Hair of the dog

Having decided that perhaps I've actually climbed out of the deepest ditch of grief related to all . . . this, I've recently tasked myself with curing what I view as my lingering IF hangover.

Doing so involves actively adding things back into my life that I've avoided for the past 7 or 8 months. I'm talking things that I associate with IF, treatments, The Clinic, and/or loss — but that still have a place in my real life, post bender.

CRAP I'M MAKING MYSELF DO:

Consult with the acupuncturist that helped me through the IVFs. I don't think I've blogged about this . . . but as my body chemistry tries to reclaim its formerly glorious groove after treatments/pregnancy, I've been experiencing bouts of pronounced hormonal hijinks that result in, among other things, regular pains to the head. It all started with biweekly migraines (December through March) before settling into a much more palatable pattern of lesser — but still sometimes sick — headaches: I can expect them at O time, the middle of the LP (hello, Estrogen Dip), just before Auntie F shows, and then one more time as AF sputters to an uncomfortable end.

The clinic's primary acupuncturist has agreed to help me ease into a new hormonal "normal." Mostly using (inexpensive) herbs, and also with occasional needlings. I've clearly gotten better on my own with time, increased exercise, and learning how to recognize/respond to signals in time to help either preempt or soften any head games. But, these spells (or whatever the hell) are disruptive to my typical days of otherwise feeling healthy, sane, and not so sad. Time to take care of it.

Get back to using a few, but not all, of the supplements I used to enhance fertility. Some I do not need. But others really help keep my perimenopausal (one can only assume) system on an even keel, and adding them back in — after going cold turkey, mind you — has helped with the headaches and, by default, my general mood.

Put a new mammogram appointment on the books. I canceled 2 appointments in 2008 due to pregnancy. Continuing to put off scheduling one now helps no one.

Do the business of life near both local clinic branches (when it makes sense to). That means eating at at area restaurants, visiting the acupuncturist's near-one-clinic's office, patronizing a favorite market, and feeling zen about driving through the 2 rather large swaths of the greater metro area I'd been completely avoiding.

Schedule more visits with family, both here and there. This is no small thing. I did visit my parents in March (which was difficult not because of them, but because it took SO much energy for me to act okay), but we need to put ourselves back in circulation as a couple, as our special brand of family unit. As it stands right now, some of our people are coming here in September, and we are visiting others in December.

Bow out or in, as I like. I'm cutting out a few things I took on during my flinging phase (which was good for me, btw) that I just do not want to do. I'm also getting back into a couple of things I gave up but came to realize weren't an actual problem.

Really plan what to do with that extra bedroom. You know, for a couple of months (okay, 4 or 5), my desire to sell the house was strong. It's bigger than we need and not of the style/location we'd have chosen had we known. But now is not the time for us to sell. I'm over the intense resentment I felt toward the house and ready to peacefully exist in it until it truly is time to move on. That room must be good for something.

Call the clinic to settle a couple of things. Namely, (1) to find out whether we have any sort of credit on account and how quickly a refund might be issued if we do (although I'm pretty sure we don't), and (2) to donate DH's banked swimmers to research or something so we can stop paying the storage fee.

File last year's freaking taxes. That's right, I got an extension. The 2008 filing will include big fat mention of our big fat out-of-pocket medical expenses. I couldn't deal with it in January and didn't feel that much better about it come April. I'm ready to clear the air of it now, though. Hoping Uncle Sammy won't get all curious. We certainly have all receipts and such, but still. That part makes me nervous.

Things to do, things to do!

Maybe the octuplets' story will shock the right people?

Ever since the new Eight Is Enough cast was born earlier this week, I've been trying to keep my distance from the story. Mostly because I find the reports that try to ramp up the freak-show aspects of it distasteful.

"Here's an exclusive look at the biggest baby bump EVER caught on tape!
(Naturally, the woman sporting it was half-naked, writhing around, and screaming from the pain of labor. Who would give permission for that to air?)

"How many babies can a human uterus hold, anyway?! We'll get to the bottom of it!!!"
(That report was informative if you listened to the doctor's explanation, but the breathless reportage surrounding it just made it sound like human litters are awesome and "YOU could have one too.")

"Strung together, the diapers those kids will go through could circle the earth 5 times!!!"
(Nobody ever says whether they're calculating with fresh nappies . . .)

Today at least we're getting more details. We need them to help put the situation in context for proper public consumption. I'm glad to see the ASRM president (who consults at our clinic) firmly stating that higher-order multiples are never the goal with an ethical doctor and that ASRM is already investigating what exactly happened with the mother's fertility treatment.

I'm not going to judge the mother here. My opinion only, but I think the unfolding story points to some issues that go beyond simple irresponsibility or greediness, the two most popular suppositions about her motives for having not just octuplets, but octuplets in addition to 6 other kids. I have to believe that this person just doesn't have the capacity to understand reality in all its glory. I don't know why she might not. But some of the details make that seem likely to me and so I have to wish the best for her and those innocent babies.

I hope the family does disappear from the spotlight, just as they say they will. If they do, maybe there's an opportunity here to bring more discussions of IF and insurance coverage for ART to the forefront. I'd prefer dialogues NOT about how many children someone should have or who gets to have kids and when . . . but talks about making ART accessible, affordable, and always ethical. And if people gain a little more understanding about how IF affects others' very lives, well, great.

Is that possible? Am I hoping for too big of a logic leap?

Or will this circus do nothing but further stigmatize use of ART and bring even more discussions about responsible care, family-building options in general, and the overwhelming expense of the pursuit of ART to a staggeringly silent halt?

Guess we'll see. I think I'll shoot off some emails to ASRM, RESOLVE, and INCIID encouraging them to step up to the mic while it's still live.

I've got no real conclusion in mind, so please accept instead a relevant Friday funny from the Onion.

This was a bad day to look at my retirement funds

Ugh. I held off peeking at the volatile-economy-driven losses in my retirement funds until last Sunday — the day before all payments for IVF #3 were due.

The news was as expected. Sobering. Then came today's downturn. I read that this marked the 20th business day out of the last 23 that the Dow has logged a triple-digit move. Today it was down 733 points.

I couldn't stop myself from looking at my funds again. It's sick-making on a number of levels.

At the top of the list here and now, of course, is that IVF is so very, very expensive.

DH and I have talked, many times, about the serious financial hit we've volunteered to take. We've been revisiting the topic this week (and last), while there's still time to back out and bury the money in the backyard. But we keep coming to the same conclusion: The hit still seems worth it, even if all we get is a chance.

New weeks rule!

It's been quite the week since I last checked in. Just when I was feeling smug for regaining some measure of control over how my days played out, things went nuts on me!

Nothing truly serious happened. Just a bunch of things that can throw a gal for some loops:

We had a sick dog that required lots of extra monitoring (and cleaning) and care (and cleaning). She's doing better right now. Hoping the good health sticks.

We fought the scourge of fleas (which, long story super-short, we now think we never had). Talk about situations that leave you feeling physically and emotionally drained . . . and helpless . . . and gross.

I got whiplash from the offer/implosion of a juicy last-minute "We must have YOU . . . NOW" writing gig. I frantically called in favors so I could fit it into my schedule, and then — just like that, as I was ready to dig in — I heard from the client, "Oh, were you counting on that? Sorry. We've killed that deal." Ah, well. Looks like I'll have just part-time work during the upcoming IVF. Maybe that's for the best.

A clinic employee who had (with NO prompting from me) flat-out offered to front us some sample meds for this IVF totally backtracked last week. When I called to plan my pharmacy order, it became clear that the "I want to help you guys out" conversation never officially happened. Grrrr. Luckily when we made our decision we factored in the possibility of that "help" saving us $0. But still. Grrrr.

My severe allergies paid a visit and then I had an allergic reaction to the allergy meds. Who knew that solid red rashes ("Look, it's Mother Teresa's face on my thigh!") and severe abdominal pain were potential side effects from a popular 24-hour OTC antihistamine. The abdominal thing is really rare, but I'm special. Yay! I was thisclose to an ER visit, but the on-call nurse's advice got me through the night.

And, as the perfect topper, all the round-the-clock nose blowing I did gave me a red-hot ear infection. I can't tell you how peeved I get when I need a doctor's visit for, uh, health reasons. I know it's silly, but it makes me feel weak. Like a big fat failure. (I know. It's a wee problem.) The fact that my PCP, who does NOT like to prescribe medications (a reason I like him), said that I had to take antibiotics didn't help my mindset. In the last calendar year alone — all due to having surgeries and so far completing two IVF cycles — I've taken more rounds of antibiotics than I have in at least 25 years, maybe even my life. And needing the pills now for an actual illness I felt responsible for inflicting (I already acknowledged it's a problem, okay?) pi$$ed me off something fierce!! I am against what I believe to be the long-time overuse of antibiotics in our culture. Of course I want people to get them when necessary. And I am a people. But all I could think about that first night (and I was up for all of it, shivering with fever and coughing/nose-blowing my brains out) was well here's another lovely side effect of IF: my year-long spate of antibiotics-swallowing (DH's too) may mean that I will now need more of them going forward . . . and so now I can add personally contributing to the rise of drug-resistant bugs that will effectively end the world to the list of things I thought I'd never do in the seemingly simple interest of trying (and trying . . . and trying) to have a baby. I've calmed down about that one since my fever broke Friday night.

I'm so glad it's a new week . . .

It's sunny and hot and blue. My marigolds are in full purple bloom. The house is definitely insect free. All clothing, carpets, and upholstered items are clean, and all surfaces are up to Mom's-visiting standards. I actually tasted my breakfast egg and nectarine. The dog is lolling in a sunbeam with a little grin on her face. I have no tissue in my hand (or pocket, or on the desk). I got an overdue paycheck in the mail. Tonight DH is running my errands and bringing dinner home.

Today is a fantastic day to be alive!

I want a microfluidic chip in my culture medium too!

Just read this article about new IVF technology on the horizon.

If findings hold up, it sounds like IVF-ers of the future will get more accurate information about embryo quality, which in turn will improve success rates and lower costs.

9.82

My IVF nurse just called with my most recent HCG reading. It's 9.82 — low enough that the clinic doesn't need to check it again. I think it's hilarious that I'd hoped for a single-digit report today and, for the first time ever when giving me a beta reading, they tacked on some decimals.

No matter. I am free from the needles! All post-D&C bleeding stopped last Wednesday (this was also the day on which I regained a nice semblance of hormonal sanity), and the no-bleeding thing has been a huge relief.

This Thursday I'll see Dr. K for a cycle debriefing. It's a "complimentary" consult, but I plan to get more than my money's worth. I've started a list of questions, the answers to which should help (we hope) narrow the focus of our decision-making discussions at home.

The nurse asked if we knew what decision we're leaning toward. Funny!

I didn't tell her that recent very serious considerations have included my getting an elective hysterectomy and rescuing a few more dogs (that was my insane self talking early on, and really meaning it); ditching the careers and opening a coffee shop on Norman Island (Travel Channel trance-a-thon, anyone?); somehow ramping up the careers, selling the house and cars, and moving into a tiny no-kids-allowed condo in the city; and — brace yourself for the big swing — draining our retirement savings and pursuing ART until something sticks or we are homeless.

Luckily none of those options sound brilliant anymore. Calm, practical heads all around.

Still, I have no idea what we'll do.

Beta result near end of rambling post

"Your insurance will pay for this one."

Today was the first time I'd ever heard that as I checked out at the clinic. It was an all-around strange experience because I saw all-new-to-me staff. The whole thing felt totally impersonal, but what are you going to do.

I got in and out of there in just a few minutes. Back in my car, I turned emotional fast. I just wanted to KNOW. I wanted to know today's result, and Monday's, and Wednesday's. And I wanted to see a sac during one ultrasound and a heartbeat during the one after that. I wanted to make it past 6 weeks, 8 weeks, 10 weeks, 12 weeks, 17 weeks, 22 weeks, and all the way through. I wanted to hear that first cry at delivery and be told "S/he's perfect." I wanted to proudly watch my child grow and learn and work and live.

I wanted all of that OR for everything to end with this afternoon's phone call. I wanted all or nothing, and I wanted it before sundown.

I didn't cry in the car, but I thought about it. I just felt robbed of getting to hope for things and also silly for thinking about all the things that can go wrong. Of course today's news wouldn't tell me anything beyond today's news. And I had to live with that. It's out of my hands. Still.

So I reminded myself that we'd come this far. That's despite one well-respected RE telling us he wouldn't treat us, another pointedly and pooh-pooh-ing-ly saying "I wouldn't" when referring to whether we should try again after our failed cycle, and the other — our primary RE — stressing to us (as she should have) that our chances for a pregnancy from this cycle were only 10% and odds that we'd get a take-home baby, if something stuck in the first place, were just 1 in 5. This far is good.

Despite all the grim possibilities that haunt me, this day, in the churning sea of wary, weary days leading up to it, has ended on a positive note:

At 14dpo/11dp3dt, my beta came back at 192.

That is real. That is solid. That is really solid. Of course it has to be monitored, along with many things to come. But right now things are good, and I can work on making it to the next benchmark.

Tonight, though, I will relax.

Ring, dang it all, ring!

I'm 10 days away from my estimated suppression check — so the real flurry has not yet begun — but I'm already needing to stick close to the phone just to stay on top of things.

Nobody involved on the other side of my IVF process EVER picks up the phone when I call. I spend what seems like a lot of time sitting through very long voicemail announcements leading up to the beep. Sometimes I pass out a little and miss the beep. Other times I suffer a minor blank out and hear the beep but forget whose voicemail I've dialed in to. Today, though, I was fresh enough to get all my messages recorded and, presumably, deposited at the back of a long queue.

People who hold small bits of my future in their hands that I would like to but won't hear from before the day is out:

My acupuncturist, J. I need to set up this week's 2 appointments. I wanted to do this Friday with J's assistant M, but M wanted to touch base with J on the weekend, call me herself on the weekend, and then have me call J on Monday. Okay. Convoluted, but I can adapt. Now I just need J to call me back, which always seems to take 2 days.

My RE, Dr. K. I want more information from her about the timing of my upcoming Cetrotide shot. I am not satisfied with the nurse's assertion that my ovulation date doesn't matter and that we only need to go by my typical cycle length. Especially since Dr. K initially described the protocol as starting at 7 DPO. I could press the issue with the nurse, but I just want to cut to the chase for an explanation better than "it doesn't matter." If it doesn't matter, I want to hear it from Dr. K because she will at least give me a why.

I also want Dr. K to okay the banking of an, ahem, sample from DH before he flies away to the opposite coast next weekend. DH has planned to fly back as soon as it's time for me to trigger. He WILL be here for ER and fresh-sample donation. But a popsicle in the freezer would help us both let go of niggling worries that his flight will be delayed or WHATEVER.

My financial counselor at the clinic, C. She and I thoroughly discussed costs before DH and I got the cycle balls rolling. But I received — from a different financial counselor — a bill that does not reflect the credit amount we have with the clinic, the base fee C and I used to calculate costs on the phone, or the 10% discount I get for being a repeat customer. The bill is about $2K higher. And I'm not having that. I don't anticipate a problem, really. Just a "Sorry for the error," which is all I think it was. But still, it took me 2 weeks and 5 phone calls to get the first cycle total in the first place.

My fertility-meds pharmacy rep, A. We discussed everything from the giant Rx order before the ship date, but I received a couple of things I asked them not to send. Nothing big, just a second sharps container ($30 is $30, and I told her I didn't need it) — oh, and narcotics I'm allergic to and don't intend to pay for.

Everything is going fine right now, really. Despite this maybe sounding like a bunch of complaints, I don't have any big ones at the moment. Just the one where I say WHY IS THIS PHONE-TAG GAME SO CONSISTENTLY ONE-SIDED?

Ring, dang it all, RING!

Choices

Today I'm grappling with an issue of work, finances, energy, and emotional health. How do all those things affect an IVF cycle? And me?

I'm a freelancer, so I'm constantly hustling to keep a steady workload. Work begets work, and all that.

Well, a major project of mine was slated to finish up by the end of March. Now, though, it has been extended by 3 months and the client just offered me the job of seeing the thing through to the end. The pay is good. It amounts to, naturally, the exact cost of our IVF cycle. (Why does it have to be that very amount? What does that MEAN, mighty Universe?)

I want to say yes, because that is how you keep your business going. It can be feast or famine, and you never know when the next dead period might hit. If it's a good deal and you know you can pull it off (even if that means you put in long, long days), you say yes.

On the other hand, I want to say no. I had a TERRIBLE time keeping it together during the last cycle attempt. I wasn't overly emotional or stressed, but I was impossibly distracted. That Lupron messed me up. Somehow I accomplished all work goals, but it was rough going. Should I really set myself up for that a second time?

Here's the part where I talk myself through it.

Possible reasons to accept the job:

• I won't be on Lupron this time.
• I've done this before and might be better at it a second time.
• The money on top of other expected income would make those 3 months particularly lucrative for this or any year.
• This would be extra money that we weren't factoring in when we decided to go ahead.
• Taking it keeps me in good with a client I want to keep happy.
• I think being super busy helped me not obsess too much over the last cycle.
• If things don't go well with the cycle, having the extra work may help me cope.
• Work may indeed be the only thing I have to keep me busy in my old age, so I should focus on that.

Possible reasons to decline the job:

• I will still be on drugs, one of them new. I don't know how I'll feel.
  
• This would be a heavier workload than I had during the last cycle. It's really too much, and my list should stop here.
• I should create breathing room where I can, and not be the catalyst for my own suffocation.
• I have enough other work lined up anyway.
• This would be extra money that we weren't factoring in when we decided to go ahead.
• I've already made this client happy.
• I can't do everything just because it's there.
• I can't do something just because the client wants me to. (This is a different concept than the one above.)
• After 15 years in the business and 6 working for myself with maybe 2 too-short-for-my-liking dead times, I need to acknowledge that I am not in a feast-or-famine situation. I can get more work.
• What kind of crap attitude is that last point under "reasons to accept"?

The Universe (or its minions) is toying with me by dangling that exact cycle fee in my face. If it was any other amount, it wouldn't stand out as anything but extra work I don't need. But because it equals the cost of IVF, I'm in the position of choosing money and meaningless pursuits over sanity and my best shot at getting my heart's desire. Something Else over Me.

I'm calling the Universe's bluff and choosing Me for a change. Now is as good a time as any to mix things up.

Baggage: What dreams are made of

So, I've been pestering the clinic for a detailed accounting of where our up-front IVF cycle money went, and most important, EXACTLY HOW MUCH WE GET BACK. The money is an issue and does affect our next steps. Because we went no further than ER, we should at least get money back for things like ICSI, AH, embryo coddling/fertilization reports, transfer, and the beta finale. That's my position, anyway. Nobody did any of that stuff. The clinic is happy to help but is taking its time getting me the info.

Yesterday's mail brought a note from the finance department, so we thought "Finally, here it is." Wrong-o, it's a BILL. For $20. Due upon receipt. It's strange because it's listed as a copay x 2 for a date neither of us went in. It looks like they successfully submitted a charge to insurance after the fact, though. We'll see, more money back for us, perhaps. I expect to know where we stand early this week.

For old time's sake last night I dreamed about the doctor who wanted to treat me to a hysterectomy for the "leaky faucet" he so expertly diagnosed 22+ years ago. I said no to the uterus removal and got a godsend of a second opinion (chronic hemorhagging clearly due to removable fibroids), but not before I'd let him spend a year pursuing myriad ineffective procedures while my life, health, college career, and relationships suffered. I was young and desperately trying to make everything work, and I just kept taking that doctor's "medicine" for too long.

The dream started with me sitting in my home office. My phone rang: Dr. Leaky calling. He wanted me to stop into his office, which was — conveniently enough — suddenly located in my laundry room. I trotted right on over to talk $$$. Oh no, sorry, no refunds for the IVF, he quickly explained. He then handed me a plain white envelope (clearly from my own stash). He encouraged me to put the $20 right on in there; he figured that was easiest since I had the cash in my purse. I said, "What exactly is this charge for?" And he told me it was for the extra unplanned hour he'd recently spent thinking about my case and concluding that he'd been right all those years ago . . .

Turns out I have money issues, lingering emotional baggage, AND the subconscious of a simpleton. Nice!

I happen to know that Dr. Leaky is long dead. I woke up rolling my eyes at him for taking time out of his afterlife to rattle some of my rusty old chains.

Suppression check, mock transfer, pay(them)day

During today's suppression check, they found a 23–24 mm cyst on my right ovary. Small enough that we think things will move forward on roughly the same schedule. But big enough that the nurse couldn't get a clear AFC on that side. Had blood drawn to see how much estrogen the thing is churning out. Will know tomorrow and get further instructions on the meds from there.

They also did a mock transfer today (that went beautifully) and showed me the catheter type they use to do the real transfer.

And, I paid the main cycle charges. An ouchie total of about $13K. That's on top of last week's meds bill for just under $4K.

Remember how I thought "Take the Money and Run" might be a sign from the Eagles? That happened the day I originally thought we had to pay up. But I had the date wrong. So, technically, that sign couldn't have applied. I wasn't looking for a sign today, not even thinking about it, but when I pulled into the lot this morning I did get one. The tune that DH tells people is "ours" (but it's not) came on (that would be "Dude Looks Like a Lady"). It made me laugh out loud and reminded me that DH was with me in spirit today.