Seeing as how at some (undisclosed) point I will be going through the IVF wringer again, I thought I would spend a little time on Lupron. It's the first non-familiar drug most people take when doing IVF (the first drug is the Pill in some but not all cases, but most people are familiar with that one!). It starts Phase One of IVF--Suppression.
In my case, in part because I have PCOS and have wacky hormones but respond really well to the ovulation stimulation drugs, I am suppressed by both the Pill and Lupron. Once the Lupron starts it's very exciting--the countdown is on for stimming medication (and Follicle Watch begins!). The point of the suppression phase is to shut your system down temporarily so that your amazing medical team can take over artificially via the FSH/LH stimulating drugs you start later. In order to get prepped for possible pregnancy, your own dysfunctional body has to be told to shut the hell up, basically. It's disturbing because essentially you are throwing your body into menopause for a short while before you are kickstarted into SuperFertility. I sincerely hope it is not a totally accurate preview of what's to come.
Lupron itself is one of the cheaper IVF drugs, and it is not scary looking. It's clear, it's stored in the refrigerator in a little vial that does not have to be mixed mad-scientist fashion on your counter, and it requires a teensy needle. Lupron is injected subcutaneously (into the fat under your skin) with an insulin needle--it's a skinny syringe with a superthin 1/2 inch needle. It is a breeze to pull up, a breeze to inject, and it doesn't burn or sting going in. What's not to love?
In my opinion, a lot. Once the drug is in your system and starts doing its quick-and-dirty menopausal magic, it can wreak havoc on your body. I had read a lot about Lupron before starting it over the summer, and was terrified of "Lupron Rage," "Lupwon Bwain," hot flashes, night sweats, and the very scary sounding "Lupron Bleed" that one book says can require lining your car with garbage bags so you don't ruin the upholstery. Ew. My actual experience was pretty nasty, but not the laundry list I read about. I definitely had increased irritability, more so than with Clomid (or at least I thought so, not sure if Bryce agrees with me there). I had the brain farts--it is so frustrating to know what you want to say but to lose the words to get it out there. Or to start a sentence and halfway through completely and totally space on what you were talking about. I definitely had hot flashes, which in the summer is just cruel. I was working mornings at the Red Cross Baking Work-Study with my student and had to wear a lab coat--despite the A/C I ripped it off and ran into the walk-in freezer more than once. Night sweats were not an issue, although apparently I radiated heat like a brick oven. I did not experience a horrible hemorrhage as I was warned I might. BUT, I did suffer hideous, awful insomnia. The kind I have never been unlucky enough to experience. I would fall asleep ok at about 11, but then wake up at 2 or 3 in the morning and...stay awake. I would listen for the birds to start bringing on the dawn. I would watch the sky get light. I would read by the early morning light until it was an acceptable time to get up and go to work, on 3-4 hours of sleep. Which once is manageable, but every night for a week is just horrific. It magnified the irritability. I had nowhere else to go because we were sleeping on the futon at the time while our bedroom was being renovated. The guest room upstairs was floor to ceiling full of our bedroom furniture. I was trapped. Luckily I talked to a nurse when I went in for a monitoring appointment, and she let me know it was ok to take Benadryl, and if that didn't work that there might be something that could be prescribed. At this point they were about to halve my dosage, so the Benadryl was enough. That was a small miracle, and such a relief! And, after the dosage was halved and the estrogen-increasing drugs were started, the insomnia and hot flashes went away entirely. Which is good, because I was on Lupron from two weeks or so before I started the stimulation meds all the way until just before egg retrieval. (After you get your ovaries to make a bunch of follicles, the Lupron helps you to NOT ovulate on your own so that the precious little eggs can be scooped up at retrieval and set up to dirty dance with the hand-picked sperm in the petri dish.)
I guess it's good to know what to expect this time, although everyone reacts a little differently. I hope you react differently each time and I can skip the insomnia, although now that I know Benadryl should help it will be better!
Monday, November 29, 2010
Monday, November 22, 2010
Prenatal Anxiety
Every month, or every other month if I've thought ahead, I have to go into a store and do one of my least favorite chores. The store is GNC, and the chore is buying prenatal vitamins. GNC carries prenatal vitamins without iron, which is great for sensitive stomach types. I figure if I need the ones with iron they can tell me that when I'm actually pregnant and nauseous anyway.
So why is buying vitamins at a supplement store so stressful? Because I have been buying prenatal vitamins for nearly a year and a half. And I have nothing--not a baby, not a bump, nothing but the satisfaction of due diligence--to show for it. Just anxiety and a couple of self-pitying experiences.
The first was just a few months in, and was more of a shot to my vanity than anything else. The guy behind the counter rang me up and then said "Congratulations, are you having a boy or a girl?" Granted, he looked like all he knew about from women he learned from his mom, so he probably didn't know that you have to be about 16 weeks to find out the sex. This was when I was skinnier, and I certainly didn't look 4 months pregnant! I mumbled, "Oh, I'm not actually pregnant, see they're PREnatal vitamins so you're supposed to start taking them before, when you're trying to get pregnant..." I ran out of the store and felt both chubby and a little sad.
The second was more recent--I went in and they'd rearranged the store, so I couldn't just grab them and be standoffish so the staff wouldn't feel like they had to ask me about my blessed un-event. Apparently there was a new wonder product available. A superbaby trifecta of sorts, with the regular prenatal vitamins, a calcium supplement, and a DHEA supplement. Supposedly it would optimize brain, eye, and bone development in the fetus. The salesman went on and on and made it seem like any good mom would want to ensure that amazing developmental boost for their growing fetus. I had to politely interrupt him and say, "Well, I'll think about that one when I actually have something developing in there. I'm not actually pregnant yet. It's an ongoing quest that's taking a while." He was actually really nice, and dropped the sales pitch to ring me out. As he handed me the receipt, he said kindly, "Good luck with that." I barely made it out of the store without bursting into tears. First because I had no reason to buy the superbaby supplement set, and second because this cashier was actually heartfelt and kind. I was touched.
Every time I go, I worry that there will be the same people in the store time after time and they will realize that I am still not pregnant and still buying and taking the prenatal vitamins (although so far turnover seems high). I worry that they feel sorry for me, or think I'm some nut who will come in one day with a creepy vacant-eyed baby doll tucked into my Baby Bjorn. More frequently I just worry that I am going to be on prenatal vitamins for years without actually growing a baby in my lonely uterus. I know that's probably not true, and especially given my uber-positive take on this next cycle I know that I will get to go buy those vitamins wearing actual maternity clothes sometime relatively soon. But it haunts me just a little bit every time a realize I've only got a day or two of vitamins left and have to make my pilgrimage to the GNC down the hill.
But, tonight I went in, bought my vitamins (two months worth so I don't have to go in when I'm full of holiday no-baby blues), and didn't cry in my car after. Hooray for progress...
So why is buying vitamins at a supplement store so stressful? Because I have been buying prenatal vitamins for nearly a year and a half. And I have nothing--not a baby, not a bump, nothing but the satisfaction of due diligence--to show for it. Just anxiety and a couple of self-pitying experiences.
The first was just a few months in, and was more of a shot to my vanity than anything else. The guy behind the counter rang me up and then said "Congratulations, are you having a boy or a girl?" Granted, he looked like all he knew about from women he learned from his mom, so he probably didn't know that you have to be about 16 weeks to find out the sex. This was when I was skinnier, and I certainly didn't look 4 months pregnant! I mumbled, "Oh, I'm not actually pregnant, see they're PREnatal vitamins so you're supposed to start taking them before, when you're trying to get pregnant..." I ran out of the store and felt both chubby and a little sad.
The second was more recent--I went in and they'd rearranged the store, so I couldn't just grab them and be standoffish so the staff wouldn't feel like they had to ask me about my blessed un-event. Apparently there was a new wonder product available. A superbaby trifecta of sorts, with the regular prenatal vitamins, a calcium supplement, and a DHEA supplement. Supposedly it would optimize brain, eye, and bone development in the fetus. The salesman went on and on and made it seem like any good mom would want to ensure that amazing developmental boost for their growing fetus. I had to politely interrupt him and say, "Well, I'll think about that one when I actually have something developing in there. I'm not actually pregnant yet. It's an ongoing quest that's taking a while." He was actually really nice, and dropped the sales pitch to ring me out. As he handed me the receipt, he said kindly, "Good luck with that." I barely made it out of the store without bursting into tears. First because I had no reason to buy the superbaby supplement set, and second because this cashier was actually heartfelt and kind. I was touched.
Every time I go, I worry that there will be the same people in the store time after time and they will realize that I am still not pregnant and still buying and taking the prenatal vitamins (although so far turnover seems high). I worry that they feel sorry for me, or think I'm some nut who will come in one day with a creepy vacant-eyed baby doll tucked into my Baby Bjorn. More frequently I just worry that I am going to be on prenatal vitamins for years without actually growing a baby in my lonely uterus. I know that's probably not true, and especially given my uber-positive take on this next cycle I know that I will get to go buy those vitamins wearing actual maternity clothes sometime relatively soon. But it haunts me just a little bit every time a realize I've only got a day or two of vitamins left and have to make my pilgrimage to the GNC down the hill.
But, tonight I went in, bought my vitamins (two months worth so I don't have to go in when I'm full of holiday no-baby blues), and didn't cry in my car after. Hooray for progress...
Wednesday, November 17, 2010
Battle Plans
I am getting ready for my second IVF sometime in the near future. I have decided to approach this one with a full arsenal of supports. Not that I half-assed our last attempt at pregnancy, but there are things that I can do now that I didn't do, or didn't do as well, then. Here is my battle plan...
1. I can vow to really relax and lower my stress levels during this attempt. My stims phase was during summer school last time and our house was under construction for the bed/bath renovation we did upstairs, so up until a few days into stimming we were sleeping on a futon (or in my case, not sleeping). It was not comfortable. I was not well rested. Once we were into the stims phase I was back in my (new) bedroom, but there were still workers in the house and outside it working on stuff involving pressure spray and chipping out fieldstones in the patio. Again, not restful. This time hopefully those kinds of things won't be going on and I can truly relax. (Side note: This is not to vindicate those who would say "Just relax! Then you'll get pregnant!" This is more of a "I need to relax in spite of all the insane things I'm doing to my body just for a chance to get pregnant, so that my body is not teeming with cortisol on top of all the other hormones that are artificially introduced" kind of thing. Super relaxation on its own merits will still fail to get me pregnant...)
2. I can really and truly vegetate after transfer. Last time our wonderful greyhound, Kayak, arrived on the same day as transfer. I went anyway to pick him up and while I spent most of the time there on a bench or sitting in the car, I still feel like I didn't do as good a job as I could have resting and staying put so those embryos could settle in. My rational self knows that going to pick up the dog isn't what caused my IVF to NOT result in a pregnancy, but my more front-of-mind irrational self thinks somehow that may have contributed to our failure. Therefore, after transfer I am going home and I am going to spend the rest of the day in bed with trashy reads and movies. And the next two days will be either in bed or on couch. No chances this time! I foresee takeout in our future...
3. I can better prepare my body. I have acupuncture appointments already lined up. I have been doing Yoga for Fertility for months and hopefully that is having a cumulative effect on my body and soul. I am not as fit as I could probably be (thank you, IVF #1) but I feel good. I know what to expect this time, so I know what to do to make myself more comfortable. I am also doing Maya Massage, more on that in #5. It's important for my body to be primed because this time they are increasing my meds quite a bit--they want me to have many more follicles in hopes that this will produce more mature eggs and more viable embryos. So my stimming experience will be different but hopefully the acupuncture, specialized yoga, Maya Massage, and the special tea in #5 will prepare my body for the stimming onslaught!
4. I can better prepare my mental well-being. This helps not only me but Bryce, too. If I can stay a little more calm and centered maybe things will work out better this time. Not that I was basketcase previously, but there was a lot of nervousness and anxiety and depression and crying and feeling sorry for myself and Bryce. I'm trying very hard to approach this time with a more meditative mind. I am opening up my mental state for possibilities and trying not to even entertain the thought that it won't work. (I'm not stupid, I know it's still at best 50% likely to work, but I am going to focus on the GOOD 50%.) I am going to attempt to not drive myself crazy with every little thought of what could go wrong. I am going to invite good things to happen to me and Bryce. I am going to meditate more frequently and set intentions for my day, every day. You never know, it might work! :) In the meantime, it will at least make me slightly more stable during this process and therefore less unpleasant to live with.
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| Look! Magical fertility vapors! |
5. I can do some really freaky holistic stuff. Since my mind is open to possibility, I am willing to try anything within reason. Like for instance, going for a massage specifically for your abdomen to externally stimulate, increase blood flow, and realign internal reproductive parts (sounds fairly creepy, but it was felt amazingly relaxing and healing). And then purchasing a beautiful packet of whole leaf herbs that looks like a really awesome fertility tea. Smells like a delicious Tazo tea you might get at Starbucks. But this tea is not meant for consumption. Oh, no... this tea is meant for steaming your uterus and her friends. I have a picture of the crazy witches' brew looking stuff boiling on my stove. Basically, I soft-boiled it, steeped it, placed it on a trivet on the floor, and then positioned my birthday-suited self directly over it while wrapped in a blanket so no cold air could interfere with the hoo-hoo steaming. Or, as it's more endearingly called by the folks at the holistic healing center/fertility clinic where I got it, a "Vag Bath." Clearly, I am very serious about wanting to get pregnant. These activities are very relaxing, albeit a little weird, and if they help me get pregnant I am 100% behind them. Although not behind them enough openly to steam in front of Bryce (who just about fell over laughing when I explained why the house smelled overwhelmingly like a soothing herbal tea when he got home yesterday).
I am giving it all I've got this second time around the IVF merry-go-round. I think our chances are good. Oh wait, I forgot, I'm changing my mindset. I KNOW our chances are good.
Tuesday, November 9, 2010
To The Pregnant People
Ok, so I am going to be brutally honest here, and hope that you respect my honesty and don't think that I'm a bitter jerk. I fully admit that I have a double standard when it comes to pregnant people.
When someone tells me (or posts) that they are pregnant, my first genuine thought is "I am so happy for you!" I am actually happy for people who can have babies when they want to. However, my thoughts then tend to shift to feelings of sadness, jealousy, hope, or even anger. It all depends on who you are. If you are someone who I am very close to, I will feel mostly happy for you and a little sad for me, regardless of the circumstances. If you are someone who I am not as close to, it really depends on the circumstance. Let me elaborate. (Note: please do not try to figure out if you are one of the hypothetical people below. I mushed a whole bunch of different scenarios together for most.)
Pregnant Person A: Best friend, pregnant with another child. First thoughts: Wow, I am so happy for you, that is awesome! Second thoughts: Wow, it must be nice to be so fertile. Third thoughts: Crap. So much for being pregnant at the same time in our lifetimes. Fourth thoughts: More cute children to adore! Fifth thoughts: I am never going to be able to have a cohesive phone conversation with you again now that there are so many miniature people to get into the car, keep occupied, keep fed and dry and burped, keep from killing each other in the playroom. Overall thought: I am really happy for this person, even though they were able to get pregnant multiple times easily. But I am stuck with a tiny, petulant "Why not me?" voice in the back of my head that I can beat into submission most of the time.
Pregnant Person B: Facebook friend, haven't seen in person in a long time. Announces pregnancy via early ultrasound (so early it's just a gestational sac, no fetus to behold). Fleeting feelings of "I'm so happy for you!" that morph into incredible sadness and resentfulness that for some people, announcing a pregnancy so early is not a harbinger of doom and gloom--they can announce that way (some even by posting a pee stick picture, talk about early!) and have a healthy baby 9 months later. Must be nice to live in a fertile bubble where once you're pregnant, easily and quickly, you stay that way with little to no incident.
Pregnant Person C: Acquaintance, find out on Facebook (everyone's doing it apparently). Feel the "I'm so happy!" vibe and then actually talk to person or partner. Person/partner is totally unenthusiastic about having another baby (or a surprise baby, or another surprise baby). Sudden feelings of wanting to shoot pee sticks through this person's skull, because they could at least pretend to be happy that the miracle of life has visited them and not you, who would be totally grateful even if it meant living on the street. (I realize that different situations are difficult for different people, but that knee jerk feeling of "can't you just PRETEND to be happy???" supercedes any compassion for the added expense of a not totally planned baby).
Pregnant Person D: Person you overhear talking at work and then realize they're pregnant when they do nothing but complain about being pregnant or that instead of having a desperately wanted girl, ugh, they are having a boy. Or vice versa. I feel "wow, that's great she's pregnant" and then immediately want to inject progesterone in oil shots into this person's nether regions. The complaining about the downsides of pregnancy I can get behind--for some people it is not a glowy joyous time but a time filled with edema, painful varicose veins, hemorrhoids, and/or constant vomiting. I get that that sucks. But you get to have a baby at the end of it, so I can't help but not be too sympathetic. Especially if you know what I am going through and complain ad nauseum to me. The people who are not happy with the sex of the baby? I feel nothing but anger. It's not the baby store, people. You get to have a baby, and while you may be bummed that you didn't get your preference, you are pregnant with a beautiful child. The happiness feeling is short-lived in this case because the sense of injustice is just too overwhelming.
Pregnant Person E: Friend of any sort who had announced they were going to try to get pregnant soon, and then announce that they are pregnant fairly immediately after starting to try. I'm happy, really I am. But I am also very, very, very jealous. I do not wish my experience on anyone, but feel particularly gypped when someone is able to say "gee I'd like to have a baby right about now" and BAM! They are pregnant. I am happy for your incredible good luck. I am happy that your wish for family transformed itself instantly into expectant motherhood. I am just feeling like perhaps I built my house on an ancient burial ground or wronged some sorceress or some other scenario where I have really crap luck while you are probably not entirely aware of just how incredibly, beautifully fortunate you are.
Pregnant Person F: Person you know from treatment, clinic, fertility yoga class, or who you just know went through some fertility issues tells you they are pregnant. Instantaneous "I am SO HAPPY for you!" that stays and is followed by a surge of hope. Because if it happened for them, it can happen for you. Especially if the person had a particularly long and arduous journey. For me, and forgive me for this but I'm being honest here, this person EARNED it. They struggled for their baby and it finally happened. There may be a fleeting "When will it be my turn" that is simply human, but in general, this pregnant announcement gets hugs, jumping up and down, and tears of joy not tears of unfairness, jealousy, and bitter sadness.
I could keep going (there are SO many different scenarios!), but I won't. A couple things to add though--if you are lucky enough to be a pregnant person coming to tell me in whatever way that you are knocked up, PLEASE do not tell me in an apology. Do not tell me as you would tell an ex-lover that you probably gave them an STD. You are pregnant, and that is awesome. If you tell me like an apology I will feel worse. It is possible to desperately want what you've got and be happy for you. This is happy news, exciting news! I will feel like a killjoy of the worst sort if you tell me like it's bad news. I may be sad later, but my first thought is always well wishing. Because I am genuinely happy that this miracle happened to you (even if later I want to harm you with infertility paraphernalia due to witting or unwitting insensitivity). And someday I want to be announcing my pregnancy too. Just not with an ultrasound on Facebook, or a picture of my pee-soaked stick (let's face it, I won't have one to share anyway), or a transcript of the IVF nurse's message on my cell phone. And I won't be announcing early, because I don't live in a fertile bubble and am too afraid of tempting fate.
If, in the euphoria of my pregnant bliss I forget all this and turn into one of the more distressing pregnant people listed above, please feel free to whack me over the head with my sharps container.
When someone tells me (or posts) that they are pregnant, my first genuine thought is "I am so happy for you!" I am actually happy for people who can have babies when they want to. However, my thoughts then tend to shift to feelings of sadness, jealousy, hope, or even anger. It all depends on who you are. If you are someone who I am very close to, I will feel mostly happy for you and a little sad for me, regardless of the circumstances. If you are someone who I am not as close to, it really depends on the circumstance. Let me elaborate. (Note: please do not try to figure out if you are one of the hypothetical people below. I mushed a whole bunch of different scenarios together for most.)
Pregnant Person A: Best friend, pregnant with another child. First thoughts: Wow, I am so happy for you, that is awesome! Second thoughts: Wow, it must be nice to be so fertile. Third thoughts: Crap. So much for being pregnant at the same time in our lifetimes. Fourth thoughts: More cute children to adore! Fifth thoughts: I am never going to be able to have a cohesive phone conversation with you again now that there are so many miniature people to get into the car, keep occupied, keep fed and dry and burped, keep from killing each other in the playroom. Overall thought: I am really happy for this person, even though they were able to get pregnant multiple times easily. But I am stuck with a tiny, petulant "Why not me?" voice in the back of my head that I can beat into submission most of the time.
Pregnant Person B: Facebook friend, haven't seen in person in a long time. Announces pregnancy via early ultrasound (so early it's just a gestational sac, no fetus to behold). Fleeting feelings of "I'm so happy for you!" that morph into incredible sadness and resentfulness that for some people, announcing a pregnancy so early is not a harbinger of doom and gloom--they can announce that way (some even by posting a pee stick picture, talk about early!) and have a healthy baby 9 months later. Must be nice to live in a fertile bubble where once you're pregnant, easily and quickly, you stay that way with little to no incident.
Pregnant Person C: Acquaintance, find out on Facebook (everyone's doing it apparently). Feel the "I'm so happy!" vibe and then actually talk to person or partner. Person/partner is totally unenthusiastic about having another baby (or a surprise baby, or another surprise baby). Sudden feelings of wanting to shoot pee sticks through this person's skull, because they could at least pretend to be happy that the miracle of life has visited them and not you, who would be totally grateful even if it meant living on the street. (I realize that different situations are difficult for different people, but that knee jerk feeling of "can't you just PRETEND to be happy???" supercedes any compassion for the added expense of a not totally planned baby).
Pregnant Person D: Person you overhear talking at work and then realize they're pregnant when they do nothing but complain about being pregnant or that instead of having a desperately wanted girl, ugh, they are having a boy. Or vice versa. I feel "wow, that's great she's pregnant" and then immediately want to inject progesterone in oil shots into this person's nether regions. The complaining about the downsides of pregnancy I can get behind--for some people it is not a glowy joyous time but a time filled with edema, painful varicose veins, hemorrhoids, and/or constant vomiting. I get that that sucks. But you get to have a baby at the end of it, so I can't help but not be too sympathetic. Especially if you know what I am going through and complain ad nauseum to me. The people who are not happy with the sex of the baby? I feel nothing but anger. It's not the baby store, people. You get to have a baby, and while you may be bummed that you didn't get your preference, you are pregnant with a beautiful child. The happiness feeling is short-lived in this case because the sense of injustice is just too overwhelming.
Pregnant Person E: Friend of any sort who had announced they were going to try to get pregnant soon, and then announce that they are pregnant fairly immediately after starting to try. I'm happy, really I am. But I am also very, very, very jealous. I do not wish my experience on anyone, but feel particularly gypped when someone is able to say "gee I'd like to have a baby right about now" and BAM! They are pregnant. I am happy for your incredible good luck. I am happy that your wish for family transformed itself instantly into expectant motherhood. I am just feeling like perhaps I built my house on an ancient burial ground or wronged some sorceress or some other scenario where I have really crap luck while you are probably not entirely aware of just how incredibly, beautifully fortunate you are.
Pregnant Person F: Person you know from treatment, clinic, fertility yoga class, or who you just know went through some fertility issues tells you they are pregnant. Instantaneous "I am SO HAPPY for you!" that stays and is followed by a surge of hope. Because if it happened for them, it can happen for you. Especially if the person had a particularly long and arduous journey. For me, and forgive me for this but I'm being honest here, this person EARNED it. They struggled for their baby and it finally happened. There may be a fleeting "When will it be my turn" that is simply human, but in general, this pregnant announcement gets hugs, jumping up and down, and tears of joy not tears of unfairness, jealousy, and bitter sadness.
I could keep going (there are SO many different scenarios!), but I won't. A couple things to add though--if you are lucky enough to be a pregnant person coming to tell me in whatever way that you are knocked up, PLEASE do not tell me in an apology. Do not tell me as you would tell an ex-lover that you probably gave them an STD. You are pregnant, and that is awesome. If you tell me like an apology I will feel worse. It is possible to desperately want what you've got and be happy for you. This is happy news, exciting news! I will feel like a killjoy of the worst sort if you tell me like it's bad news. I may be sad later, but my first thought is always well wishing. Because I am genuinely happy that this miracle happened to you (even if later I want to harm you with infertility paraphernalia due to witting or unwitting insensitivity). And someday I want to be announcing my pregnancy too. Just not with an ultrasound on Facebook, or a picture of my pee-soaked stick (let's face it, I won't have one to share anyway), or a transcript of the IVF nurse's message on my cell phone. And I won't be announcing early, because I don't live in a fertile bubble and am too afraid of tempting fate.
If, in the euphoria of my pregnant bliss I forget all this and turn into one of the more distressing pregnant people listed above, please feel free to whack me over the head with my sharps container.
Friday, November 5, 2010
Laying Down Bets
Beginning infertility treatment is exciting in a way. You are upset that you have to go through this process, but once you have made at least a little peace with that you just want to get going. You might have a highly hypothetical "hmmm, how far are we willing to go?" conversation with your partner, but it's in passing and deep in your heart you know, just know, that you will get pregnant before you seriously have to consider that question.
But then things might not quite work out the way you hoped, and you might not experience a miracle and get pregnant sooner than later. You, like me, might have one IVF under your belt and be looking seriously at the question "When is enough enough?" Because IVF is expensive. It eats away your savings, your future earnings, your financial freedom. For us, a fresh cycle is estimated at about $13,000. Several thousand dollars of that cost is the medication, which is ridiculously expensive. A friend just told me that one medication she needs to go on next cycle will cost her $1,800 out of pocket. Eighteen hundred dollars for maybe a week's worth of meds! If we are were to pay out of pocket with no financial assistance, three fresh cycles of IVF would cost us $39,000. "Fresh" meaning that an egg retrieval is performed and new embryos are created. "Frozen" cycles are where surplus embryos from a fresh cycle have been frozen and can be thawed and transferred with minimal medication and monitoring--those are wicked cheap in comparison. I was not lucky enough to have any surplus embryos to freeze last time, so I am working with "Fresh" numbers.
$39,000 is a crazy amount of money. And if you don't get pregnant after that, adoption is not free. That can also cost tens of thousands of dollars. It is very overwhelming. It begs the question, "How the hell can we afford this???"
It ends up feeling like you are at the high-stakes poker table at a casino. How many cycles can we feasibly afford? Which financing options are the best short-term and long-term? At what point do we say Uncle and throw our energies into the adoption process? (Which, by the way, is not a shortcut to getting pregnant. Lots of people apply for adoption and do NOT then miraculously get pregnant on their own, despite the anecdotes that creep out of the woodwork when you even mention in passing that you are open to adoption at some point.) This is supposed to be a time of great hope for us--we are trying to build our family one cell at a time and have a lot to look forward to. Our doctors are very enthusiastic and positive about our chances this second time. We have a new, juiced-up protocol that will likely make me very uncomfortable but produce more, and higher quality, embryos. But it stinks because before we can move forward we have to seriously entertain "The End" conversation. Which is what we recently did for hours, with T-charts and tears and long silences, as we tried to figure out which financing option that is offered by our clinic is best for us in the long term and will give us the best chance with the least financial strain.
Your first IVF is largely diagnostic, so you can't really go into it 100% thinking that you will get pregnant that first time and just do it once. Some people manage this, and I envy them. Many people need to do 2 or 3 so that the protocol can be tweaked and everyone can see exactly what happens when your genetic material meets so that they can figure out how to get the best numbers. We have been very lucky and so far have not paid full price, and for that we are tremendously grateful to our clinic. We qualified for a grant the first time so it was about half the sticker price, and we qualified for the same grant this next cycle. We were in the running for the refund program as well, but with the grant available and questions over whether we would actually be approved, we decided to go with the grant. This is largely because the cost for the grant for one cycle was less expensive by almost $10,000 if we manage to get pregnant. And if we don't, and we have to pay out of pocket for a second fresh cycle, the cost of the grant versus the refund program is within $600 of each other. So it's not unless we fail after three total cycles that the refund program really kicks in and becomes financially a better choice. It was a really hard choice to make. Mostly because with the refund program I would have the option for 3 more fresh cycles (a total of 4 tries), and with the grant we will have to stop and reevaluate after 2 more. I am not ready to really think about that. I want to believe that the doctors' enthusiasm and belief that this next cycle is IT and we are totally getting pregnant with the second IVF. But it is hard to do that when you have had the same level of enthusiasm for your first IVF only to have it end a failure. And, what if the IVF that will work for us is the fourth one? What if we quit right when we would have gotten pregnant?
This process brings up a lot of difficult questions, difficult circumstances, and no good answers. Did we decide on a definitive stopping point? No. Did we decide on a "reevaluation" point? Yes. Did we choose the option that is best for the short term with the hopes that we'll get pregnant as quickly as we're projected to, instead of the one that offered the better long-term protection if we have multiple failures? Yes. Maybe that's a sign that we are thinking positively about our chances as well. Or maybe it was partially because if we didn't take the grant, there was a chance we could also lose the refund program and end up empty-handed (and really in a pickle to even get two more cycles in). Honestly, I am starting to feel like a racehorse. Everyone--ourselves, the team of doctors--are projecting potential wins and losses and hoping we made the right call. I really, really hope we made the right call.
But then things might not quite work out the way you hoped, and you might not experience a miracle and get pregnant sooner than later. You, like me, might have one IVF under your belt and be looking seriously at the question "When is enough enough?" Because IVF is expensive. It eats away your savings, your future earnings, your financial freedom. For us, a fresh cycle is estimated at about $13,000. Several thousand dollars of that cost is the medication, which is ridiculously expensive. A friend just told me that one medication she needs to go on next cycle will cost her $1,800 out of pocket. Eighteen hundred dollars for maybe a week's worth of meds! If we are were to pay out of pocket with no financial assistance, three fresh cycles of IVF would cost us $39,000. "Fresh" meaning that an egg retrieval is performed and new embryos are created. "Frozen" cycles are where surplus embryos from a fresh cycle have been frozen and can be thawed and transferred with minimal medication and monitoring--those are wicked cheap in comparison. I was not lucky enough to have any surplus embryos to freeze last time, so I am working with "Fresh" numbers.
$39,000 is a crazy amount of money. And if you don't get pregnant after that, adoption is not free. That can also cost tens of thousands of dollars. It is very overwhelming. It begs the question, "How the hell can we afford this???"
It ends up feeling like you are at the high-stakes poker table at a casino. How many cycles can we feasibly afford? Which financing options are the best short-term and long-term? At what point do we say Uncle and throw our energies into the adoption process? (Which, by the way, is not a shortcut to getting pregnant. Lots of people apply for adoption and do NOT then miraculously get pregnant on their own, despite the anecdotes that creep out of the woodwork when you even mention in passing that you are open to adoption at some point.) This is supposed to be a time of great hope for us--we are trying to build our family one cell at a time and have a lot to look forward to. Our doctors are very enthusiastic and positive about our chances this second time. We have a new, juiced-up protocol that will likely make me very uncomfortable but produce more, and higher quality, embryos. But it stinks because before we can move forward we have to seriously entertain "The End" conversation. Which is what we recently did for hours, with T-charts and tears and long silences, as we tried to figure out which financing option that is offered by our clinic is best for us in the long term and will give us the best chance with the least financial strain.
Your first IVF is largely diagnostic, so you can't really go into it 100% thinking that you will get pregnant that first time and just do it once. Some people manage this, and I envy them. Many people need to do 2 or 3 so that the protocol can be tweaked and everyone can see exactly what happens when your genetic material meets so that they can figure out how to get the best numbers. We have been very lucky and so far have not paid full price, and for that we are tremendously grateful to our clinic. We qualified for a grant the first time so it was about half the sticker price, and we qualified for the same grant this next cycle. We were in the running for the refund program as well, but with the grant available and questions over whether we would actually be approved, we decided to go with the grant. This is largely because the cost for the grant for one cycle was less expensive by almost $10,000 if we manage to get pregnant. And if we don't, and we have to pay out of pocket for a second fresh cycle, the cost of the grant versus the refund program is within $600 of each other. So it's not unless we fail after three total cycles that the refund program really kicks in and becomes financially a better choice. It was a really hard choice to make. Mostly because with the refund program I would have the option for 3 more fresh cycles (a total of 4 tries), and with the grant we will have to stop and reevaluate after 2 more. I am not ready to really think about that. I want to believe that the doctors' enthusiasm and belief that this next cycle is IT and we are totally getting pregnant with the second IVF. But it is hard to do that when you have had the same level of enthusiasm for your first IVF only to have it end a failure. And, what if the IVF that will work for us is the fourth one? What if we quit right when we would have gotten pregnant?
This process brings up a lot of difficult questions, difficult circumstances, and no good answers. Did we decide on a definitive stopping point? No. Did we decide on a "reevaluation" point? Yes. Did we choose the option that is best for the short term with the hopes that we'll get pregnant as quickly as we're projected to, instead of the one that offered the better long-term protection if we have multiple failures? Yes. Maybe that's a sign that we are thinking positively about our chances as well. Or maybe it was partially because if we didn't take the grant, there was a chance we could also lose the refund program and end up empty-handed (and really in a pickle to even get two more cycles in). Honestly, I am starting to feel like a racehorse. Everyone--ourselves, the team of doctors--are projecting potential wins and losses and hoping we made the right call. I really, really hope we made the right call.
Tuesday, November 2, 2010
Waiting
Infertility is all about waiting. Waiting, waiting, waiting. Most of the time by a phone.
First you wait for results to your workup. What's wrong? What else is wrong? Why is nothing showing up wrong? Then that wait gets replaced with the wait to get started on your treatment. When can you get on the schedule? When will you actually get the chance to put your plan into action? Then you wait for medication to kick in. This is a twofold wait. When will your ovaries start bubbling up with new follicles, and when will your body start displaying any number of side effects? This part of the process can take what seems like forever. For a Clomid cycle, you take the pill days 5-9 and have your first monitoring appointment around day 14 or so. Then, depending on what they see, you come in again after another couple days. And then another day or two, and then possibly daily depending on how slow or quick you respond. With injectibles, it can go really long. I had a cycle where I was on injectibles for 17 days. They monitor you much more closely on those medications because of the risk of hyperstimulation and too many follicles to proceed with IUI (depending on the clinic you go to, you can be cancelled or switched to IVF if you make more than 5, because the chances of having high-order multiples is so high). I was in the office every 3 days, and then every 2, and then every day.
And, every day you go in they take blood. Every time they take blood you receive a phone call sometime in the afternoon letting you know what your estrogen levels are and whether or not you have to come back or if you can stick a fork in it 'cause you're done. You become a slave to your phone. Missing the call is not a disaster, because they will leave a message, but taking the call could be your only shot at talking to a live person that same day, depending on the timing. My clinic is AWESOME about getting back to you if you leave a message on the nurse line, but then you are just a slave to your phone a second time. I carry my phone with me in my pocket, even at school, when I am expecting these calls. I quell any dirty looks with "I am expecting a very important call from my doctor regarding some test results." That usually stops people from thinking I'm some slacker with my phone out while I'm teaching! Hopefully you get the call that tells you you can take your trigger shot, which will release your eggs from the follicles so you can have the IUI two days later. After you take the shot (at home, given yourself, not by any licensed medical practitioner unless you happen to be one), you wait for your procedure. After the procedure, you wait for two weeks. The longest two weeks of your life. The dreaded Two Week Wait. Then, if you didn't get your period at the end of the two weeks, you are REALLY pasted to your phone. Because then you go for bloodwork in the morning and expect your most important call. The call that either starts with "Congratulations!" or "I'm so sorry."
If you're doing IVF, the waiting (like everything else) is more intense. You have the same wait to get started--ironically, the thing you desperately want NOT to see at the end of a cycle is the very thing you need to get in order to start the cycle. Your period, Aunt Flo, monthly visitor, Martha, red flag of freedom or despair--whatever you want to call it. It calls the shots. You have all the waiting for stims (injectible medications) to start and for stims to take effect, but this time when you take the trigger shot it is to ripen your eggs, not to release them. Then you have your egg retrieval procedure and wait to see how many eggs were in your haul. For me, the time between the trigger shot and retrieval was really stressful--I was terrified that my eggs wouldn't cooperate and that they would release on their own (which would cancel the cycle). I couldn't wait for the doctor to tell me how many eggs they retrieved. They tell you a rough number when you are loopy from the anesthesia, but then you have to wait for the call from the embryologist to tell you how many were truly mature enough to attempt fertilization. This wait was the third hardest wait because you can have eggs retrieved, but then not have them be mature enough or good quality enough to try fertilization. Then, the second hardest wait: waiting for the call from the embryologist to see how many embryos you have and their quality. Having eggs fertilize does not guarantee that you will have good embryos to transfer, which makes the call scary until you get your stats. Then you have the embryo transfer and the two week wait begins (thankfully shortened in a way since it is 2 weeks from fertilization, not transfer). You get two weeks when you don't have to have your phone in your pocket on vibrate so you don't miss an important call. (Those two weeks are difficult for other reasons, but that's for another time). Then the day of your blood test comes and you are a wreck, just a wreck, waiting for that phone call. This is the call that will tell you if all of your money, time, discomfort, and emotional distress resulted in a pregnancy, or if you are once again waiting for your period to arrive so that you can give it another go. I got my call at 1:27 in the afternoon and had to wait until after 5 when Bryce got home to listen to it because I did not want to get the news by myself. The little green voicemail light flashed at me all afternoon long. Now that was a long wait.
The waiting doesn't get any easier the further down the infertility road you go--I had to wait for a call just yesterday regarding my test results for the refund program. I sat through a haircut with my phone in my lap and then put it on vibrate so that I could at least feel it go off since the blow dryer was so loud. I took a phone call mid-blowout because I was waiting for those results, so that I could find out how much longer I have to wait before I can get started on my next IVF cycle. It doesn't get any easier, but I am sort of getting used to it. I just want to trade in all of these stressful waits and phone calls for a nice, long, 40 week wait for my healthy, happy baby to arrive. At least I will have plenty of practice with waiting!
First you wait for results to your workup. What's wrong? What else is wrong? Why is nothing showing up wrong? Then that wait gets replaced with the wait to get started on your treatment. When can you get on the schedule? When will you actually get the chance to put your plan into action? Then you wait for medication to kick in. This is a twofold wait. When will your ovaries start bubbling up with new follicles, and when will your body start displaying any number of side effects? This part of the process can take what seems like forever. For a Clomid cycle, you take the pill days 5-9 and have your first monitoring appointment around day 14 or so. Then, depending on what they see, you come in again after another couple days. And then another day or two, and then possibly daily depending on how slow or quick you respond. With injectibles, it can go really long. I had a cycle where I was on injectibles for 17 days. They monitor you much more closely on those medications because of the risk of hyperstimulation and too many follicles to proceed with IUI (depending on the clinic you go to, you can be cancelled or switched to IVF if you make more than 5, because the chances of having high-order multiples is so high). I was in the office every 3 days, and then every 2, and then every day.
And, every day you go in they take blood. Every time they take blood you receive a phone call sometime in the afternoon letting you know what your estrogen levels are and whether or not you have to come back or if you can stick a fork in it 'cause you're done. You become a slave to your phone. Missing the call is not a disaster, because they will leave a message, but taking the call could be your only shot at talking to a live person that same day, depending on the timing. My clinic is AWESOME about getting back to you if you leave a message on the nurse line, but then you are just a slave to your phone a second time. I carry my phone with me in my pocket, even at school, when I am expecting these calls. I quell any dirty looks with "I am expecting a very important call from my doctor regarding some test results." That usually stops people from thinking I'm some slacker with my phone out while I'm teaching! Hopefully you get the call that tells you you can take your trigger shot, which will release your eggs from the follicles so you can have the IUI two days later. After you take the shot (at home, given yourself, not by any licensed medical practitioner unless you happen to be one), you wait for your procedure. After the procedure, you wait for two weeks. The longest two weeks of your life. The dreaded Two Week Wait. Then, if you didn't get your period at the end of the two weeks, you are REALLY pasted to your phone. Because then you go for bloodwork in the morning and expect your most important call. The call that either starts with "Congratulations!" or "I'm so sorry."
If you're doing IVF, the waiting (like everything else) is more intense. You have the same wait to get started--ironically, the thing you desperately want NOT to see at the end of a cycle is the very thing you need to get in order to start the cycle. Your period, Aunt Flo, monthly visitor, Martha, red flag of freedom or despair--whatever you want to call it. It calls the shots. You have all the waiting for stims (injectible medications) to start and for stims to take effect, but this time when you take the trigger shot it is to ripen your eggs, not to release them. Then you have your egg retrieval procedure and wait to see how many eggs were in your haul. For me, the time between the trigger shot and retrieval was really stressful--I was terrified that my eggs wouldn't cooperate and that they would release on their own (which would cancel the cycle). I couldn't wait for the doctor to tell me how many eggs they retrieved. They tell you a rough number when you are loopy from the anesthesia, but then you have to wait for the call from the embryologist to tell you how many were truly mature enough to attempt fertilization. This wait was the third hardest wait because you can have eggs retrieved, but then not have them be mature enough or good quality enough to try fertilization. Then, the second hardest wait: waiting for the call from the embryologist to see how many embryos you have and their quality. Having eggs fertilize does not guarantee that you will have good embryos to transfer, which makes the call scary until you get your stats. Then you have the embryo transfer and the two week wait begins (thankfully shortened in a way since it is 2 weeks from fertilization, not transfer). You get two weeks when you don't have to have your phone in your pocket on vibrate so you don't miss an important call. (Those two weeks are difficult for other reasons, but that's for another time). Then the day of your blood test comes and you are a wreck, just a wreck, waiting for that phone call. This is the call that will tell you if all of your money, time, discomfort, and emotional distress resulted in a pregnancy, or if you are once again waiting for your period to arrive so that you can give it another go. I got my call at 1:27 in the afternoon and had to wait until after 5 when Bryce got home to listen to it because I did not want to get the news by myself. The little green voicemail light flashed at me all afternoon long. Now that was a long wait.
The waiting doesn't get any easier the further down the infertility road you go--I had to wait for a call just yesterday regarding my test results for the refund program. I sat through a haircut with my phone in my lap and then put it on vibrate so that I could at least feel it go off since the blow dryer was so loud. I took a phone call mid-blowout because I was waiting for those results, so that I could find out how much longer I have to wait before I can get started on my next IVF cycle. It doesn't get any easier, but I am sort of getting used to it. I just want to trade in all of these stressful waits and phone calls for a nice, long, 40 week wait for my healthy, happy baby to arrive. At least I will have plenty of practice with waiting!
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