Mrs. X, You’re Turning 33. What Now?

I’m going to Disneyworld!

Yep, the Mister and I are departing this world for the magical land of politcally incorrect rides, cotton-candy princesses and anthropomorphic animals.  I mean, really, what better way is there to inaugurate the year of 3’s than spending it in an orgy of rollercoaster-riding, Mickey-stalking-sighting, and general juvenalia? 

All of the pieces just fit into place: Mr. X had two free roundtrip tickets on Southwest thanks to all of his travel for work so we are flying for all of $10 (damn you, security fee!).  He also has a free car rental weekend, so free car for two days!  And, can I tell you what a deal we got on the hotel?  It pays to have your birthday land in the off-off season at the Most Magical Place on Earth.  It was as if Mickey was saying, “I dare you not to do this!”

I could not say no to the mouse.  I could not say no to my overwhelming glee at the idea of Mr. X and I frolicking through Epcot.  And, hell, it’s my birthday. I can do whatever I want. 

So, as you read this, I am either on the plane already or we have landed in Orlando and are making a beeline for “It’s a Small World”.  Either way, we have big plans and typing on a computer for four days is not one of them!  Au revoir !

ps: No need to thank me for putting that damn ear bug “When you wish upon a star” in your head. Your look of agony is thanks enough.

image: rdo_jeep

Don’t Make Me Use My Angry Infertile Voice

I’d like to think that even in the midst of this struggle, I maintain a certain level of self-control and politesse when coordinating with Dr. Salsa’s office.  They are just trying to help us realize that elusive goal and I try to let them know that I appreciate that by being polite and courteous.  There is hardly ever a need to raise one’s voice or be just plain rude. image: haxed

But, this credo was sorely put to the test this week.  On Thursday, to be exact.

When I was at the office for my whirlwind of a visit last Friday, Nurse Chipper (as in she’s always chipper and happy and actually chirps) promised that she would have my IVF schedule ready by the following Wednesday.  I called her on Thursday because I hadn’t heard anything. 

I wanted to give her the benefit of the doubt, that she had forgotten to send it to me the day before, that she was just finishing it up and would have it over to me in no time.  What I didn’t want to hear is what she told me:

Nurse Chipper: “So, I was looking at the calendar [WHICH WE BOTH WENT OVER AD NAUSEUM ON FRIDAY] and it looks like the lab will actually have to close the week that we had looked at for your retrieval, so we are going to have reschedule your cycle.”

Me: Silence. Inside, I’m beginning to feel that heady mixture of anger and disappointment.

Nurse Chipper: “See, the lab has to close for one week every three to four months for an inspection and this just happens to be that week.”

Me: “And they can’t move it?”

Nurse Chipper: “No, it depends upon the inspector. And, I knew that they were going to close it, but I just didn’t know when. But, now I do know.”

[What I wanted to say: THEN WHY THE F*CK DID YOU POINT OUT THAT WEEK AS BEING A GENUINE POSSIBILITY AND NOT EVEN MENTION THAT THIS WAS A POTENTIAL ISSUE!?!?!]

What I did say: Really big sigh.  “I have the worst luck in the world.”

And, then it just got worse.

Nurse Chipper: “We can move it up so that we have a retrieval the last week of February.” [WHICH IS THE EXACT WEEK I TOLD YOU MR. X IS OUT OF TOWN, IN ANOTHER TIME ZONE FOR THE WHOLE WEEK.] Or, you have to wait until the end of March to begin stims and have a retrieval in April.”

[What I wanted to say: I CAN’T BELIEVE THIS BULLSHIT!!! HE IS GOING TO BE SO PISSED BECAUSE HE SCHEDULED THAT TRAVEL ON THE ASSUMPTION THAT WE WOULD DO EVERYTHING THAT REQUIRED HIS PRESENCE IN MARCH!!! AND NOW THAT I’VE DECIDED THAT I’M READY, AND OH YEA, I STARTED THOSE G*DDAMN BIRTH CONTROL PILLS ALREADY, I DO NOT WANT TO WAIT UNTIL THE END OF MARCH!]

Me: “Like we discussed last week, Mr. X will be out of town that whole week.  But, let me talk to him and see if he can move his travel schedule. I also really don’t want to wait until the end of March to get going.”

“Nurse Chipper: “Ok! Talk to him and then give me a call back so that I know where to put you on the calendar.”  No sorry, no I should have told you that this was a distinct possibility when we went over the calendar on Friday, no oops. 

And, when I tried to call her back that afternoon with questions that Mr. X and I had about scheduling, I’m informed she’s gone for the day. At 1:30pm.  I appreciate that you work on Saturdays, lady, and I don’t begrudge you the right to have your time off. BUT FREAKING TELL ME SO THAT I DON’T GET EVEN MORE FRUSTRATED AT EVEN MORE INFORMATION THAT YOU AREN’T GIVING ME THAT IS KIND OF IMPORTANT.

How did it end?

Vidi, Vici, Venipuncture*

*I saw, I conquered, I got poked for blood. Again.

Yesterday, I took my first solid step into the land of IVF Number 2.  I plunked down the Mastercard, attended the IVF Class, gave up the first of many vials of blood and, (bonus!) got an SHG to start things off with cramps a bang.  I was out of there in an hour and a half.

First things first. We made the payment for the entire cycle on the plastic and I had a very inappropriate laugh with the financial coordinator about how many points I was earning on the conception of my hopefully future child.  It was then that she just had to share with me that she had IVF in December and was pregnant.  Talk about a double sucker punch – pay five figures AND get a pregnancy announcement. 

Now, if you’ll excuse me for one second while I say something very rude: “WHY ON EARTH WOULD YOU SHARE THIS WITH ME, ME WHO YOU CAN EASILY SEE FROM THE CHART IN FRONT OF YOU HAS HAD TWO MISCARRIAGES, BOTH AROUND THE GESTATION THAT YOU ARE AT NOW? WHY WOULD YOU DO THAT, WITH THAT STUPID GRIN ON YOUR FACE AND VERY ANNOYING ASSUMPTION THAT I MUST BE HAPPY FOR YOU? RULE NUNMBER 1 OF WORKING AT AN INFERTILITY CLINIC, HONEY: NEVER, EVER SHARE YOUR REPRODUCTIVE HISTORY OR STATUS WITH PATIENTS, OR MORE PARTICULARLY, WITH ME. IT’S BAD ENOUGH THAT I’M GOING TO HAVE TO WATCH YOUR BELLY EXPAND.  I WISH YOU WOULD HAVE NOT TOLD ME AND JUST LET ME DECEIVE MYSELF THAT YOU WERE GETTING FAT.”

Ah, I feel better. 

I didn’t have much time to collect myself before I was called back and told to pee in a cup and whip off everything below the waist.  I stood there for a minute, looking very stupid, and said, “but I thought I was here for the IVF class?”  Apparently, it was decided without my knowledge that yesterday was also SHG time!  At least this gave me very little time to ponder what a terrible experience with an SHG I had had before.  So, I went and peed in a cup, knowing that it was likely for a pregnancy test which I could have told them would be as white as snow (“UPT was negative,” the nurse chirped).  I delivered the precious cargo to the nurse and went in to the exam room to do my favorite strip tease.  Flat on the exam table, I waited for Dr. Salsa to appear and amused myself by looking at the screen on the ceiling to see what the dildocam looks like when it is not dildocaming (pretty much as incomprehensible as it does when it is dildocaming). 

Dr. Salsa promptly arrived and looked like…. Ted Kacz.ynski?  Apparently, he has decided to start growing a beard.  I looked at him with furrowed brows and successfully fought the urge to point out the similarity.  I also subtly shook my head at the coincidence: when I first started seeing Dr. Uterus, he too had the Mountain Man beard thing going on.  He shaved it off about half way through our relationship.  Now Dr. Salsa has begun to grow the Mountain Man beard.  What is it with my REs and beards?

Dr. Salsa was damned efficient.  He had that catheter in before I could say “hey, where are you sticking that?!” and then it was time for the dildocam and saline action.  Everytime he would push in saline, he would say, “and now, some cramping” and he was so not kidding, and I would yelp.  We did this twice and then, thankfully, he stopped squirting water into my lady parts and merely took a perfunctory looks at my ovaries which he pronounced, “photogenic.”  I would think that he was trying to pick me up except that he already had me on my back. I’m easy that way.

With the SHG (or “mapquesting of my uterus” as the nurse called it) finished, I headed over to the patient education room waiting to learn all that the IVF masters had to teach me.  Pretty quickly I realized that it was as I had thought. It was IVF 101, or what I would have loved to have heard the first time around but is no longer information that I didn’t know.  Some highlights though – they do a lot more monitoring than Dr. Uterus did and they will work with the schedule so that all procedures will be done when Mr. X is in town.  I also learned how to use the Follistim pen and that they will allow a subcutaneous HCG injection, rather than the intramuscular that Dr. Uterus swore was the only thing that would work. 

I then gave up the vial of blood to test for exotic diseases and I was released. 

So, I’m feeling ok about getting started again.  There is enough that is done differently – different protocol, different medicine, different doctor, different procedures – that mentally I don’t feel as if this is just a repeat of our last IVF and may not automatically be a repeat of how it ended.  Right now, that’s about all I can ask for.   Well, that, and for the lady at the office to NOT share her news with any other patients.

Calculating

It seems to be a theme recently.  Once again, we have been asked to put a number on hope.  This time, a price tag. 

When we cycled with Dr. Uterus this time last year, we still had our insurance benefits.  He told us how much IVF cost and we filed the information away knowing that of that amount, we would only have to fork over a fraction because through discounts he gave to the insurance company and our remaining benefits, we were covered.  If it had worked, if we had taken home a wailing little baby, I don’t know if we would have appreciated how lucky we were to have coverage for an entire IVF cycle.

A year later, here we are, getting ready to dip a toe into the pool of IVF again, only this time, we have no insurance benefits, no fiscal balm to help with the five-figure sting of IVF (not including drugs).  After the failed FET in August, we knew that it was only a matter of time before our benefits well officially ran dry.  So, when we started to look for a new RE in September, one of the many considerations was cost.  Dr. Salsa was an attractive choice in this respect because he had some form of shared risk program. 

That is how we found ourselves discussing this week whether to go for the 1, 2 or 3 cycle option for ever increasing amounts of money, all of it upfront.  If we got successful on the first try, we would end up paying more than twice as much for a baby than if we had taken the one cycle option.  If we do it one cycle at a time and get lucky on the third one, then we would still end up paying more than we needed to.  Sure, you get a deep discount if you take the largest volume plan, but this is not Costco.  We aren’t discussing buying Kleenex in bulk. We’re talking about IVF cycles. To have a baby.

After we had been around the bend a few times trying to decide which one to go with, Mr. X made a wonderful and grounding observation: no matter which option we choose, we will likely have some regrets.  And, he’s absolutely right. We can never have the information now that we would need to make a completely informed choice.  Who can predict the future and how many cycles it will take for that elusive live birth?  So, we just have to make the best choice for us right now.

We’ve decided to go with the one cycle option, although not because we think it will be one and we’re done.  It’s because it gives us some flexibility in choosing how we want to proceed if it fails.  What if I do get pregnant again and I miscarry again? If we chose the two or three cycle option, I’d hate to put that obligation on myself and know that the money had already been forked over for more cycles that I may or may not be able to bring myself to do again.

In the end, we may spend more than if we had chosen a two or three cycle option. But then again, when we have that child, will we tell that child how much they cost?  I don’t think so.  We will simply say, “what price love?”

image: unprose

Will There Be a Quiz?

Well, I don’t have a schedule* yet, but I do have a plan.

Monday was CD 1 and I was so thankful for having a genuinely normal 30-day cycle, complete with 13 day luteal phase that I wasn’t even that upset that Big Red showed up.  I called Dr. Salsa’s office and had The Talk with the IVF coordinator about timing. 

And, once again, Mrs. X learned that ever important lesson: jumping to conclusions does no one an iota of good.  Apparently, under their schedule I would start BCPs next Sunday and wouldn’t start stimming until the end of February which means that all of the important stuff that Mr. X needs to be around for happens in mid-March – precisely when we want it to.  I don’t have specifics yet, but she assured me that his scheduled travel at the end of February will not cause any problems. Cautionary whew.

Part of the reason I don’t have any specifics, though, is that Dr. Salsa’s office is kinda sorta holding them hostage.  The ransom? I have to attend their IVF class and do my upfront payment for the entire cycle.  Some would call this extortion.  I’m so far into IF treatment that I call it the cost of doing business.  I choose to believe that they have legitimate reasons for doing it this way (getting their money to avoid nasty money battles later) and are not doing it just to cause angst and further stress on the part of already frayed nerves.  I also choose not to extol on the breathtaking unfairness that I have to pay exorbitant amounts of money to get knocked up.** 

So, guess what I’m doing Friday morning? I’m attending IVF class, because it was either Friday morning or wait until February to take the class and, duh, get my schedule. That was a no-brainer for me. 

I am decidedly curious about this class. Dr. Uterus had no such protocol.  During my tenure under his care, my only ‘class’ , if you could call it that, was a 5 minute lecture before my first injectible IUI cycle from Nurse to a T on how to fill a syringe and where to do the deed.  Seriously.  So, it will be very entertaining to see what they will attempt to educate me on that I haven’t already done.  I’ve been through 6 injectibles cycles, 1 IVF and 1 FET with a bonus mock cycle.  I have mixed my own medicine (no pre-filled syringes here, I’m afraid), I’ve given myself all of my own shots – PIO injections, HCG triggers, Lupron, Menopur, oh my! -, I’ve shot up in airport bathrooms, hotel rooms and relatives’ homes in at least three states, I can take medicine on a schedule (hello, phone alarm!), and I can follow directions.  IVF is not a walk in the park, but what requires a 2 hour class to explain? 

And good student that I am, I will bring along something with which to take copious notes and will raise my hand before asking a question. So far, my only question is “will there be a quiz?”

* Do any other Americans out there have a lovely chirpy British lady’s voice in their head who says ‘shedule’ whenever they read this word?

** Check back later, though. I may change my mind on that one.

image: Buster McLeod

The Slow Road to IVF

Ah, just when I begin to wrap my head around the idea of doing another honest-to-God IVF, we hit a few roadblocks, ironically put up by ourselves. 

It all started with that damn Clomid.

See, I had it all planned out.  We would do the Clom.id challenge in November, I would have my usual and customary 30 day cycle which would oh-so conveniently start at the beginning of the month and end at the end of the month, and so on through December and January. Then, at the beginning of February I would start popping those good old ovary-suppressing BCPs, maybe adding a little Lupron into the mix if Dr. Salsa is feeling particularly saucy.  Then, I would start stimming in March and bob’s your uncle, I would have the retrieval and (hopefully) transfer by the end of March.  Perfect plan!  Mr. X had scheduled work travel around this plan. I had scheduled work travel around this plan. It was a thing of beauty.

Unfortunately, it was all based upon me having 30-day cycles, which is where the aforementioned evil Clomid must take credit for totally derailing the plans.  I popped the Clomid as directed, showed up for my date with the dildocam and then Mr. X and I got to the business at hand.  Two weeks later, I have a very light period, Dr. Salsa does a pregnancy test to rule out an ectopic (negative, thankfully), and I go on my merry charting way.  But, there is something underfoot. My temps are above coverline, when they had not been the entire two weeks after I ovulated.  Sure enough, 20 days in to the new cycle, Big Red shows up with a vengeance.  WTF. 

In addition to causing me a great deal of anxiety, frustration and teeth-knashing (not to mention huffing, puffing and glowering at my nether regions), this also has the extremely annoying side effect of moving my schedule for IVF up by three weeks.  Case in point: today is CD 30, my temp is precipitously flirting with the coverline and I had spotting this morning.  I’m pretty certain Big Red is around the corner, which means that CD 1 when I would start calculating the IVF schedule extraordinaire is now 21 days early!  Why is this a problem, you ask?  That pesky work travel.  From my (amatuer) calculations, I would probably start stimming right around when my travel is supposed to be.  Since I have had my travel on the books for several months now, I cannot in any way under any circumstances get out of it (nor do I want to. It’s a very important trip).   Considering the monitoring required, this is not ideal, but possibly doable. 

But then, there is Mr. X’s work travel. Bless his heart he did exactly as we had discussed.  We had planned that March would be the Big Month when it came to his required assistance because I figured I would be stimming in March, not February (damn you Clomid!). So, he scheduled a week-long business trip in another time zone at the end of February which is – yep, you guessed it – right around where I (again amatuerishly) calculate that we would have egg retrieval and his presence would be required.  Oy gevalt.

We have several choices. I can go on the BCPs now and we can see if the stims and retrieval can hit the appropriate windows when we are both in town.  Or, we can wait another cycle, meaning I wouldn’t start BCPs until mid-February (again, I’m assuimg a 30-day cycle, which I seem to be very capable of having if no extraneous hormones are introduced. We would be stimming from mid-March to the end of March with an egg retrieval around the end of March. 

Personally, I choose to wait another cycle because the stress of getting everything coordinated is so not worth the negative effects that stress would likely have on the entire process.  Of course, this is also dependent upon the schedule of the clinic.  The good news is that Mr. X’s travel schedule appears to be pretty flexible after February and I have no travel scheduled or even on the horizon.

Extra bonuses: another month to try to slip one past the goalie the old fashioned way, no traveling with needles, I can get some extra acupuncture in to help with egg quality and there would be no chance that I could miscarry in March!   

We will get it worked out. Someway, somehow. It will all fall into place. It always does.

image: markymarko

Canary in My Coal Mine

Ah, the things we do for the chance to gestate another human.

This morning, for the third morning in a row, I pulled out various items from the fridge to prepare for myself a nice little breaking of the fast.  There was some bread for toast, orange juice (no pulp, thank-you-very-much-parental-units-who-insisted-on-purchasing-medium-pulp-variety-over-Christmas-which-I-just-finished-yesterday!), quasi-butter spread, fruit salad, and liquid of iron. 

Yes, you read that last item right.  You see, upon the advice of my acupuncturist, I am now downing a capful of the most vile drink every morning with the cheerful name of Flor.adix. It’s supposed to increase my lining, which I’ve never heard that I have a problem with, but what’s the harm in trying it on for size?

From the Dickensian looking bottle to the admonition to refrigerate it upon opening lest it start to ferment (!), I have to say that I was a wee bit leery of getting involved with something like this as my first foray into the world of herbal medicine.  And, it’s taste has not helped matters. It has quickly become more vile to me than coffee, Kahlua, Bailey’s Irish Creme and a banana milkshake thrown together.  It continues to taunt my gag reflex, although, by day two I learned that it was made considerably less objectionable with a quick chaser of orange juice. 

But, there is at least one bright spot, one thing that keeps me constantly amused. 

This pièce de résistance? 

It turns my pee bright, canary yellow.  It’s so cheerful, like having a smiley face looking back at you every time.  I don’t think my pee has ever been so happy.

image: Marianne Perdomo

Putting a Number on Hope

Boiled down to its essence, inferitility treatment is a numbers game.  Everything about the process is quantified – number of follicles, number of sperm, percentage of motility, dosage of medication, size of cysts, size of follicles, number of eggs retrieved, number fertilized, number transferred, HCG number, number of heartbeats, heartbeat rate, measurements of the fetus, days of pregnancy,  number of miscarriages, the list just goes on and on.   And, statistics loom large with every decision, from how many IUIs to try to how aggressive to be in the number of blasts that are transferred during IVF.  Numbers are everywhere in infertility, often making a clinical process seem even more cold.  

You would think that there were some areas that were immune from being quantified, such as feelings.  Ah, if only.  When I was filling out the questionnaire for the acupuncturist last week, that last wall fell with this question:

On a scale of 1 to 10, with one being the lowest and ten being the highest, how would you describe your current level of hopefulness towards attaining your fertility goals?

Rather than treat this as one of those quizzes in Cosmo where you put down the answer that you know gets you the most points and proves that you really are boyfriend material, I knew that I needed to answer the question truthfully.  Much like you are instructed to blurt out the first thing that comes to mind in a Rorschach test, I circled the first number that came to mind:

4.   

I used to have hope of probably around 7.  If I could pinpoint that moment when my hope dipped below the magic halfway point of 5, though, it would be when I learned that my second miscarriage was also a monosomy, after we had been assured that it probably wouldn’t happen again.  I lost a lot of hope in that fiasco and most of it has not returned.  I don’t know if it ever will.  Like money, you learn not to put too much hope on the line lest you lose it all.

I have no idea what the acupuncturist will do with this information.  Like the rest of the questionnaire, it may go unread.  But, I thought it was interesting that of all of the things that we have left in this journey of infertility that have not been reduced to numbers, couldn’t they have left hope alone?

image: velo_city

Pins and Needles

You would think that once I realized that things were not as they should be reproductively wise, I would enlist all manners of assistance to get knocked up and stay that way.  On the Western side of the equation, that has been the case. I was popping Clomid within eight months of starting to try to get pregnant and I had a full RE workup a little over a year after we started trying. But, West is not the only game in town.

East has quite a few weapons in the arsenal.  None of those weapons, however, were in my infertility tool kit. Why was this?

The people I have known in my life who turn to Eastern medicine have done so as a last resort, not as a first option.  It didn’t help that what I did know of it involved sticking needles in strange places. At that point in my life, my dates with needles were few and far between, the fewer the better.  In other words, I had no positive experiences to view Eastern medicine as a serious and worthy compliment to Western medicine.

And then I became infertile.  My opinion of Eastern medicine, however, did not change, partly because Western medicine did get me pretty far.  Acupuncture probably wouldn’t have cleared out my tubes, but darned if that laparascopy did the trick!  And, then I got pregnant.  And, I miscarried.  Then I got pregnant again, and I miscarried again. With the same chromosomal abnormality.

It was at that point that I began to look at what we had been doing to see what we could do differently to change our outcome because even though we had been given a diagnosis of Bad Luck, I wanted to see what we could differently to possibly counteract whatever was causing things to go awry.  I began to seriously consider acupuncture, having read a lot about its benefits with IVF, and general well-being.  Dr. Salsa recommended it, something Dr. Uterus never mentioned, and Dr. Salsa had even partnered with an acupuncturist so that they would work out of his office.  It couldn’t have been any easier to get acupuncture treatment.

And yet I still hesitated.  That little part of my brain* kept saying, “this is the last step to you declaring that you are a desperate infertile!”, obviously a throw back to my original opinions about Eastern medicine.  Then my cycle started getting out of whack and I reached the point where I wanted to do something, anything, that did not involve more hormones to get things moving back in the right direction.  And, it wouldn’t hurt that acupuncture has been shown to help with IVF, which we are on schedule to do in the spring.  So, I made an appointment and I have now had two sessions.  I will have two a week up until it’s IVF time and then one on the day of retrieval and two on the day of transfer. 

So far, it’s been interesting. Some of the sticks hurt, others don’t. Once the needles are in, she leaves me for 30 minutes to sleep, which so far I haven’t been able to do.  I’ll stick (ha!) with it, though, because even if it has few to no physical benefits, the mental benefits of knowing that I am doing something toward our goal and that it is something new, are worth it. 

*The little voice has completely changed her tune, by the way. She’s now convinced that acupuncture will magically fix everything.  I’m going to have my hands full beating down her expectations and remaining realistic. 

image: run dorkas run