Posts Tagged ‘Medical Professionals’
I remember after I’d gotten married, how many of us who were over the hurdle of wedding planning would jump into ANY conversation we overheard from other people who were planning their own. We’d found our way through battles of chicken or fish, and we’d managed to find a safe seating chart where our divorced aunts and uncles weren’t forced to sit within each other’s eyeline. We were vets basically, and could solve whatever little issue the newly fianceed would possibly face. (whether they wanted our advice or not)
Infertility feels like it should fit in that vein, but it is not one of those situations for me.
I don’t believe, outside of just continuing to encourage people, that I’ll feel like much of an expert after this. It has moved so fast and so…seamlessly, that it freaks me out a bit. Like I’ve said before, I’m so used to this NOT moving smoothly, that the idea that it has, is uncomfortable for me to say the least. Every phone call, I’ve expected or at least prepared myself for bad or disappointing news. Every visit, I’ve been expecting my blood pressure to be high, or my uterus to have decided suddenly that she’s had enough and would like a divorce. Every time, they say, “Nope, everything looks great!” or they give me instructions for the next step.
I’m constantly wondering why then, if this is all so simple now, was it so horribly NOT simple before. The only answer I can surmise is that it’s simple now, because now is the time.
So Thursday was our egg retrieval. To prepare for that procedure, you have to take what is called an HCG Trigger shot about 36 hours before. So remember when I said I had to take Ganirelix, the medicine that tells your ovaries to tighten their grip on those eggs? Well, the HCG shot is what tells them, “It’s cool now, I got it, go ahead and let em go.”
The problem with the trigger shot? It has to be taken at PRECISELY the time they tell you. And of course, on the day I receive mine, I’m scheduled to work until closing. Because of course.
In a sheer stroke of ingenuity and spinning plates, I found myself asking someone to man my desk at work for ten minutes while I ran out to my car, had my husband drive us around to a side-street off the path and give me a shot from the front seat of the car while I sat in the back. I am absolutely CERTAIN that anyone who just happened to have the misfortune of laying eyes on our ridiculous ordeal believed wholeheartedly that their friendly, neighborhood librarian was on the side of the alley shooting heroine. I’m convinced there are rumors. I’m certain I don’t care.
The next day, nothing really felt much different, and I was convinced that we’d done it wrong and the whole cycle would be cancelled. Because that’s how my brain deals with things not being chaotic. My husband rolled his eyes at me, and proceeded to plan for the retrieval as though I was speaking gibberish. He’s smart like that.
Thursday morning, we flew down the highway to office, and things moved really fast from there. A really nice anesthesiologist gave me some really nice happy juice through an IV, and a really nice nurse came in to talk me through everything that was about to happen. My doctor sat with me for a sec just to explain why the timeline had moved when it did. My body, as predicted, had gotten seriously excited about the meds and was very close to hyperstimulating. For my safety, and to save the cycle, it was best to move now.
The face of someone who could use a nap, and is waiting for the IV to provide one.
So what is involved in egg retrieval?
The procedure involves using a needle to extract the eggs directly from the follicles. Yes, ANOTHER needle. Hence, the need for light anesthesia. You aren’t completely asleep, or at least I wasn’t, but you’re out of it enough to not freak out about that. Overall, I think most of mine was spent yammering on about whatever came to my brain. Nervous tick.
On the way out of the room, and back to recovery, my doc stopped my chair and showed me the lab techs already at work cleaning and counting the eggs. I told her, “You do realize the blogger in me wants to take a picture of this whole situation, right?” She said, “I know,…but no.” LOL
Back in recovery, or just across the hall, I was finally allowed to have something to eat and drink. The most delicious saltine crackers and apple juice I may ever have, to be exact. And then, I was allowed to just chill for a bit and get my bearings while the nurse came in to talk to me about what was going to happen next. Basically, once those eggs are extracted from the follicles, the follicles tend to fill back up with liquid. This is what causes much of the discomfort people feel after retrieval.
While I don’t really make much of a fuss about discomfort or even pain sometimes, I have to admit that it isn’t the most comfortable of feelings to basically have saddlebags inside of your hips filling with fluid. And that’s generally what’s going on in there, I’ve decided. Also, I’d suggest getting your hair done sometime before this. You feel really yucky and hideous, but if you can look in the mirror and say, “Oh, but no, my hair is laid.”, it helps. I promise.
Once the techs have counted and cleaned the eggs, they immediately collect the sperm as well so as to move forward with fertilization. It still amazes me, that people get pregnant unexpectedly, when I look at all of this really intense biological precision.
Anywhoo, our final egg count at the end of the day….TWENTY. The average? Eight.
Come on, overachieving ovaries!
Now, after retrieval, most people are highly uncomfortable. You should really go home and lie down if possible. So of course I instead went to the Goodwill for a few minutes, and then went to look at an apartment that we’re interested in. Because I’m hardheaded.
Fast forward to the next morning.
Do you ever get annoyed at your phone ringing because it isn’t who you’re expecting to call? That was my Friday. It just kept on ringing, and none of the numbers belonged to my doctor OR her office. I told you, I tend to expect the worst, (I’m working on it), so I was curious about whether any had fertilized at all, let alone if anything had gone wrong overnight.
Finally, a little after 2, my phone rang with the right numbers.
Call #1, was the lab, to process payment on that embryo storage fee. They’re serious about that. Thank you to EVERYONE who has bought a shirt from our shop, or attended our fun-raisers. You helped pay them!
But call #2, was finally my doctor, to let me know how things were looking.
In the follow-up call, we talked a bit about just what has been the problem all these years, and it was explained in what I have to say is the best way I’ve ever had it explained. Looking at the full picture now, she was able to see CLEARLY what had been our issues.
Basically, my PCOS and Hypothyroid have been BFF’s for years. Together, they decided that they ain’t have no time for no stupid ovulation. Add to that a pair of blocked tubes and what you have is great eggs, that have been all dressed up with nowhere to go, for decades. Then, on my husband’s side, you have diabetes and a childhood hernia surgery that made breaking through all my barriers basically impossible. IVF was and is the only route to getting around our unique and numerous hurdles. Through ICSI (Intra-cytoplasmic sperm injection), the magicians of the lab were able to further get around the foolishness of our bodies by taking one individual sperm and implanting it directly into one individual egg.
So, what’s the final count?
Of the 20 eggs collected, only about 13 of them were mature. This is fine. Again, remember the average is eight. Of that 13, one presented with an extra set of DNA and was therefore abnormal. Also fine and common. Of those 12 left, NINE fertilized and were growing as of the next day. She said, “everything looks PERFECT. IVF was the only way we were going to get around this stuff and it worked.”
So, those nine are being housed in what is called a MINC Incubator. Now, according to the manufacturer of the incubator’s website, (Yes, I looked it up, because I am a librarian and a thug), the MINC is described as such: “the MINC holds a constant temperature, provides rapid pH recovery and helps the embryo maintain homeostasis to reduce embryonic stress.” All of that to say, this thing is a pretty big deal and the BEST possible place for them to be.
In traditional IVF, this is where my doctor would let us know if she wanted to let them grow for 3 days or 5, and when the transfer would be. However, a TON of research has suggested that a better route is to get to day 3 or 5 and then freeze the embryos. Freezing them, allows for the woman’s body to take a little time to decompress from all those medications and stresses of the stim phase. It will allow for my ovaries to calm down, and my body to get back to pre-meds status. As my nurse described it, “it took two weeks to get up, now you take two weeks to get yourself back down”. After that time has passed, then we’ll move to the transfer. (and then wait another painfully slow two weeks to see if any of this worked).
So we’re giving those little guys a five day, all expenses paid (by the sheer grace of God), vacation in the MINC. On Tuesday, we’ll find out how many of the 9 have continued to grow and will be frozen. Also on Tuesday, we’ll decide a transfer date.
And that, my friends, is how you work around a lazy Stork and get pregnant in 9 petri-dishes…kinda.
Next up…seeing if any of this works.
My mom always says, “You have to have yourself in order, even if nothing is moving forward, because when God finally says “Go”, it’s gonna move SO fast, you have to be ready.” She’s right, you know.
So following my initial appointment, where we found the dreaded polyp, I was scheduled for yet another polypectomy and hysteroscopy. Big whoop.
Cue panic #1
When the nurse called to pre-register me for surgery, he let me know that the hospital where the surgery was scheduled, does not typically accept my insurance, and that I should check in with them again in two days to make sure that I didn’t have a bill. I freaked out EXTENSIVELY (and internally) as I waited the couple days before I could call the office and ask. When I finally got in touch, they assured me that all was covered.
Having had this surgery previously, I was expecting more of the same. But my doctor came to my room to greet us. She hung out with us for a few minutes, explained the procedure and talked with my mom for a good while. She even apologized that I’d had to get up so early to make it to the hospital. She stopped in to see me two more times that day, and walked alongside my bed to the OR, just chatting away.
Have I mentioned how much I love her? I think I have, but I’ll say it again: I LOVE HER.
So, last week, I went into the office for my follow-up. I was prepared for a repeat of the stalled out meeting I had following the last procedure with my previous clinic. You know, the one where they lay out all the things that don’t work, and how much delay we can expect? As hopeful as I’ve been trying to be, I’m also cautious, having been at the starting line more times than I can count, and STILL never taking off.
So imagine my surprise, when my nurse proceeded to move along to baseline testing and ultrasounds. While drawing my blood she said, “So did you get your meds yet?” I didn’t even try to hide my confusion. “I sent in the order for your meds and you should have them by Friday because your protocol will start Saturday.” Here’s some perspective,…this was Thursday morning.
I went into my ultrasound, still reeling from that little bit of info. They were a little wary of my notoriously ridiculous uterine lining, but said it wasn’t a huge issue and that most importantly, I was polyp free! From there, we sat in an injection walk-through and a layout of our drug protocol.
Let me remind you, when I came into the office, I was expecting to just hear about my polypectomy, and find out what was the next thing for us to wait on. At this stage in the game previously, we were again at “hurry up and wait”. We were extremely unprepared for the amount of information that was being hurled at us.
We left the office, called the insurance regarding the meds, and were told to await a call from the pharmacy.
Cue panic #2
When the pharmacy called to confirm the meds order, they ended the phone call by saying, “We’ll call you back with your final bill.” I freaked out. Everything had been going so fast and so well, that here was where the hammer was going to come down. They were going to call me back with an astronomical cost that my t-shirt sales and fundraising events weren’t going to be able to cover.
The pharmacist called back. She said, “We just need a credit card to cover your final balance on your meds. The total is $5.85.”
I asked her to repeat herself. I thought I’d heard $585″.
She laughed and said, “$5.85. Your insurance covered everything except for an antibiotic.” Remember how I was freaking out because my insurance had changed? Turns out, it was for my good.
In 24 hours,…this was in our front hallway:
In 20 minutes, this was in our apartment, along with the giant cooler of follistim cartridges that was also packed in the huge box:
When I talked to my aunt, to fill her in on the meds being PAID FOR and DELIVERED,…she said, and I quote:
“They not playing around. You are.”
She’s right too, you know?
When you get used to being slowed around and pushed back, it can be easy to fall into routine. We have had so many stops and starts. Job changes, insurance changes, new diagnoses, extra issues, dosage changes, and a few mind-calming breaks in between. Every, single, time that I have gotten really excited about this, or even when I put this aside completely, and stepped out on faith for adoption, things have consistently found a way to grind their way down to a standstill.
There have been times where I couldn’t even bear to visit my own site, because it seemed like a glaring reminder of failure and the most excruciatingly slow timeline. People have asked me if I was afraid of getting pregnant, or if I was choosing not to move forward, because they couldn’t comprehend just what was taking so long. Most of these stalls and setbacks were so unbelievable that even explaining them sometimes, made people look at me like,
But as discouraging as it’s been, and as long as it’s taken, and whatever other dramatic culmination I could use right now…
TODAY, is stim day 3.
And we are officially in an IVF cycle.
And regardless of the 1 1/2 inch needle that delivers these meds intramuscularly.
And not getting focused on the money we still have to spend on embryo storage, etc.,
Whatever else happens on this journey, for just getting HERE, to this exact moment of this exact thing,
THANK YOU LORD.
Random question: Do you watch Portlandia? If you don’t, you should. But anyway, more on that later. In Portlandia, a sketch comedy show featuring Fred Armisen and Carrie Brownstein, there is a sketch called “Put a Bird On It”, where they play two enthusiastic local art personalities who expound on the wonders of putting a decorative bird on things. Drab old sweatshirt? Put a bird on it! Hideous wall portrait? Put a bird on it! Everything going downhill? Put a bird on it!
While there are various theories about what the phrase means, I like to think that the idea is that when things are at their worst, sometimes you just have to “put a bird on it”, and change your perspective.
As of this year, my job changed their insurance coverage for the second time in three years. This “little” change, wreaked major havoc on my (already stalled) infertility treatments because it meant that they would no longer be covered at the fertility center I was a part of. So needless to say, I panicked a little. The clinic was listed really highly in my area, but staying there meant basically paying out of pocket.
I started to get a little (a lot) freaked out. The tally of obstacles had mounted considerably. I mean, seriously. I was so discouraged after the last appointment, because everything was out of my control. My doctor basically listed out every obstacle we had and kind of left it at that. I couldn’t see an out, other than just to start fundraising, and hope that by the time I’d done what I could to help us raise the money for medications and embryo storage, etc., that The Spouse would have heard something back from urology. Beyond that, the ball was not seemingly in my court.
Fast forward to this year’s National Infertility Awareness Week. For the past two years, I’ve invited some friends in the industry to visit the library where I work, for a panel discussion on building families. I called in representatives who could discuss IVF, adoption, foster care, etc., for an informal and accessible way for people in my community to get information on building their families.
For the second year in a row, I had a great RE on the panel, whom I’d been introduced to through a mutual friend in the infertility community. Her honest, matter-of-fact, and most of all knowledgeable demeanor, combined with her added experience of having dealt with infertility herself for ten years, made her a great addition. In the few moments before this year’s panel, she asked me how things were going with my own journey, since when last we’d seen each other, I was awaiting a follow-up appointment. I told her how stalled I was, and how flatly my RE had told me just that at our last appointment.
She looked at me squarely and said, “Come see me. Call my cellphone. Because this is ridiculous. You just need to get there. You keep getting up to the starting line but you just can’t seem to get there. Call me. It’s a distance, but we will make it work.”
I have to admit, I was a little thrown. I shook it off to prepare for the panel, but I could NOT stop thinking about it. A few weeks prior, my mom and I had hunted down a list of fertility centers that were available under my new insurance. Many of them had been either really far away, or didn’t have the greatest success rates, and I’d filed the list away and retreated into myself. When I got home on this day however, I went and took a look at at the list a little closer and out of allllllllll the clinics that were no longer covered for me, HERS WAS.
After going through a few annoying hoops to get a shiny new referral, I finally got in to see her. The Spouse and I had quite a drive, but when she walked into the office, as she was returning from another procedure, she said, “How was the drive!? I know this was far for you! We’ll do what we can to make this process fast so that you don’t have to do it too often.”
In that quick, 2 minute interaction, she was my favorite person. Because she SAW us. She didn’t see another patient on the roster, or another chart, but she saw US. People. People who had been dealing with this heart-wrenching condition for YEARS, and even in that, she took the time to also see, even after running from god knows where to get there in time for our appointment, that we were people who had driven a distance to see her.
Sitting in her office, I have to admit I was still a little nervous. When last I’d sat across from an RE with my chart, the doctor had basically told me “this is going to suck. Because you have all this crap interfering with each other that is making this whole thing virtually impossible, but here, go talk to the nurse a bit about what it’s all going to cost you and call me when you get that urology stuff worked out.” I was prepared for more bad news, or just a really extensive time line.
And then she started talking.
Now here’s where things got interesting. Nothing in my chart has changed. All the issues there before are still there. But she put a bird on it. She talked with hope, and positivity, and excitement. She was honest about each issue, but didn’t regard any of them as an issue, but rather something we would get through together. As a team.
By the time we left her office that day, we’d completed bloodwork, HAD AN ULTRASOUND, and had a timeline. A DATE. Something we have never, ever made it to before. Every single time that we get started, we run into a brick wall. Lots of stops and starts that never much amount to anything other than hurt feelings and heartache. But for the first time, we saw a lot of hope on the horizon, and had a doctor who had a lot of hope for us.
So all our issues are still what they are, but we’re putting a bird on em.
Things don’t always go as planned.
Sometimes IVF doesn’t work.
Sometimes there are complications.
But sometimes, just sometimes, you gotta put a bird on it anyway.
Sometimes you gotta give yourself hope.
And sometimes, you need a really great doctor, who LISTENS, to help you get the hope you need.
I was talking to a friend yesterday about the ridiculous changes the both of us have had to endure over the past year or so regarding our infertility. We droned on and on about most of it, but then in a brief moment of clarity, one of us finally went, “This is HARD!”, and the other of us replied with, “RIGHT?!”
It really, truly is hard.
There are no “right” answers.
Life doesn’t stop and give you the opportunity to catch up to yourself.
You can’t call in “infertile and devastated” to work.
It just keeps moving.
What IF infertility wasn’t so hard, though? What IF I didn’t have to fight for every single inch? What IF this had come easy for me like it has for so many others? Who would I be, and what would infertility mean to me?
If this weren’t so hard:
I probably wouldn’t know as much about my body as I do now.
I can admit to being rather flighty about it when I was younger and thought that all bodies were created equal. I track everything about myself now to the point where there is a separate section in my google calendar just for monitoring. I’m my own obsession now.
I would be one of the ones who didn’t get it.
As a teen, I can remember asking my mother why some family members didn’t have children, and my FIRST thought was always that they must not have wanted any. Because if you wanted kids, you had them, right? So to be an adult, with a job and a house, and still no children of your own, you must have decided that kids just weren’t for you, and that you didn’t want to be bothered. The millisecond that this thing gets real for you, all that ignorance falls away like leaves.
I wouldn’t be so aware of how much my community is lacking in reproductive health information.
You really never know what’s missing until you’re looking for it. In my years of haphazard pap smears and birth control pills thrown in my direction, I never even knew there was something else I should have been asking about. All I knew about fibroids was taught through the radio commercials that proclaimed loudly about how there was a “NEW procedure that would only require outpatient surgery and no hysterectomy!”. These commercials usually aired midday on V103, right after an Anita Baker song, and just before Luther Vandross.
I can remember no pamphlet or discussion with any doctor of mine which explained fibroids themselves OR hysterectomies.
I never knew to ask why my periods lasted so long, or what kind of effects my birth control pills could have on my future reproductive health. I did whatever my doctors told me was best. They said hypothyroid, and I stopped at hypothyroid.
Which brings me to my next revelation…
I wouldn’t know how to advocate for myself medically.
I never questioned a doctor in my life prior to fighting for my infertility choices.
I never willingly CHANGED doctors in my life prior to fighting for my infertility choices.
I never brought a pen and pad, or researched before an appointment, prior to fighting for my infertility choices.
I never mapped out my medical choices so extensively.
I never checked my doctor’s “report cards”.
I never got to know the nurses at my doctor’s offices, or even thought much about the office itself after my appointments.
I have conversations. I recognize that while that doctor is in the room with me, they are on MY dime and MY time, and neither of us is leaving until I’M satisfied.
I wouldn’t know how to advocate for and with YOU.
In learning to speak up for myself, or at least get some of this really difficultness off of my chest, I’ve been able to interact and support hundreds of others who found themselves in very similar positions. Together, we’ve cried, yelled, laughed, and pushed through to our own resolutions. Some have gone to become parents, others have decided enough was enough, but each of us have grown just a little more. I owe those friendships to this struggle. As hard as it has been.
I wouldn’t know my own strength.
I have learned a lot about myself in these past years, but some things I’ve always known. I know that when I’m hurting, I tend to shut down and deflect. I know that when I’m afraid, I roll into a ball and try to protect myself. I know that I scare pretty easily, overall, and that my pain threshold is meek.
I have learned that when I’m afraid, I will go anyway, and do whatever is needed.
I have learned that when I’m hurting, I find peace in helping others, and in speaking out.
I have learned that trying to protect myself is secondary for me when others are in danger, or uninformed.
I have learned that while many things scare me, never having tried, is my most frightening thought.
I have learned that when it matters, my pain threshold is far higher than I ever would have imagined.
I have learned that I can be stronger than I ever thought possible, because it’s often all I have left.
I have learned that I DO NOT GIVE UP.
Featured image courtesy of stockimages/FreeDigitalPhotos.net
So finally, after battling insurance requirements to get to the testing phase of my pre-IVF life, it’s time for a saline sonogram to investigate the condition of my uterus itself. The reason a good RE will do this test before moving forward with IVF is to ensure that the home we’re going to place defenseless embryos into, is a good one, with ample parking and whatnot.
So what is a saline-hysterosonogram? Basically, it’s an ultrasound. The doctor inserts saline into your uterus while performing the ultrasound, so that the saline will coat the area and provide a clear image of the shape and lining.
Now, silly me, because I’d had a d&c and hysteroscopy a year ago, which pretty much cleared my uterus out completely, I thought this would be a minor procedure just to get out of the way. I mean, I just had my uterine reset button pressed, what bad elements could have moved into the neighborhood in such a short time?
Well, apparently, a polyp.
Wait, what? Seriously?
Because if I haven’t learned in this infertility battle, I’ve learned that NOTHING on this journey can be simple for me. NOTHING.
So as we’re all looking at the ultrasound monitor, I can see there’s one small portion that won’t allow the saline to spread. And THAT little, pebble sized dent, is what my doctor said was a polyp. In fact, she and the technician went back and forth about whether it looked like a polyp or a fibroid, but I just shook my head and faded out for a minute, because fibroid or polyp, to me, it was a roadblock. One more thing I’d have to get around. Great.
The next step would be yet another d&c and hysteroscopy.
So we sat down with our nurse after my sonogram to get some directions about where we were going next. As the doctor had already said, my first trip would be back to my regular ob/gyn to schedule the hysteroscopy. I was hesitant to ask, because I didn’t want to seem as time-obsessed as I actually am, but before she continued, I asked her how long after that would I be back in business. Thankfully, she said two weeks is the recovery time, and that the IVF consultation meeting I’d have to do next would line up with that. In the meantime, all our bloodwork was back and fine, with the exception of my thyroid because its a jerky mc jerkface, and it was time for me to restart Metformin.
So a couple days later, it was back to the gynecologist I went. True to form, this too could not be without dramatics.
So let’s see, the appointment was at 10:30, and there was no traffic getting to the office, but when I got ONE block away, traffic was stopped. 10:50. Finally got around the traffic debacle and parked, the office had moved, and I went to the wrong building first. 10:55. I get into the office, get signed in, and of course my insurance has changed so I have to call to make sure I’m even able to see my doctor at all. After arguing with the automated system for 25 minutes, I finally talked to a person who finally found the doctor in network. 11:30. And I STILL didn’t see the doctor until 12.
It’s a blessing to have a doctor who knows you, or at least knows enough about you and your journey to be fully on board. I have that blessing. Every visit, she asks me how YOU Eggshells are doing, and speaks to how great it is that I blog about this. We chatted for a while about how many patients she gets who don’t consider their fertility until it’s just about too late, and the number of those patients that happen to be African American.
Listening and talking to her reminded me that beyond my frustrations about having to stop and go so much, there are so many other women who haven’t even started. More even than that, I think about the ones who probably never will, out of fear or procrastination. So I took that as encouragement to push through this roadblock. I could look at the polyp as a pebble in my way, or an opportunity to exercise a mustard seed of faith.
I chose the mustard seed.
I scheduled the hysteroscopy surgery and told myself not to complain. I’d taken the time to take a step that was necessary to reach my goal. If for no other reason, that was enough to feel a little satisfaction. I then took that high and used it to walk myself over to the other medical building and leave word for my other doctor regarding my thyroid needs. Hell, I was already on a roll, may as well take it all the way, right? With every little step, I was reclaiming just a sliver of my control, and it felt good.
Once again, I felt like an infertility gangster. LOL I pulled off feeling ten times better than I had when I got there, and blasting my motivation playlist.
I hope you’re learning to take your small victories, too! They add up.
Mustard Seed image courtesy of olivcris/ Flickr.com
Apologies for the delay, but even a year later, this post seems to be RIGHT on time.
The final installment of BrokenBrownBelle’s journey to her daughter, Buttercup. (more…)