Meds are here!

meds You know how you’re kinda excited each time you get a package in the mail? That’s kinda how I felt about my meds delivery. Well, also paranoid that we would miss it/the ice would wear off/the delivery guy would break something. But mostly weirdly excited. I think its just that all my wishing that I wasn’t on this path doesn’t change the fact that this is my path. Given that, I might as well get moving and start the journey.

In the meantime, I’ve been trying to familiarize myself with the process, watch the injection videos, and generally get myself into a decent state of mind.

The injections themselves don’t scare me (well, not the subcutaneous ones at least). The side effects worry me a bit. Overstimulation – well, that’s the doctor’s responsibility to control for that so I’m not thinking about it. Nausea, tiredness, whatnot — all par for course with any meds. But bloating, constipation — not what I would have thought of (thank you ladies of the blogosphere for giving me a heads up). It’s not that I’m scared of those; just that I’m not sure how to handle them. Does heat help? Mint tea? Walking more? Walking less? Eating.. fiber? Any tips?

The thought of egg retrieval freaks me out. There are too many variables for my type A brain to be comfortable with — the lack of control, the long needles in rather sensitive parts, the logistics. Mostly I’ve been trying to talk myself into a frame of mind where I let go — the doctor/clinic is good; they’ve done this tons of times; and IVF isn’t that rare a procedure.

After that — actually I’m not too worried about things after that. The growing embryo(s)  have nothing for me to do other than cheer them on. The transfer itself seems easy. And then it’s PIO shots for a while but I figure I’ll be used to shots by then. And progesterone kinda sucks but I’ve dealt with it before.

When it comes down to it, its really only like 2 shitty weeks and then 2 waiting weeks and .. done.

Oddly enough, I find that I’m not that worried about outcomes. At this point, I can’t change anything I’m doing to affect that so… it’s on someone else. The doctor? The clinic? My body? Luck? God, maybe. But not really on me and that gives me some comfort.

Also w00t! it was all covered by insurance. I was kinda terrified we’d owe thousands but in the end, it was around $500. Admittedly they did some brand/generic substitution to get there but whatever. So yay for that! (That bit of news was probably the thing that made me happiest in a while).

First days

It’s been kinda strange leaving my grad school life behind. I’m still so weirded out by the PhD following my name (for reasons unbeknownst to me, my new lab insists on email signatures).

And I realize that I have a raging case of imposter syndrome. For instance, my PI or other collaborators will be all “this is something we think you’ll be able to add a lot of value to” and mentally I just go “umm… yeah… I have no idea if I’ll be any use for that” Still, I’m trying to not let these feelings hold me back.

One change I have noticed in myself — I’m speaking up more! I’m typically one of those people who only really expresses an opinion/question/comment when directly asked or in a one-on-one. But somehow, surprisingly, here, I’m finding my voice. Without constantly feeling a pit in the middle of my stomach about talking! Part of it, I’m sure, is that because I’m so new, I’m still allowed to ask stupid questions. Part of it could be that since I’m in a different field, I feel more confident about the stuff that’s mine. And part could be that I have less riding on this job (compared to grad school). After all, worst case, I leave and find another job. There’s no sunk cost. And I think all the fertility stuff has a role in that too — work isn’t my whole identity the way it was several years ago which helps.

Anyways, who knows if this strange new oddly confident (and yet not) me will last. 🙂

Next steps

RE meeting actually went well. I wouldn’t say I’m perfectly calm about all this but I have a better measure of the process and what to expect and actually feel a bit better about everything. One freeing realization is that I actually don’t have many decisions at this stage. Another is realizing that it really isn’t that long a process. Because I was on birth control, it’s really just a 4 week cycle. So it’s 2 weeks of icky shots, 1 shitty day of the egg retrieval, a couple of recovery days and then it’s pretty easy. Ok, so I’d still have the PIO shots but I feel like at that point, what’s one more injection. And the transfer itself feels like it’ll be a trivial process.

So where are we – well, tubes are out, ovaries are enh but so far, nothing wrong (that we know of) with the uterus or eggs (and really praying it stays that way). One possibility for the tubes being wonky that I have an undiagnosed case of endometriosis but honestly, the solution for that anyways is IVF so on some level, I don’t care.

Also, hah, I think I have a reputation as person who asks a lot. I printed out all our questions, sorted by topic with one topic per page so there was space for the answers. RE saw page 1 and was like “oh, I’m surprised that’s all you have to ask.”

To my consternation, we’re waiting a few weeks to start. Too many new things and as much as I want to start NOW, the doctor wants to wait for a less stressful time (post-starting new job and post-move) so we’ll start at the end of August. It’s a little frustrating but on the other hand, I don’t want to waste a cycle just because I’m stressed. On the plus side, this give a little time to work out the logistics and the financials. And a few more weeks to enjoy coffee and wine. 🙂

Financials – it’s mostly covered. Medical stuff is fully covered and I think with this, we’ll hit our out of pocket max and be done with that. Prescriptions are.. sorta? I haven’t been able to get a read on how much we’ll owe but presumably not a huge amount since technically, IVF is covered? Sperm freezing isn’t (to be used as a backup). That kinda makes sense. Embryo freezing isn’t either (which makes no sense – after all, it cuts down on their costs if I use frozen embryos rather than restart a whole cycle).

The financials are worrying me primarily because we had a bunch of hits this month between car expenses/new car, additional fees for the HSG, moving, etc. Plus, I’m not getting paid for the month. But hopefully these will even off after August. Sometimes, I really feel the hit of both hubby and myself being in academia.

Too much time to think

So much for a vacation – now I’m waiting for work to start if only so it’ll provide a distraction and different things to worry about.

I had a dream yesterday about IVF in which we retrieved 16 eggs (and 7 fertilized). Thank god it wasn’t a nightmare. Mostly it was about me running around trying to find a phone to call back the doctor’s office to find out results.

We’re doing our best to prep and go in with our eyes wide open. Hubby and I spent our Sunday watching these IVF training videos (which actually was only partially helpful. I do not need more information about the risks.) Still, it did give a good sense of the stages involved. And at least felt like the shots themselves were the easier part of the process.

I really need more going on in my life. I originally thought, ‘oh, lets wait till I’ve been at the job a couple of months so things are more stable.’ Now I just want to get it over with. And yes, I’m clearly still operating under the naive impressions that once will be enough. But I figure at least it’ll get me through the first time and after that, the process itself won’t be a surprise to me.

More things not to say to someone struggling with infertility (even if you don’t know)

  • “Don’t wait too long to have kids” : Oddly, this isn’t an unusual one for me. People seem to assume that I prioritize career over family. It’s sometimes useful to go with that assumption, especially when I’m asked:
  • “When are you planning to have kids?” : One of these days, I’m going respond with a rant about the state of my insides. And I know plenty of information that makes the average person squirm.
  • “Do you have kids?” : This one’s a new one and unexpectedly painful. The context was that I was at a friend’s kid’s bday party. And yes, there were lots of kids running around. But surely if one of those were mine, I would have introduced him/her? And can’t I attend a birthday party without having a kid? Is that somehow a prerequisite?
  • Inviting a baby-ed couple to their kid’s bday party. And not me. Right in front of me. : Yes, this actually happened. And couples A and B had pretty much just met.

As I’ve crossed 30, increasingly, it feels like the mommies have some exclusive club. And because you don’t have a kid, you can’t possibly know how hard it is to be a parent. And you can’t possibly understand problems that arise or how to trouble shoot those. I actually like hearing about their kids and how they’re doing. These are my friends, of course I want to know what’s going on in their lives. But not at the exclusion of all else. And, please, return that friendship and do me the courtesy of asking “Are you doing ok?” or “I’m sorry you have to go through this.”

Definitely with certain friends, it’s felt like I’m now less worthy to be a friend. For now, I’ve ghosted but honestly, I think one of these days, I’m going to break and end up saying something like “F*** you. You have no idea what I’ve been through.”

Pulling myself together

I have a meeting with my RE next week to figure out the plan of action from here. Well, clearly it’s IVF now but we’ll have to work out timelines/protocols.  While a lot of me wants to know why my tubes have issues, I realize that on some level, it doesn’t really matter. My main concern is whether I have something like undiagnosed endometriosis or something else that could affect implantation. Does this change expected success rates? I would think not since IVF anyways bypasses anything tube related but who knows.

I realized yesterday that I don’t actually like our RE that much. I trust his judgement but I’m feeling talked over. Like when I bring up a concern I get a lot of very friendly, very polite “oh don’t worry about it, its not a big deal.” But it is a big deal for me. None of it is major but just lots of little things are increasingly making me feel like we’re not communicating on the same plane. Bear in mind my ideal doctor is one who sits and explains the hows and whys of the process gives me the primary source literature to  read. For instance, I was trying to gauge just how hard is IVF on my body/emotions/etc. His attitude was ‘oh don’t worry, its not a big deal.’ Compare this to my OBGYN (who i love!) who’s been through ivf herself – her response was “sigh, well, its not fun, you just have to power through it. But when it works out, it’s all worth it in the end.” Fair enough.

Or yesterday, after I was in shock after finding out that basically my tubes are garbage, I was still processing a little information. I was trying to ask, well, if tubes are out, how do you access the eggs? He kept saying ‘through the vagina’. Well, in my mind that means you have to thread through the uterus, through the (blocked) tubes. The nurse understood exactly what I was asking (for the record, the eggs are accessed via a needle that goes straight from the vagina to the outside of the ovaries where the eggs are. No incision, just a needle prick). Doctor meanwhile thought I was an idiot. I might not have the medical knowledge but I am smart. You just have to give me the information.

I’m not sure whether it makes sense to switch – mostly I just want to grit my teeth and get through the next several months. And there’s no guarantee that there wouldn’t be other issues with someone else. Plus, I like the nurses, general staff and functioning of the clinic.

Oh and in general, what I found – nurses are amazing. Doctors do their stuff but when it comes to being taken care of, I’ll take a nurse. They listen and make sure that I’m not in pain or anything. After the procedure when I was quietly sobbing on the side, they made sure I was warm and comfortable and got me water and everything.

On a different note, before the HSG, I made sure my legs were waxed and things down there were generally.. tidy. I’m actually really thankful for that. Unlike every other test/procedure where I’d at least sorta covered/draped, I was all out in the open in this one. Of all things to be defensive about, I don’t want to be defensive about the state of my body hair. I’m also thankful that since I started doing more regular.. maintenance last year, I’m at least sorta used to people looking at random parts of me. Small stupid thing maybe but it’s something that’s making more just a tad more comfortable with being poked around and looked at under bright lights.

HSG

is negative. Or positive depending on how it’s counted. Both tubes are blocked (the non-ectopic one worse than the ectopic one).

Somehow I didn’t really think that there was an issue with the tubes. Saline ultrasound was fine. It’s not I’ve ever had something that was a risk factor. The worst part of the test was actually the speculum. Everything after was fine. Cramping’s not bad either.

Today is my mourning day. Yet another way that my body has failed me. And I’m pretty sure this means that I can never have children without intervention (I was hopeful that after kid #1, PCOS issues would resolve itself). At this point, my ovaries don’t work. Nor do my tubes. What guarantee do I have that my uterus would work? The ovaries are fixable with meds. The tubes can be bypassed with IVF. But the uterus .. as far as I know it needs to function properly.

So where am I now? Well, at least this shitty news simplifies decision making. IVF is the only way forward. We have a meeting with the RE next week where we’ll work out the how’s and when’s. And.. I’ll brace myself for the next couple of months.

 

Baby Gifts

I find the act of gift giving for a new baby bittersweet. On one hand, I truly am happy for the friends and hope everyone will be healthy and happy. On the other hand, well, there’s always a persistent thought of ‘when will it be my turn?’

For a long time now, I’ve tried to knit things for expecting friends. The earlier ones used to just be full of joy and excitement. The latter ones are more bittersweet. Some I never get around to knitting because it’s too painful to handle. Some I wait a long while until I can knit with (mostly) love and not envy. I’d like to think I’m infusing the gift with some of that love and child would feel the affection of his or her entire community. Or maybe I’m just being overly fanciful.

 

The little things

One thing I’m learning about grief/disappointment/frustration is that often, it’s the little things that remind you of the losses and the could-have-been’s.

I started packing for moving next month. There’s plenty of time still but I like having things sorted and planned and organized. And in that sorting came across various sentimental items. Among which was a onesie.

When we finally got the positive pregnancy test, I told one of my best friends. She’s one of the people in my life ‘in the know’ so she was overjoyed for us. That was the first (and only) gift we received for the baby. Yes, it was super early but it was such a sweet gesture on her part, especially since she knew that we had been trying for years. When I found out about the ectopic, I told my mom to hide it someplace where we wouldn’t see it. I found it today. I’m not actually sure what to do with it. The practical part of me wants to keep it for our future baby(s). The sentimental part wants to keep it with my other sentimental items as a memory of this baby. The still-hurt part of me wants to add it to the donation pile so I never have to see it again.

I would have been a little over 20 weeks by now. Wow. Halfway through.

A decade from now, I hope all this will just be a memory of a really shitty year. Certainly others have been through worse. If this is my lowest point in life, then frankly, I’ve had a good life.

Rants and Ramblings

I had a month off before starting postdoc. The plan was to leisurely get some work done, submit a paper, and slowly start prepping for it. What ended up happening was a whole hodge podge of stuff.

My big rant of the last month — I hate incompetent people. Ok so here’s a list of things that were/are on my plate:

  • Car (resolved): The short version of the story is we got rear ended, insurance made us drive out over an hour to inspect the car and then refused to repair an old car, cut us a low ball check instead for the cost of the car, decided to buy a new used car, ran around researching/looking, bought a car, took out my first loan in my life (and trying to stave off panic attacks from the thought of the loan. But the loan leads us to the next thing…
  • Credit (ahh!!): So our credit rating was low. Specifically, my husband’s. Why? Well, as much as we could trace/remember/work out the story: He thought he hadn’t applied for a credit card but he did (well, more like he started the application and then ditched it but it somehow went through?). Never received the card, never activated it and never used it. Two years later (this is like 3 years ago), somehow got a mail about an annual fee payment due, worked out what had happened, called the company, canceled the card and was told that they’d take care of the fee (since you know, we never even saw the card). Fast forward to current day, surprise!, they didn’t take care of it. So apparently they dinged his credit rating for non payment. I mean note that in the intervening years, we’ve received no notice about this. Inspite of them having all the ways to contact us. 3 phone calls, 1 in person meeting and about 5 hrs later, its still not resolved. Also got called liars, delusional and irresponsible (for not checking our credit rating every month). At the end of the day, it’s a relatively small amount but man oh man, am I pissed that (a) they didn’t take care of it as they said they would and (b) they are so incredibly rude. 10 years of being a customer and I don’t even rate polite-ness
  • Apartment hunting (done): Found; lease to be signed this week. Compared to the other things, this was rather painless.
  • HSG (also ahh!): Scheduled for this week. Got a call from the center saying that I’m on the hook for the money for it. 4 calls to the insurance company, 2 calls to the center’s billing office and 10 emails to my nurse later, this is where I am: the procedure is covered by the insurance. My doctor is in network. The surgery center is in network. The procedure doesn’t need any clearance or pre-authorization. But because of some PPO discount, the surgery center doesn’t get paid by the insurance. So they refuse to do the procedure without my self-paying for the facility fee. Which is $1200 (so not chump change). I’m not even sure who I’m pissed off at. First off, I had to wait an extra 3 weeks for this procedure because of the center’s scheduling. Secondly, they tell me now, three days before it’s being scheduled. Thirdly, my doctor has used them before – why is this an issue that’s only been flagged now with me? Fourthly, if this type of thing is an issue, why wasn’t I given a choice about which center to use? Oh and let’s not forget how everyone treats me like an idiot on these calls. Oh and not to mention, it’s an actual procedure that I’m kinda of worried about. Why is all the onus on the patients?? [EDIT: So this type of thing is standard? If shitty? https://www.publicintegrity.org/2012/12/20/11978/hospital-facility-fees-boosting-medical-bills-and-not-just-hospital-care%5D

Mostly, I’m tired of being on the hook, financially and time-wise, for other people’s mistakes or lack of clarity. Or systemic issues. Hah, and politicians think that free market is what will solve health care. Hah! First off, for a free market to function, certain conditions need to be met:

  • Perfect competition: Yeah, medical doctors/clinics aren’t interchangeable unlike say, toilet paper.

  • Perfect information: Umm, there’s such a ridiculous opacity in information on the part of the consumer. And to be fair to the industry, on the part of most of the components of the health care system. Clearly my doctor/nurse doesn’t know what are the costs to the patient of different things. The billing department has only parts of the puzzle. The insurance company knows either only the member side or the provider side (this one sounds dumb to me)

  • Perfect mobility of resources: This one should be obvious.

  • No externalities: Ofc there are externalities! Duh. Poor health in communities leads to other issues. Other issues lead to poor health.

  • And so on…

All this is from an intro econ class too. Anyways, I didn’t mean to get political. Just frustrated at an opaque system with invisible moving parts that I end up getting charged for. In spite of coloring within the lines, I’m finding that the lines are constantly being redrawn and then I’m penalized for going outside those. And then being treated like an idiot when I don’t see then.