The “First Tracks” series highlights the pregnancy, postpartum, and parenting experiences of noteworthy athletes in cross-country skiing in various stages of their professional careers. The sharing of these experiences can benefit athletes in any stage of their career, whether they are an elite or recreational skier, by demonstrating that it is very possible to return to skiing, competition, and an active lifestyle with a growing family. The series will include the physical challenges of being an athlete during and after pregnancy, balancing family life with skiing, and the joy that starting a family can bring. The first athlete highlighted in this series was Kikkan Randall, whose story can be found here: Part 1 | Part 2.
When Holly Brooks retired from professional ski racing in 2016, she shared with FasterSkier that she and her husband, Rob Whitney, were trying to start a family. About a year after this conversation, she gave birth to twins, a daughter, Ruby Joy, and a son, Brooks on August 24th, 2017.
While the process of getting pregnant can be easy for some, their journey to create their “insta-relay team” was complicated by the fact that Brooks had been without a period for eight years. This condition, formally called amenorrhea, can be a result of many factors, from low body weight to thyroid problems, to heavy or high volume exercise, to excessive stress. It can also be a side-effect of some forms of hormonal birth control, as was the case for Brooks.
Brooks initially lost her cycle while using the Mirena IUD, which is known to reduce the frequency or severity of periods, or to eliminate menstrual cycles for women using it. At first, Brooks didn’t recognize this as being problematic. In fact, as a professional athlete, not worrying about her cycle had plenty of perks.
“Let’s be honest, for a really long time I was happy not to have a period as an athlete,” said Brooks in a call. “It was pretty convenient.”
Brooks shared that having amenorrhea as an athlete is not an uncommon phenomenon. While she believed that her nutritional habits were sound and that she was not underweight during her professional career, the condition is often linked to relative energy deficiency syndrome (RED-S, formerly known as the female athlete triad) which is typically a result of under-fueling possibly coupled with inadequate rest to accommodate an athlete’s training load. It is commonly seen with athletes with disordered eating habits, but the two are not always linked. The implications of having amenorrhea for women can include low bone density, leading to osteopenia or osteoporosis, and also infertility.
The pervasiveness of the condition was a concern for Brooks, and her own experience losing her cycle raised a red flag long before she and Whitney began trying to conceive.
“I think that there’s this myth that if you don’t have a period, you’re in shape. If you don’t have a period, it’s okay,” she said. “I’m not a doctor, so it’s hard for me to speak directly to that, but at some point, if you’re not taking birth control that takes it away as a side effect, you probably should be having a period, you should be having a cycle.”
When the Mirena IUD expired five years after it was placed, Brooks switched to a copper IUD called Paragard, which is a non-hormonal form of birth control, in hopes of regaining her cycle. This IUD can increase bleeding or frequency of periods, in contrast to the first. However, her period did not return.
As her professional career waned and her age and desire to start a family with her husband increased, Brooks began hormone replacement therapy (HRT) to coax her reproductive system back into functioning normally in preparation for conception. HRT involves taking artificial hormones sequentially to mimic the changes that naturally occur during a menstrual cycle.
“So essentially, I had to stop exercising, take a bunch of estrogen, then take a bunch of progesterone to try to jump-start a cycle,” Brooks recalled.
It took a few months of HRT for Brooks to successfully regain her period.
“It almost felt like my body had just been kind of dormant and was fine with not having a cycle. And sometimes that’s convenient when you’re an athlete, but when you want to start a family, it’s not that awesome.”
Because she was 35 and it had already taken so much effort to get her body back into a fertile state, Brooks began working with a team of infertility specialists to help the couple get pregnant as quickly as possible. In any other context, the mid-30’s is likely considered the prime of life, but medically speaking, the risks of perinatal complications increase significantly after this point. A woman over the age of 35 who conceives is classified as a “geriatric pregnancy”, or listed for insurance purposes as having “advanced maternal age”. Typically these pregnancies are also labeled “high-risk”.
Brooks describes herself as an “eternal optimist” and managed to handle her battle with infertility with grace, but she expressed that she was not immune to the emotional challenges her situation created.
“There’s tons of frustration, there’s tons of impatience, and there’s also a lot of comparison too,” she said. “Which is human nature and it doesn’t always help.”
She shared that one of her favorite quotes is by Eleanor Roosevelt who said, “Comparison is the thief of joy.” While she remained hopeful that she and her husband would eventually be successful in becoming pregnant, she still found herself pulled into the comparison trap.
“Especially when you’re trying to get pregnant, you notice everyone else who is pregnant,” she observed. “And you’re like, ‘Well these athletes who were super fit, they had no problem getting pregnant.’”
With their infertility team, she and Whitney began the process of Intrauterine Insemination (IUI), which is a less invasive infertility treatment than In Vitro Fertilization (IVF). The IUI process involved Brooks taking a follicle stimulant during the first half of her cycle, prompting her ovaries to develop and grow a follicle containing a mature egg. She then took other fertility medications to induce ovulation, at which time doctors would inject a washed and concentrated sample of her husband’s sperm into her uterus, increasing the likelihood that the sperm and egg meet. This process requires close and careful monitoring throughout the cycle in order to be successful, which was not totally unlike the process of being a professional athlete.
“At some point, when you’re doing infertility [treatments], it starts to take over your life because you are paying so much attention to your cycle, and what day it is in your cycle, and what day you’re ovulating, and what day you’re going to trigger ovulation, and how many follicles you have, and how big the follicles are,” she explained. “As an athlete, you pay a lot of attention to periodization and training. And doing infertility [treatments], you kind of do the same thing, but it feels like you have way less control.”
She expanded by explaining that in training for skiing, she had control over her rest, how hard she pushed in a workout, what she ate, and so on, whereas during the conception process, no matter how hard a couple might “try”, much of it is out of their hands.
Although not frequently discussed, studies estimate that between 10-25% of pregnancies end in miscarriage, most commonly during the first trimester. In many cases, miscarriages occur early during the implantation process and go unnoticed, as the bleeding that occurs as the body sheds the undeveloped embryo often occurs when the woman might expect her regular period, leaving the pregnancy undetected. Miscarriage can also be a result of a chromosomal defect or other abnormality of the developing embryo, or due to lifestyle factors such as poor maternal health, smoking, or drug use.
Regardless of the cause or when the miscarriage occurs, the experience of pregnancy loss can be incredibly difficult for parents. During their voyage through cycles with IUI, Brooks was able to conceive twice before her successful pregnancy with the twins. In both of those cases, she lost the baby just before the end of the first trimester, which is when a pregnancy is typically deemed viable.
Miscarriage is one of the primary reasons most couples choose not to announce their pregnancy until the second trimester begins, lest they also are faced with sharing their loss. Many women that go through one or more miscarriages choose never to divulge their experience. Brooks wants to bring more attention to the topic as it is so commonly experienced but rarely discussed. This lack of attention can leave women grieving in silence and feeling as though they have failed, even though miscarriage is most commonly out of one’s control.
“I’m really happy to [talk about it] because it’s really common and a lot of people don’t talk about it.”
She added that it is one of her missions in life to talk about “the hard stuff” in order to reduce the stigma about these issues.
Because of the treatment method they were using, Brooks was closely monitored in the weeks following the IUI.
“If I were to go back and track how many ultrasounds I’ve had, I would guess 50, 60, 70.”
She explained that her doctors wanted to closely track whether an embryo was growing, and if so, whether it was growing at the appropriate rate with no noticeable problems. This was a stressful process since she and her husband remained so acutely aware of the processes happening within her body.
“Although it’s out of your control, you’re very in tune with what’s happening,” she said. “And it’s a rollercoaster of excitement and disappointment and excitement and disappointment.”
Her doctors were able to determine very rapidly whether or not the IUI had been effective, so in each case, the couple found out they were pregnant rather quickly after the treatment. Then the wait began; there was nothing that she could do but hope that the pregnancy would last through 13-weeks. She remained optimistic but tempered her excitement.
“That was really, really hard,” she emphasized. “It’s such a long journey to get there, and you get excited, but in the back of your mind, you know some of the statistics.”
At about the 12-week mark in both cases, she experienced bleeding which indicated a miscarriage. In some cases, women experiencing a miscarriage are able to pass the contents of the uterus naturally over the course of a few days, sort of like a very heavy period. In others, women need the support of medication to help force the body to shed everything.
Brooks fell into the second category, sharing that she spent two days in bed with horrific cramps each time, only to find out with an ultrasound that her body still had not shed everything, indicating that she would need a procedure called a dilation and curettage (D&C) to surgically remove the remaining contents in order to prevent a severe infection.
“I ended up having to do that twice around the 12-week mark, which felt kind of like deja vu,” she recalled. “And then you’re wondering if it’s ever going to happen or if you’re cursed. And then again, you look around at everyone else with their kids or their pregnant bellies, and you ask yourself the question, ‘Why can’t I get there?'”
Luckily, she did get there. With infertility treatment, multiples are more commonly seen. Brooks’ three younger siblings are also triplets, indicating that she is also genetically predisposed to conceiving multiples herself. While the risk of complications increases with twins, after all that she and her husband had been through, they were “ecstatic” about the idea of being able to complete the family that they envisioned in one pregnancy.
“When you feel like you’re behind and you feel like you had such a hard time getting pregnant to begin with, then you find out you’re getting a twofer,” she laughed. “We were ecstatic, slash terrified.”
After such an extended battle to achieve a healthy pregnancy, it seems impossible not to experience some trepidation about its success. Brooks reflected on if or when she began to feel confident that the pregnancy would work out and that they were finally stepping off of the rollercoaster.
“I think that there’s always some anxiety,” she stated matter-of-factly. “There’s always that voice in the back of your head, ‘Should I do this? Should I not do that? Even if I do all the right things, something could still happen.’ You hear these horror stories of people being pregnant with twins and one of the twins dying. These stories come out of the woodwork and your attention goes to weird places when you’re pregnant, and of course, you’re overly hormonal, obviously.
“So the anxiety was pretty much always there, then it’s there during birth, and it’s there when you have newborns, and it’s still there when you have toddlers,” she ended with a laugh.
Though she acknowledged that many women and also men experience more severe forms of anxiety and depression surrounding pregnancy, which she commented on further later in the conversation (see Part 2), ultimately, few parents are truly immune to some level of it.
“I think to some extent, some anxiety is part of being a parent,” she said. “And it can be heightened or lowered, based on not only your genetics but the environment you’re in and the situations you’ve experienced.”
Stay tuned for part two of this story in which Brooks discusses the remainder of her pregnancy with twins, birth, and adjustment to life as a working parent and athlete. She also shares what’s next for her business, Holly Brooks LLC.