June 9, 2010
The last batch of doc visits have been different from what I did the first time I was pregnant. This time, the bloodwork and nuchal fold test, a screen that measures the amount of a certain hormone in the blood along with the measurement of the back of the fetus’ neck, came back not so great.
These tests show the risk of having a baby with Down’s Syndrome or two other chromosomal defects called trisomy 13 or trisomy 18. My risk, as a 40 year old, is 1 in 75 for Down’s. The baby neck measurement came back within a non-risky range, but combined with the low hormones in my blood and again, my age, my risk decreased a bit to 1 in 72 for Down’s.
“I know this is disappointing, Mister L.,” said our awesome OB. “You asked for everything to be the same as when you were pregnant with Toddler L, and this isn’t.”
When I had that test before, the same doc congratulated me when she got the results, saying my risks were the same as a 20 year old’s. That is to say, miniscule.
With this higher result, we decided to do an earlier invasive test that would definitively tell us if the fetus has Down’s Syndrome or one of these trisomies (which I had a very low risk for developing). If I wanted to wait a few more weeks, I could have had an amniocentesis, which takes a bit of amniotic fluid from the uterus through a needle in the belly.
But since we wanted to know right away, I ended up having a Chorionic Villus Sampling, or a CVS, which takes a piece of tissue from the placenta. The options are to take it through the cervix, or through the abdomen if the placenta is in an area that can’t easily be reached.
We were told the Down’s risk on a Friday, and by the following Thursday, I was in to have the CVS. Throughout the week, Mr. L and I would say “good thoughts” and we do this ritual where we rub a clay and ceramic painted pomegranate in our bedroom (a symbol of fertility) and say “Woo, woo, Go Lima.” (This is leftover from our first round of IVF, where we bought the pomegranate at an art fair because, hey, why not?)
(Our working name for the fetus right now is Lima, as in, it’s the size of a lima bean. Mr. L. sometimes calls it Lima, as in the capital of Peru. “It’s not Peruvian, unless there’s something you haven’t told me,” I’ve said.”)
We’ve done a lot of pomegranate rubbing recently.
The day of the test, Preschooler L was at school early and the Mister and I went to the hospital. There’s no anesthesia, but I took a couple of extra strength Tylenol as a pre-emptive measure. (Some past vaginal tests have been excruciating.) At the same time, being an infertility vet, I told the doc about my tipped uterus, my raised cervix, the advice past IVF docs have told us about “going in at 7 o’clock,” and my plea to please use the smallest speculum possible, as again, past experience has been excruciating.
The doc did as directed, and was pretty nice about our type A explanations and questions. This doc happens to do a lot of these CVS procedures, which means his experience hopefully will translate into no miscarriage. (The rate of miscarriage following a CVS is about 1 percent, something weighing heavily on our minds. But the truth boiled down to that if the fetus was found to have a chromosomal problem, we’d be much more inclined to terminate, as tough and painful as that would be, and it’s easier to do that at 13-15 weeks with the results of a CVS versus a 18-20 weeks if we’d waited until the right time to do an amnio (which has a lower miscarriage rate, but again, can be tougher to terminate after your belly is swelling a bit more and you are more likely to feel movement.
Shockingly for me, the speculum was the toughest part of the procedure. Once that was in, the doc somehow got where he needed to go past my cervix and got the right amount of tissue from the right place… without me feeling a thing. At the same time, I was breathing deeply and staring at the ceiling (at these ceiling tiles that had the texture, of ice cream, of all things) and clutching Mr. L’s hand.
A day later, I got a call from a genetics counselor (which, I’d forgotten, I’d met an hour before the CVS. She had explained all the details of the test and when we’d get the results.). Initial results come about a day or two later, but the full chromosomal analysis is done in two weeks. From what the genetics counselor told us, the initial results are about 95 percent accurate, and are 100 percent accurate with the full result report. Of course, there could still be some chromosomal problem that the test doesn’t measure, but the results, when good, seemed as reassuring as they could be.
The initial results were… all normal for Down’s and for the trisomies, thank God. We’re still waiting for the final results, which should come right before Father’s Day, and once we know they look good, we plan to tell our families as they are having a meal at our house in honor of Father’s Day.
Hopefully things will go well.
I actually went back to the OB’s office where a nurse practitioner did a heartbeat check. They did one immediately after the CVS and confirmed the heartbeat was good and strong, and the heartbeat check yesterday (five days later) also showed a strong heartbeat. So thankfully, I did not miscarry as a result of the CVS.
The NP asked how the pregnancy was going, and the truth is, I’m so focused on my blood sugars and which was my Dexcom is trending that I sometimes feel like the actual pregnancy is on the back burner. It isn’t, of course, but I’ve thought about my diabetes and my current kid a lot more than I’m thinking about the progeny of this pregnancy. Pregnancy the second time around, for me, has been more worries about high blood sugar excursions despite my admirable and recommended-for-pregnancy A1cs. I haven’t even glanced at one of those “what is your fetus doing this week” emails or websites. All I care about is if my sugars are in range and if I’m eating relatively properly.
So far, the rest is taking care of itself.
Showing posts with label The Mister. Show all posts
Showing posts with label The Mister. Show all posts
Monday, August 16, 2010
Tuesday, July 27, 2010
Pregnancy and Chronic Illness: Discuss.
Late July
Pregnancy and Chronic Illness Webinar August 2
Laurie Edwards, of the excellent blog A Chronic Dose and terrific book Life Disrupted, and I will host a webinar on Pregnancy and Chronic Illness at WEGO Health next Monday night, August 2, from 8-9 pm eastern time. Thinking at all about pregnancy with a chronic condition like diabetes, or heck, anything else, and want to hear more perspectives than just mine? Definitely RSVP and check us out!
May 18
Weight, Weight--Don't Tell Me
I met with my endo and the nurse practitioner who works with my high risk OB on Friday.
Two weeks after my last appointment.
The NP was someone I’d never met before, though I suspect I will get to know her very well over the rest of this pregnancy. The first thing I learned, going in to see her, was that I’d gained three pounds in the last two weeks. Bringing this pregnancy’s total to five pounds in ten weeks.
Is that some kind of new record?
I’ll admit that last week, I ate a bunch, and covered for it with ginormous amounts of insulin. I’ve also started eating a LOT of cheese. In part, because cheese doesn’t really wreck my sugars the way many other foods can. I also treat at least one, if not more, insulin reactions a day, with some amount of juice.
So the weight gain isn’t really surprising.
I pointed this out to the NP, and she was all, “are you concerned about your weight?” I replied that it seemed like a lot, and that while I’d lost all my pregnancy weight the first time, I’d put on a good ten pounds or more since starting with actively trying to conceive and taking copious amounts of infertility drugs a few times over the past year. I told her I’d gained 40 pounds with the first pregnancy.
“So do you want to gain 30 this time?” she asked.
“I want to deliver a baby that’s healthy, happy and alive,” I responded. “If I put on more weight, so be it. I need to do what I can to maintain my blood sugars.”
She said she sympathized, that type 1 pregnancies were so hard. Yep. Weight gain is really the least of it.
No one even blinked when I stepped on the scale anytime during my first pregnancy, and that was from a starting point of about 30 pounds over where a height-weight chart says I should be.
The rest of the NP visit was uneventful, because she tried to listen to the baby’s heartbeat through my stomach. I was nine weeks six days that day, and she told me she typically doesn’t hear a heartbeat until 12 weeks. Nothing happened, so she sent me to my endo appointment and told me to return to her office after the endo visit, where she’d do a regular ultrasound to check on things.
You Say 90, I Say 80
I then saw my fabulous Kind Endo, who was pleased that I’d actually brought not just weekly and daily Dexcom readings, but actual logs of insulin rates and boluses and carb counts written out for a few days. Looking at the Dexcom readings, particularly the weekly ones, have scared me. I see a lot of peaks and some valleys, but the valleys don’t freak me out the way the peaks do.
Kind Endo was nonplussed, telling me that I need to just let the insulin do its job and not to worry about short bursts of high blood sugars. She thought I was overcorrecting, and worried that I was running too low at times.
“But I feel fine at 60. And I work from home, so it’s not like I’m driving much with such lows. And I always treat them.”
We have also battled about the target blood sugar I should set on my pump to correct to. I have set it to 80, with the reasoning that you’re suggested to be between 60-99 before a meal, so 80 is in the middle. She argues that’s too low, and that she typically tells people to correct to 100, but that I should correct to 90. We went back and forth on this point.
“Surely I’m not the only patient who fights you on this, right?” I asked. (I end up saying something like this to a lot of people)
“Well," she conceded. "You're a journalist.”
The Downside of Writing A Book
Because my A1c dropped recently, from 6.1 to 5.7, Kind Endo really thinks I’m doing fine, despite the highs I see more frequently due to the CGM. “You really don’t think this baby is going to be deformed because of these highs?” I asked.
“Absolutely not,” she said.
I feel like I overthink everything these days. Mr. Lyrehca, who is just now reading my book, will quote it back to me when I tell him I’m worried. “The book says …. That highs will happen. The book says… that you need to take care of yourself,” he reads.
Whoever thought my published words would be used to taunt?
The irony is that Mr. Lyrehca rarely reads for fun, so he’s s-l-o-w-l-y making his way through the book itself. Which gives him all the more time to find sentences to read back, sometimes citing page numbers as well.
I also think maybe the Dexcom CGM is adding to my fears. Before, I tested regularly, sometimes every hour, but not always. Now, the Dexcom shows me a sharp incline immediately after some meals. Sometimes I can counteract the climb by immediately hopping on the elliptical and doing a 20-30 minute workout, but I can’t always exercise within the hour after a meal. Sometimes I have to work. Or drive. Or do something that makes exercise impractical. And while I can and sometimes do bolus a hit of insulin, the damn stuff doesn’t start working for an hour or two. It is beyond frustrating to see my sugar spiraling upUpUP and know I can’t do anything but sulk and wait for the insulin to kick in and then I watch the spiral reverse and come back down.
Moving Forward
So after Kind Endo, I went back to the NP, who tried to do an abdominal ultrasound (cold gel on my belly), but again didn’t find a great view of the uterine activity. “Would a vaginal ultrasound do it?” I asked. It would, so once again, the Tam Cam did its job and voila! There’s finally a clear shot of what’s going on, and hold-my-breath… all is good.
The NP found the gestational sac, the fetal pole, and look at that--the heartbeat. “It’s in the 150s, 160s,” NP said. “Totally normal.”
The funniest thing was that both she and I could see things moving, as tiny as they are.
“The arms and legs are waving, see?”
And what do you know—I could see tiny limbs all akimbo, dancing around.
Unbelievable.
Afterward, I went to have blood work drawn so that we can learn some early chances of whether this baby has higher chances of carrying some chromosomal concerns. Three years ago, the nuchal fold test was done on the same day as the blood draw, so the full results came after a week or so after the blood was analyzed. This time, they draw the blood first, then we go back in two weeks and see the nuchal fold test. This is where they measure the fold of the back of the fetus’s neck to see if its chances of having Down’s Syndrome are high. Last time, the result came back great, but this time, I’m three years older and officially an old lady being pregnant at 40.
I hope it’ll be all good.
Despite the highs.
Pregnancy and Chronic Illness Webinar August 2
Laurie Edwards, of the excellent blog A Chronic Dose and terrific book Life Disrupted, and I will host a webinar on Pregnancy and Chronic Illness at WEGO Health next Monday night, August 2, from 8-9 pm eastern time. Thinking at all about pregnancy with a chronic condition like diabetes, or heck, anything else, and want to hear more perspectives than just mine? Definitely RSVP and check us out!
May 18
Weight, Weight--Don't Tell Me
I met with my endo and the nurse practitioner who works with my high risk OB on Friday.
Two weeks after my last appointment.
The NP was someone I’d never met before, though I suspect I will get to know her very well over the rest of this pregnancy. The first thing I learned, going in to see her, was that I’d gained three pounds in the last two weeks. Bringing this pregnancy’s total to five pounds in ten weeks.
Is that some kind of new record?
I’ll admit that last week, I ate a bunch, and covered for it with ginormous amounts of insulin. I’ve also started eating a LOT of cheese. In part, because cheese doesn’t really wreck my sugars the way many other foods can. I also treat at least one, if not more, insulin reactions a day, with some amount of juice.
So the weight gain isn’t really surprising.
I pointed this out to the NP, and she was all, “are you concerned about your weight?” I replied that it seemed like a lot, and that while I’d lost all my pregnancy weight the first time, I’d put on a good ten pounds or more since starting with actively trying to conceive and taking copious amounts of infertility drugs a few times over the past year. I told her I’d gained 40 pounds with the first pregnancy.
“So do you want to gain 30 this time?” she asked.
“I want to deliver a baby that’s healthy, happy and alive,” I responded. “If I put on more weight, so be it. I need to do what I can to maintain my blood sugars.”
She said she sympathized, that type 1 pregnancies were so hard. Yep. Weight gain is really the least of it.
No one even blinked when I stepped on the scale anytime during my first pregnancy, and that was from a starting point of about 30 pounds over where a height-weight chart says I should be.
The rest of the NP visit was uneventful, because she tried to listen to the baby’s heartbeat through my stomach. I was nine weeks six days that day, and she told me she typically doesn’t hear a heartbeat until 12 weeks. Nothing happened, so she sent me to my endo appointment and told me to return to her office after the endo visit, where she’d do a regular ultrasound to check on things.
You Say 90, I Say 80
I then saw my fabulous Kind Endo, who was pleased that I’d actually brought not just weekly and daily Dexcom readings, but actual logs of insulin rates and boluses and carb counts written out for a few days. Looking at the Dexcom readings, particularly the weekly ones, have scared me. I see a lot of peaks and some valleys, but the valleys don’t freak me out the way the peaks do.
Kind Endo was nonplussed, telling me that I need to just let the insulin do its job and not to worry about short bursts of high blood sugars. She thought I was overcorrecting, and worried that I was running too low at times.
“But I feel fine at 60. And I work from home, so it’s not like I’m driving much with such lows. And I always treat them.”
We have also battled about the target blood sugar I should set on my pump to correct to. I have set it to 80, with the reasoning that you’re suggested to be between 60-99 before a meal, so 80 is in the middle. She argues that’s too low, and that she typically tells people to correct to 100, but that I should correct to 90. We went back and forth on this point.
“Surely I’m not the only patient who fights you on this, right?” I asked. (I end up saying something like this to a lot of people)
“Well," she conceded. "You're a journalist.”
The Downside of Writing A Book
Because my A1c dropped recently, from 6.1 to 5.7, Kind Endo really thinks I’m doing fine, despite the highs I see more frequently due to the CGM. “You really don’t think this baby is going to be deformed because of these highs?” I asked.
“Absolutely not,” she said.
I feel like I overthink everything these days. Mr. Lyrehca, who is just now reading my book, will quote it back to me when I tell him I’m worried. “The book says …. That highs will happen. The book says… that you need to take care of yourself,” he reads.
Whoever thought my published words would be used to taunt?
The irony is that Mr. Lyrehca rarely reads for fun, so he’s s-l-o-w-l-y making his way through the book itself. Which gives him all the more time to find sentences to read back, sometimes citing page numbers as well.
I also think maybe the Dexcom CGM is adding to my fears. Before, I tested regularly, sometimes every hour, but not always. Now, the Dexcom shows me a sharp incline immediately after some meals. Sometimes I can counteract the climb by immediately hopping on the elliptical and doing a 20-30 minute workout, but I can’t always exercise within the hour after a meal. Sometimes I have to work. Or drive. Or do something that makes exercise impractical. And while I can and sometimes do bolus a hit of insulin, the damn stuff doesn’t start working for an hour or two. It is beyond frustrating to see my sugar spiraling upUpUP and know I can’t do anything but sulk and wait for the insulin to kick in and then I watch the spiral reverse and come back down.
Moving Forward
So after Kind Endo, I went back to the NP, who tried to do an abdominal ultrasound (cold gel on my belly), but again didn’t find a great view of the uterine activity. “Would a vaginal ultrasound do it?” I asked. It would, so once again, the Tam Cam did its job and voila! There’s finally a clear shot of what’s going on, and hold-my-breath… all is good.
The NP found the gestational sac, the fetal pole, and look at that--the heartbeat. “It’s in the 150s, 160s,” NP said. “Totally normal.”
The funniest thing was that both she and I could see things moving, as tiny as they are.
“The arms and legs are waving, see?”
And what do you know—I could see tiny limbs all akimbo, dancing around.
Unbelievable.
Afterward, I went to have blood work drawn so that we can learn some early chances of whether this baby has higher chances of carrying some chromosomal concerns. Three years ago, the nuchal fold test was done on the same day as the blood draw, so the full results came after a week or so after the blood was analyzed. This time, they draw the blood first, then we go back in two weeks and see the nuchal fold test. This is where they measure the fold of the back of the fetus’s neck to see if its chances of having Down’s Syndrome are high. Last time, the result came back great, but this time, I’m three years older and officially an old lady being pregnant at 40.
I hope it’ll be all good.
Despite the highs.
Monday, June 21, 2010
Urban Legend
April 5, 2010
In some ways, 2009 was kind of a rough year. I pulled together all our tax paperwork last week for our accountant, and I noticed, over and over again, all the bills for our medical expenses.
A large chunk of those expenses were for infertility coverage. There was extra insurance to cover the costs of fertility treatments in our state. There were extra procedures to figure out if we can have a girl without chromosomal defects. And sometimes there were extra costs on top of those procedures that aren’t always reimbursed.
That’s a bunch of extras.
And that doesn’t include the ongoing costs: parking and routine lab-work, co-payments and babysitters so we don’t have to schlep our son to these appointments. More to pay to get additional coverage at daycare and nursery school. More excuses. More guarded explanations.
Our three-year-old knows what it means when I say I have to go to an appointment. “What’s the doctor’s name?” he’ll ask. He hasn’t yet figured out which name signifies what medical issue is being examined.
So what exactly did we do in 2009?
* One fresh IVF cycle over the summer, that ended in an early miscarriage and D&E. (transfer July 4th. Try explaining to your friends who have come to your neighborhood to watch the parade in front of your house about why you are leaving your son with a babysitter while you and your husband are trying to sneak out of the driveway. To get to a clinic. That no one knows you are visiting. At 9 in the morning, no less.)
* One frozen embryo transfer in the fall that didn’t develop into anything. (Circa Columbus Day Weekend).
* One vaginal procedure to figure out if there was any scarring obscuring anything en route to the uterus. (The week of Thanksgiving. Some minor scarring, but only enough to direct future people to enter with their assorted medical tools and whatnot “at 7 o’clock.”
* Another fresh IVF cycle that started around MLK weekend, 2010, but ended in an even earlier miscarriage by Valentine’s Day.
We honestly didn’t plan any of this around holidays. It just worked out that way.
For my 40th birthday this spring, the insurance company gifted me with yet another test. To prove that my old lady ovaries were still working properly (and therefore, worth insuring for another round of IVF), I had to do a Clomid challenge. This entailed yet more blood tests, several days of taking Clomid to help amp up my ovaries, and then a vaginal exam to determine my uterus was still clean and clear.
The nurse who did the exam remembered me from an appointment last summer, when she confirmed that I’d need a D&E for a miscarriage/failed IVF. “How are you doing,” she asked mournfully. “Still trying to have a baby,” I replied, all matter-of-fact, with advice: “By the way, go in at 7 o’clock and use a tiny speculum.”
She did and she did. “I see one follicle in here,” she noted. “I’ve been taking Clomid,” I reported. When not being mandated by one’s insurance company to prove ovaries are still working right, Clomid is the first line of treatment when you aren’t conceiving. I’d taken it many cycles before, long before the IVFs and the IUIs, the workups and the endless bloodwork. It had never done much for me, honestly.
But maybe could it work now?
I went home with a new mission.
“Let’s have sex!” I told Mr. L. What did we have to lose? A follicle was in sight. Never mind that we’d been here many times before, so many times that actually having sex for recreational fun was something I’d nearly forgotten how to do. As I had many times before, I bought an ovulation predictor kit and dutifully peed on a week’s worth of sticks.
The ovulation predictor tests were never entirely conclusive, but the egg white mucous pouring out of me one day suggested it was all systems go. Once again, we tried to do what most of the rest of the world does to conceive.
How shocking—we were in a bed, just the two of us! For once, I was not draped in a hospital gown and a paper shower cap, my feet up in stirrups, Mr. L sitting at my side, both of us freezing in a clinical exam room, our eyes glued to a monitor as a pipette with fresh or frozen embryos were gently, carefully, guided through my cervix and into my uterus, as my full bladder threatened to leak all over the doctor doing the transfer, the nurse assisting, and the embryologist who was always there telling us which embryos looked the best for the procedure.
Romantic, no?
But this time, things were a bit more ordinary. The typical way the majority of people conceive.
Again, since I’ve been here many times before and have never gotten pregnant with just sex, without a round of fresh IVF, both the Mister and I carried on with the rest of our lives. My day-to-day blood sugars were okay, but not stellar. My thyroid levels were a bit low. The only minor change this time: I was taking Metformin, a drug my infertility doc recommended, not because my sugars were out of line or because I’ve ever shown any sign of having polycystic ovaries, but because it might “help my hormones,” whatever that meant. I continued to eat deli meat and drink diet Coke.
One week later, at a party, I ate a smidge of Brie cheese. Weirdly, after we were on our way home an hour or two later, I felt sick to my stomach. Mr. L had to pull off the highway so I could find a bathroom. I couldn’t tell if I had to vomit or sit on the toilet for a long time. Thankfully, I didn’t vomit.
“Maybe you’re pregnant,” Mr. L said, after I left the Gas and Go’s public bathroom, shuddering.
“Maybe. Wouldn’t that be something?” I said.
I didn’t have a lot of faith.
In the meantime, we met with a few other doctors. This included another infertility specialist to get a second opinion. She told us she would keep doing what we’re doing, but to stop using PGD, an expensive procedure that tells you the chromosomal makeup (and gender) of embryos before you they are transferred via IVF. We didn't have any history of chromosomal abnormalities, and the procedure might even damage healthy embryos, so it wasn’t worth doing, she told us. A nutritionist said I was on the right track. My endo told me my A1c was 6.1 and that my bloodwork, for the most part, looked fine.
“We did try this month, but I’d be shocked if it meant anything,” I told them all. “Good luck,” they all said. One medical assistant, who waited with me as I waited to see my diabetes endocrinologist, regaled me with stories of patients she’s seen who get pregnant on their own after years of infertility treatment. A friend I haven’t seen in ages told me a distant mutual friend, one I’d lost touch with over the past year, recently delivered her healthy son. The new mom was a woman who’s done as much if not more fertility treatment than me, and had conceived her toddler daughter after a lot of IVF. Her newborn son? Conceived naturally.
I’d always thought these stories were urban legends. You hear about them, but do they really happen?
We had our follow-up appointment with our reproductive endocrinologist on a Friday in April, about two months after the last IVF ended in another early miscarriage. We’d waited the appropriate amount of time. We’d had more bloodwork to see if there were chromosomal or genetic reasons why my last two pregnancies ended so prematurely. Nothing showed up. All we had to do was wait for my period to start and we were geared up to start the next fresh IVF cycle. I was all set to order the drugs the day my period started.
That weekend, my period never showed.
I bought a pricey digital pregnancy test that promised results in three minutes.
In less than one, we had our answer:
We’ve never been here. We don’t know the embryo cell count, the potential for implantation, exactly how many days post-transfer I am. How many were transferred?
That Monday, I went to the infertility clinic for a blood test. The nurse left her message on my cell.
Beta count: 165. “Very good. We want it to be anything over 100.”
Progesterone level, that indicates the uterus is prepping to support an embryo: 40. “It doesn’t get much better than that,” the nurse said.
How did I get here? The Mister and I actually had sex and get pregnant? And me at age 40, no less?
I honestly have no idea.
In some ways, 2009 was kind of a rough year. I pulled together all our tax paperwork last week for our accountant, and I noticed, over and over again, all the bills for our medical expenses.
A large chunk of those expenses were for infertility coverage. There was extra insurance to cover the costs of fertility treatments in our state. There were extra procedures to figure out if we can have a girl without chromosomal defects. And sometimes there were extra costs on top of those procedures that aren’t always reimbursed.
That’s a bunch of extras.
And that doesn’t include the ongoing costs: parking and routine lab-work, co-payments and babysitters so we don’t have to schlep our son to these appointments. More to pay to get additional coverage at daycare and nursery school. More excuses. More guarded explanations.
Our three-year-old knows what it means when I say I have to go to an appointment. “What’s the doctor’s name?” he’ll ask. He hasn’t yet figured out which name signifies what medical issue is being examined.
So what exactly did we do in 2009?
* One fresh IVF cycle over the summer, that ended in an early miscarriage and D&E. (transfer July 4th. Try explaining to your friends who have come to your neighborhood to watch the parade in front of your house about why you are leaving your son with a babysitter while you and your husband are trying to sneak out of the driveway. To get to a clinic. That no one knows you are visiting. At 9 in the morning, no less.)
* One frozen embryo transfer in the fall that didn’t develop into anything. (Circa Columbus Day Weekend).
* One vaginal procedure to figure out if there was any scarring obscuring anything en route to the uterus. (The week of Thanksgiving. Some minor scarring, but only enough to direct future people to enter with their assorted medical tools and whatnot “at 7 o’clock.”
* Another fresh IVF cycle that started around MLK weekend, 2010, but ended in an even earlier miscarriage by Valentine’s Day.
We honestly didn’t plan any of this around holidays. It just worked out that way.
For my 40th birthday this spring, the insurance company gifted me with yet another test. To prove that my old lady ovaries were still working properly (and therefore, worth insuring for another round of IVF), I had to do a Clomid challenge. This entailed yet more blood tests, several days of taking Clomid to help amp up my ovaries, and then a vaginal exam to determine my uterus was still clean and clear.
The nurse who did the exam remembered me from an appointment last summer, when she confirmed that I’d need a D&E for a miscarriage/failed IVF. “How are you doing,” she asked mournfully. “Still trying to have a baby,” I replied, all matter-of-fact, with advice: “By the way, go in at 7 o’clock and use a tiny speculum.”
She did and she did. “I see one follicle in here,” she noted. “I’ve been taking Clomid,” I reported. When not being mandated by one’s insurance company to prove ovaries are still working right, Clomid is the first line of treatment when you aren’t conceiving. I’d taken it many cycles before, long before the IVFs and the IUIs, the workups and the endless bloodwork. It had never done much for me, honestly.
But maybe could it work now?
I went home with a new mission.
“Let’s have sex!” I told Mr. L. What did we have to lose? A follicle was in sight. Never mind that we’d been here many times before, so many times that actually having sex for recreational fun was something I’d nearly forgotten how to do. As I had many times before, I bought an ovulation predictor kit and dutifully peed on a week’s worth of sticks.
The ovulation predictor tests were never entirely conclusive, but the egg white mucous pouring out of me one day suggested it was all systems go. Once again, we tried to do what most of the rest of the world does to conceive.
How shocking—we were in a bed, just the two of us! For once, I was not draped in a hospital gown and a paper shower cap, my feet up in stirrups, Mr. L sitting at my side, both of us freezing in a clinical exam room, our eyes glued to a monitor as a pipette with fresh or frozen embryos were gently, carefully, guided through my cervix and into my uterus, as my full bladder threatened to leak all over the doctor doing the transfer, the nurse assisting, and the embryologist who was always there telling us which embryos looked the best for the procedure.
Romantic, no?
But this time, things were a bit more ordinary. The typical way the majority of people conceive.
Again, since I’ve been here many times before and have never gotten pregnant with just sex, without a round of fresh IVF, both the Mister and I carried on with the rest of our lives. My day-to-day blood sugars were okay, but not stellar. My thyroid levels were a bit low. The only minor change this time: I was taking Metformin, a drug my infertility doc recommended, not because my sugars were out of line or because I’ve ever shown any sign of having polycystic ovaries, but because it might “help my hormones,” whatever that meant. I continued to eat deli meat and drink diet Coke.
One week later, at a party, I ate a smidge of Brie cheese. Weirdly, after we were on our way home an hour or two later, I felt sick to my stomach. Mr. L had to pull off the highway so I could find a bathroom. I couldn’t tell if I had to vomit or sit on the toilet for a long time. Thankfully, I didn’t vomit.
“Maybe you’re pregnant,” Mr. L said, after I left the Gas and Go’s public bathroom, shuddering.
“Maybe. Wouldn’t that be something?” I said.
I didn’t have a lot of faith.
In the meantime, we met with a few other doctors. This included another infertility specialist to get a second opinion. She told us she would keep doing what we’re doing, but to stop using PGD, an expensive procedure that tells you the chromosomal makeup (and gender) of embryos before you they are transferred via IVF. We didn't have any history of chromosomal abnormalities, and the procedure might even damage healthy embryos, so it wasn’t worth doing, she told us. A nutritionist said I was on the right track. My endo told me my A1c was 6.1 and that my bloodwork, for the most part, looked fine.
“We did try this month, but I’d be shocked if it meant anything,” I told them all. “Good luck,” they all said. One medical assistant, who waited with me as I waited to see my diabetes endocrinologist, regaled me with stories of patients she’s seen who get pregnant on their own after years of infertility treatment. A friend I haven’t seen in ages told me a distant mutual friend, one I’d lost touch with over the past year, recently delivered her healthy son. The new mom was a woman who’s done as much if not more fertility treatment than me, and had conceived her toddler daughter after a lot of IVF. Her newborn son? Conceived naturally.
I’d always thought these stories were urban legends. You hear about them, but do they really happen?
We had our follow-up appointment with our reproductive endocrinologist on a Friday in April, about two months after the last IVF ended in another early miscarriage. We’d waited the appropriate amount of time. We’d had more bloodwork to see if there were chromosomal or genetic reasons why my last two pregnancies ended so prematurely. Nothing showed up. All we had to do was wait for my period to start and we were geared up to start the next fresh IVF cycle. I was all set to order the drugs the day my period started.
That weekend, my period never showed.
I bought a pricey digital pregnancy test that promised results in three minutes.
In less than one, we had our answer:
We’ve never been here. We don’t know the embryo cell count, the potential for implantation, exactly how many days post-transfer I am. How many were transferred?
That Monday, I went to the infertility clinic for a blood test. The nurse left her message on my cell.
Beta count: 165. “Very good. We want it to be anything over 100.”
Progesterone level, that indicates the uterus is prepping to support an embryo: 40. “It doesn’t get much better than that,” the nurse said.
How did I get here? The Mister and I actually had sex and get pregnant? And me at age 40, no less?
I honestly have no idea.
Sunday, January 10, 2010
At What Cost?
My period's gonna come any day now, and that's when I start taking the drug that amps up my ovaries.
Until then, I almost feel like IVF hasn't really kicked off yet.
Oh, but it has.
I've been on the Lupron for about five nights now. As I've mentioned before, it's like injecting ten units of insulin. Been there, done that. I even need to time it to a certain hour or so each night, but other than that, I've sort of forgotten about it the rest of the day.
We have a stack of papers that I'm supposed to sign, along with Mister L., and send them off to our IVF clinic. In the past, I've been super on top of this and had everything in like a model patient.
This time, I've gotta go track down a notary to watch the Mister and I sign these things. My nurse tells me to get the paperwork in by the egg retrieval, which I know is more than a week away. (I'm too lazy to go and figure out what my estimated egg retrieval is right now, but I know I've got time).
I also wrote out another check to my secondary insurance plan--the one that pays for a majority of the infertility stuff since our primary insurance covers little. It may have been the Lupron working its hormonal magic, but seeing myself write out the amount of the check made me tear up.
Every other month, since last spring, I've written this check without a problem. Just like every other medical expense, I've told Mister L, it's been matter of fact.
Hundreds and hundreds of dollars in out-of-pocket expenses for diabetes medical supplies, doctor copayments and co-insurance until we hit the "catastrophic out of pocket maximum" our insurance says is the limit before they cover everything else? An amount we hit by April or so each year?
"It's just the way it is," I've told Mister L. Other people pay for their kids' braces, or their rehab stints, or their own health or money issues that may not be chronic like mine, but I know they're coming for everyone one day or another. We pay for health insurance and its assorted coverage for various medical expenses. (We also fund our retirement accounts as much as we can each year. Because although we may be poor by the time we actually make it to retirement age, fuck, yeah! we plan to live that long and enjoy life with whatever our dollars will buy by then.)
However, this week it hit me exactly how much I have paid for this secondary insurance. Along with other out-of-pocket things (parking at the doc's places, acupuncture before and after an embryo transfer, who-the-fuck-knows how much on juice boxes and sugary snacks and other crap to treat who-knows-how-many-insulin-reactions to keep my blood sugars in a tight range for pregnancy or potential pregnancy).
It struck me that all the money that's paid out for diabetes has a result: I am alive. My blood sugars are reasonable enough to get pregnant without worry. My eyes haven't fired up (too many) extra blood vessels and so my retinopathy isn't angry and my eye doctor and endocrinologist are fairly happy with me. Those dollars, to me, have been well spent.
The money for infertility insurance coverage, for genetic testing to figure out exactly what embryos will be viable, the acupuncture, for extra child care so I don't subject other people at the IVF clinic to my toddler running around in the waiting room, and more?
Gone with the wind, baby.
The Mister and I have heated discussions about expenses and where we can cut back and how I can bring in more freelance income. We've spent thousands. My bank account flirts with minimum balances.
So far, it's all been for nothing.
We spent a ton out-of-pocket to conceive our first child, and while it took more than a year from first-fertility-doc-appointment to Welcome-Baby-L!, there finally was an end. From today's vantage point, it was easily the best money we ever spent.
But here, in the midst of my third time trying to do all this again for a second kid, I worry that it might not end so well. Or maybe it will... but we'll have little to no money if and when we ever get there.
Until then, I almost feel like IVF hasn't really kicked off yet.
Oh, but it has.
I've been on the Lupron for about five nights now. As I've mentioned before, it's like injecting ten units of insulin. Been there, done that. I even need to time it to a certain hour or so each night, but other than that, I've sort of forgotten about it the rest of the day.
We have a stack of papers that I'm supposed to sign, along with Mister L., and send them off to our IVF clinic. In the past, I've been super on top of this and had everything in like a model patient.
This time, I've gotta go track down a notary to watch the Mister and I sign these things. My nurse tells me to get the paperwork in by the egg retrieval, which I know is more than a week away. (I'm too lazy to go and figure out what my estimated egg retrieval is right now, but I know I've got time).
I also wrote out another check to my secondary insurance plan--the one that pays for a majority of the infertility stuff since our primary insurance covers little. It may have been the Lupron working its hormonal magic, but seeing myself write out the amount of the check made me tear up.
Every other month, since last spring, I've written this check without a problem. Just like every other medical expense, I've told Mister L, it's been matter of fact.
Hundreds and hundreds of dollars in out-of-pocket expenses for diabetes medical supplies, doctor copayments and co-insurance until we hit the "catastrophic out of pocket maximum" our insurance says is the limit before they cover everything else? An amount we hit by April or so each year?
"It's just the way it is," I've told Mister L. Other people pay for their kids' braces, or their rehab stints, or their own health or money issues that may not be chronic like mine, but I know they're coming for everyone one day or another. We pay for health insurance and its assorted coverage for various medical expenses. (We also fund our retirement accounts as much as we can each year. Because although we may be poor by the time we actually make it to retirement age, fuck, yeah! we plan to live that long and enjoy life with whatever our dollars will buy by then.)
However, this week it hit me exactly how much I have paid for this secondary insurance. Along with other out-of-pocket things (parking at the doc's places, acupuncture before and after an embryo transfer, who-the-fuck-knows how much on juice boxes and sugary snacks and other crap to treat who-knows-how-many-insulin-reactions to keep my blood sugars in a tight range for pregnancy or potential pregnancy).
It struck me that all the money that's paid out for diabetes has a result: I am alive. My blood sugars are reasonable enough to get pregnant without worry. My eyes haven't fired up (too many) extra blood vessels and so my retinopathy isn't angry and my eye doctor and endocrinologist are fairly happy with me. Those dollars, to me, have been well spent.
The money for infertility insurance coverage, for genetic testing to figure out exactly what embryos will be viable, the acupuncture, for extra child care so I don't subject other people at the IVF clinic to my toddler running around in the waiting room, and more?
Gone with the wind, baby.
The Mister and I have heated discussions about expenses and where we can cut back and how I can bring in more freelance income. We've spent thousands. My bank account flirts with minimum balances.
So far, it's all been for nothing.
We spent a ton out-of-pocket to conceive our first child, and while it took more than a year from first-fertility-doc-appointment to Welcome-Baby-L!, there finally was an end. From today's vantage point, it was easily the best money we ever spent.
But here, in the midst of my third time trying to do all this again for a second kid, I worry that it might not end so well. Or maybe it will... but we'll have little to no money if and when we ever get there.
Wednesday, February 25, 2009
Lame Waiting Rooms
Doctor's office waiting rooms—why aren’t they more customer friendly?
I see some of the best doctors in my area. They’re renowned for what they do.
So why are the waiting areas so ghetto?
Right now, I’m in a waiting room where people wait for their eyes to be dilated (yep, another retinopathy check). There's a bunch of chairs facing a big television screen where there’s always some earnest historical show or slow moving travelogue that’s mind-numbing. And with the eye dilation business, it's not like you can read while waiting for your pupils to expand.
I brought my laptop, as I do whenever I know I’ll have time to kill. And not for lack of trying, but there’s no free Internet connection for me to surf onto. And I’m sitting in the middle of a thriving metropolis.
Of course, there are password-protected networks, and heaven forbid I get the password of the office's network because you know I could wreak havoc with patient records. (Please. I've got such better things to do online.) I just want to be able to check my email, surf the Internet, and catch up on work while I sit and wait. And wait.
Mister Lyrehca is seeing a doctor this week and I will need to sit in the office’s waiting room for at least two hours while he’s seen. I just called ahead to try to find out if this location happens to be in an area where I can get to the Internet on my laptop while I wait.
The administrator who answered the phone clearly had no clue what to tell me and told me so. Her coworker overheard her talking and seemed to yell over that “sometimes you can connect, and sometimes you can’t.”
Great.
Why don’t offices like these have wireless free Internet access for those of us in the 21st century who want to work virtually?
Seriously, it's 2009. The Internet and email aren’t going anywhere. And I shouldn’t have to spend more of my hard-earned dollars for a Crackberry or some other mobile device for me to be able to connect wireless when I already have a great laptop and Internet capabitlity right at my fingertips?
Why are these doctor’s offices stuck on a virtual dirt road when it comes to waiting room services?
I see some of the best doctors in my area. They’re renowned for what they do.
So why are the waiting areas so ghetto?
Right now, I’m in a waiting room where people wait for their eyes to be dilated (yep, another retinopathy check). There's a bunch of chairs facing a big television screen where there’s always some earnest historical show or slow moving travelogue that’s mind-numbing. And with the eye dilation business, it's not like you can read while waiting for your pupils to expand.
I brought my laptop, as I do whenever I know I’ll have time to kill. And not for lack of trying, but there’s no free Internet connection for me to surf onto. And I’m sitting in the middle of a thriving metropolis.
Of course, there are password-protected networks, and heaven forbid I get the password of the office's network because you know I could wreak havoc with patient records. (Please. I've got such better things to do online.) I just want to be able to check my email, surf the Internet, and catch up on work while I sit and wait. And wait.
Mister Lyrehca is seeing a doctor this week and I will need to sit in the office’s waiting room for at least two hours while he’s seen. I just called ahead to try to find out if this location happens to be in an area where I can get to the Internet on my laptop while I wait.
The administrator who answered the phone clearly had no clue what to tell me and told me so. Her coworker overheard her talking and seemed to yell over that “sometimes you can connect, and sometimes you can’t.”
Great.
Why don’t offices like these have wireless free Internet access for those of us in the 21st century who want to work virtually?
Seriously, it's 2009. The Internet and email aren’t going anywhere. And I shouldn’t have to spend more of my hard-earned dollars for a Crackberry or some other mobile device for me to be able to connect wireless when I already have a great laptop and Internet capabitlity right at my fingertips?
Why are these doctor’s offices stuck on a virtual dirt road when it comes to waiting room services?
Sunday, February 01, 2009
Achieve to Conceive?
We're actively trying to get pregnant.
And since I may know you in real life, unlike the first time I started chronicling our experience, please keep it to yourself if you see me and want to know "How's the baby quest going?"
It's a lot of waiting.
Not that this is anything new.
I'm in the midst of month one of fucking for fertility's sake.
I dragged out this ovulation prediction software I bought the last time and got it set up on the upstairs computer. So every morning now, I take my temperature and chart it to figure out when I might be most fertile. Or about to ovulate.
The Mister has been sick for more than a week now. The first bout of achiness and sneezing and feeling like crap coincided with--whaddaya know!--with the month's prime time for getting down.
"Tonight's the night," I explained.
"I just can't," he said. "I'm sick!"
Sick, schmick! Do you know how much fine-tuning--of blood sugars, of thyroid levels, of menstrual cycles--it took to get me to this night?
But the guy really looked like doom.
I fumed about this for a bit before I realized that sex the next morning would still count as a BEST TIME! according to my fertility software. So he got the night off.
The next morning, he was up to the task. Still sick. But not incapacitated.
So now I'm about a week away from when my software predicts I'll get my next period. Or I'll feel like peeing on a stick not to check for ketones, but for a possible embryo.
My blood sugars have been all right. I'm trying to test at least an hour after eating, and I've tried to exercise or take a titch of insulin if they're above where they should be. But I definitely don't obsess if my waking blood sugar is, say, 112 instead of 70-90 mg/dl.
I'm slated to see my Kind Endo for a regular checkup this Friday. Around the same time when my period is due.
It would be mind boggling beyond belief if I were to actually get pregnant the first month of trying for Baby #2.
But for the next week or so, I'm willing to be boggled. I'm willing to join the bloggers I read who naturally conceived after doing IVF.
Stay tuned.
And since I may know you in real life, unlike the first time I started chronicling our experience, please keep it to yourself if you see me and want to know "How's the baby quest going?"
It's a lot of waiting.
Not that this is anything new.
I'm in the midst of month one of fucking for fertility's sake.
I dragged out this ovulation prediction software I bought the last time and got it set up on the upstairs computer. So every morning now, I take my temperature and chart it to figure out when I might be most fertile. Or about to ovulate.
The Mister has been sick for more than a week now. The first bout of achiness and sneezing and feeling like crap coincided with--whaddaya know!--with the month's prime time for getting down.
"Tonight's the night," I explained.
"I just can't," he said. "I'm sick!"
Sick, schmick! Do you know how much fine-tuning--of blood sugars, of thyroid levels, of menstrual cycles--it took to get me to this night?
But the guy really looked like doom.
I fumed about this for a bit before I realized that sex the next morning would still count as a BEST TIME! according to my fertility software. So he got the night off.
The next morning, he was up to the task. Still sick. But not incapacitated.
So now I'm about a week away from when my software predicts I'll get my next period. Or I'll feel like peeing on a stick not to check for ketones, but for a possible embryo.
My blood sugars have been all right. I'm trying to test at least an hour after eating, and I've tried to exercise or take a titch of insulin if they're above where they should be. But I definitely don't obsess if my waking blood sugar is, say, 112 instead of 70-90 mg/dl.
I'm slated to see my Kind Endo for a regular checkup this Friday. Around the same time when my period is due.
It would be mind boggling beyond belief if I were to actually get pregnant the first month of trying for Baby #2.
But for the next week or so, I'm willing to be boggled. I'm willing to join the bloggers I read who naturally conceived after doing IVF.
Stay tuned.
Thursday, November 20, 2008
Stars In His Eyes
My name is Lyrehca and I am married to a Craigslist Addict.
The Mister spends hours cruising the listings of Craigslist searching for gadgets, free or cheap, that he can acquire, futz with, and show off to our family and friends
Our house is sort of like a museum.
Tonight, we became the proud owners of a jukebox that has 45 records from the 1960s and ‘70s. It took three of the Mister’s burliest friends, the better part of four hours, and $80 (for the music; the jukebox itself was free) to get this thing into our house.
Why free, you ask?
The jukebox has electrical problems and doesn’t currently work.
For the Mister, this poses an interesting challenge and bragging rights. He tends to get things like this working again. For the next week or two, he will submerse himself into all things jukebox, pondering and tinkering. He already joined a Yahoo group of jukebox enthusiasts and posted questions about the electrical system.
(Never mind that four days ago, the Mister didn’t even know such a group existed, or that he would become its newest member. The man never even bought a 45-record for himself as a kid.)
The jukebox is sitting in a room with a full-size antique telephone booth that’s been fully restored. The next room in our house is filled with dozens of antique telephones that feature fruit (a banana phone), TV characters (the Incredible Hulk) and personal hygiene (the Crest toothpaste phone is my favorite), among others.
And did I mention the airplane seats?
These were the first things the Mister found on Craigslist—two actual business class seats from a retired TWA jet. They sit in front of a cheap TV also acquired from Craigslist. Right now they’re rooming with the jukebox.
I only agreed to the jukebox because I found my own 45 records from the 1980s in our basement. We’ll swap out the ‘60s stuff we don’t know for my tunes. Ten years from now, our son will nod and smile at his crazy parents as he’s plugged into his iPodmicrochip-music-device of the future.
All this to say that I’m about to have a stash of unopened vintage Minimed 508 supplies as soon as my new Animas Ping arrives. I have lancets and old boxes of syringes, too.
You think someone will want the stuff on Craigslist?
The Mister spends hours cruising the listings of Craigslist searching for gadgets, free or cheap, that he can acquire, futz with, and show off to our family and friends
Our house is sort of like a museum.
Tonight, we became the proud owners of a jukebox that has 45 records from the 1960s and ‘70s. It took three of the Mister’s burliest friends, the better part of four hours, and $80 (for the music; the jukebox itself was free) to get this thing into our house.
Why free, you ask?
The jukebox has electrical problems and doesn’t currently work.
For the Mister, this poses an interesting challenge and bragging rights. He tends to get things like this working again. For the next week or two, he will submerse himself into all things jukebox, pondering and tinkering. He already joined a Yahoo group of jukebox enthusiasts and posted questions about the electrical system.
(Never mind that four days ago, the Mister didn’t even know such a group existed, or that he would become its newest member. The man never even bought a 45-record for himself as a kid.)
The jukebox is sitting in a room with a full-size antique telephone booth that’s been fully restored. The next room in our house is filled with dozens of antique telephones that feature fruit (a banana phone), TV characters (the Incredible Hulk) and personal hygiene (the Crest toothpaste phone is my favorite), among others.
And did I mention the airplane seats?
These were the first things the Mister found on Craigslist—two actual business class seats from a retired TWA jet. They sit in front of a cheap TV also acquired from Craigslist. Right now they’re rooming with the jukebox.
I only agreed to the jukebox because I found my own 45 records from the 1980s in our basement. We’ll swap out the ‘60s stuff we don’t know for my tunes. Ten years from now, our son will nod and smile at his crazy parents as he’s plugged into his iPodmicrochip-music-device of the future.
All this to say that I’m about to have a stash of unopened vintage Minimed 508 supplies as soon as my new Animas Ping arrives. I have lancets and old boxes of syringes, too.
You think someone will want the stuff on Craigslist?
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