infertility is the new black

First TV, now this?

call me snarkypants

Three unrelated items.

From the “you know you know too much” files:

I picked up a textbook on Infertility from the Medical School section of the campus bookstore, randomly opened the book to a sample patient history for a patient who likely has PCOS, and began seething at how long the suggested protocol (suggested, in the textbook, that teaches doctors) would take to actually diagnose (let alone treat) the problem, and how their basic set of suggested tests (TSH and prolactin only, apparently - WTF is up with that?) were so severly lacking in useful diagnostic information. (The suggested protocol? Try Clomid for a while, and if that doesn’t work then you should add in Metformin. Riiiiight. That’s a lovely plan.) 

After dumping the book back on the shelf, I stormed away, muttering and grumbling about how it's no surprise that so many doctors don't have a clue about PCOS.  Sheesh. (J wanted to know if I had made some helpful corrections in the margins of the book. I did not. But I know where the book is...)

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I saw NPF yesterday, and was secretly pleased to note that she’s not looking perfect. She’s fine, and I don’t wish any baby scares or weird illnesses on her or anything at all, but it was mildly satisfying to note that things aren’t entirely perfect in NPF world (even though sometimes it looks like they are). Here’s the thing: she didn’t look great in her maternity dress. It made her hips look weird. She’s probably having trouble finding maternity clothes that are comfortable, appropriate for work, and suit her style. And I think maybe she’s between sizes (so she’s wearing clothes that will still fit in a month or two.) But still, it was just the tiniest bit satisfying.

There was something else I was gloating about, too, but then karma lept up and made me stop. (It was an uncomfortable but noncritical side-effect, and then I got something similar last night.) So I’ll stick with the clothing thing. It’s okay with me if when I get pregnant I don’t look perfect in my maternity clothes either, karmically. I never really thought I would, so it’s not going to be much of a sacrifice.

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Lest I forget, I’ve been tagged (thanks Jenn!)

THE RULES:
1. Go into your archive.
2. Find your 23rd post.
3. Find the fifth sentence.
4. Post the text of the sentence in your blog along with these instructions.
5. Tag five people to do the same.

The fifth line of my 23rd post is

Um.

That’s it. Pretty boring, eh?

Actually, it was a stretch to even get to the fifth sentence - I had to count the title. Here, for your reading pleasure, is my 23rd post, in its entirety.

Monday, February 14, 2005
Thank you universe. I think.

It’s Valentine’s Day, and I have what looks like EWCM.

And we’re at my in-laws’ house, in a room that shares a wall with my BIL.

Um.

Valentine’s Day cervical mucus. How romantic (and naive). Ah, the good old days.

I’m too lazy to keep track of who has done this and who hasn’t, so if you haven’t, and you want to, consider yourself tagged.

snazzy and groovy and totally stressed out

I got an email from a friend (who recently had twins after IVF) checking in to see if I was pregnant and not telling (ha!), mad at her (um, no) or just really busy (we have a winner!)

I’m still immersed in the writing, so this will be brief and probably not all that exciting. I apologize for my general lack of posting and commenting - sometimes I sneak a few minutes of blog reading, but my commenting is really pathetic right now. These papers are kicking my ass. Not sure if I’m going to finish on time, but I’m trying to take it day by day. My therapist said some especially useful things today. One was less something she said and more an agreement - that I’ll keep plowing ahead for another week, but we can reassess then. Because thinking about several more weeks of this is enough to drive me mad. I’ve been worried that somehow my stress levels in this month leading up to the IVF will impact our success, and I don’t want to be sitting here in December blaming myself for a failed IVF due to stress. My lovely therapist (she needs a name, doesn’t she? Dr. Groovy, I think - she has some groovy glasses, and funky hair - we’ll try that for now) - anyway, Dr. Groovy pointed out that people get pregnant under the worst kinds of stresses imaginable (rape, famine, whatever) and that I shouldn’t be blaming myself for stress or its effect on IVF. “You probably will anyway,” she said, “and I’ll tell you the same thing then.”

Also, I wore my snazzy shirt (many thanks to Ollie) to my appointment today, and Dr. Groovy loved it. “Yes,” she said. “Telling a woman going through IVF to relax is one of the worst possible things to do. It just makes it more stressful.”

Um, yeah. And it’s not like I’m not already stressed.

Five reasons why I hate having to wait for IVF

5. Far-away pregnant friend (not to be confused with NPF) is due in October. She’s younger and they’ve only been married for a couple of years, and they thought they might have trouble conceiving - it took them four whole months! We’d already been trying for a year when we heard that she was pregnant, and now she’s going to have the baby. I’d hoped to be further along with things before she delivered. I guess this is further, just not as far as I’d hoped.

4. An extra month of dodging well meaning but frustrating questions about our timetable or whether we have any news.

3. Watching fellow bloggers start their cycles. Not that I’m not happy for them and excited and lucky to be able to learn from their experiences, but it’s hard to avoid stressing thinking about our upcoming cycle.

2. More time to worry and anticipate.

1. I’m terrible at waiting.

To be fair, I’ll try to come up with...

Five reasons why the wait is a good thing

5. Time to get my papers written. At least in theory. Don’t ask how that’s going.

4. More time to come up with snappy retorts to people’s boneheaded comments and ridiculous assvice.

3. Gives me time to figure out the vibe at the new job before I start having unavoidable last minute scheduling problems. (My schedule is actually really flexible, but I have a lot of meetings, only some of which I can reschedule.)

2. Gives me time to contemplate switching to Typepad so I can use the “categories” feature.

1. Maybe I’ll be able to relax and get pregnant naturally.

And now for something completely different

In my other life I’m in grad school. I don’t write about it much here for several reasons - partially it’s because the blog is my break from that world and that kind of writing, partially it’s because that world is so much about the writing at this point, and the whole writing-about-writing thing just seems like a kind of procrastination, and partially it’s because I haven’t really been spending the kind of time and energy on school that I should be, so there isn’t much to say.

However, a big part of the reason for this break before IVF is to give me a chance to focus on school and writing, and it’s silly to think I can somehow separate the two huge things in my life as if they have no connections. So here I am, writing about writing. Or more specifically, writing about not-writing.

I have two deadlines for the papers I’m currently writing - one is the deadline I’ve agreed upon with my advisor, based on the fact that she’ll be out of the country for a couple of months so I should finish before she leaves. The other, which I’ve scheduled to coincide with the first, is based on the fact that defending the papers I’m currently writing (a bunch of profs asking me potentially tough and often off-topic questions about why I did what I did in the papers) while on hormonally-altering medications is a Very Bad Idea. So I have to finish the papers, soon, for both reasons.

I’m trying to be as detail oriented and outcome focused as I’ve been with persuing diagnosis and treament of our fertility issues. The problem is that I’m great at compiling and organizing information (lab results, important articles, whatever) but less good at focusing long enough to write more than a blog’s length worth of sentences. A few weeks ago, my dad told me to just write the damn thing, and I almost cried since it sounded so much like the academic version of just relax - if it were that easy, don’t you think I would have done it already? But I think I’m at that point now - I just have to write these papers, now, and be done with them so I can focus on what my advisor calls my “other project.”

So I’m taking a suggestion from a popular dissertation writing book and from an article I read recently, and just writing a bit every day. Hopefully those bits will turn into the papers they need to be in the next few weeks, or I’m screwed. And not in the fun way. Which is all to say, I need to stop writing here so I can go write there. Not that I’m taking a break from blogging or anything. Even at my best (and I’m definitely not there right now), I can’t be immersed in academia all the time - it makes me nuts. I just needed to put this out there so it’s not hanging over me as one more excuse not to write.

Now if you’ll excuse me, I have to go write a bit.

Let’s all be not-urban-legends together

Well, at least I’ve got lots of company in the IVF camp. Now we just need some marshmallows and a campfire. And some songs. And cheesy skits. Definitely the skits. Or at least the marshmallows.*

It’s been a crazy week. I’ve spent more time than I’d like trying to get settled in my new job, and trying to focus on the writing I need to do, and working on the house, and trying to come to terms with our decision to take a month off from the baby chase.

Actually, that last one was a fairly easy decision, initially.** I have to - HAVE TO - write these papers. Now. In the next 3-4 weeks. And J has a big project in October and so won’t be available to hold my hand or even provide his manly contribution to the whole process. I wouldn’t want his stressed out sperm, anyway. Better to stall for a month.

Except that given the pain and horrendous clotting of the last period, and my historically irregular cycles (though the last couple of unmedicated cycles have turned out okay), and the need for there to be no chance in hell that we’d get pregnant (so our break is really a break and I don’t have to temp or watch what meds I take or what food I eat or what I drink) - because of all that, I’m on the pill. As a form of birth control. Hahahaha. It’s okay when I think about it as cycle timing. I mean, I’m going to be on the pill next month at the beginning of the IVF, too. But it’s still bizarre. I had to psych myself up for the first pill. I think that was the final moment of acceptance. We’re really doing this IVF. We’re really not going to get pregnant on our own. I’m really not going to be an urban legend.

And in the meantime, I really have to buckle down and write these papers, and start being productive in my new job. I promise I will write about choosing a clinic soon. Really. But I have to spend at least 30 minutes writing my papers, first.

*Actually, at my camp, the campfire would have been more likely to be accompanied by some people streaking than by cheesy skits. Though we had those, too, sometimes. And our semi-official camp songs often contained repeated shouted profanities. I guess you could say I went to an interesting camp.

**I lied. It wasn't easy. But I'm trying to come to terms with it, because I know it was the right decision, even if it was a hard one to make.

I am not an urban legend

This last cycle began with a course of Femara, which did nothing for me, and the news that J’s Kruger results were really low. He began acupuncture. The cycle continued. I made appointments with the two potential clinics. The cycle continued. I ovulated naturally on CD42, after having lovely, well-timed sex. And we hoped. Hoped that somehow we wouldn’t have to go through with the consults, that the decision wouldn’t matter, that we would escape. Hoped that we would become that annoying urban legend that well meaning but clueless families and friends use to reassure infertiles - “I knew this couple that got pregnant on their last cycle before IVF!” But, no. I have my period. And we’re moving ahead with IVF.

It’s a mixed bag of emotions. On the one hand, I’m glad to finally be moving ahead with a plan. Given our combined problems, IVF/ICSI really is our best chance. I think we’ve found a clinic we like, with a doctor who didn’t seem phased by all of my questions, and a patient coordinator who seems, maybe, to have a sense of humor. We’re lucky to have the means to be able to do this - to look at the clinic options without regard for the financial considerations of one over the other, to have families who can support this financially and (if they can figure out how) emotionally. And I’m optimistic that this IVF/ICSI will do the trick for us.

But I’m also mourning the loss. Going ahead with this means acknowledging that we need more than just a little bit of help. That this conception is going to be a medical event (even moreso than it already has been). That we’re giving up control (not that we ever had it). I’m jealous of people who don’t have to go through this. I’m scared of what this will do to me, to my body, and to our relationship. And I’m not sure I’m ready.

I have been so consumed by this process for so long, and have put so many things on hold. And now, before we go ahead with this, some of those things need to happen. Things like finishing my papers and defending a dissertation prospectus. Things like cleaning the house. Things like reminding ourselves why we’re doing this.

Today is our fifth anniversary, and we’re not having a glass of champagne and a romantic evening and thinking that might lead to offspring. Instead we’re regrouping. We’re coming back together to remind ourselves of what’s really important. We have each other. We have a comfortable home. We have supportive friends. And we have an open door. We just need to step through.

Big plans, many questions

This is a big week - we have new patient consults with two clinics (Monday and Wednesday) and in between I have my first (and very full day) at my new job. All of which have the potential to be good. I’m trying not to think about the job until then - trying to savor the last days of a summer in which I should have accomplished more. So instead, I thought I’d share the absurdly long list of questions we’re taking with us to the consults. I suspect much of this will get covered in the consult, so I won’t actually have to ask, but since we’re trying to decide between two clinics, I figured we should have a comparable dataset from each clinic from which to work. Except that I suspect it will, in the end, come down to the things that are peripheral to the list - the vibe, the feeling we get from the staff, the feeling we get from the doctor. Both clinics are highly regarded. Both have good success rates on the (totally out of date) CDC statistics. Both are in town (though one is more convenient than the other). Both clinics seem to do lots of ICSI, blast transfers, and FETs. Both have well-trained embryologists on staff. In the end, only a few of my questions will be deciding factors. Based on my initial dealings with them, I already have a tentative preference. But I’m trying to keep an open mind until Wednesday. And then I’m all about choosing one and moving on.

Without further ado, here’s the list of questions:

Ambiance (to observe, not to ask, obviously)

• What's in the waiting room? (Are there pregnancy magazines? Toys? Comfy chairs? I will spend a lot of time here - how does it feel?)
  
• Is the receptionist friendly? (Also all other staff I meet?)
  

Procedural

• Number of patients cycling each month? How many retrievals and transfers do you do each week?
  
• What are the embryologist's qualifications: degree, experience, etc.?
  
• Are there any times when they don't do cycles (holidays, etc.)?
  
• Will we be working exclusively with one doctor or will we rotate depending on availability?
  
• Who does morning ultrasounds? What are the hours for labs/monitoring? How long should I expect to be here each morning for monitoring?
  
• How often do you perform ICSI? Blastocyst transfers? Frozen embryo transfers?
  
• Do you have specific expertise with PCOS? What kind of protocol might you suggest to reduce the risk of OHSS? What percentage of your patients experience OHSS?
  
• What are your criteria for canceling a patient's cycle? Who has the final say - the RE or us? (Thanks, unfortunately, to InSpring and Thalia for this one.)
  

Communication

• Who does callbacks with instructions? With good or bad news? If we have questions the nurse can't answer? How long does it take to get a call back from the doctor?
  
• Will we have emergency access to the doctor after hours (on call)? By phone or email?
  
• Is there a nurse or coordinator I'll be able to speak with consistently (same person throughout the cycle)?
  

Specifics

• How do you feel about the use of acupuncture in conjunction with an ART cycle? Do you allow the acupuncturist to do treatment on site before or after transfer?
  
• What do you think our prognosis is? What kind of protocol do you recommend for us? How many embryos would you recommend we transfer in an IVF? Is there any merit in doing another IUI? What medications would you use in an IUI or IVF?
  
• Do you prefer patients who ask detailed questions about treatment, diagnosis, or symptoms? Are you comfortable with patients requesting detailed information about their treatment? (In other words, how do you deal with involved, well-informed, detail-oriented patients... patients who bring in obsessively long lists of questions they’ve vetted with their infertile friends...patients who aren’t going to stop asking questions even after choosing a clinic...patients with no patience like me?)
  

Given the ridiculous length of this list, I’m not so worried I’ve forgotten something anymore, but if I have, please tell me. What would you ask?

More fun search terms

Apparently I’m a budding Miss Manners over here:

ettiquitte for teens
breakup ettiquitte

I think it’s because I misspelled ettiquette in a post, so when people also misspell it in their search, they get results from other people who can’t spell (like me, apparently). Have I mentioned that I’ve developed some bizarre version of adult-onset typing-dyslexia? It’s very odd

Then there’s the “you found me HOW??” category:

lying and saying your pregnant and your not

This time it’s not about my typos. Which is good, because that leaves me with the possibilities - were they looking for instructions? Ways to get back at someone after this?

And of course, the really bizarre:

I want to buy tea cups dog

I can’t even imagine what they were going for here. Tea cups for a dog, maybe? Do dogs drink tea? I am so confused. It makes up for that last one, though.

Tentative understandings

I had an interesting conversation with a friend of mine the other day. Generally our relationship is pretty uni-directional (she calls me to talk and we mostly talk about her) but I told her vaguely what was going on with us a few months ago, so now it comes up in conversation occassionally. We've been talking more regularly lately because she just got engaged and so there's lots of wedding stuff in her life for us to talk about. But this time, after an hour of “this venue or that venue” and “what kind of wedding dress” and all that, she asked how things are going with us. So I told her how we had maxed out our options at the ex-clinic and are meeting with new clinics in anticipation of a likely IVF/ICSI.

Now, this friend of mine is a bright person. She’s a lawyer. Her dad is a neurologist, and she’s been around medical stuff her whole life. She’s had her fair share of medical scares and mishaps. And she knows nothing about IVF. But she’s willing to ask, and seemed to want to know what it entailed. So I explained. Every so often she’d ask a question. At one point, she said, “This is probably a dumb question, but do they just pick one sperm, or do they put the egg with a bunch of sperm or what?” And I was able to explain that no, that’s actually a really good question, and that they’re both options. And then I explained ICSI.

It got me thinking about people who aren’t going through the process, and what it looks like from the outside. I ranted a bit about Inconceivable and my friend and I talked a bit about gestational surrogacy and why I’m concerned about the show’s portrayal of infertility. But it also got me thinking about something Beaver Girl said a while ago (here and here) about the possibility that even a bad representation of infertility is better than none at all. That people will start to have a sense of what the terms mean and what the process entails. (Presuming, of course, that they’ve got a halfway decent medical consultant on the show to keep things at least mostly accurate. If not, I’ll organize a letter-writing brigade right away, because that would be absolutely unforgivable. Of course, if they do like CSI, it will give people all sorts of unreasonable expectations about the innovations of technology. But I digress. Sort of.)

Another thing. We’d had my in-laws read the first couple of chapters of a well-written book about infertility, and I think it contributed to my MIL’s sudden comprehension of what we’re going through. So I figured it couldn’t hurt to try out on my mother. It took her a bit longer to get around to reading it (she insisted on buying her own copy of the book, so I guess I won’t have to explain the basics of my various tests and procedures anymore) but now that she’s read the first couple of chapters she seems to be trying to get it. “This sounds like you,” she said. I said something vague about the author’s tone (like a blogger, which is to say, like the best possible kind of snarky friend). But later I thought, it’s not that her story is like mine. It’s just that she’s managed to capture what it’s like. (At least, what it’s like for many of us.)

Mom will be here for a quick overnight visit tomorrow - we’ll see how this plays out.

Nothing we didn’t already know

We had our postmortem* with Dr. L yesterday. It started somewhat badly, both because I was a bit peeved that we had to pay for a visit to discuss how they don’t really have anything else to offer us there, and because the nurse (I think she’s actually a medical assistant) made me pee in a cup so they could do a pregnancy test. It’s an obnoxious habit they have. I understand testing before certain procedures (the HSG for sure, and even the IUIs - someone less obsessive and more ovulatory than myself could, I suppose, be pregnant and not know, and sticking things in the ol’ ute isn’t so good for a pregnancy). But why I had to do a pee test yesterday is beyond me. I didn’t even have to undress for the appointment.

Dr. L pretty much told us what we already knew. I didn’t respond to the Femara. The Kruger results meant that ICSI might be a good idea. But, some people have gotten pregnant with the same or lower Krugers, so we could try an injectable/IUI cycle and see. I asked if there was any reason we shouldn’t just move on to IVF w/ICSI. “If you have the resources to do that, it’s probably the right time,” she said. And then I thought, again, how lucky we are to have a family that can support our IVF efforts and how if I hadn’t done so much research I might have listened to only the surface of her statement and thought it was worthwhile to keep cycling with them because it’s less expensive.

I did ask her about the evil-HMO hospital’s OB/GYN and NICU services - because, you know, there’s this theory that I might need at least one of those at some point. She had positive things to say about the doctors for both, and says that there are Nurse-Midwives on staff, too (though that doesn’t mesh with what little I’ve read so I need to check further). In light of the recent conversations on other blogs it was on my mind. Not that I’m anywhere near needing an OB or anything.

She did tell us to have faith in God and each other, which felt like the Godspeak version of “just relax”. Which she got very close to when we were leaving - telling us about people who had gotten pregnant when they stopped trying or worrying about it, and who didn’t even know because they didn’t get regular periods and then suddenly they were very pregnant. I know it happens, occassionally, but I can’t even imagine NOT KNOWING I was somehow pregnant. How would I miss something like that? So, she didn’t quite say we should relax, and when I made a face she said, “I know. Easy for me to say, right?” -- which was a lovely observation coming from her.

Instead of just not thinking about it, as she suggested, we have our new-clinic consults the week after next. I received a new patient packet from one of the clinics yesterday, which I thought was appropriate timing. A bit depressing, though, since I’d failed to account for the amount of time it will take to get tested and integrated into their treatment schedule. But at least it’s progress. And I am trying to not think about it too much between now and then, because I’ve already made a long list of questions and requested that my old records be sent to the new clinics and scheduled another few acupuncture treatments and I’m not sure what else I can do. So hell, maybe I’ll try “not worrying”.

* A postmortem is the meeting after an event or project has concluded to discuss what worked and didn’t work:

“Sooner or later this situation happens to us all: You and three others just spent the last thirteen months of your lives and careers working on a special corporate project. Unfortunately, that project produced less than satisfying results. Now, instead of basking in the glow of your team's achievement, management asks you to organize a review meeting for the failed project. That's right, you've landed in the dangerous territory of the post mortem.”

Sounds familiar, doesn’t it?

The Learning-how-to-be-bitter Channel

I was watching A Baby Story (because apparently when I’m depressed I’m a sucker for punishment) and the family was having their second child - a mere TEN MONTHS after the first. I guess they got pregnant the first time they had sex after baby #1. (They called them Irish Twins - isn't that cute? No.) All together there are something like 15 cousins under the age of 10 in their family (from maybe four sets of parents). Aside from insane jealousy (seriously, they got pregnant again when baby # 1 was 6 weeks old? C’mon, share the wealth, people...) I can’t help but wonder if there’s another sister-in-law in the family someplace that doesn’t have any kids. I can’t even imagine being an infertile in the midst of such an excessive display of fertility. That must suck. I guess in comparison my life is just peachy.

I do not think it means what you think it means.*

I found this article by way of a post over at Blogging Baby (which I don't usually read, so I’m not sure how I came across it this time) about the new NBC show, Inconceivable. Basically, the producers of the show came up with the idea after sharing stories of the trials and tribulations of fertility treatments. Because they’re two gay guys (not a couple) who both had kids using gestational surrogacy.

More power to them, to be sure, but this really explains a lot. The show seems like it’s going to focus on the cutting edge technology - the stuff that people look at and think, “they can really do THAT now?” Like using the combination of an egg donor and a gestational surrogate to help a gay couple have a baby. It’s new frontier for most people. And that’s fine. But the bulk of people undergoing fertility treatments aren’t trying to be cutting edge, they’re trying to build families. And that’s emotional, and hard, and if they already were a heterosexual couple and assumed they had the necessary bits between them, then it’s brutal and can feel like a failure to do what comes naturally to so many people. (Just to clarify - I have nothing against gay couples using surrogates, or lesbian couples using inseminations, or whatever else. And I know those situations can be fraught with their own concerns and frustrations, too. But it’s a different kind of situation, in some ways.)

It was the jaw-dropping thing that convinced writer-producers Marco Pennette and Oliver Goldstick, co-creators and executive producers of the new NBC drama "Inconceivable," that their experiences with in vitro fertilization and surrogate pregnancy had the makings of a television series. (From the Yahoo article.)

See - shock value. New technology, far removed from what “normal” reproduction looks like. “Jaw-dropping” technology. I guess that’s what sells. But it doesn’t inspire much confidence in the accuracy of the show - hopefully they’ll get the terminology right (transfer vs. implant, for example) but I’m not so sure they’ll capture the experience.

As the program description suggests, the “noble quest” to “help desperate couples give birth” will be balanced by the clinic staff's “own occasional adventures involving sex, deception and secrets.”

Actually, I don’t think the show is really about fertility at all. I think it’s just a new backdrop for the same old ensemble dramas we see everywhere else (the right balance of science a la CSI and soap opera a la Desperate Housewives seems a timely choice, given the ratings). So maybe it won’t really suck that much, since it won’t really be about fertility.

Plus, have you seen the graphic for the show? That egg isn’t going to amount to anything!



* "You keep using that word. I do not think it means what you think it means." (The Princess Bride, of course)

decisions decisions

Thank you all for your understanding comments - it’s nice (and of course incredibly reassuring) to know that I’m not imagining the insanity that is the soon-to-be-ex-clinic. In answer to the questions, yes, some of it is an insurance issue - the evil-HMO only covers services they provide, and they don’t provide any other injectable options beyond the Repronex (and they DEFINITELY don’t provide IVF). And yes, I’m looking into a new clinic. We have consultations with two potential clinics in a couple of weeks. They will not be covered by insurance AT ALL, but J’s parents have been incredibly generous with an offer of financial help so we can do IVF if we need to. And that’s looking very likely. And no, I’ve never ever seen people chatting it up in the waiting room. Eyeing each other warily, sometimes, and an occasional half-hearted smile, but never chatting. I wish we could all sit in the waiting room together, instead. It could be quite the happening party, don’t you think?

I’m going to spend the next couple of weeks (because otherwise I’d spend that time twiddling my thumbs or something) compiling a list of questions for the new doctors at the new clinics, thanks in part to your suggestions. If you have further suggestions for things to ask or to look for while we’re at the clinics, please let me know. I’m counting on the shared expertise of the internets to help us make the decision. That is, which new clinic to choose, not whether to stay with the old one. I’m very sure about that part of the decision.

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.

You take the good, you take the bad...*

Good:

1. I got an email from my MIL the other day. All I can say is oh my god, she got it. And she got that she didn’t get it before. And she apologised for a couple of things she said back in the not getting it stage of things. This is so important on so many levels, all of which I'm sure you all understand, so I'll stop there.

2. We had good sex the other night - not about timing or positions or EWCM or temps, just good sex. It’s been a while, y’know?

3. I finally went and got my tattoo today - the one I’d been thinking about for ages now but kept putting off because it was the wrong time in my cycle or schedule or whatever. But now I have it. Very happy about this. Trying not to expect too much from it, although Muddy got a similar tattoo a while back and then promptly got herself knocked up. I’m just sayin...

4. There’s a nest of baby birds right outside our bathroom window - we’ve watched the MamaBird bring bugs (and even a tiny lizard!) back for the babies over the past couple of days. Today the little birds ventured out of the nest for the first time - just to the nearby branches, but it’s only a matter of time before they’re gone. But so cute right now!

Bad:

1. Not that I wasn’t pretty sure about this before, but this cycle is a definite bust. Femara seems to do nothing for me (though I was also pretty sick through the first part of this cycle, which I’m sure didn’t help).

2. J’s Kruger analysis sucked. (But he’s about to start treatment with an acupuncturist, so maybe things will change for the better, even a bit.)

3. The injection training we’re going to this week is scheduled to be led by Nurse NBM. Though I figure if she doesn’t have a wand up my twat that I’ll like her more. The whole thing is probably pointless, since we’re gearing up to switch clinics, but I want to go through with the training just in case we end up doing one last cycle with the current clinic.

* More good than bad, really, and most of the bad stuff is nothing new. I’m in a strangely good place with things right now - we’re not sitting around doing nothing, we’re researching options. And we’re researching the strongest options we have - no more pussyfooting around dealing with the crappy clinic. It’s time to move on to the experts. In fact, I have a ‘moving on’ kind of question: What questions should I be asking when interviewing new clinics? Or really, what should I be looking for to get a sense of whether the staff is good and whether I’ll get focused treatment or just be another case file? We’re only consulting with a couple of clinics, and we picked them because they have good numbers from the CDC listings, and good recommendations from other medical folks in the area. So I’m sure they’re both fine, medically. What I’m trying to figure out now is how to gauge the little things that can make or break a clinic experience - compassionate staff, prompt attention, comfortable facilities, etc. I’m hopeful that I’ll just be able to tell that the place is a good fit, but I’d love some guidance from those of you that have gone through this already.

heartbreak not pain

I called the evil HMO the other day to double check that we don’t have acupuncture benefits, just a discount.

“Oh, you have those benefits,” the woman said. And then she told me I needed to get a referral from my primary physician before I could use the benefit.

So yesterday I called to request the referral.

Her: You’ll need to make an appointment with the doctor. How’s August 26?
Me: Nothing sooner?
Her: I’m not seeing anything. For how long have you been experiencing the pain?
Me: Pain?
Her: Acupuncture is only indicated for chronic pain. Where is your pain located?
Me: Well, I think my heart is breaking. Does that count? Um, I was interested in acupuncture for my PCOS and fertility. I’ve read some studies that show...
Her: Oh, for that you can self-refer. It’s not a covered benefit, but you will get a discount. I’ll give you the number to call...
Me: Is there someone I can talk to about that policy? That seems really flawed.
Her: Well, you can call member services.
Me: Will they be able to do anything?
Her: Probably not.

I knew I hated the evil HMO going into this - I used them as a kid and the experience was not pleasant. But they’re good for some things - J’s been getting decent care from them for a couple of years, and they’re good for basic medical needs, and they have at least some level of fertility benefits, which my old insurance didn’t have at all. So we gave them a chance. And now I’m done.

Except for maybe just one more cycle.

* When J called and used the “migraine pain” buzzwords, he got an appointment with the doctor for THIS WEEK. And it’s the same doctor. I think maybe they just don’t like me.

NBM

J called and got finally got the clinic to give him his Kruger results on Friday, so I spent the weekend Googling and planning and scheming and stressing. On Monday, I went in for my final ultrasound of this cycle with the nurse I’ve now nicknamed Nurse No Bedside Manner. Nurse NBM prodded me and found me lacking in follicles (despite one VERY tender left ovary yesterday, and some twinges from that general area today - makes me wonder about her technique). This is the first cycle I’ve worked with Nurse NBM, and while I honestly don’t think she’s a bad person (or even a bad nurse), she seems to really be lacking in compassion (in addition to her previously demonstrated lack of humor). She offered no acknowledgemet of the crushing lack of success on Femara, just a quick - “Looks like it will make sense for you to move on to injectables now.” I asked, puzzled, if that really made sense given J’s Kruger results, and she said, “It’s worth a try. We’ve had patients get pregnant from an IUI with results like his - not everyone can afford IVF. ... Of course, who knows if they were having affairs on the side!” I was so stunned I didn’t say anything, though I’ve been making a mental list of comebacks. Foremost among them at the moment is the not-so-snappy observation that perhaps this was her attempt at humor, in which case I again reference the (much greater) need for compassion, above. Instead of a snappy retort, I asked about IVF (which the clinic doesn’t do) and she suggested that I make another appointment with Dr. L to discuss our options. (I’ve already Googled the hell out of the options, but it will be nice to get a second opinion from the professional.

If I cycle again at this clinic (which is a big IF at this point), I WILL NOT be seeing Nurse NBM again.*

*Except if we go for the injection training, since she’s the one who teaches it.

Hey, how's it going?

Lorelai: Hey -- tomorrow, if you have time, I'm planning on despising everyone who says, "Hey, how's it going?"
Luke: You're on.
[A woman enters Luke's restaurant.]
Woman: Hey, how's it going?
Lorelai: [to herself] Oh, now that's just too easy.*


I didn’t have as bad a time as I’d expected at my reunion. Not a ringing endorsement, I know, but as we were driving over there (after I spent an eternity trying to decide which necklace to wear or something equally trivial) I was dreading the entire experience.

I went to a very unique high school, that in some respects was free from the typical inane social activity and cliquishness. (And if that was your thing and you were happy with it, then more power to you. You probably would have hated my school, and I probably would have hated yours. And that’s fine.) My school was a school full of misfits, of kids who would have been the odd ones at their old schools. And my school was a safe haven. In some respects.

The thing is, it was still high school, and we were still teenagers. So there was still a bit of that whole high school thing. Which is all a preface to saying that some things never change. And while there was never one clear popular group, there were still groups, and peripheries to those groups, and weird overlaps between groups and all that. And they’re all still there.

So, the reunion (which was an all-school reunion with people from the last 20 years) was in a private room (well, rooms) at a bar. It was packed, and loud, and I’m still getting over bronchitis so the whole shouting to be heard thing was a real treat for me. But I saw some people I wanted to see, and some people I didn’t know I wanted to see but ended up having the best conversations with. I forgot to bring business cards, so I collected a few from other people and wrote my info on little pieces of paper. And there weren’t any noticably pregnant women (at least, not from my class). One former classmate asked if we had kids (she has a 5 year old) but it seems most everyone else is still single or newly married and many are still in that post-college lifestyle -- working some job that’s vaguely interesting and living alone or with a roommate and just going about their lives. Nothing wrong with that. But it makes my almost five years of marriage and two years of homeownership look so serious and grown up. Weird.

The weirdest part of the whole thing was the discovery that there are a lot of people I don’t really care that I haven’t seen in years. Either we weren’t really close in high school or we’ve completely drifted since then. Those were the “Hey, how’s it going” crowd. You ask, and you look interested, but we both know we don’t really care what’s up with this person, and the whole forced conversation is just pointless. Then, of course, there were the people I did really want to see, who seemed to regard me as a “hey, how’s it going” kind of conversation. Which was a bit sad. As was the absence of my high school best friend, from whom I’ve drifted, but who would have been the only person fully able to grasp some of the weirdnesses. I tried to explain some of them to J, but there’s really no way of condensing three years of history into a thirty-second explanation. So I missed my former BF. But at least now I can say I survived my high school reunion.

*Gilmore Girls 1.16 (Star-Crossed Lovers and Other Strangers) - Yes, I am rather obsessed with GG lately. Such good writing!

eye contact

As I sat in the waiting room this morning, I looked around at all the other unfortunates, and I sort-of wished the waiting room ettiquitte was different. I don’t have any infertile friends IRL (except for one that lives clear across the country) and if anyone would understand the craziness that is the evil HMO, it might be them. (On the other hand, I’m continually amazed at how other people just blindly accept the statements of their medical providers without questioning or challenging. And don’t crack snarky jokes to their wand monkeys. I’ve never witnessed that last part firsthand, of course, but given the nurse’s puzzled look this morning when I made some stupid quip, I have to believe it’s rarer that I’d think after hanging out with all you internets. So maybe they wouldn’t understand. But I digress.) So I sat there thinking how sad it was that none of us could make eye contact until I got called back for my date with the dildocam.

The date, it was not good. CD15 and nothing to show for it. The nurse (who also wasn’t making much eye contact) said that I could have a blood test next week to confirm that I hadn’t ovulated and then start Provera, or I could come back for one more check next week. I’m not holding my breath for that last ultrasound, but since I’ve already had the experience of missing a very late ovulation (at the old clinic) because the doctor counted me out too soon, I’m not really ready to throw in the towel. That said, I have no real hope that things will be different next week. And that’ll be it for oral meds. Nice knowing you - have a safe trip. But the nurse (not my favorite nurse at the clinic) didn’t seem too optimistic. I’m not either, but I could have used a little encouragement from her - at least enough to help me hold it together until I got back to my car. But no, it was another of those half-naked crying on the exam table kinds of days. And there were no fucking tissues in the room.

We’re already signed up for the next available injectables class in about 2 weeks. So ideally, we’ll hold off on inducing a period (if it comes to that) long enough for me to actually apply the ever-so-useful skills I’ll get from the class to our next cycle. It’s the clinic’s last chance, really. Once you get to injectables, it’s Repronex or nothing. And I don’t know that it’s the right drug for me. So I’ll try one cycle, and if that’s not the magic bullet then we’ll be seriously considering a move to a private, out-of-pocket clinic. And potentially skipping right along down the road to IVF. But I’m trying not to think about that too much today.

And in the meantime, they wouldn’t give me the results of J’s Kruger analysis. The one that will tell me if it even matters if we can get me to ovulate on schedule. The one that will help us decide what to do next. The one that was in my file, but couldn’t be released to me because of privacy regulations. I understand that in theory, but why couldn’t they tell me that two days ago when I called to request the results? I mean, I could have dragged J to this appointment. I could have brought in a written request that the results be released to me. I could have had HIM call for the results. But since I’m the patient at the clinic, I tried to take care of it. And look how successful that was.