Friday, August 05, 2005

The last straw. Maybe.

This is really long. Sorry. I can't edit it right now because I have a paper I have to finish, so it will just have to be really long.

Yesterday I had my first appointment with my new therapist, who specializes in fertility issues and is a fellow infertile. So far what that means is that I don’t have to waste time and energy explaining terms and treatments and clinics and options and abbreviations. It’s a nice change of pace from seeing a therapist on campus in so many ways - this office is in a nice building, with a private waiting room and a comfy couch and a nice view from the spacious office. And the best part for someone like me is that there’s a separate exit - “one way traffic,” she said. Now that I’m not on campus, I’m less worried about running into someone I know (and even less worried that I’ll run into one of my students), but it’s still nice to be in a place where they recognize the importance of that privacy. The old therapist had quite a exchange with me about this where I felt like I was somehow being paranoid for being concerned about my privacy - so this is really a nice change.

On the opposite end of the spectrum, yesterday was also the day of the introductory class for the injectables program at the evil HMO clinic. I’m not sure what I was expecting - I mean, their initial fertility class was a joke, but this class was with one of the nurses from the fertility clinic (Nurse NBM, but still) and was only for people who had already been approved for injectables.

What I was not expecting was the presence of a 5ish-year-old child in the room during the class. Not cuddly enough to make me all fluttery and jealous. Just annoying enough to make me unable to ignore her. Just cute enough to make Nurse NBM interact with her during the class. I know it’s really hard to get childcare, especially for regular monitoring appointments, and that even the best plans sometimes fall through, but really. It was pretty inappropriate.

I know I’m Little Miss Overinformed, so I didn’t expect to learn much, but I also didn’t expect misinformation and misdirection from Nurse NBM. She began with a book of illustrations and showed us how the normal cycle works. (”This is the ovary, and it produces the egg. When you have sex, the semen is deposited in the vagina, here, and then swims up through here and meets the egg...”) The little girl was sitting next to her for this part and looked raptly at the pictures - I guess it was like storytime. Creepy.

NBM went on to guide us through the booklets of information detailing the clinic’s COH program. To their credit, they seem to have decent monitoring in place (which had been one of my concerns, since I hadn’t seen this evidenced in my previous experiences with them). They do daily bloodwork and sonograms during the cycle (in two different locations - so you have to drive to the network hospital for a 7:30am blood draw, and then back to the fertility clinic across town for an ultrasound at 8:30 - convenient, no?). They have voicemail boxes for you to call for your daily instructions. They’ll do monitoring on the weekends (which they wouldn’t do for my Clomid/Femara cycles). They start with BCPs to downregulate the ovaries. (Is this normal for an injectables cycle? It seems like they do it for scheduling purposes as much as anything else. It was funny watching her explain the concept of birth control pills, though. Not why they’re used in fertility treatment, but how there are different colored pills and we’ll be taking just the active pills and not the “vitamins” that you’d normally take during an off week.)

That part is all mostly okay, even with the annoying schedule. But they only use Repronex - no Follistim or Gonal-F or whatever. And I don’t think I’d be able to guarantee that I wouldn’t be seeing Nurse NBM all the time, since they take weekly shifts with the injectables patients (so either she’d be on that week or not, but I couldn’t just see someone else). And she went on and on about the risks of having multiples and their potential for birth defects and retardation and considerations of selective reduction. I know they have to do this before we sign the consent forms so that we’re making an informed decision, but it was really excessive and not all that informative. Mostly she just read the ASRM info sheets that were in our packets, and punctuated some of the points with her own examples and explanations. Oy.

And then we got to play with the needles, but not actually stick them in anything (not even oranges). After learning to do the HCG with the big needle, the little subQ needles look so damn cute I almost laughed. And this from a girl who is (was?) a major needle phobe. I’ve never even given myself a shot, and I already felt like a pro. (And the little girl was fascinated and kept getting up close to the needle so that I was somewhat worried she was going to get stabbed in the eye.)

I spent much of the time contemplating the other couples in the room - where are they in this process? Are they snarky? Is this the first time they’ve heard this information, or have they already done their research? I don’t know for sure, but I felt a bit more informed and jaded than the rest. I did joke with one woman before the class (she was the only one there without her partner, and the one I’d be most likely to be friends with) - she said something about her partner being the only one to miss it and how she wasn’t too happy with him about that, and I suggested that she tell him she needed to practice the injections on him since he wasn’t at the class. Fair’s fair, right? (She laughed and agreed, which is why I’d probably be friends with her. Having a sense of humor about all of this is key.)

If I had written this yesterday when I got home from the class I might be better able to explain how by the end of it I was certain that I’m done with this clinic. There’s no single point I can put my finger on (except for the limitations on drug options) but I’ve never been particularly pleased with the service there, and I’m not even sure we’re going to do an injectables cycle at all - IVF is looking more and more likely. And as we were leaving, I asked Nurse NBM why the clinic or the HMO doesn’t offer some kind of infertility support group and she suggested that I just talk to people in the waiting room. “Well,” I said, “I’d try, but since you can’t really tell if someone just had a miscarriage or is waiting, full of hope, for their first Clomid cycle, or is, like me, pretty jaded about the whole process it wouldn’t really be fair. I don’t want to intrude on someone’s pain or burst someone’s bubble of glee. But I also don’t want to be alone in all this.” And she didn’t really have a lot to say about that.


  1. What an idiot that nurse is. A class? You had to take a class? I got a sit down with my favorite nurse and a bunch of flyers with how to shoot up instructions.

    Listen, my assvice (for what it's worth) is you need to be 100% comfortable. Or, at the very least, as comfortable as you can be with your doctor and your clinic. Even though we never made it to IVF, I never once doubted my doctor or her staff's ability to treat me. If you aren't feeling it - then time to find a new clinic.

    I'm glad to hear you found a good infertility therapist. Ours was invaluable when going through treatment. It was nice to call her and tell her I need to see her because my FsH shot up to 32 and her response was "I'm sorry" instead of "what does that mean".

  2. I am sorry you had to deal with nurse Doofus. I hope you find a clinic that is a better fit.


  3. Man oh man what a dipshit. Do these people seriously need an illustrated explanation of how sperm is supposed to meet egg? Egads!

    Not your crowd, sister. Your crowd is out there, somewhere, but not in that room. And I can totally identify with wanting to avoid Nurse NBM.

    Yours in tattoo,

  4. Yup. That nurse was definately certifiable, but so were the parents who brought a 5 year old to an injectibles class. What the hell could they have been thinking? It's not just the other patients, but I would take serious pause at exposing a 5 year old to reproductive details. Creepy.

    I wish you all the luck in finding a new and better clinic.

  5. Cass, I'm so glad your new therapist is a good fit, and I'm so irritated with Nurse NBM, the drug limitations and the parents of that five-year-old girl. Whether or not you go through with the injectibles cycle, I hope that you find an R.E. (and, most importantly, an R.E.'s staff) that you feel comfortable with and whom you trust.

    Thinking of you,


  6. Cass,

    So glad you were able to find a therapist who specializes in infertility. I have one too and it's a huge help.

    Now, as to the clinic, it sounds like a pussymill, but I'm sure that you can make the best of it even with idiots around. And also, keep in mind just because the clinic says they only do certain things, doesn't mean you can't question or demand something different.

  7. So glad to hear that the new therapist seems to be working out for you.

    About the clinic--God, that sounds so "one size fits all," which I can understand resenting. And the 5-year-old in that class?!?! WTF were they thinking?

    Best of luck to you, sweetie, needles or no.

  8. I have never, ever seen anyone talking in the waiting room in my clinic.

  9. Just talk to the people in the waiting room? Now that's rich. Run.

    I'm glad the new therapist is working for you.


  10. Has she ever observed the waiting room? No one looks anyone in the eye, everyone is angling for the good wand monkey or slightly gentler vampire. Honestly the woman has no clue.

    We're surrounded by clueless professionals, heaven help us. Except your therapist, she sounds good.

    I'd start looking for a new clinic now if possible - is this an insurance issue? Doing one cycle with them may make sense just to get it done, but doesn't hurt to get another one lined up.

  11. Your clinic sounds awful and it's so important to feel like you're getting good, specialized (not one-size-fits-all) care.

    I'm not sure where you are in SoCal exactly, but if you're interested in hearing about our RE and his staff, who we love, email me.

    Best of luck to you, Cass.