Thursday, 30 May 2013

Another trip around the sun...

Recently, my time on this planet observed that I have completed another trip around the sun. I'm actually not too bothered about adding another year while still being barren. Although, I probably should be concerned as I am now 37; the age when oocyte quality and quantity starts to rapidly decline. While hardly stellar, my ovaries have been described as "age appropriate". My cheeky second opinion REI consult thought my AMH of 4.54 represented a strong reserve. My grandmother had my father one week before her 45th birthday, (in 1946 -I can only wonder what it was like for her to be pregnant at that age during that time) so I hope I inherited the legacy of her ovarian longevity.

I find this birthday to be annoying as I just don't like the number 37. I have a quirky appreciation for numbers. I like palindromes and patterns. I prefer even numbers. 36 was really cool, as it is a square number. 37 is a prime number. Prime numbers strike me as being losers in the number world. Only one whole divisor -the number one, which is such a slut and goes into every number, as well as themselves. Johnny-no-mates. When Husband was booking the venue for our wedding, he had a choice between 23 September 2006 (23-9-06) or 30 September 2006 (30-9-06). I was hoping that he would know me well enough to identify that I would prefer 30-9-06 (all multiples of '3'). To my initial displeasure, he chose the 23rd, but in a way having a prime number wedding date seemed fitting for a marriage of two only children. Additionally, it was a beautiful sunny day on the 23rd and it rained heavily on the 30th. Maybe it's also fitting that the conception or birth for the only child to be spawned from two only children should be in a prime number year.

I've referenced the brilliant HBO program Girls in previous posts; but IRL, I have  discussed that you need to have been a 25 year old girl to truly appreciate the show. The way Lena Dunham is able to gain this perspective of her current generation is what I feel defines her genius. After watching a half hour review of the common mistakes one makes in her twenties; working at an unpaid internship for too long, wanting to fall in love with the one who took your virginity, or labeling a friend with benefits as a boyfriend, I acknowledge the wisdom that comes with age. There is a sense of peace that is achieved with establishing your career, settling down with your life partner or finding other ways to distinguish yourself. Professionally, I find that I am not having to verify my work experience as often; the affects of time seems to accomplish that.

While there is value to the process of aging, it is still disheartening to feel that you are growing older. I would participate in various forums and discussion groups and as the youngest contributor, I was viewed as one who was 'up and coming'. Now as I am no longer the youngest on a panel, it's perceived that my time has come or past. Our practice has hired four newly graduated physicians who are all younger than me. Recently, I spoke with one of our new primary care providers about submitting an REI referral for an HMO patient who was planning to become a single mother. "Sure" she replied, and then added "I'm considering doing that when I get older, like when I'm 32." Sigh. As soon as I suspected that my cat had diabetes, I was willing to see 'the new vet' who had the soonest available appointment. She introduced herself by her first and last name and wore a jeweled hairband. When I returned her call regarding A's diagnosis, she answered the phone with "hey!" I realised that not only was she much younger than me, she is probably still in her twenties.

There was one more harsh reality that I would discover. Based on his looks, I estimated my RE to be in his late 30s or early 40s. The other day while I was waiting in his office, I took note of the dates on his diplomas. Presuming that he didn't take any time off during his schooling, (which is likely for most Ivy League types) he is two years younger than me. This marks the first time I've actually been under the care of a provider who is younger than me. What was even more distressing -he graduated the same month I started working at a hospital that trained students from his medical school. He just missed being one of my students, and would have attended my two part lecture on contraception -of all ironies.

Monday, 27 May 2013

Accentuate the Positive

They say you shouldn't do certain things in a particular frame of mind. Don't confront your boss when you're angry. Don't grocery shop when you're hungry. Don't phone your ex-boyfriend when you're drunk. Don't clean your closet after a BFN. I'll explain...

Husband responds really promptly to postcard reminders that we receive in the mail. If a card arrives informing us that we're due for an oil change, vet appointment or dental cleaning, he calls up immediately to schedule the visit. I've thought about sending him some postcards with notices like "put away your clean laundry" or "wash up your breakfast dishes", but I am digressing. We received a flyer offering a 15% discount on carpet cleaning if we booked within the next three weeks. Husband called as soon as he read the card and arranged for service the next day.

I came home from work and found that he had moved furniture and most items out of the three bedrooms in our house. In addition to cleaning the heavily soiled carpets, it was also a good opportunity to do a spring clear out. We are fortunate that in our area, local charities will collect your used clothes and small furniture if you leave it out on your curb. I decided that I would donate any clothing item that I haven't worn in the past year, and quickly had three bags full of used clothes.

Then I came across my 'hope chest' items. When the first of our local friends started to procreate, I purchased a few cute onesies and some stuffed animals while I was shopping for their shower gifts. I had collected some pregnancy related magazines from our waiting room. Also haunting from the ghosts of my five minute pregnancy; books on running and exercising during pregnancy. In a fleeting moment, I gathered all these items and threw them in the trash bags. I figured I could always go shopping again if the occasion was ever needed and maybe it was better to get rid of any bad karma these items could be bringing. Then a few days later I came across this:

About 4 or 5 years ago, in my pre-maternal instinct days, my mother came for a visit and she wasted no time trying to convince me to spawn her grandchild at every opportunity she had. We were shopping in town, when we walked past a Jack and Janie store and saw this sweater in the window. She started fawning over it, "Ohhhh! This is just so precious! Can't you imagine in on your baby?" she gushed. I replied, "Yes, it will look adorable when it's covered in puke." in my most sarcastic tone. "Oh, Jane." she sighed in exasperation. 

A few weeks later, after my mother's visit, I walked past the Jack and Janie story and noted that they had changed their display in the front window. I wondered if they still had that sweater. I went inside and found it on the sale rack. Maybe there was some life in my ovaries at that moment, as I decided to purchase it. Yes, I lied when the sales lady asked if it were a gift for someone. I figured it would provide me with a reminder that I had to look past the negative aspects of parenting and try to see the positive experiences. 

I couldn't part with the sweater (firstly because it is so adorable, even covered in puke) but also, because the original purpose was to help me accentuate the positive and eliminate the negative. Two failed IUI cycles is discouraging, but I still have reasons to be hopeful. Taking the message of positive thinking to heart, I rescued all my hope chest items from the bags set for Goodwill and hid them in a box in the back of my closet. Besides, I had previously set an arbitrary deadline that if Myrtle became pregnant with her second before I had a baby, I would give those items to her. At least I could keep them in the family.

Friday, 24 May 2013

The English Diplomat

When we last left our heroes... IUI#2 resulted in a BFN, so Jane emailed her RE's office to determine if the logistics surrounding the upcoming Memorial Day weekend would permit her to proceed with another IUI attempt. Meanwhile, there was a looming threat to the potential procreation of their baby as her claims had not been paid by her insurance company and they could have been stopped from any further IUI procedures...

Hours later I received a response from the office manager informing me that I needed to speak with the billing coordinator before I could proceed. My chart had been flagged and was successfully cock blocked. I sent a reply indicating that I had addressed my balance with her when I discovered that all my charges needed to be re-submitted to my insurance. Also, I was inquiring as to whether or not the cycle would be feasible before pressing the issue of my balance.

This was the awkward situation that I was hoping would have been avoided if the prior IUI had been successful or if my insurance quickly paid the outstanding claims. I wanted to make my case, but felt that I needed to tread lightly. I was struggling to find the words that would tactfully present my argument. 'It's just not fair!' resonated on my mind, but I didn't want to come across as a petulant child. I find it hard to accept that we are being penalised for something beyond our control. As I know we are ultimately responsible for payment, I began to wonder if I should be been more proactive. To be honest, when I get my explanation of benefits I just look for the note of "patient responsibility" and don't pay too much attention to the dates of service. I hadn't received any bills from my RE's office and we were only alerted of this situation two weeks ago. Is it possible to grant us a courtesy...

I put my pen down and tore up the scrap paper I was jotting on. I may be a good wordsmith, but it dawned on me that I was overlooking one of the greatest assets I had at my disposal.  A naturally charismatic husband with a dashing English accent. This was a job for the Geico Gecko himself. It was now 4 PM and my spotting had started, I needed this to be resolved ASAP. I texted Husband that I still had a few patients to see and asked if he would call the billing woman. I received a one letter reply, -K. He knew his assignment: this was a charm offensive mission. Ten minutes later I received this text message: Sorted. We pay half, you have an appointment tomorrow at 9:30.

He recounted the details of his negoiation when I arrived home much later that night. The billing woman resubmitted the claims and had confirmation that they were received by my insurance company, but it would take about 30 days to process. Naturally, she was most concerned about the $2000 surgeon fee from my hysteroscopy and the recent IUI charges and less so about some earlier office visits. Due to the amount of the balance, she wouldn't budge and could not permit us to proceed without payment. Husband asked if we could pay the outstanding charges now and receive a credit once the insurance payment came through. This was her response, "Oh, that's a great idea! Why didn't I think to suggest that?" Seriously! You're in accounts receivable and didn't think about having someone pay their bill! (okay, I'll shut up now) Then she offered that she would be comfortable if we just paid half. I was reluctant to use this word earlier, but I felt that was completely fair. We had a deal.

I recently wrote in my post Present and Accounted for that I wondered if our partners sometimes feel like they're bystanders in this process. I felt reminded of just how much they are invested with us. Husband often comments, "you have to go through so much (physically)". While true, it certainly is easier having him by my side. It is hard to express my gratitude for all the support he's given me, and when called upon, he stepped up and took one for the team. He may not have to go through any invasive procedures, but he does his part by managing the financial matters of this venture, as well as being a rock of unwavering emotional support for me. I'm so glad he came to terms with male factor infertility and divorced the notion that sperm are a reflection of masculinity. Honestly, it's probably the least defining factor in a man. I wouldn't want to procreate with anyone else.

It had a been a really good day for Husband as he received his assignments for umpiring field hockey games in the fall collegiate season, and he was thrilled to have been awarded several games with nationally ranked teams and one or two may be televised (on the PAC-10 network or ESPN 5). I asked him, "Shall I be in the crowd holding a sign that reads 'I'm doing the Umpire'?" "No," he paused. "It should say, 'I'm I-U-I-ing with the Umpire'."

I just can't express enough gratitute for the role our partners play. Especially when it's just finding a way to make you laugh.

Wednesday, 22 May 2013

2013 Challenge Update #2

"What are you doing for the rest of the weekend?" the medical assistant attempted to make small talk during while my RE was prepping the ultrasound probe during a previous monitoring appointment. "Painting and running" I replied, trying to be as brief as possible. "What medium?" he asked, pausing mid-roll. As someone who can't draw a straight line with a ruler, I laughed a little to myself at the thought that I could be painting creatively. Since technically, he is a participant in the game, I decided to tell him about about the 2013 Challenge -our quest to see if I could become pregnant before finishing painting the cabinets and trim in our kitchen. "Well, most likely it will be getting pregnant." he said confidently, but then inquired about the details with our project to assess what we were up against. At that point in time, I had six doors in process, nine more to go, plus a rack for the window garden and we haven't even picked out the materials for the trim. "Well, maybe you can get up early in the morning to do some work..." he suggested. Those words sounded eerily familiar, as if it's not already annoying that he and Husband have the same first name. "You sound like my husband" I replied with a slight snap to my tone. I think he realised that he struck a nerve, and apologised immediately. Meanwhile, I was wondering why he was encouraging me to finish my kitchen project quicker, as it gave more latitude toward his involvement if I took my time.

Well, in the duration of an IUI cycle, I finished a batch of doors. As some may recall from my prior Update, Husband placed the handle on the wrong side of one. The repair is pictured above and below is the progression of our renovation:

After our last IUI, I felt that I had reason to be optimistic. Not only because our numbers looked good, but that morning just felt like we had the wind at our backs. It was as if you were driving through town and every traffic light is green. I had a great set during my morning swim, my patients were straight forward and I got out of the office in time. Best detail of all, I didn't have to go back until the afternoon, so Husband and I enjoyed a post IUI-coital lunch together. It was a beautiful sunny and warm day. Almost too ideal.

It was the night before test day. Husband and I shared nervous looks with each other as we acknowledged that we were less than eight hours away from learning if we were successful. I woke up at 3:30 in the morning and couldn't fall back to sleep. Around 4 AM, I was still awake and I noticed that Husband was also up. Apparently, he couldn't sleep either. It was time to just face the music. I got up and did my test. This time I waited in the bathroom, I figured you can never floss enough and went to work until my gums bled. I kept checking the stick, but the blue line failed to appear.

I climbed back into bed. "I'm sorry," Husband whispered to me. "I'm sorry, too" I replied. This time the disappointment was palpable. Our prior cycle was such a long shot that the BFN seemed procedural. We both believed we had a chance this time around. I can only imagine how discouraged he must be feeling. I know he carries a sense of pressure on himself to come up with a good count and I'm sure we were both doubting our prospects if we couldn't succeed with our best numbers to date. I wondered if it were possible that we could both have our best performance in the same cycle again. My cat's animal instinct sensed our grief and he jumped up on the bed and snuggled next to me.

I was planning on swimming that morning, initially thinking it would be the best place to metaphorically drown my sorrows after a BFN. However I had a long day ahead of myself and really needed more rest. I decided that if I feel asleep before my alarm went off at 5:15, I would skip my swim in lieu of another hour of shuteye. I slipped into a rather deep slumber and actually slept through my alarm. When I woke, I wondered if it had been a dream. Maybe I didn't POAS yet and there was still an opportunity. Unfortunately, I had left the test on my bathroom counter. I'm not sure who started the urban myth that a pregnancy test can look positive after it dries. After ninety minutes, there was still only one line. I recalled that I once had a patient who told me she heard that you can get a positive pregnancy test if you put it in the microwave. I replied that you have to interpret your unadulterated pregnancy test. Fixing a test to make it look positive, won't actually make you pregnant. A few staffers in the clinic were tempted to try it, but decided against cooking urine soaked sticks in the same place where we reheat our lunch.

I threw the test away and sent an email off to my RE's office inquiring about starting our next cycle. We may have lost this round, but I still like our chances the longer we stay in the game.

Monday, 20 May 2013

The Elephant in the Room

While the seaweed may seem greener in a fertile's lake, everyone's life has static. Myrtle's husband worked for a large retail company. Sort of like Chandler from Friends, no one was really sure what his job exactly entailed. I got the impression that it was a niche position, created many years ago to serve a specific purpose, but now had run out it's utility and his employers didn't know quite how to use him, which led to his dissatisfaction. Myrtle started encouraging him to look for a new job shortly after her positive pregnancy test, but he didn't pursue anything. By Thanksgiving he decided that he had enough and handed in his resignation letter at the end of a work day. Myrtle has been trying to balance being supportive while also being concerned. She knew his unhappiness with his job was placing a strain on their marriage, but she had just gone back to work after little Myrtle's birth and would now be the sole provider for her family. She wanted to help her husband find the colour of his parachute, and she came up with a lot of good ideas for job leads and unique ways for him to market himself, but he kept coming back with "No. I don't want to do that."

I remembered how annoying it was to be asked if I had a job after my graduation. It's almost as irritating as having people ask you if you have any fertility related news. Thus, both issues have become the metaphorical elephants in the room. I've enacted my 'don't ask, don't tell' policy regarding any discussion of our infertility, but I haven't figured out how to handle asking Myrtle about Mr Myrtle's job search. I want to express my concern for her without causing aggravation.

It turns out that I didn't need to find the right words to ask her during our previous conversation, as she just launched away. She's growing more frustrated as his quest has been limited to faxing his resume (without a cover sheet) and waiting for a friend who promised to pass it to a potential employer (back in December). I think she revealed her desperation when she asked me (an established atheist) to pray for him to get a job. Probably because that would equal his efforts.

I recognise that this is probably how Myrtle feels when she is trying to offer her support regarding our infertility issues. I really can't relate as Husband and I grew up with the instructions that you never quit a job until another position is established. My husband created an 'oh shit' savings account in the event that one of us loses a job. He holds on to some business cards and regularly emails these contacts, so that if he were to be laid off, he would have a few active leads. I'm not nearly as organised as he is, but I have a few options for per diem work. Offering her pep talks of "keep trying" or "it will happen" is haunting to me, as those are the words she has given to me and I found them irritating. The other delicate aspect is that her husband is not necessarily being lazy with his casual job search, but it's a reflection of his lack of self-confidence. As I've come to know Mr Myrtle, it's apparent that he is really insecure, which doesn't help when you're trying to get a job in a slow economy. I know Myrtle has tried to build up his professional mojo on several occasions, and I can't help but wonder if he may some therapy sessions. I've not shared this with her as I'm never sure how much truth people are really ready or willing to hear.

I've come to accept that the only thing I can do for her is listen when she needs to vent, which is all I really want from her with discussing my infertility issues. I'd like to be open about our struggles without her giving Aunt Jane advice to wear post coital socks and stand on my head. I'd like to be able to tell her about our fertility treatments without fearing she'll say 'I don't know why you're doing that when you got pregnant on your own...' and then having to explain the difference between IUI and IVF for the umpteenth time. Maybe we don't need to talk specifics about the elephants in the room, but it would help for us each to acknowledge them.

As Mother's Day approached, I wanted to express to Myrtle how proud I am of her for balancing working full time (as the sole provider for her family) and being a great mother. I know the first official Mother's Day is a special occasion for every new mom, but it thought it was especially significant for her given the extra challenge she absorbed. I sent her a card and I texted her to arrange a call on Mother's Day.

I was alone as Husband was away for the weekend and I spent the day cleaning. The day was a little harder for me than I thought it was going to be. As I hung some laundry on drying racks in the spare room, I felt reminded that we could be prepping the room to be a nursery if I were still pregnant. I could have been celebrating this day with my Mum as a mum-to-be, but instead I am still an infertile woman who is doubtful that she will ever be a mum. As much as I am dreading 5 August, (the would have been due date) I want it to get here so I can move on to 6 August.

I confess that a small part of me thought Myrtle might sense that today would be tough for me and would ask how things are going. Maybe I had sniffed too much ammonia from the glass cleaner, but I felt that I wanted to talk with her. I was just finding it hard to keep something so difficult in my life from my oldest friend in the world. I was prepared to repeat my explanation of the difference between IUI and IVF in order to unload some of the pain I've been carrying. I'm fortunate that I have so many other people in my life to talk with, but at times it hurts that Myrtle isn't one of them. Maybe I just needed reassurance that my friend still cared enough to ask. Then I got a text from her: Well, unfortunately my day just ended with a screaming baby and more puke! So I am probably not good company right now :(

Sigh. It was always about her. It seems that almost every conversation we have is always focused on her, but today was her day. How selfish and foolish of me to think that I had a claim of any recognition toward it. In my world of infertile bloggers, we could celebrate ourselves as potential mothers and acknowledge the difficult feelings, but I was reminded that no one outside our realm saw me that way. It was her day. She was observing the event by enduring the challenges of the job. The last thing she should have been burdened with is her friend's sorrows over her miscarried pregnancy and quest through infertility. I realised that I could resent how easy it was for her to conceive, and I could be jealous of her gorgeous baby, but I felt that I could no longer feel bitter. This was probably not how Myrtle envisioned her motherhood experience would be.

Saturday, 18 May 2013

Accepting Limitations and Exceeding Expectations

I love running in organised races, but I hate training. It's not a lack of motivation, although finding the time can be challenging. It's not isolation, as I've trained with a partner or groups. Mentally, I just can't get my head into putting the same amount of effort that I would for an official race. I know training is going to be more important as I get older, but for now I seem to be able to get away with throwing down my best times on race days. Husband is always chiding me that I could be much faster if I trained properly. Interestingly, he is much more diligent about training, but doesn't want to race as much.

So, apparently I did announced in my post A Marathon versus a Sprint that I was planning to run an 18 mile run this month. I've been able to keep my baseline fitness level at a point where I can easily run a 10K at any time, so I find that I only need a few weeks to train for a half marathon. I wanted a challenge that would actually require me to properly train. January was a little colder than usual, which discouraged me from engaging in long runs. I started running more in February, but by March I had to work around having swim meets every other weekend. As a sprinter in swimming, I needed to preserve my legs for kicking. Suddenly it was April and I realised the 18 mile run was only  6 weeks away. I set up a training plan and started increasing my distance every 2-3 miles each weekend. The day I was slated to run 15 miles, I found that I ran the first 12 easily and struggled during the last three. I was starting to doubt if I would be able to run the 18 mile distance. Then I took note of the fact that I wrote the wrong date of the race in my calendar. The race was actually one week earlier.

It kills me to back down from any challenge and to admit that I can't do something. I realised I had a choice to make. I could probably finish the 18 mile race, but it would be a slow struggle, or I could change my distance to a half marathon and complete it in a semi-decent time. It was time to accept my limitations. At this point in my life, I'm not able to manage running more than a half marathon. 13 miles is still a recpectable distance, and probably not too many people can pull it off with only a few weeks of training.

I figured I would probably come in around 2:25, but somehow I managed to keep my pace per mile under ten minutes for ten miles, which would put me close to a 2:10 finish. It was a rather hot day, so I stopped at the last two aide stations are really took time to rehydrate (I don't usually stop at all during a race). My runkeeper time (which does pause when you stop running and I know isn't completely accurate) had my time at 2:15.43 (my best time was 2:14). The official clock recorded my finish at 2:20.17. I had exceeded my own expectations.

So the obvious analogy is that I accepted our biological limitations that we likely won't conceve wihtout assistance and I hope our fertility treatments will exceed my expectations. The last time I ran a half marathon was on the exact same course (although in the opposite direction) the day before I found out I was pregnant. I looked up my time on that day -2:20.15 (although I didn't stop at all during that race). I know it doesn't mean anything more than consistency, but should I become pregnant this cycle, I'll declare there is something lucky about that race course.

Thursday, 16 May 2013

Don't Rock the Boat...

I developed pneumonia during my third year at University. I missed classes for an entire week, but kept up with my assignments while I was recovering. When I handed in a paper, the professor informed me that he was "very disappointed with my absence" and he was questioning "my commitment to my studies" I tried to explain that I had been diagnosed with pneumonia, but he cut me off "Do you know how many sick days I've taken in 35 years?" he asked. "Zero!" he answered his own question and made a zero with his hand just to emphasize his point.  I turned away and went to my next class, but I couldn't concentrate. I walked out of my international relations class, leaving my books on my desk and returned to confront the professor. I pointed out that this was the first time I had been sick. (I was the nerdy child who won the Perfect Attendance Award -three consecutive years) I was doing my best to keep up with my studies while I recovered, and I really objected to the way my commitment had been challenged by him. To my surprise, he apologised.  He admited that he felt badly about the way he spoke to me and was proud that I came back to confront him. It would be one of the most important lessons I learned at University: knowing when you admit that you're wrong, and knowing when to stand up for yourself.

I thought back to this event after reading Lentil's post describing how her RE berated her after a recent IUI procedure. It's much harder to stand up for yourself in this context. She commented, "For some reason, I desperately want this particular human being to like me. I think it's because I am relying on her for something so huge." There is such a precarious relationship between you and RE as well as their office staff. As it feels like they have the life of your potential baby in their hands, it's only natural to want to appease them. At the least, it is desirable to have a collaborative and cohesive relationship with everyone on your team. No one wants to rock the boat and or make any waves...

Update on our billing/insurance issues: When we were proceeding with our hysteroscopy we weren't sure what the total cost would be or how much would be covered by my insurance. My insurance covers 50% of infertility treatments, but we weren't sure if this would only apply to my RE's surgeon fee or to the entire hospital operating room charge. Additionally, they used the code of  'uterine anomaly' rather than an infertility diagnosis, so we weren't sure if the 50% rule would apply. A month after the procedure, we received an explanation of benefits informing us that the $17,000 in charges from the hospital were "in review". As with all correspondence from my insurance company, they always include the statement, "authorisation of services does not guarantee payment." Every time we opened the postbox, we were fearful of receiving a bill for the entire amount. I started entertaining the worst case scenario; where would be be if the savings we had earmarked for IVF were eaten up by the hysteroscopy? "Don't worry, we'll figure something out." Husband tried to stay calm and reassure me, but I know he was thinking, 'yeah, we're fucked...'

I was inspecting my account from the insurance's secure website on a weekly basis and the status finally changed from "pending" to "processed". I called to speak with an agent, who informed me that a check had been issued. He couldn't tell me the amount, so there was some relief that they were at least paying some of the bill. We were still on edge until the explanation of benefits arrived and indicated that all charged were paid in full. Despite seeing the words "Patient Co-insurance $0, Patient Co-pay $0" we still won't feel assured until a few months go by without a bill from XYZ hospital.

After learning from the billing coordinator at my RE's that I wouldn't be able to proceed with any further treatment until they received payment from my insurance company, I decided to do some investigation on my own. I worked in accounts receivable for a medical office and I know how these bastards at insurance companies operate; they'll apply any and every trick in the book to hold off paying as long as possible. Their electronic submission system is rigged so that the slightest hiccup in the transmission will erase data. Their fax machine is permanently engaged; and if you're sending paper claims via snail mail, you'll note their mailing address is in the Bermuda Triangle. I'm convinced sometimes they'll just sit on charges just to see if busy clinics will try to pursue. I'm not sure which tactic was used in my case, but sure enough a phone call to an insurance representative confirmed that none of the charges from my RE's office were ever received.

When Husband paid our portion for our last IUI, he shared this information with the billing person. "Oh, she called?" the woman asked, as Husband detected a slight attitude from her tone. I gave her back the printout of my outstanding charges (which she printed for me on paper that still has small holes on the sides) where I had highlighted which one needed to be re-submitted and I had listed the address. "No, I don't need this. I know the address." she replied in pissy manner. Husband and I looked at each other and had a conversation without speaking any words
"Is it me, or is she acting like a [bad vagina word]"
"Seriously! You're doing her job"
Husband and I just turned to her and smiled sweetly. We both know better than to risk getting on her bad side.

As I drove back to my office, I could appreciate some of her resentment: no one likes to be called out for failing to complete a task. Yet, did she seriously not expect that I would look into this? After being told that my fertility treatments would be placed on hold, I was supposed to just continue to wait? For how long? The account was 90 days past due and she hadn't bothered to chase up.

After encountering so many delays, I've started to view infertility as a chess match -you always want to think two or three moves ahead. Okay, I don't really play chess, but sometimes when I have writer's block, I'll play Tetris for a few minutes, which also requires forward thinking. If it could be logistically possible, I was reconsidering our decision to skip an IUI in May, as we looked to June and saw that Husband would be away for a few days during the trigger and IUI week. That seemed to be a bigger gamble. I also recounted memories of our difficulties with timed intercourse, and began to realise that we could conceivably (pun intended) miss two months in a row.

Even if this current IUI cycle doesn't work, I feel we will still have reason to feel encouraged and I want to continue the momentum from this last cycle, which numbers-wise represented our best chance to date. Truth be told, I was tempted to ask if they were sure that it definitely was Husband's sperm after I heard what the count was. Other parameters were similar and I think the MA mentioned that we were the only IUI on schedule that morning. We're not sure what he was doing three months ago, but I hope it had lasting effects. If we can keep these numbers up, I believe it could be merely a matter of time, and I want to try to do as many IUI cycles before our tentative plans for IVF in October.

Although, if we were able to navigate around the Memorial Day holiday in terms of my monitoring, we would need to be excused from the 'no treatment while you're carrying a balance' policy. I think it's only fair since technically my insurance can't pay for services when they have no claims on file. If she insists on sticking to the rules, we can offer to clear the unpaid charges and receive a credit when the insurance payment comes through. I just really don't want to have to negotiate with this woman. I don't intend to ever use it, but I feel the ultimate threat I carry in my back pocket is to bring up that I am in a position where I refer patients to their office. The ultimate question -is it worth it to rock the boat over one IUI cycle when we don't know how long we're going to be dealing with this person in our life and may be dealing with greater sums? Oh, there is such an added bonus if this IUI cycle works!

Tuesday, 14 May 2013

Where the Magic Happens

I know it's not the typical location for a fashion show, but one of the things that I most enjoy about running races, is watching what others are wearing. I've done races around Halloween, where costumes are encouraged. I did an 80's themed run, that literally took you on a jog down memory lane. I like looking at shirts from past events, area running clubs and various charities. Some people write their own messages with various memorials or fun slogans like "will run for wine!" (Napa Half Marathon) I saw a guy who must have been in his late 60s or 70s (knee braces on both knees) who used the old iron-on letters to spell out, "C'mon! Is that all you got?" on the back of his shirt. It's all in the spirit of having as much fun as possible whilst running 6 or 13 miles with a group of people who are as crazy as you are to run 6 or 13 miles or more. At a recent race that traversed the Golden Gate Bridge, one guy established a new purpose with the handwritten message on his shirt;

Decent Job
Come say Hi!

As I ran past him, he seemed to be fit and fairly attractive. I admired his courage to put himself out there with such a public display and I hoped it paid off for him and led him to score some digits, or email addresses, Facebook friends, Twitter followers...whatever the kids are doing these days. This man's bold steps to try to land a date reminded me of how necessary it is to take some risks in life in order to reap any potential rewards.

This is my 100th post on this blog. I must admit, a year ago I probably didn't think I'd still be barren at this time, and I never would have anticipated that I would become an infertile blogger. Probably because I didn't really know what a blog actually was. Months after we learned of Husband's semen analysis, received our prognosis from my RE and crept closer to Myrtle's due date, I found that I had so many conflicting feelings running around my head and I needed to find some kind of outlet. It started out with a letter to Myrtle. It was a letter that I knew I would never actually send to her, but it enabled me to release all my feelings of jealousy and frustration. Mostly, the letter detailed how aloof she was, both ignorant to the actual mechanics of conception and oblivious to the feelings of one who is infertile. The letter remained as a file on my desktop. I would read it to myself, make some edits now and then and close it. I decided that I wanted to share it with others who would understand the experience from my point of view. I joined an online forum, just so I could post my letter. I was welcomed into the online infertility community, as like the Cheers theme song, everyone knows your (profile) name and troubles are all the same.

A few weeks later, Amanda at Growing Griswolds and now Our Griswold  posted on the forum that she was looking for a guest blogger. This was my opportunity to check out the blogging world. I sent her my letter and explored her and other blogs. It was like having your own focus group within the online community! Six weeks later, I decided to take the plunge and lost my blogging virginity. I describing blogging as having an interactive on-line journal, where rather than a written diary, you can include pictures, music, web links and video clips to tell your story.

What I have ultimately learned from this experience, is that when you expose your Achilles heel and reveal your deepest vulnerabilities, you have the potential to become your strongest. I am so thankful for the intimate connection I have with fellow bloggers. I feel that many of us probably would be friends in real life and I enjoy learning about your lives beyond infertility and I am often amazed at how many things we have in common besides infertility. IF is just the vector that brought us together from many different locations.

I feel my point was best illustrated on an episode of HBO's Girls. The aspiring writer, Hannah, is meeting with the editor of an on-line pop culture magazine. As Hannah resists some initial suggestions for her piece, the editor asks if she saw the sign on the wall.

"Umm-hmm" she nods
"You get it, right?" The editor asks, clearly unsure of Hannah's comprehension
"Yeah, I get it. Of course it get it." Hannah defensively lies in order to appease her boss

The editor draws it out for her. "This is your comfort zone" she represents with her first. "This" she waves her other hand in the air "is where the magic happens..."

"So, like the magic happens outside your comfort zone?" Hannah asks, as the penny finally drops.

Yes, it does.

Sunday, 12 May 2013

Oh, you're infertile! Congratulations!

I've always had my bits waxed before my hoo-ha appointments long before I started fertility treatments; it's a GYN vanity thing. I started going to a national chain waxing centre as it is close to my office. I feel I've traded the convenience of the location for the imposition that the staff are all sales people and they are always promoting a special on a product or service. Additionally, the techs try to schedule my next visit after each appointment. I usually decline and explain that I'll call closer to the date when I'm due (the salon is not that busy and I've even been served on a walk-in basis). At my last visit, the tech again pressured me to commit to a follow up session. I decided to inform her that I'm going through infertility treatments and my waxing needs revolve around those appointment. "Oh, Congratulations!" she said to my surprise. I'm sure my head spun a little bit; did she seriously offer me congratulations for being infertile?

I know it's an awkward announcement and many people aren't quite sure how to respond. Most will offer some form of well wishes and recount a story of someone they knew who was infertile and somehow became pregnant. Seriously though, are congratulations really in order? As she was young, I figured maybe she just didn't understand and thought I was revealing that I was pregnant. Or perhaps she didn't fully comprehend the situation of infertility and just through that was an appropriate response. Amber at Old Lady and No Baby had a similar experience when she had some paperwork notarised before her FET and the agent offered her congratulations, not once, not twice, but three times for good measure.

Well I've decided that it is an appropriate response and congratulations are in order:

  • For acknowledging your infertile status
  • For having the courage to meet with a specialist or adoption agency 
  • For mastering skills such as giving yourself injections
  • For being brave enough to face the uncertainty of fertility treatments or adoption process
  • For holding it together during many baby showers, first birthday parties and a pregnancy announcement from a friend who 'wasn't even trying!'
  • For enduring the well intended suggestions to 'go on a holiday and relax!' 'wear socks after sex and stand on your head!' only to eventually be told 'it will happen when you stop trying...'
  • For all the times you dried the tears from your eyes and found a way to laugh or smile
  • For discovering that you are much stronger than you ever thought you were
  • For finding how much love is in your heart for your baby long before he or she arrives

Happy Mother's Day to my infertility sisters. Amazing women who are already mothers in their hearts and are merely waiting for their babies.

Thursday, 9 May 2013

Present and Accounted for...

"Do you want me to come with you?" asked Husband on the night before our first IUI. I paused a second before answering. Of course I wanted him to be there. I know this isn't the "natural" method of procreation, but it still felt logical that we both should be present for the moment of possible conception. However, I wanted to know how he felt about being there. "It's up to you." I told him. That morning I wasn't sure if he was going to be present for the procedure until he texted me from a Starbucks after the emission was accomplished to report that he was getting a coffee whilst he waited.

A few days after the insemination, we were invited over for dinner at one of Husband's hockey friends. It was an uncomfortable evening for me, as I don't know him nor his wife that well and I couldn't drink as I had a swim meet the next morning (oh, and could possibly be implanting at that moment). Meanwhile, Husband enjoyed a few beers, and naturally I was the designated driver. Once we were in the car, Husband revealed that many years ago his friend engaged in extramarital relations, but he and his wife managed to restore their marriage. "Now, I would never cheat on you..." he garbled, "but if I did, I wouldn't expect you to forgive me..." We were stopped at a traffic light, so I looked over at the drunk boy in the passenger seat. Not that I didn't have full faith in his fidelity, but the possibility of him having an affair just seemed like an unlikely scenario. The light changed and I shifted the gearstick into first position. "Well, technically, you've had sex with [my RE]" he informed me. My foot struggled to find the biting point and I nearly stalled as I proceeded through the intersection.

Many, many years ago, I did in fact sleep with someone who shares a lot of similar physical features with my RE. It's an observation I have never shared with Husband as I didn't feel it was relevant, and I've worked really hard to repress that memory. Anyone who has been through an IUI or embryo transfer acknowledges that there is nothing remotely titillating about this situation. It tallies one more aspect to the list of fertile resentment. Not only is their process natural, free, discreet and intimate; it hopefully is sexually satisfying and yields an orgasm or few. In addition to the socially awkward nature of the clinical setting, some women find the IUI or ET procedure physically uncomfortable.

I replied that technically, it's not really cheating, since we're using his sperm. I know he was only making a joke, but I'm keenly aware that Husband often uses humour as his primary defense mechanism. I have never asked him what he really feels about being an obsolete observer in this process and that his actual presence is in fact optional?

I've heard that some RE's will invite the partner to push the syringe and thus feel more responsible for the possible impregnation. Mine has never offered, but I suspect Husband would find it far too nerve-wracking and would decline. Co-worker's RE took it to a whole new level. As her Husband is an orthopaedic Physician Assistant, her RE commented "You've had some ob/gyn training, I'll talk you through it and you can do the entire procedure" as he handed over the speculum. "NO!" exclaimed Co-worker. "This" she said motioning her hand toward her VG "is to remain sexy for him. It is not part of his clinical experience." She later shared that her husband only attended the first IUI as it happened to occur on his day off . He was unavailable for their second, so her mother accompanied. On the third and successful attempt, she went by herself as she described the procedure to be as routine as having a Pap smear.

Well, here's the TMI for our IUI #2. My left ovary decided to be an active participant this time and boasted the dominant follicle at 21 mm, as well as a 15 mm companion. Not just along for the ride, my right ovary also produced two follicles at 15 and 13 mm respectively. My endometrial lining recorded it's thickest measurement at 11.2 mm. Fortunately, Husband had his best sperm day ever. His pre-wash total count was 27 million with 66% motility and we ended up with 8 million for the insemination. A bit immature, we high fived in celebration. When my RE had finished, I looked over at Husband and asked,

"Was it good for you?"

Monday, 6 May 2013

Beyond My Control

I've often referred to my ovaries as inconsiderate, inconsistent, sadistic little bitches, who have felt under appreciated for many years and now enjoying their moments of revenge. My follicular phase follows our google calendar and my LH surge seems to be correlated with the most inconvenient time for coitus. However, I have to give an nod of appreciation to the girls, (although it's probably the influence of the Femara and HCG trigger, but at least they're playing along) as my recent cycles have allowed me to schedule my monitoring appointments on a Saturday. I can bank my excuses for needing to leave work and use them when we're doing IVF.

I initially had little sympathy when my RE told us at our initial consultation that he works 6 days a week. I admit I developed some sub-specialty resentment while caring for a morbidly obese woman who was impregnated via IVF. My first objection was to the fact that someone in such an unhealthy state should not be exposed to the dangers of pregnancy (she had premature rupture of membranes at 28 weeks and later developed a blood clot in her leg) but on a personal note, I was woken up many times during the night to help the nurses locate the baby's heartbeat with an ultrasound so she could continue to be monitored. Every time I left the call room, I thought about how soundly her RE must have been sleeping at that moment.

Well, I have a newly found appreciation for RE's schedules, as well as for many other aspects of their difficult jobs. In particular, both providers at my RE's office work their own schedules on Saturday. The office of Co-worker's RE was open 7 days a week, but each provider alternated working on the weekend. She found it was interesting that the two had such conflicting approaches and styles, and she ended up preferring her RE's partner and awkwardly hoped her cycles would coordinate with his weekends. I was relieved that my RE didn't say anything to the effect of 'I'm sorry this IUI didn't work'. Especially, as he was probably thinking, 'yeah, I'm not surprised to see you back here.'        

After getting the green light from my quiet ovaries to proceed with this IUI cycle, I started thinking about the logistics for the next one. If my trigger and procedure dates followed the same time as my last one, the mid cycle monitoring would need to be done around Memorial Day weekend. I'm sure the office will be closed for their rare long weekend, but I also have to travel to the east coast that weekend. Last year when I flew back on Memorial Day, I was bumped of my flight and didn't return until a day later. I would be hesitant to proceed with a cycle that compromised the time frame in any way. There was another consideration; Husband has a hockey tournament that weekend. Although I know running around for three days probably won't have too much of an effect on his count, but it just doesn't seem ideal. The more practical consideration was how he would be able to adhere to the wank schedule in order to  reset in time for IUI day. I've heard stories from others who succeeded on cycles that felt less than optimal, but I don't know if I want to take that risk. Husband and I began to consider if we should skip the IUI cycle in May.

I had a voice mail from my RE's office at 10 AM on a Monday morning. It's never a good thing when you get an unexpected call from your RE's office. I figured my appointment would need to be rescheduled. Ugh, I would have to come up with an excuse to leave the office after all. It turns out the phone call was from the insurance person. Although, my last authorisation letter indicated a time frame from 1 March - 15 June, that apparently was only for one IUI. I need to get an authorisation each cycle, she informed me in a rather lecturing tone.

"Do you want to proceed with this cycle?" she asked

I realise that it was a valid question, and she is just doing her job. I worked in a medical office obtaining surgical authorisations one summer, it's a shitty job.However, my initial response to her inquiry was, No, I've only been waiting to do this since last year, so by all means, I won't proceed if it will inconvenience you...
Maybe I am being a bit harsh as I don't like feeling that I'm being reprimanded in any way, but seriously it was only cycle day 4. I called late Friday morning to report AF's arrival, we were only half a day behind in this process at that time. She acknowledged my intention to continue with this cycle and reported that she already placed a request to my insurance. "Oh, and just so you know," she continued "You won't be able to do a treatment next month, as your account shows a balance. I know you paid your co-pay, but we need payment from your insurance company."

I thanked her for her efforts and hung up the phone as quickly as I could. I wanted to scream. As my blog title notes, I've been discovering that the fertility process is not mine to command. I've accepted the limitations from my inconsistent ovaries, divided uterus and male factor infertility.  I was not prepared to discover that our procreation potential is not also dependent on someone sitting at a desk signing a permission slip for me to proceed with a procedure that is one of my covered benefits, but also for someone in the claims department to actually process the payment. (For the record, I do know that I am fortunate to have some insurance coverage, but it can also be restrictive) I understand that it all comes down to the money -everyone needs to get paid. She could have presented us with the option of clearing the balance and receiving a credit once the insurance payment came though.

I felt that it wasn't worth arguing, as we had already accepted that this cycle would conflict with the holiday schedule (I've grown accustomed to these types of delays). However, it started to resonate that this process is not supposed to be this complicated, even after acknowledging that we won't reproduce by simply having sex. There's a tempting thought to say, fuck it and give up. Fortunately, I'm just too stubborn. Case in point; I asked my RE if I could use Femara next month, even if we won't be doing an IUI, just so I can keep my cycle on the same calendar schedule. Given that there are so many elements beyond my control, I want to command any aspect that will work to my advantage. "Well, let's wait and see if you actually get pregnant this cycle" he responded to my inquiry. I laughed a little inside my head and felt an accompanying sense of pity oh, how sweet!, you think this could actually work...

Saturday, 4 May 2013

Perhaps, not so kindred spirit...

There are several different idioms that warn of the consequences when one decides to assume. However, sometimes there is a rational basis for making an assumption; and does anyone notice that if your assumption turns out to be correct, it gets retrospectively defined as a presumption? Our personal experiences often shape our perspectives and there are some underlying kernels of truth that allow sterotypes to survive. Nonetheless, it still is never wise to assume, as I was recently reminded.

When I had to leave in the middle of my swim meet for my baseline ovarian monitoring, I simply explained that I had an appointment. Perhaps my coach thought I was seeing one of my patients, but she didn't ask any further questions, and I didn't offer any information. Although, I thought about telling her about the real reason for my departure. In the time that we've gotten to know each other, I learned that she got married was she was 36 and she had her first and only daughter at age 40. Okay, I have to claim a little professional bias, but I suspected that she may have had fertility issues given her age at conception. I thought she may have been a kindred spirit. Guilty as charged for assuming.

Last night our swim team got together for a few beers at a local bar. One woman announced that her older sister was pregnant again. Wow, I remembered shortly after I started swimming, she learned what I did and asked me some questions about her sister's upcoming induction. It was only a few months before we started trying to conceive. I've now been swimming and attempting procreation during someone''s interconception period. "And you?" asked Phelps, who had three kids before reaching the age of 30. The soon to be an aunt replied, "I have a year left of my physical therapy training and then I need to get a job, but after that, I'll be open to the idea..."

"How old are you?" asked our coach, who is now in her mid 50s
"I'll be 35 in two months, so 36 when I graduate" she replied.
"Ohhh... plenty of time..." she reassured.

Hmmm. I thought to myself. No infertility or pregnancy loss survivor would advise a woman already classified as advanced maternal age as having 'plenty of time'. Although I do realise I am making another assumption, which is what would have led me into trouble if I confided in my coach, believing her to be an infertility survivor. However, how many of us personally know others that age or younger with diminished ovarian reserve? Her husband is a very nice computer programmer, who enjoys brewing his own beer and created his own couch to half marathon training program (day one, couch; day two, 13.1 miles). He can swim, but can the little boys?

"I can run numbers for you" I offered.

Thursday, 2 May 2013

Always take the weather with you

I can so appreciate that people process their experience with infertility differently. Everyone has his or her own coping strategies. Co-worker was much more open with the people who surrounded her. Her mother and in-laws were in the loop with their treatments, and while she didn't broadcast her situation, she freely shared details with some staff members. In contrast, only a handful of people IRL know of my circumstances, but I have no reservations about divulging my deepest feelings on the internet. It has also been interesting to witness how at times, men and women can process their feelings toward infertility in such a similar manner, given that we hail from different planets.

Husband was initially comforted when his friend Raj, informed him that two mutual friends, Angus and Colin, were also experiencing issues with infertility. He would later be sent into a funk when on the same day that Angus announced that his son was born, Colin reported that he and his wife Claire, were expecting twins. (For the record, Angus's son was a first time IVF success, for Colin and Claire, the third time was the charm) When the first of our English friends started to reproduce, Husband expressed that we were falling behind. At the time, I reminded him that it wasn't a race. Now, the non-existent race is over. We lost. Among our friends back in England, we are the last married couple sans child. I pointed out that we could be the first of the English ex-pats living in America to procreate, but he just sent me a look that said, 'don't count on it.'

He revealed that it was hard for him to swallow that Angus had become a father before him, as he was the last person Husband figured would do so. Angus is someone we met during our University days; he was a better than average hockey player, decent quiz team member and he had the ability to chin a pint in less than 3 seconds. He had a certain attraction to Indian women and he was quite the serial monogamist. The attraction to their beauty was self explanatory, but I think the real appeal was that those relationships protected his commitment issues. He was aware that her family would not find him to be an acceptable suitor, and thus he wouldn't feel pressure toward marriage. So it shocked everyone when he announced his engagement and impromptu wedding to a Brazilian women, whom he met just three months earlier.

Even more shocking, was that his new bride had a 3 or 4 year old son from a prior relationship. While not wanting to judge someone I hadn't met; I wondered if a single mother should be jumping into such a quick marriage with someone who describes himself as being "emotionally retarded" on his Facebook profile. Nonetheless, as Angus was a dear friend (and the namesake for my cat), I was hoping things would work out for them. I think Angus adjusted to the changing role from a carefree bachelor to a family man. He committed the social faux-pas of tagging twenty people into a photo that featured only the little boy and later explained, "I'm sorry, I just love that picture of my [step] son!" I figure that by now, if Angus and his wife survived infertility hell, he must have resolved all his commitment issues.

I asked Co-worker if her Husband (who is very similar to mine in many ways) had any dealings with his own jealousy issues. "I don't remember" she honestly claimed. She then followed, "You know, we just don't talk about our infertility experience much anymore." It made sense to me, as they have to prepare for welcoming twins into their lives; why would they? Still, it stung a little to hear those words. Her expanding bump reminded me that she had physically defeated infertility, it was a bit disheartening to learn that she had moved on emotionally.

On the day of my initial BFN, but before AF's appearance, I asked Co-Worker when the bitch arrived in relation to the timing of her IUI. "I think it was exactly two weeks later." I asked when she stopped her supplemental progesterone "Oh, I'm sorry, I really can't remember if I started it before or after the BFP. I just don't think about it anymore. I feel like I got pregnant just like a normal person." I definitely felt let down. I knew she was no longer in the trenches with me, but I didn't realise she was a deserter in the war. I felt more alone, not because she was pregnant and I wasn't, but because it seemed that she wanted to distance herself from infertility.

I'm not about to suggest to any infertile woman how she should or shouldn't feel; there was a part of me that was happy to hear Co-worker use the word 'normal' in the same sentence as she described her pregnancy, as I fear if I do become pregnant there won't be anything that will feel 'normal' about it. Here is my vow if I ever find myself in that position, and my plea to infertility survivors:

Forget the details. Forget the number and size of your follicles. Erase the post wash counts. Leave behind the memories of your retrieval and fertilisation reports. Disregard your initial beta numbers. Think no more about the dose and instructions of your fertility drugs. Just don't ever lose sight of the feelings during your infertility journey.

Remember what it was like to see the lonely single line on a stick each month. Keep in mind how hard it was to see a picture of a newborn baby on Facebook and refrain from posting five pictures of your little one in a single day. Recall the frustration of failed treatments and be sensitive before asking someone about family planning. Be mindful of the annoying advice you received from your Aunt Jane and don't explain that a miraculous spontaneous conception resulted from a relaxing holiday in Hawaii. (Okay, that one was directed to my cousin). Recognise the sense of despair that you felt on the darkest of days when you wondered if it would ever be your turn to be pregnant. At the same time, just because you escaped that place of despondency, please don't make the empty promise that it will happen for me.  Although you've been here before, they are still only words, even from you.

Sure enough, two weeks after my first IUI, I started spotting in the evening. I texted Co-worker to let her know her recall about the timing was accurate. "OMG, I'm so sorry I didn't ask about your test results this morning" she wrote back. I explained that I would have notified her if I had any good news. "Yes, but I still appreciated when you asked me." she replied.

She may not talk about her experience; she may not remember the details of her medications or her schedules, but she hasn't forgotten how she felt. Maybe infertility is like the Hotel California, "you can check out any time you like... but you can never leave..."