick-me up. A recharge of serotonin. The unhappy part of my brain needs to shrink. For two years, I haven't achieved anything - seriously. I working freelance and I am not actually doing anything, so not bringing in any wonga - more pressure on hubby, but another dent on my self esteem.  

I've tried the usual. Exercise. Meditation. Diet. Fish oil. 

I am starting the monitoring cycle with ARGC this week and a view to IVF next year.

I've asked the same question on ARGC thread a few days back but haven't received a response. I am guessing ARGC won't like it!

I know that doctors will prescribe some anti-depressants because benefits outway risks. 

Any ideas girls?

Thanks,

Deedee


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## CrazyHorse (May 8, 2014)

I'd suggest talking to your regular GP and doing some research on which anti-depressants are relatively safe in pregnancy. I took fluoxetine (Prozac) all through my IVF treatment, and am coming off it now that I am pregnant. However, if I start having serious depression in pregnancy, I will start taking it again, as the very small risk of heart defect and and lower birth weight will be a lesser danger to my fetus than my having a mental breakdown. If there's an antidepressant you already know works for you, it's really important to do your homework and see what's known about the drug's possible effects in pregnancy.

Your IVF clinic is unlikely to be set up to advise you on this, unfortunately, as the consultants there are reproductive endocrinologists whose job is to get you pregnant and keep you that way, not to look after aspects of your health that don't immediately have a direct effect on fertility/pregnancy. If you can afford it, a visit with a private maternal-fetal medicine specialist (also known as a perinatologist) would be the way to go -- they will have the most knowledge and experience in weighing medication for maternal health against possible risks to the fetus. I did this years ago in the U.S. before DH and I started TTC, and it was enormously helpful in setting my mind at ease about the relative risks of the medications I might need to maintain my own health in pregnancy.

Wishing you best of luck! It's great that you know when your state of mind needs a "tune-up" before you end up all the way down the rabbit hole of depression.


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## janieliz (Jul 25, 2014)

Hi,

I was on anti-d's prior to starting fertility treatment due to hormonal receptive depression - bad PMT which results in two weeks of the month feeling really low. My fertility doc advised me to come off them, however my GP was more neutral about it and said the risks were minimal, but were there with regards to baby developing potential heart defects. I decided in the end to come off them and started having acupuncture and I think that has really helped with my moods and hormones. I also find journaling helps to.

I totally empathise with the freelance thing, I am also freelance and work on fixed term contracts so I understand that anxiety. I would say doing something purely for yourself and totally fertility unrelated is really important to. This is going to sound totally off the wall   but I lead choirs and I see lots of people come along who have difficult things going on in their lives and they find singing really helps, they prioritise that 1.5 hours each week! It keeps you in the moment and releases lots of endorphins and happy hormones! So even if its not something like that, doing something that makes you feel good and in the moment might help in the short term and give you a boost.

x


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## deedee_spark (Aug 6, 2014)

Thank you both. Some good options.

I am seeing the clinic this week so will have a word with them about antidepressants, and also book to see my GP. My GP refused me medication in the summer and I wish I had pushed for it as at least I could have picked myself back up in time for IVF. As opposed to dragging myself through the last few months, achieving little work. I have taken sertraline before. Mindfulness is useful, but infertility is relentless and monthly and there are reminders everywhere. 

Crazyhorse - I agree about the breakdown in pregnancy. If I start to break, I will have to take medication. Having had a full down melt down before, I know any baby would be far more at risk of mummy's inability to look after herself than short term anti-depressants. My DH has strict instructions to watch me closely after giving birth too. Major depression scares living daylights out of me. Horrible feeling!

Janieliz - fantastic idea about the singing. Although I really can't sing so it will have to be something else. I am thinking drama. I used love amateur dramatics. There is bound to be one local. New years resolution sorted. 

I have just been to Tesco and bought some Rhodiola Rosea. I have used 5-HTP before but I think it made me more anxious. Maybe the Rhodiola will give me enough serotonin to finally lift me from this two year slump. A month or so rest would be so good. I am just working out how to build oxytocin now.  

Thank you,

Deedee xx


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## purpledream (Nov 6, 2013)

deedee_spark said:


> Hi,
> 
> Does anyone know whether you can take anti-depressants during IVF? I am not on any at the moment. I am just very tired of the infertility journey. Sleep is not that great, I suffer from anxiety, but mainly I feel permanently flat - not happy. I have suffered severe depression and post traumatic stress in the past so I know what really bad depression is, and I'm not at that stage or anywhere near. I feel like a need a pick-me up. A recharge of serotonin. The unhappy part of my brain needs to shrink. For two years, I haven't achieved anything - seriously. I working freelance and I am not actually doing anything, so not bringing in any wonga - more pressure on hubby, but another dent on my self esteem.
> 
> ...


HI Deedee,

I am sorry u feel this way. Actually I feel very much like you.
For me, I find talking to a non friend, neutral party helps. But a shrink cost a lot and I have stopped. 
I know this sounds crazy but my only coping mechanism now is to stop caring so much about everything. Only the fertility part I cannot stop caring, the rest I try not to force things in place. Your situaton sounds like mine a lot - you are not alone. The been there before no where near need a perk me up thing.
If u would believe it, I don't even have any motivation to take vitamins, it has become a chore to me. After failing fresh cycles 3 times and running out of money.


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## mierran (Apr 24, 2009)

Hi,
I am on lofepramine which is a tricyclic antidepressant and is used against pain. I was on it for the whole of my last pregnancy and my twins are now bright happy 4 year olds. 
The main risk is withdrawl symptoms after birth. However, that is easily sorted by breastfeeding. 

The risk to baby, as you say, is much higher from untreated depressiin or psychosis ( which can occur in pregnancy as well as post natal period ).  So while in an ideal world we wouldn't take any meds during pregnancy, sometimes it is the lesser of two evils.

good luck , and it is worth doing some research yourself. In the us the FDA ( food and drug administration ) categorises drugs based on their risk in pregnancy. Ideally what you want are category B which is not licenced but no evidence of harm to baby. There are no antidepressants licenced in pregnancy as far as I know. Ones like prozac are category C which is evidence of harm in animals but can be used if benefit to mum outweighs risk to baby. But obviously it is better to use a category B if possible. But often it is not - you need a drug which works for you.m

Hope that helps.

x x


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## CrazyHorse (May 8, 2014)

A clarification: Category C drugs in the US are drugs that do not currently have clear statistical evidence of real risk/harm to the fetus in human pregnancy at normal dosages. Here's the definition of a Category C drug:

_"Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks."_ (http://chemm.nlm.nih.gov/pregnancycategories.htm)

Category D drugs are the ones where there is real evidence of risk of harm to the fetus based on data in humans, but the risk may be small enough to justify use of the drug in some pregnant women if the likely benefit outweighs the likely harm. Category X drugs are the ones that should never be administered to any pregnant woman, ever. If I am not much mistaken, the large majority of prescription drugs are Category C, due to lack of good quality data collection for the population of pregnant women.

If you'd like to check the FDA classification of a drug, a reputable site like www.rxlist.com or www.drugs.com will be able to provide that info for you. HTH!

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## deedee_spark (Aug 6, 2014)

Thanks for all the information on FDA the categories. I have looked up 3 antidepressants that I know of via drugs.com: Citalopram, sertraline and amitriptyline, all 3 are category C, and all 3 look pretty scary. Is lofepramine cat C? I can't see that one listed (possibly because it is not a USA drug).

Purpledream - I try to stop caring but I think because I have always wanted a family I can't help beating myself up with regret about how I didn't sort myself out early. If a man wasn't required, I'd probably be a mum of 10 by now. But I am glad that a man is part of the deal; they're someone to love and someone to share parenthood with. 

I am about to take my first Rhodiola Rosea -so we'll see if it makes any difference. I'll also call ARGC tomorrow and see what they say. They might refuse IVF, but after waking with another panic attack early this morning it's probably time for my brain to have a little respite.  I read a few weeks back that writing all the good things that happened that day in a book at night, can really help. I'll start tonight. 

I wish there was something that automatically grow all the serotonin back immediately. Like a one pill miracle!

Thanks for all your help. x


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## deedee_spark (Aug 6, 2014)

Do any of you know whether tricyclic anti-depressants are safer than SSRIs? Suppose I mean, have you been told or seen any articles relating to this. 

I saw an article saying SSRIs have a very, very minor risk of causing autism. I've not really seen an major problems with tricyclic.

I am going to take a short antidepressant break. Even if I only get 1 months respite (3 months course), it's better than this. 

The Rhodiola Rosea seems to have made no difference. Unless it build up!

xx


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## CrazyHorse (May 8, 2014)

deedee_spark said:


> Do any of you know whether tricyclic anti-depressants are safer than SSRIs? Suppose I mean, have you been told or seen any articles relating to this.


There's not a lot of evidence that one class is really safer than the other. The Mayo Clinic (very highly respected medical centre in the U.S.) has a layperson's article about treatment of depression in pregnancy: http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/antidepressants/art-20046420. With SSRIs, it's probably preferable not to take them in the last trimester if that's an option (http://www.gpnotebook.co.uk/simplepage.cfm?ID=1785397323, http://www.aafp.org/afp/2011/0515/p1211.html).

I don't think you can expect any herbal supplement to work in one day, so I would give it more time if you think it might help. 

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## deedee_spark (Aug 6, 2014)

I've seen the doctor. I'm taking 50mg sertraline - will ween myself off when I get a BFP. Feeling like this, I can't imagine my body wanting get a BFP. Whether clinic like it or not, realistically I am not a functioning human being. I had to be really honest with DH last night and say that the black cloud has start re-igniting past traumas. So just like I need a little help through IVF, I need a little help with my brain. 

Looking forward to feeling better in about 3 weeks. 

Thanks everyone. Baby dust and best wishes.

x


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## CrazyHorse (May 8, 2014)

Deedee, as someone who's also suffered a lot with depression from time to time, I think you're absolutely doing the right thing. To have your best shot at success with IVF, you have to take care of your body, and that's infinitely easier to do when your head is in the right place. I very much understand the feeling of your brain chemistry getting out of kilter and requiring a top-up with the right medication -- thank goodness you have something available to you!


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## janieliz (Jul 25, 2014)

Hi,
This whole process is as stressful enough as it is, so you are absolutely doing the right thing for you. I was on 50mg of Setraline until recently and it was brilliant, really helped my mood and that it was I needed at that point in time. Make sure you are doing lots of self-care even though that might seem hard at the moment. I always find it hard to take vitamins and eat properly when I feel the black cloud coming, very bizarre the vitamins one, but its a sign for me!  

x


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## kjoris (Oct 9, 2014)

I am also on Setraline. My doctor told me it was a good medication for those ttc.
I have been on it for over a year now. Everything went black after 2 treatments last year and nothing seemed good and I was constantly negative and horrible with my family.
I thought I was ok last summer and decided to ween me off. After about 2 weeks I started going down again. So I started again.

It will get better in maybe 1-2 weeks  When you realise one day that there are actually things that are doable and not everything will be so damn hard.


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## deedee_spark (Aug 6, 2014)

Thank you so much for the support. 

Janieliz - yes, it is hard to take the right vitamins and eat well. We do manage it mostly. 

kjoris - thanks for the reassurance about setraline. At least by christmas day, I might actually feel better; but the new year, I might get some work done and contribute to our household (and the increasing debt).  

Crazyhorse - yes, it is my brain chemistry that is out of whack and I no longer have the ability, my own strength, to pull myself up (IVF or no IVF, medication is required). That's exactly how I explained it to my doctor. Congratulations on the BFP. 

Thank you all for making me feel a bit better. Mental illness is a really ugly illness; almost as ugly as infertility (which show how bad infertility is). 

xx


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## kjoris (Oct 9, 2014)

Yes, the depts... I am not working, just trying to finish a masters degree, "just" have the essay left... and not much has happened the last months. So I will probably not get any stuedentloans for this semester... Well. Better start working some after christmas... This will all sort out.


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## CrazyHorse (May 8, 2014)

Thanks, deedee.   Yes, depression is a lot like infertility in that it's hard to explain how horrid it is to anyone who hasn't gone through it, and you learn to avoid telling most people about it because you end up having to answer so many ignorant questions and field so much insensitive (albeit usually well-meaning) advice.

Here's hoping the new year rings in happiness and positive changes for you.


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## deedee_spark (Aug 6, 2014)

Thank you everyone. 

x


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## mierran (Apr 24, 2009)

Hi,
yes, lofepramine is FDA category C

I hope you feel better soon. 

X X


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## Flossy34 (Aug 11, 2013)

Hi Deedee
I spotted this post tonight and I couldn't have read it at a better time.i am in totally the same position as you and hoping to begin treatment at ARGC in the new year. I also have a history of post traumatic stress after I was in a bad relationship for many years. While my life is nothing like it was then, after two failed cycles in close succession I have had a very difficult few months. I'm working hard to stay positive and doing exercise, mindfullness etc to try and stay calm. I know for certain in my previous state of mind there is no way I could undergo another cycle.
I'm getting better each day but still find myself to be very restless, panicky and also quite irrational at times. I regularly wake up during the night screaming as my nightmare are so awful. I really fell I need some help in the form of medication but my husband is dead against it. I'm also worried that they won't want to give me ivf while in anti depressants. Can anyone advice on this? A few years ago I had cipralex and found them to be very good, they got rid of the feelings of total helplessness and stress which I do seem to have at the moment.

Flossy x


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## CrazyHorse (May 8, 2014)

I can't speak to any other clinic, but my clinic had no problem with treating me while I was taking fluoxetine. They recommended I come off it if I became pregnant, if I was able to do so without becoming seriously depressed, but they were not concerned about it having any effect on the IVF cycle. HTH!


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## deedee_spark (Aug 6, 2014)

Flossy34 -

Seems we have walked a similar path.

I am on day 6 of the anti'd and the nightmares have gone. I am very, very tired and a bit brain dead but I know that feeling will pass in a week or so. I feel a bit more relaxed already. I was a bit worried that I would get worse before I got better.

I do not regret taking the anti'ds. I only wish I'd done it sooner. My GP refused me them in the summer because I was talking of adoption/IVF, but I forced the issue this week. I couldn't go on without some help. I think it is difficult for people who have not had major depression to understand that you get to a point where the brain has become so unbalanced that only medication (or complete removal from the situation) is going to help. Yes, I needed something to pick me up because I wasn't strong, anymore, to do it myself. Infertility is relentless. If you have past trauma, for some reason it re-triggers it. My life is nothing like my previous life so I don't really get it. Do you think nightmares will ever go completely?

Another FF responded that ARGC were ok with her taking the anti'ds but wanted her to come off them once she got a BFP.

I haven't asked the permission of ARGC to take the medication - I was beyond that point. I've just had my chicago test and I am on my monitoring cycle so when I get the results back, in 3-4 weeks, I'll tell the doctor then. If they refuse to treat me, we'll find another clinic. I know I'll be judged by people who haven't walked a path similar to mine, but I've decided I can't go through IVF without them.

TBH, I think I have far better chance at conceiving now because I am not depressed/chronically anxious/having nightmares.

I'm really sorry for your 2 cycles. That must be really traumatic for you. My husband was against it at first, but he then realised that people are taking steroids and all other potions as part of this TTC journey. Are anti-d's any different/any safer?

If I were you, I would try to assess the quality of your life right now. Have you spent months trying to pick yourself up daily? If so, I'd at least have a chat with your GP. If you are just feeling a bit low temporarily, I would see if a natural treatment would help.

Also, have a look through this post. It might make you feel better.

http://www.fertilityfriends.co.uk/forum/index.php?topic=317705.0

3rd time lucky at ARGC for you.

xx


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## janieliz (Jul 25, 2014)

Hi,
I think all clinics are different and its probably best just to speak to them about it. My fertility doctor wanted me to come off them, but my GP was really supportive. I guess she must see lots of women who conceive naturally on them and take them throughout pregnancy and afterwards with no ill effects. I think you have hit the nail on the head though, you have to feel comfortable at your clinic and a good clinic will understand how stressful this process is and also personalise their treatment plans accordingly. I am not continuing treatment with my clinic because it does not specialise in individual care - nothing to do with taking anti d's. In my opinion, after a long running history of low mood, being able to ask for some anti-d's is a good thing, it means you are aware and able to ask for help and spot signs before it gets any worse. This is only a positive thing. With regards to IVF and adoption, I work a lot with looked after children and the social worker I work with (in fostering and adoption) says that depression is not a barrier, its actually about how you manage it. So, being able to spot warning signs and know yourself well enough to put things in place is actually seen as a positive thing. Sometimes depression can be seen as a negative thing, but in a strange way, it also has lots of positives. Most people I have met who have some experience of it are empathic, non judgemental, open and have brilliant sense of humours! To me they are pretty important qualities and fundamental to parenting.

x


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## kjoris (Oct 9, 2014)

My experience is that you always wait too long before starting taking anti´d.
I have used it 3 times in my life and I always wait longer than I should, too see if I will not bounce back and stop this nonsense. And then finally when I start, I always think "why did I wait so long"

One time I even got divorced bc of depression. I just didn't have any feelings for my db and when he had been working in other part of the country for 3 months with short leaves in between I told him it was over, I just didn't love him. A few days later I started taking anti´ds and a few days after that I realised what I had done! It took me some time to get him back, he was really hurt.

So my point is that it can do horrible things to try and cope with depression. It does not have to be forever, but a few months, maybe a year can help you get up. 
I have never been that good after a BFN like now (first time I am on anti´d during treatment). I was in more contact with my feelings, had a breakdown (normal reaction to one more BFN) the night I knew the answer and the next day I was starting to plan my next move. Usually I have been down and numb for months after BFN´s.


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## Greyhoundgal (Oct 7, 2013)

Dee dee - I'm glad you've got the meds you need   This IVF journey is relentless and of something helps when you are in a dark place, all the better.

I wanted you not to worry about pregnancy and anti-ds. Two of my best friends took them through their pregnancies for long term issues (and are still on them) and their children are both lovely sunny children, happy and healthy   no harm done...there will always be naysayers but we have to make our own decisions. I have never taken them so I don't feel in a position of authority to speak about them but I can only say the good they have done for people I care about.

Good luck with the treatment (both infertility and for depression)

Grey xxx


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## deedee_spark (Aug 6, 2014)

I just have to write this I don't care if anyone thinks I am crazy or doesn't respond. 

I just had my follow up anti-depressant appointment. My own GP was away and I had a very young, newly qualified lady. She looked like Peter Andre's girlfriend. I know I am being judgemental but I don't think she has ever had anything go wrong in her life, because she didn't know what depression was. I've tried the fresh air and diet!!!  Can you imagine how much she understood infertility and depression? Bless her, she tried but she didn't get it. I said I hadn't been doing enough work and my life was on hold. She told me to take some time out. I said that I've spent the last 2 years taking time out, looking after myself, fighting depression, and it was all a bit boring.  And it is!!

I wanted to up my antidepressant to 100mg for a few months, then reduce down to IVF cycle. She didn't agree with me and wanted me to stay on 50mg - in fact she printed out the 50mg prescription. But when I am alone I am still crying , waking hubby in the night and having frigging nightmares about my past! I have had depression far too many times and I know that I got myself beyond natural health options or counselling. My brain is out of sync. I know myself well enough to know I need the meds and a higher dose, be it for a few months.

Anyway, after being a bit emotional she gave in and I have a stronger dose. It's funny, I feel so guilty about it!!! Why do I get this guilt when I get my way?!

The irony is that had I been slightly more depressed, I would have taken the lower prescription and walked out of the surgery. Then I would have got in my car and started crying and spent the next 3 weeks in misery. Imagine if I'd been suicidal? To be honest, I couldn't really tell her my troubles, she seemed to think everything was so easily solved with rest. If only!

Doctors are brilliant with years of medical knowledge that I don't have, but sometimes, especially when we have experienced an illness a number of times, we know more than GPs about what dosage/medication we require. 

Rant over.

Thanks for listening!


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## Cloudy (Jan 26, 2012)

Rant away honey  

Personally I think there is a desperate need for the introduction of a Mental Health Professionals available at every GPs surgery with the same hours as an Ordinary GP. It's ridiculous that in this country we expect GPs to deal with the wide variety of things that they do - they often don't have the time or the inclination to deal with emotional and psychological well-being, as well as the benefits stuff and social work type roles they also have to do. Ironically I had to book in for NHS counselling 6 months before I needed it to get on the waiting list to support me through an expected BFN (which even more ironically ended up being an MC, thank heavens for foresight!)

Don't feel guilty, feel proud that you stood up for yourself. Besides, next time she has someone in to see her about something similar she might actually be a bit more understanding.

Sending you loads of love xxxx


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## deedee_spark (Aug 6, 2014)

Thanks Cloudy.
I'm really sorry about your miscarriage. I think the mental health professional in every surgery is a brilliant idea - perhaps a psychotherapist so that they can assess medication and make recommendations (I know they can't prescribe). We have a counsellor in our surgery but she is not very good with the fertility stuff, and she sets and agenda and we have to stick to that agenda! I saw her for sleep issues associated with infertility and my past. She would only talk about sleeping techniques, even though the fertility issues and past were causing me anxiety at night. It was very bazaar and it didn't improve my sleep. Mindfulness is the most useful technique - it's so hard though. I'm starting to practice again.

The GP I saw yesterday was lovely. Unfortunately though it was like talking to a medically unqualified person, and someone who has never experienced depression, let alone severe depression (which was were I was heading). I don't want to take medication. I don't like taking it. And if I hadn't suffered infertility, I doubt I would have needed to take it. 

Thanks for the love and understanding. I hope 2015 brings you a healthy and happy pregnancy. 

xx


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