Saturday, December 31, 2011

What has happened so far?

I had someone ask me the other day what the testing and preparation is like leading up to a decision to continue with IVF.  One thing to note is that this ultimately could be very different for anybody, but essentially the "basics" are:

Basal Antral Follicle Count (transvaginal ultrasound):  This is normally completed on day 2 or 3 of your cycle.  It measures the ovarian reserve (essentially how many egg follicles you have in your arsenal).  This number acts as a predictor for how many mature follicles you have that should react to the stimulation hormones taken during the IVF cycle.  If you have an above average number (like 8 or more), your chances are much higher that you'll retrieve a good number of eggs.  My specialist stopped counting at 12, so we're sitting pretty there!

Hysterosalpingogram (HSG):  This is done at the radiology lab.  A dye is injected through the cervix into the uterus and fallopian tubes.  My RE (reproductive endocrinologist) actually performs the procedures.  This helps look for blockages of the tubes, issues with the uterus, etc.

Hormone Blood Test:  One of a few different blood tests required.  This one is done the same day as the follicle count and is another assessment of the ovaries' ability to be stimulated and produce eggs. This is sometimes also called the "Clomid Challenge Test", which measures the hormone FSH at two different points in the cycle.  One issue with this test is that you can't really get a positive one, rather just a negative one.  Said another way, it can identify issues with your hormone balances and quality of eggs, but a "clear" test does not mean problems DON'T exist.

Preparatory Blood Tests:  These basically test for HIV, Hepatitis, Rubella, Rh, and  your Blood Type.  This is done on both partners.

Semen Testing (Morphology and Immunobead Test):  Obviously this one wasn't on me :)  This test verifies sperm count, motility, microscopic structures and looks for sperm antibodies (most likely produced after a vasectomy reversal - essentially antibodies that try to eat up your sperm).  Hubby had major count issues, antibody issues, and some morphology issues.  Hence, the IVF!

Sonohysterogram (vaginal ultrasound):  This was the last procedure we did before moving forward with the IVF decision.  Sterile water is instilled into the uterus through a small catheter in the cervix.  The water helps separate the inside walls of the uterus and allows any defects to be detected.  This is the time for a trial transfer as well - the doc utilizes the same tools for the embryo transfer so he cn measure the depth of the uterus.  This way, he'll know the best placement of the eggos at the actual time.  This one was pretty cool, as we could see the "empty" uterus - and hope the next ultrasound we saw had a baby in it (or two!).

Other common tests include many related to endometriosis, which is can be a common cause of infertility.  As I have had procedures unrelated to this done in the past, our doctor knows I have no endo, and therefore no tests were required here.

If anyone is having issues and wants to go through the testing to at least get the "lay of the land", I do highly recommend it.  While neither of our insurance will cover fertility treatment, both will cover fertility testing.  This is pretty common.  The trick is that once you are diagnosed or treated, all further coverage stops.  The out-of-pocket costs of the above would have been around $5,000, but fortunately I just had my copay for all of it.  Now that we're moving forward, insurance has washed its hands of us, but it was nice to not have to worry about money to at least get to this point.

If you do need to go down this route, be sure to check with your insurance very specifically on when coverage would stop (i.e. they consider a procedure to be treatment rather than testing).  I had heard rumors of a woman having her gyno prescribe Clomid when she had difficulty getting pregnant, while not really doing any testing.  However, that Clomid is then seen as treatment, and no fertility coverage is allowed past that point.  You certainly don't want to jump the gun with any treatment before absolutely necessary. 

So that's what got us here...I'll start my first medication sometime next week (a big, bad.....birth control pill?), and off we go!

Monday, December 19, 2011

Well, why not try...?

The first thing that most anyone asks if they learn someone close to them is doing IVF is "why not....?" (Fill in the blank).  Why not try intrauterine insemination (IUI, aka "turkey baster")?  Why do anything (e.g. leave it up to God, if you so believe)?  Why don't you just adopt?  Some of these questions are more easily answered than others, but here is our view:

Why not try IUI?
For those that haven't researched every method of babymaking, IUI is the acronym for  intrauterine insemination, which is a type of a broader category of "artificial" insemination.  Essentially, the semen is "washed" to isolate the actual sperm.  The washed sperm is then injected directly into the uterus.   In general, IUI would be most people's preference over IVF, at least to start:
  • It's quite a bit less expensive than a cycle of IVF.
  • The drugs/injectables, depending on the situation, are normally quite a bit less daunting.  Some people can do without any drugs at all.
  • It is not as invasive as IVF.
  • It can potentially solve whatever infertility issue is out there, especially if the issue is the "motility" of the sperm.  If the sperm are just pretty dumb and can't swim in a straight line, IUI can help them out by depositing them closer to the party entrance.
Unfortunately, IUI isn't for everyone, and it wasn't feasible for us.  The count in washed sperm will be quite a bit lower than the starting count, so if count is your issue (as it is for us), then you're pretty much washing away all of your chances.  Also, the success rate of IUI isn't fantastic if you have issues, and the likely need for several cycles can make costs add up fairly quickly.   IUI is often used for anyone trying to get pregnant without male involvement (e.g. a single mom-to-be or two female partners).  Normally, these people don't necessarily have fertility issues; they just don't need a male outside of the "donation".

 Why not leave up to God (or fate, or Buddha, or Baal, the pagan god of fertility, or whoever you so choose)?
This one is a tough one.  My husband and I DO believe in God and do believe in an "everything happens for a reason" kind of doctrine.  So, it was definitely a consideration to just step back and live our lives and see what was around the corner.  But, in reality, infertility IS a disease.  It is likely that kind of disease that people can write off as not a "real" condition, like cancer.  But it is something that is not "right" with our bodies.  And if modern science can assist with that, similar to providing treatments for other diseases, why would God not want us to utilize the research and learning we as humans have accomplished?

As with anything, there is a spectrum.  I feel that couples desiring children, of any religion or belief, should absolutely have the right to attempt IVF or similar procedures without judgment from others.  However, this should be done in a responsible, credible, and moralistic fashion.  This does not give people the moral green light to genetically engineer perfect babies in a lab or stuff their uterus with as many embryos as possible (I'm looking at you, Octomom).  It is absolutely a slippery slope and one that should be managed with care.

Why not just adopt?
This is absolutely a valid question, and one I may have even phrased this way before seeing friends go through this process and learning more about myself.  The key here is that NO ONE can "just" adopt.  Adoption is an expensive, mentally exhausting, drawn-out process that can end in heartbreak.  It can also be an absolutely beautiful way to create a family.    In that regard, it is very similar to IVF, in that you devote yourself and your resources to this process without knowledge of the outcome.  I think the misconception is that babies are just sitting around waiting to be adopted, but the potential parents are just not there. 

IVF and adoption are two extremely independent paths that couples without children will potentially travel.  Some will do only one or the other, some both and in no particular order. 

For us particularly, we decided to start with IVF, and will likely consider adoption if we don't have luck here (or potentially even if we do).  We could have easily decided to try adoption first, and then consider IVF if we were unsuccessful.

Our decision came down to:
  • Money:  Our cycle of IVF will likely cost around $15,000.  We are able to utilize flex spending for about $11,000 of that through both our employers.  This means we will not pay taxes on that $11,000 and will also have it available to us to use on January 1st, even though we'll be paying it throughout the year.  Think of it is an interest-free loan from our employers, and one that comes with tax benefits to boot.  Alternatively, adoption is often in the tens of thousands of dollars.  There are some tax credits and help available from my employer, but not nearly the same level.
  • Time:  We'll know in an approximately 35 day period (starting early January) if the IVF worked or not.  Substitute "days" with "months", and you're more in line with adoption timelines.  And that time waiting for a child after you've spent 12 months or more trying to get pregnant naturally can be very mentally defeating all over again. 
  • Ability:  If we do get to the point we'd like to adopt, we are actually disqualified from many potential sources, due to divorce history, age, the fact we have my stepdaughter, etc. 
  • Desire:  I'd like to be pregnant.  I'd like to be fat and have stretch marks and puke my guts out for a trimester or more.  That is a miracle that only women can experience, and I'd like to have at least a chance to experience it myself.  We'd also like a biological child.  That is really only natural -- after all, if that desire to procreate wasn't innate in our systems as a human race, we'd have died out years ago.
That being said, I love the concept of adoption.  I always thought I'd like to adopt even without fertility issues.  So who knows where we end up with that?

I think it is important to remember that the IVF vs adoption vs other alternatives decision can be a tricky one, and you can be pretty assured that anyone going through any of it as carefully assessed each choice before committing to a decision. 

Wednesday, December 14, 2011

Dogs vs Babies

I promise I won't post three times a day when I get used to this thing, but this was too much of a gem to not share.

To preface, I love the shit out of my dog.  He's nine years old, and therefore has been with me for slightly less than 1/3 of my life.  My husband has asked me if I love the dog more than him, and I always hesitate slightly.  I mean, of course I don't love the dog more than him.  At least not in the same way.  But the dog is so sweet and cute and NEVER fights with me and always licks my face.  So there is that.

Anyway, I get the dogs are not babies.  But he is my baby.  And let's face it.  The stories that moms tell can always be aligned with a dog story.  But don't listen to me on this one.  This blog post spells it out PERFECTLY.

Some highlights:

How my dog is similar to a human baby:
  • He poops a lot
  • He eats a lot
  • He sleeps most of the day
  • When he was little, he woke me up at all hours of the night
  • He drags his toys out into the middle of the living room and leaves them there
  • He doesn’t like strangers
  • He wants to sleep in our bed
  • He loves to cuddle
  • He loves his mom and dad more than anyone in the world
  • He is endlessly fascinated by laser pointers
Now, more importantly, how are my feelings toward my doggy similar to a parent’s feelings toward a human baby?
  • I worry about leaving him with other people
  • I think about how I could not live with myself if anything happened to him
  • I miss him when I’m away
  • I have recurring nightmares (awake and asleep) about him running into traffic, getting backed over by my car, smooshed by the garage door, and many other mental images too awful to mention
  • And so on and so forth

And in some ways, dogs have the upper hand over babies. Dogs:
  • can scrub the kitchen floor at a really young age, and will faithfully do so FOREVER
  • don’t sass you or call names when they’re mad
  • are always happy to see you
  • don’t turn into mouthy, jackass teenagers having unprotected sex and getting thrown in jail
  • will never wreck your car or throw a house party without permission
  • don’t need college savings accounts
  • don’t need to get dressed in the morning
  • will never take you kicking and screaming to the Shady Pines Nursing Home

Now if you'll excuse me, I need to go have some cuddle time with my baby.

How did we get here?

The funny thing is that I always assumed I'd have problems procreating.  During the times I was actively preventing pregnancy, deep down I would think any of the methods didn't matter.  I would not be getting pregnant anyway.  As I got closer to the point of really actively trying, I then found myself hoping that my prior pessimism was enough to override reality.  Basically, because I assumed that I'd have issues, I'd be "surprised" by how easy it really was.

No such luck.

Although, ironically enough (sidebar:  I always struggle with the appropriate time to call something ironic - it certainly isn't rain on your wedding day.  But I think this counts), it was not ME who gave rise to our current situation.  After all sorts of pokes and prodding, the doctors confirmed that I have no fertility issues.  But it does take two to tango, so unfortunately that "all clear" on my account would not be enough.

To be clear, I married my husband knowing some baggage he was bringing to the relationship.  I love him for him, not to be a vessel for the male factor in babymaking.  I knew it was not going to be a painless experience, and that somewhat helps ease the pain I have today.

Without all the gory details, my husband got a vasectomy in his prior marriage.  He and his then-wife felt that best represented their relationship - a life without the responsibilities, issues, and headaches that children can bring.  Therefore, what better thing to do than a little snip snip?  It is an interesting course of action in your twenties.  I'll never be inside his head enough to fully understand that decision.  Surprisingly enough, it was very early in our relationship that he said he DID want kids.  It took me awhile to believe him; after all, this is a guy who took the decision away from God and in his own hands.  But once I realized this was something we were both committed to fully, it was time to give the possibility of a biological child a chance again.

So he got the reversal about 4 months before we were married.  Part of me again thought the hard part was over --- maybe we'd even end up with a shotgun wedding and I'd be giggling inside knowing that I technically did things out of order.

No such luck.

So here we are.  Staring down the beginning of 2012 and our first cycle of IVF/ICSI.  The reversal itself worked, so it can be considered a success.  But his count, among other things, just isn't enough to get to that egg.  Blame drinking, caffeine, a nasty smoking habit from his twenties.  Blame nature and age.  Blame anything, but facts are facts.  His daughter, now eleven, could have been the happiest of accidents at the time of her birth (and we're certainly happy to have her!). 

So here we are.  I can honestly say I have never been so scared and overwhelmed in my life.  All angles -- is this messing with nature and God's intent?  Can my body even handle it?  Can my mind handle it?  Can our relationship  handle it?  Should we consider adoption first? (that is a whole separate blog post that needs to occur).

I "knew" what to expect by reading blogs and hearing others' experiences, but nothing in the world prepared me for our class in which they laid out the drug protocol.  Where they stressed the time commitment.  When they essentially f'd with my mind in a way that was unfathomable.  This is a ridiculous amount of lemons for anyone to have to be handed.  It is unfortunate that I am not unique by any means, and women are needing this in droves.

So here we are.  In the words that a dear friend of mine has in every other Facebook status (and I love her the more for it) --- let's do this.

Life with lemons

I've been told that I'm very lucky and have an enviable life.  While I certainly am blessed in countless ways, I think that a healthy sense of optimism is what spreads to those around me.  I constantly want to make the best out of a tough situation, and that tenacity does allow me to not just focus on the positive, but to actually BE the positive, FEEL the positive, and eventually the positive is all that remains.

I have a great husband....after a not-so-great divorce.  I have a good job...after a not-so-great mass layoff at the start of my career that made me move to a new town for employment.  I have a wonderful stepdaughter...who also has a wonderful mother who is (and should be) first in her life.  I have a great education and great certifications...after countless hours of studying on Saturdays, working through the week, and essentially missing out on quite a lot of fun.   Sure, I know those ifs, ands, and buts are there, but really it is the former part of each sentence that I focus on; those are the parts that make me ME. 

And I hope the path continues will be the same.  I want to say that I am a great mother to a beautiful child...even after countless injections, hormones, procedures that are enough to drive anyone insane.  Or perhaps after hours of home studies and waiting for an adoption referral.  It's pretty hard to remember all the positive things in life when this large negative cloud hangs overhead.  But that's what I do...because it makes life all that much better and richer.  We (barely) have the financial means to make this happen.  We have a wonderful relationship and partnership, that I believe will be all the stronger throughout this experience.  We have humor and support and family and friends that love us. 

So, anyway, this blog will be a bit of musings on what I consider our current "predicament" -- infertility.  I'll also give the down and dirty, because I know that's what I would want to know.  Not all this feelings crap :)  So, I'll be totally TMI for those of you that want to know the details but felt uncomfortable asking.  But I didn't name this blog after infertility issues...because I hope that we find the positive in this situation - even if it isn't a baby - and I can continue to find recipes for any lemons that God gives us.
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