Results

Day 3 bloodwork (estrogen, FSH, LH, TSH, and prolactin) and ultrasound were normal, and I have 16 antral follicles, which I had never heard of before but which is a really good predictor of how ovarian stimulation for IUI or IVF will work.  Apparently 16 antral follies puts me in the best possible range!  Only weird thing from the ultrasound is that apparently my left ovary sits a little low, more on the tip of the uterus.  I think Leftie there just likes to be different, just like me.

Progress

I'm getting up at 6:45 tomorrow so that I can go in before work and have my bloodwork and pelvic ultrasound done.  DH was asking if I wanted him to go; I told him no, since the bloodwork is the worst part of it and we won't get results right away, but that I appreciated him asking.  (When I texted him earlier about the appointment, auto-correct changed "bloodwork" to "bloodworm," and DH said he didn't realize it was going to be as invasive as that!)  Shady Grove calls you the afternoon of the day your tests were to give results, so in less than 24 hours, I'll know at least a little more than I did before. 

I also scheduled my HSG today; that'll be August 5.  DH can't be there for it because of stuff that he has for work.  I told him it should be ok since even though the paperwork says it's better if someone's there, it's so they can drive you home if you ache too much.  I'm going to be going straight to work after the HSG, so that point is kinda moot.  DH said very emphatically, though, to call him if I was too achy to go to work and needed him to take me home.  He's so sweet.  :-)

Raising Awareness

First of all, I'd like to congratulate Katie at From IF to When on her 2011 Hope Award for Best Blog!!!  There's also an article in today's Wall Street Journal about infertility.  I had seen an excerpt from this online a few days ago, but I enjoyed reading the full article.

The bigger (ok, to me) item related to raising awareness, though, was an email I got from RESOLVE yesterday and was finally able to read in depth today:

Dear Jessie,
Bloggers are so important to the infertility community.  You share your stories and insights into a very personal journey.  We have another way for you to raise awareness.  RESOLVE has partnered with a major women’s magazine to develop an exciting project to raise public awareness about infertility.  We need your help to make this a success.

A big part of this awareness campaign will be a video component.  We need a number of RESOLVE community members to submit the first videos.  Your videos will serve as examples and inspiration for when we ask the larger audience to submit videos when the campaign launches in November.  

So here is your script:  “I wish I’d known…”  

Then it’s up to you.  What message do you want to share?  Tell us what you wish you’d known about fertility drugs… or about adoption...or about IVF...or about being a foster parent...etc.  Tell people who haven’t dealt with infertility how you would like to be treated.  

Videos should be short and sweet – one to three minutes. We are taking a grassroots approach to this, so don’t worry about fancy production.  Uploading your video will also be easy.  Videos will need to be submitted by September 1.

If you would like to participate, here’s what we need from you now:  send an e-mail to Andy at aschwarz@resolve.org with your name, age, state, and what topic you plan to talk about. You do not have to send a video right now. 

Andy will follow up with you in the upcoming weeks with a few more details as well as those upload instructions.  Thank you for considering lending your voice (and face!) to this exciting public awareness campaign!

 I already told DH I'll be needing help with filming my video about the things I wish I had known about insurance coverage of infertility.  Like when I participated in the Bust an Infertility Myth Blog Challenge and when I emailed and called my Senators about the Family Act of 2011, I feel good about being able to do something other than just my random posts to advocate for infertility awareness and consideration.

And Now the Post You've All Been Waiting For!

For the lucky 100th post, we learn about The Appointment.

I was so NOT ready for the alarm to go off at 5:45 AM, but I had scheduled a 7:15 appointment when later ones were available in order to interfere with DH's workday as little as possible.  After dealing with all of the new patient stuff, we met with Dr. McKeeby.  He looked at our paperwork, and we pointed out the most pertinent parts. 

We discussed the possibility of PCOS that had been raised by my OB, and he said that PCOS does not appear to be the problem.  I could still have polycystic ovaries, since PCOS is a symptom of insulin resistance rather than the other way around, but the 18 months of basal body temp charts with LH surges marked indicate that I am ovulating the way I should be.  Plus, I don't have any of the other symptoms of PCOS.  I'm going to continue to take the Metformin that my PCP had given me, but he prescribed it to help prevent/delay the metabolic syndrome that I don't have yet but am at risk for, rather than for infertility.  

OK, so if it's not PCOS, what is it?  Dr. McKeeby said that DH's previous results look close enough to normal to not be a concern, although he is of course going to have to repeat the testing.  We both have to have bloodwork (a repeat for me) to make sure we don't have HIV, Hepatitis B or C or syphilis (insert Grey's Anatomy Season 1 joke here).  The more key things, however, will be the tests I'll have done in the next couple of weeks.  Day 3 bloodwork (testing FSH, TSH, estrogen, and prolactin levels) and another pelvic ultrasound, and several days later a hysterosalpinogram (HSG).  For those who don't know infertility terminology, that involves putting dye into my anatomy to look for problems, especially with the fallopian tubes.  From what I hear, I will be very definitely taking a couple of Aleve ahead of time, because it hurts.  Not like a sprain or break hurts or anything, but enough for me to want the meds.  DH wants to be there with me for it, which I thought was really sweet.  Fortunately for us both, we can get it done at a non-Shady Grove facility in Annapolis rather than going all the way to the main SG office in Rockville.  One thing that I love so far about SG is that they will call me later that day (or Monday if it's on a weekend) with results of bloodwork and other tests...almost no waiting!

Based on all this, we'll be looking at either Intra-Uterine Insemination (IUI) or IVF.  IUI is less invasive in a lot of ways and involves few if any needles going into me.  It does have an increased risk of twins, but not much risk of higher-order multiples, and we wouldn't mind twins.  IVF has for people like us about triple the success rate of IUI and more control over how many babies are likely, but it involves a lot more needles and hormones and anesthesia.

Our nurse, Crystal, then came in.  Yes, we get one designated nurse to work with through all of this rather than just dealing with whoever's available at any given time.  So far, I am loving the service!  She went over the testing with us, as well as how to get it done.  Once I hit Day 1, I'll call her and she'll schedule me for my testing.  She also told me to go ahead and start taking prenatal vitamins again (if you remember, I stopped taking them months back when I lost hope completely).  That felt kinda weird tonight, digging the bottle back out from the bottom of the bin where we keep medications and first aid stuff.

Crystal then took us to Darlene, who handles the finances.  She had talked to my insurance company when we were with Dr. McKeeby and Crystal, and she found out that my insurance apparently doesn't cover IUI.  I had thought that all of the mainline IF treatments were covered, but looking back at my emails when I got to work, I saw that the insurance broker had said the policy didn't mention IUI one way or the other and that she would need to look up the procedure codes.  I called Darlene and got the codes from her, and the insurance broker will get back to me by the end of the week on whether they're covered. 

DH and I talked about the possibility of IUI not being covered on the way to the cars.  My main feeling was that I would hate to have to go with a more intense and invasive procedure just because of money and insurance coverage.  DH pointed out the higher success rate of IVF and noted that it might not be that bad.  So we'll see.  I'm sure there will be many conversations about this.

Next stop on the Magical Bodily Tour, the vampires of the opera (or at least of the doctor's office).

T Minus About 6 Hours

Man, tomorrow is going to be a long day!  7:15 appointment, work till 6:30, meeting from 7-8, running home, and webinar from 8:30-10:30.

Weekend Update with Jessie B

So, I only had one night last week when the number of toddlers was really getting to me.  I was also tired that evening, so I just went to bed early and was fine after that.  Disappointed that I missed sitting up talking with my cousins, but I did need the rest.  The highlight of the week was midnight Harry Potter in 3D with my stepmom and 5 of my cousins.  I had to get up at 8 the next morning to drive to SC for a wedding, but it was SOOOO worth it!!

Friday night I got to have dinner with DH and a friend we hadn't seen in several years.  Later that night, DH and I got used as a jungle gym by our friends' 4- and 7-year-old.  We've started seeing these friends (who live 10 hours away from us) often enough that the kids remember us from visit to visit, and they are so sweet and snuggly!

At the wedding reception, we were seated with a couple from APO that we didn't know before.  The wife and I got to talking, and we found out that we have IF in common; we sat there for a while trading info.  This morning, we sat with them at the post-wedding brunch, which turned out to be a very good thing for me.  The seat next to me was empty for DH, who was a little late, and while I was in the buffet line, a woman sat there with her baby to talk to the non-APO people at the table.  When I came back to the table, I waited for a break in the conversation and mentioned to the woman that I had been saving the seat for DH.  She said that was fine, that she'd move when DH got there (although she was really slow to move when DH did arrive).  The woman next to her then said, "Wouldn't you rather take the baby home than the husband?"  I just kinda looked at her; I had no idea what to say or how to respond.  Ideally I would have had some sort of witty comeback, one that didn't even touch on infertility (since I assume the person didn't mean any harm), but I just couldn't come up with anything.  There was an awkward silence and then they resumed their conversation.  Even before my new friend leaned over to remind me that some people with babies can be really rude, it just really helped me to know that the person sitting next to me got it and understood my reactions, both the reaction that showed and the reaction that didn't show.  I told DH about it when he sat down (in a whisper, since the people were still there), and he was sweet and supportive, but it still helped to have someone understand me in addition to having someone support and care for me.

Just over 2 days till my appointment!

8 1/2 More Days

I can get through until then.  I can deal with the high toddler content here.  I can do it. I can. I promise.

The Waiting Game

I was amazed from the beginning that I only had a one-month wait for my appointment at Shady Grove.  It still could have been a hard wait, but I've been lucky to have a really full month in the meantime.  First Membership Academy for APO, then running a quizbowl tournament for JROTC teams, then the 4th of July weekend.  Now I'm spending the last full week before the appointment at the beach with my family.  On the one hand, there are toddlers everywhere, with something like 7 kids below school age, and one cousin that's here is due in August, but it makes it easier to deal with it because I have the appointment coming up.  On the other hand, it could be really hard to wait with the anticipation of the last week, but it makes it easier to deal with it because I have fun things to do with my family this week.

2011 Hope Awards

When I voted for the Hope Award for Best Blog, I found out that there are other Hope Awards besides the publicly-voted Best Blog and Best Book.  I was interested to see that the Hope Award for Achievement was given to SELF magazine for their article about infertility last year, "This Woman has a Secret".  This is particularly special to me because that article was the main thing that inspired me to start this blog.

Also, when I read the finalists for Best Blog, I came across a great post from Whitney & Erick.  What Whitney wrote about the statements of "just relax" really resonated with me.  The rest of this post is copied from her (and thus contains some medical details that I hope don't apply to me).

The truth
First and foremost, infertility is a disease that affects 1 in 8 couples of reproductive age.  The definition of a disease is “disordered or incorrectly functioning organ, part, structure, or system of the body.” Infertility is due to some malfunction in the body, whether it be hormonal or structural.  Ergo, a disease.  Even for people with unexplained infertility, clearly something is wrong, but the reproductive system is complicated and sometimes it’s hard to diagnose.  In my case, I do have several diagnosed problems including a uterine abnormality, luteal phase defect, Factor V Leiden, and autoimmune issues.
Without medical help, there is nothing I can do to have a baby.  And, possibly not even with medical help.  Nothing short of a miracle from God, that is.  And, while I pray for that all the time, I can’t count on it.  If you apply this “relax” thinking to the rest of your life, imagine this. Sitting around and waiting for a great job to land in your lap.  Waiting to magically learn something new without studying.  That doesn’t work – just like everything else, you have to work for it.  And, just because some people didn’t have to work hard to have a baby, doesn’t mean I don’t have to. A little Marvin Gaye and a bottle of wine might work for some, but for me the recipe involves follitropin alfa injections, human chorionic gonadotrophins, anti-coagulants, steroids and lots of poking and prodding.
When people tell me to “just relax,” it’s insulting.  Even though most people have good intentions when they say it, it hurts.  It somehow insinuates that I have done something wrong. It makes it my fault.  I know it’s not true, but it still hurts. It’s an accusation that somehow because of my inability to “relax,” I cannot have a baby.  If only that were true, and that easy, I would have a 4-year-old by now.
Besides,  I don’t feel “stressed” about my situation all the time.  Usually just at key decision points.  Everyone does and would.  This has become part of my life, and I have learned to live with it.  Usually, it’s a quiet sadness, not a throbbing stress.  I talk about it all the time, but that’s because it’s cathartic to do so. To imply that I should be able to make life-altering decisions without a little stress is absurd. I’m pretty sure that lots of regular women who get pregnant all the time are stressing about their job, their kids, their relationships or something.  Stress is not the problem.
Those of us struggling to conceive have been through hell.  We’ve put our lives on hold.  We have put our bodies through the ringer. Our relationships have suffered. We’ve had to deal with loss. We’re emotionally spent. We deal with failure on an almost permanent basis. We’re tired, frustrated and beaten down.  Relax is not something we want to hear and it’s not the answer to our problems.

What people say [and my response]

• Maybe if you just stop trying/relax/forget about it/etc. “My cousin’s friend’s sister-in-law tried for a long time and then they gave up and what-do-you-know, they got pregnant. You never know…” [ Well, I pretty much gave up a while ago, but I'm still not a mommy.  Also, all of those months in between the IVFs, I haven't "been trying."  And, not all infertility is equal. Unless you know the nitty gritty details of your friend thrice-removed and my reproductive history, how can you compare?  Your friend trying for 6 months and going on Clomid and giving up and then getting pregnant does not even remotely resemble anything to do with me or my situation. For the record, in this scenario, that would not even constitute an infertility diagnosis at all.  Usually the threshold is one year of trying.]
• You need to stop thinking of all of this.  [There have been times when we have taken a break from this battle.  That didn't work. And, like or not, infertility has become part of me. It doesn't define me, but it's always there lurking in the background.]
• Take a vacation.  [I've taken many during the five plus years we've been trying to conceive. Really gotten away from it all. Gone half way around the world.  Sailed in the Mediterranean.  Slept in the rainforest.  Hiked a volcano.  And, I didn't think about infertility at all.  Nope, that didn't work. But, man, if it did, that would be awesome. Pregnant and lots of travel.  Perfect!]
• You should meditate. [That might be a good thing to do, but it's not going to get me a baby.]
• Mind over matter. [Well, I have visualized a happy outcome, but it just hasn't worked. Besides if I could just conjure up anything I wanted, I would not only have a baby, I would also live in a custom house on the beach, travel the world, have great muscle tone and speak five languages.]
• You need to think positive. [It used to be easier to be more positive.  Along with that positivity, I was also naive and blissfully ignorant. It's not that I'm not positive, but I'm a realist. I always hope for the best, but am prepared for the worst.]
• You need to stop being so stressed.  [If you are experiencing stress and then feel pressure to not be stressed, the stress just multiplies.  And, for me, there have been times that I have been stressed and times I have not. Not being stressed did not give us a healthy pregnancy.  Also, when undergoing IVF, since all of the hormones are administered, stress does not play a part. See this study.]

New Project

Since I do actually have another side of me besides infertility, I've started a new blog, a collaborative effort.  Basically, it's group commentary on food shows, with a heaping helping of sarcasm.  Come check it out!

Insurance Antics

Don't worry, this isn't about my current insurance or anything that would interfere with my appointment on the 20th (22 more days!).

I was looking up something on the RESOLVE.org website, and I saw something about states that require infertility coverage of some sort by law.  I stopped in my tracks when I saw that Maryland was on there!!  I went to the page that explained further, and I saw that, since 2000, Maryland has required insurance providers that cover pregnancy-related healthcare to also cover the cost of 3 IVFs per live birth (max lifetime benefit $100K).  Now, this has no direct effect on us since there is no requirement to cover the diagnostic testing that we were having trouble paying for.  However, I do find it extremely interesting since DH's insurance from United had very specifically said that it did not cover ANYTHING related to infertility.  Not that it didn't cover anything until IVF, but that it did not cover anything at all.  Again, UMR, how I loathe thee.

A Sense of Purpose

I was reading another blog post today, and it made me think about mine.  Amazing how this whole blogging community thing works, isn't it?  :-p  Anyway, one of the blogs I follow, From IF to When, is one of only 4 nominees for the Team RESOLVE Choice Best Blog Award.  This was Katie's reaction (aside from trying to not spit her dinner on the floor):

"Last year, I was shocked to be nominated. This year, I'm floored. I don't blog nearly as much as I used to. I am whiny. I have no infertility success story (yet), and I'm not going through treatments. So, uh, what the hell?"

When I looked at the description on the RESOLVE website about the Best Blog Award, they described what they were looking for as someone "whose blog posts raise awareness about what life is like when you’re faced with infertility."  DH and some others have had difficulty understanding how working to raise awareness about infertility fits with posts like this where I'm complaining.

In some ways, that's probably my fault, because, as I looked back at the beginning posts of this blog, I see that I didn't say anything about the purpose of this blog other than that I refuse to be silent about my/our infertility like so many other people.  That has left me in the position of having to choose between justifying myself and my posts and telling people that if they don't like it they can screw themselves, which anyone who knows me well can tell you just is not how I do things.  Even worse, it has left DH in the position of trying to justify what he doesn't fully understand himself, as some people have addressed their thoughts about the blog to him instead of me.

The wording that RESOLVE uses really struck me as a good description for what I'm trying to do (even if I'm not one of the 4 best people in the country at doing it).  I raise awareness about what life is like when you're faced with infertility.  I don't raise awareness about what people would like life to be like when you're faced with infertility.  I don't put a pretty little bow on infertility to make people feel good about being nice to infertile people/supporting legislation that addresses infertility.  I share with people the real, (almost entirely) unvarnished truth about what my life is like facing infertility.  Sometimes that includes things that people don't like.  Sometimes that includes things that I don't like.  Sometimes those two overlap.  But whether you or I like them or not, whether they're pretty or not, they are "what life is like when [I am] facing infertility."  For people who need their description or understanding of this blog to fit in a neat little box (and there's nothing wrong with needing that, people have different ways of understanding and processing things), here is your neat little box.

Good Day

No, I haven't gone to Europe with that subject line! (Although going back would be nice sometime.)  I'm just having a good day, without anything hitting me upside the head so far (about infertility or otherwise), and I thought I'd post something contented for once.  Normally, I'd avoid posting this, as I'd worry about jinxing myself (we'll see if I post later retracting this entry!), but instead of worrying about what will go wrong next and when, I'm going to take a moment for once and enjoy the calm. 

For the last 2 days at work, I haven't had to hospitalize anyone or deal with any crises.  After the few days before, that is a nice change!  I even had time to catch up on contact notes, and I'll be spending my entire day tomorrow writing treatment plans.  I know that doesn't sound like a plus, but it is...it'll be peaceful and I'll be a LOT closer to completely caught up with things.

Also, tonight I'm going to go check out the all-ages color guard near Baltimore, the Arbutus Sailorettes.  I was playing things by ear today as far as whether I would go or not, given the headaches I'm still getting over, but my head hasn't been bad today, and I'm looking forward to it.  It felt SO good this morning to even just take my practice flag out of the coat closet and put it in my car.

Tomorrow is another day, with its own potential crises, but I'll worry about those when they come.  After all, tomorrow also has its own potential positives.

Lapped Again

I found out today that someone I know is pregnant with their second in the time I/we have been trying for the first.  That's the second person I know to lap me, and I keep looking at the first one, someone I see most days, waiting to see that she's double-lapped me.  After all, I didn't know that one was pregnant with the second for the longest time because it was so soon after her first that I thought she was just taking a while to get her shape back after the first one.

Five weeks to the day until my appointment...

APPOINTMENT SCHEDULED!!!

Gee, can you tell I'm a little excited today?!  I've been waiting for so long for this, though, and now things are finally progressing!  I have an appointment for July 20 at 7:15 AM.  I would rather have taken the 8:30 appointment, or better yet 9, but things have been so crazy for DH with work that I took the super-early appointment for his sake.

We'll see what I think of Shady Grove and which side I end up on once I'm really working with them, but so far I'm pleased with the service.  Rather than calling them (which I was going to do in short order if I didn't hear from them), I filled out their New Patient thing on their website.  The page said they would call within 24 hours unless it was a weekend or holiday.  I had a few moments between clients, and I submitted it at about 3:25 PM.  They called me back at about 4!  I was with a client then, so I called back when that client left, and we got me/us scheduled.  Their first available was July 14, but I'm going to be out of town with my family then.  They had more during the day on July 19 and then morning appointments on July 20.  So here we go!  I know it might take a lot of tests and a long while to get anywhere even once I'm seeing a clinic, but at least we're getting to start that lot of tests and long while rather than just treading water with no idea when that part will end.

On another note, when we first started TTC, I had taken a preparing to conceive class at the hospital, and what the doctors and nurses there had said about caffeine was to try to limit it to 240 mg per day if you could be or are pregnant.  So since then, that's what I've been trying to go with anytime I could be pregnant.  Today, though, I saw on RESOLVE.org that more than 100 mg per day could interfere with egg development.  So I'm going to work on cutting down on the Diet Coke.  Thank heavens I'm not a coffee drinker, since that's got a lot more caffeine, but to keep under 100 mg/day, I can only have 2 cans of Diet Coke.  Woo, buddy, that's gonna be hard!

INSURANCE!!!!!

I didn't get out the door this morning in time to drop the enrollment form off at the main office on my way in, but I had a client no show right before lunch, so I drove the 20 minutes each way to give it to the person today rather than tomorrow.  Just got this email, and it brought happy tears to my eyes:

Jessica,
I've enrolled you in the health insurance plan along with vision and dental. I placed a copy of the coverage information in your mailbox.

You will receive in the mail your medical card and a debit card that allows you to charge the medical deductible costs up to $1250.00.  (note from Jessie: it costs the company less to give us a high-deductible HMO and then give us an HSA pre-loaded with the deductible than to pay for a traditional plan)

Any questions please let me know.

Thanks,
Person Filling In for HR Person on Maternity Leave

One Step Forward, Hoping For No Steps Back

After I called United again today, my certificate of creditable coverage ended up coming in today's mail.  So now I am filling out the enrollment form I still had from October, hoping to drop it off at work tomorrow morning on my way to my other office.

So where does that leave me?  As soon as I can get a group number and ID number, I'm calling a fertility clinic.  I know that a couple of you guys said to call right away, but I'm too gun-shy after my experiences in the past year.  This is still United I'll be dealing with, and I don't trust them not to find any reason they can to avoid paying for things.

One person commented on my last post asking about whether I had chosen an RE to go to.  I just looked at where the new insurance covers, and I think I'll try Shady Grove first.  Their Annapolis office is the only clinic closer than Greenbelt or Columbia that is in-network.  I've heard some feedback that they treat people like numbers, and some feedback that they are great.  Still, it makes sense to me to at least try the local one first to at least attempt to minimize the disruption of going for appointments and procedures.  So here we go...

Oh, UMR, How I Loath Thee

DH got his card for his new insurance today.  I still haven't been able to get the certificate of creditable coverage.  And I had to go to my PCP on Thursday and get $50 of scripts on Friday.  I wonder how long it takes to get in to see any of the local REs.

New Resource

So, I picked up a copy of What He Can Expect When She's Not Expecting when I was at the mall yesterday.  I told DH I would be interested in reading it once he was done with it, and I'll let y'all know what I think.  I also told the cashier at the Books-A-Million at Arundel Mills that their infertile customers would be a lot happier if the books about infertility weren't mixed in with the pregnancy books, if they were on a separate shelf like Barnes & Noble and Borders do.  Yeah, the migraine had been lessening some, but it came back full force when I saw that.

Hell of a Day

To top my day off, I just realized that this post from 12 hours ago posted to the wrong place.  So here it is:

I'm so mad at DH's work and insurance that I don't know whether to punch something or cry.  Today's the day DH switches to the new company after 6 months of waiting, so it's the day when we both get dropped off of his crappy insurance and I can move to what my company has. 

His company's HR (yes, the same people from whom we could not get a listing of what insurance covered for MONTHS) said that the insurance company would mail us the certificate of creditable coverage.  I called the insurance company to see if they could fax it instead to decrease the amount of time when I have no insurance before the new coverage takes effect and gets backdated.  For comparison, when I left BBH and therefore left Aetna, I could print the certificate off of their website rather than waiting for them to fax it to me.
First of all, UMR told me that they could not fax or let me print my certificate, I would have to wait 7-10 business days for them to send the letter.  Once the letter is sent, I have to wait for regular US Mail since they of course can't overnight it to me even if I offered to pay for the shipping.  The crowning glory, however, was finding out that DH's HR department for the old company hasn't bothered to tell UMR that he and others are no longer on their insurance.  I told him that I'd be lucky if I had insurance by July and that it would be August or September at best before I'd get to see an RE!  And he has no ability to complain about how HR treats him and me because his exit interview was not anonymous and so he's afraid of repercussions.

And of course life had to be more fun, so I'm on day 2 of a massive migraine.  I was able to function last night and even have fun, but only with a large dose of naproxen.