Money, money, money

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In news that will surprise no one that has undergone fertility treatments, they are expensive. While planning for my upcoming IVF cycle, today I found out that the cost to genetically test our embryos was out of our range. I’d thought, perhaps naively so, that cost was already included in what I’d paid out of pocket.

Before I explain/complain about that, I will say that I am remarkably lucky in that my health insurance plan through my employer is very generous to cover a lot of my treatment. My company values family and that extends to health care for infertility, paid time off and other family-expansion options like adoption assistance. I know I am lucky. Having said that, I am still relatively new to the company, so these incredible benefits are new to me, too. My last health insurance provider (a policy that I shared through my husband’s employer) didn’t cover any fertility options, so our first year of treatment was paid entirely out of pocket. Four IUI cycles, meds, labs, ultrasounds, a D&C… the list goes on. It added up quickly, as any couple in a similar situation knows well. Much of my “disposable” income last year went somehow to my fertility doctor inserting something into my vagina.

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Now, with new (superior) coverage and another failed pregnancy behind me, we decided to take things up a notch with IVF. The new plan with my doctor includes what could be referred to as the “base model.” Standards labs and medical screenings pre-IVF, a brief class on how to inject the required medications (note: not the medications themselves, they are separate), monitoring, egg retrieval, egg insemination (half traditional and half ICSI) and embryo transfer. But because the cause of my first miscarriage was a chromosomal abnormality, we were advised (and agreed) to perform genetic testing on the embryos prior to transfer. This bonus feature helped me to alleviate some of the anxiety I feel about trying IVF, primarily in that we would be essentially guaranteed a viable embryo would be transferred. After two miscarriages, a little security felt necessary.

Today, though, I was informed that my insurance, generous as it may be, does not cover this screening and is, therefore, off the table. You know how in old cartoons characters’ eyes will bug out? That was me about an hour ago.

Financially speaking, the added cost of this is totally reasonable to pay out of pocket for a lot of people (I’d imagine). But, for a couple that lives paycheck to paycheck (and whose savings had previously gone to non-covered attempts to get pregnant), it is out of reach to afford it after the out of pocket cost of the base model, plus required medications. And for as lucky as I feel to even be able to do IVF (it would have been financially impossible for us without the added assistance of my company’s insurance), I still want to scream that I’m not someone who can get pregnant without medical intervention — the “free” way, as I often refer to it. While fertility clinics will likely be the reason I one day have a baby, they are an absurd money drain sometimes.

The removal of that genetic testing safety net is quite a disappointment, but, as my optimistic husband reminds me, not insurmountable. Without the testing, the embryos can be transferred shortly after their insemination, and not having to wait until the following cycle. So, perk there. And I trust that the team of professionals handling my tiny future children will use their best judgement and experience in choosing the lucky one that will meet my uterus. All my dolla bills (not to mention my hopes and dreams…) are counting on them.

 

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In April I only see showers

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Some days I’m not sure my heart can take it. I want to turn it off. On the radio I hear of a mother who left her child to die – simply neglecting him. On Facebook I see another story of parents accused of abuse. A friend tells me of her own child who, before she adopted her, was sexually abused by her biological father as a toddler. Biology has allowed these people to have a child, yet me, not.

The other night I was at a work event and remarked to a coworker that I was drinking my first glass of wine in more than a year. She asked if that was by choice. I guess I’d forgotten that she didn’t know. I don’t have any problem discussing my history with people – friends – that see me every day. I told her that no, it wasn’t really by choice. I was pregnant last spring, then on fertility medication, then pregnant again, until recently.

I’ve just had my second consecutive miscarriage, one year apart. In April I only see showers. Dark clouds roll in and the rain that follows washes everything I hope for away.

Physically this miscarriage was much more difficult than my last. In both cases I required medical intervention, but I chose to forgo the D&C this time in favor of pharmaceutical assistance. The pain and bleeding lasted much longer than I’d anticipated – six days – but emotionally my brain shut it down. It flipped the switch, sort of knowing what to expect. I’ve talked about this at length in therapy since, and I find it pretty remarkable what our brains can do. While I was more emotionally invested in this pregnancy, I transitioned quickly into a protection mode. The day of and following the diagnosis of a collapsed sac (when one week prior everything looked very promising) I was in disbelief. But the acceptance of another miscarriage happened within a few short days. My brain sort of said you know what happens now, and you’ll make it through.

And I have. I still experience the waves of sadness and fits of anger that I do not have the child that I desire. Some days are better than others. Today my heart and body hurt from another loss. But tomorrow may be better. My brain is pushing me forward.

I spent much of 2015 in a very dark place with my depression over my miscarriage. I didn’t say the word aloud very often for fear that I’d well up in tears. When the situation called for it, I’d often say my surgery. It spared me, sometimes, the few moments of remembering what I’d lost.

This year had more promise. I found out I was pregnant for a second time while in my hometown visiting my family and meeting my then-six-week-old nephew. I told him he was going to have a cousin, and then quietly sang him “Dear Theodosia” from Hamilton, thinking that before year’s end I could sing it to my own baby.

When this April ends I’ll begin IVF. I am 20 percent hopeful, 40 percent scared of what it will do to my body and brain and 40 percent resigned to feeling like all of those other people have a privilege that they don’t deserve.

The things I’ve lost

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The last several months have been more difficult than I anticipated. In many ways, I feel like I’m losing my ongoing struggle with depression. The continuous push and pull is stressful and exhausting — both emotionally and physically. The physical symptoms of depression — the ones you see commercials about — suck all of my energy and I feel happiest when I am being still. Even then, that happiness is short-lived. I fidget constantly.

I don’t want to, but I consistently think about what I thought 2015 would look like when we started the year with good news. A baby would be born in December. My birthday, along with many members of my family, is that same month. It would be joyous. Early in my pregnancy my husband commented that December would be the best month ever — the arrival of our child and the new Star Wars movie?! Pure perfection for him. It was wonderful for me to see him look forward to something given that he’s often in much physical pain because of chronic back problems.

Now, December is a month I don’t want to start. I’d like to fast-forward it. Knowing that I can’t sometimes fills me with dread. If I have to turn the page in the calendar, I’d like nothing more than to just stay in bed with my dog, hiding under the covers. No birthday. No Christmas. Just leave me be.

Therapy, thankfully, has been tremendously helpful in reminding me that I did lose something I wanted desperately and it’s okay to be sad about that. There’s no timeline for that grief. The pain demands to be felt and I need to make peace with that. Life has thrown a lot at me and my loved one (in forms other than my infertility) and it’s okay to feel overwhelmed at times.

Overwhelmed has been my natural state over the last few months. When one more thing happens I ask how much more I can take. Jobs, cancers, money… it has been one thing on top of another. I desperately need something for the win column. My husband hates when I talk like this — from such a place of negativity. What he has a difficult time seeing, of course, is that many days when I search, I find literally nothing else. I am self-aware enough to know that it’s the depression taking over, but it can be impossible to explain to sometime who isn’t there mentally just how powerful it is. It’s a monster.

Next month I’ll have a second surgery for two unexplained “spots” in my uterus. I’m scared, of course, about what those spots could be. But the small part of me that is still capable of being hopeful is, because, perhaps, what’s found in me could explain my otherwise unexplained infertility. At the tail end of an awful year, a diagnosis can point me in the right direction. The 10 percent left of me that can be positive wants to believe this surgery can bring about some clarity.

For now, I’ll do my best to refocus. I’m waiting on some non-fertility-related news this week that, if positive, could nudge the dominos to fall.

One step forward, two steps back

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It’s been just more than seven weeks since I miscarried and they’ve crawled by at a snail’s pace. I didn’t put any expectations on myself to feel better, physically or mentally, in any finite amount of time.

Emotionally some days are better than others. That’s often how grief works.

Physically has been a series of ant hills and mountains. Since I did not miscarry naturally, I assumed the recovery period would be pretty limited. My doctor, who also performed the D&C surgery, told me to expect some heavy bleeding and cramping for a few days, and mentioned to be aware of fevers or other unexpected changes. After a little more than a week, I was feeling more like my pre-pregnancy self. I was tested to ensure that my hormone levels were dropping appropriately, and it was confirmed that they were. After another follow-up, my doctor cleared my husband and I to try again following my next period. She expected that I would see that unwanted, old friend again within about four weeks, perhaps six.

I’m not sure why I thought my body would adhere to the normal timeline — considering that my infertility is largely unexplained — but as I passed weeks four, five, and six without a period I wondered if things were okay. I was feeling fine physically, so what was going on? I consulted Dr. Google (which, really, why do I ever do that?) and fell down a Babycenter rabbit hole. More than two-thirds of the women posting in the thread about post-miscarriage menstruation said they’d actually discovered that they’d almost immediately gotten pregnant again. Reading this, of course, gave me some hope. I mean, this was a lot of women who said this happened.

I even took a pregnancy test on my husband’s birthday thinking wellll… Negative.

Every time I’m tempted to ask myself why not me?, I just stop. Because I’m not those other women. I really never am. None of this has gone my way. I’m more like the one woman who posted that she was 13 weeks post and her hormone levels were still high and no red in sight. Ugh.

This week, though, I’m bleeding like a stuck pig.

Asking why not me? always ends in tears and frustration. This hasn’t been easy. In fact, it sucks. Today I’m feeling a little tired of pretending that it doesn’t. There’s not a handbook for it. I’m writing my own.

Treating my whole self

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I’ve struggled with depression and anxiety for many years. Because of this, and the help I’ve asked for in getting through some of the most difficult times, I’ve been in therapy pretty consistently since I was 22 years old. I strongly believe that this, paired with a cocktail of antidepressants, have allowed me to be a (mostly) normal, functional human. They’ve also kept me from slipping farther into the black hole that depression can crate. In a lot of ways, a combination of therapy and medication has kept me alive.

Like with any subject, there are people on the other side of the fence that believe that depression and anxiety can be controlled without therapy or medication; some may even say that “it is all in your head.” I’m not here to change their minds.

One of the most challenging things about infertility is managing the flood of emotions that come with the highs and lows of the experience. I’m no stranger to recognizing my own triggers for depression and anxiety, so I’ve tried to stay on top of coping with my emotions. That is, of course, when I can even process them. Occasionally it feels like everything I’m feeling — particularly since my miscarriage — gets stuffed into a cheese cloth and then wrung out when I least expect it. At the height of some of my worst months of previous depression, the feeling was very much the same. Some of what is in the cheese cloth remains, but much is coming out in a steady stream of everything inside. It’s hard to plan for what often comes out unexpectedly.

This weekend The New York Times Magazine ran a piece that hit close to home — “The Secret Sadness of Pregnancy with Depression.” It’s a tremendous, eye-opening read that focuses on antenatal depression (depression while pregnant) and how serious of a condition this can be, particularly if left untreated.

The article comments:

“Though antenatal and postpartum depression are linked, antenatal depression has remained underground. Much of the stigma around maternal depression — antenatal and postpartum — seems to focus on women who fail at joy, often suggesting that such women are heartless. How can anyone not be swept up by the momentousness of producing a child who will give her life purpose? The myth of the pregnant mother who is high on hormones has had considerable staying power.”

The emotional needs of the soon-to-be mother are too often ignored and pushed aside. Even the healthiest of pregnancies is still an insane journey of physical and emotional stress on a woman.

This piece reminded me why I recently decided to find a new therapist and spend that hour a week examining everything that I’m feeling now, and have felt in these two-plus years of trying to conceive a baby. Returning to treatment means taking the bull by the horns and owning that what I’m going through is enormously stressful and emotional as hell. I’ve never been one to take for granted what it can mean to have a clear head, and I’m certainly not ashamed to say I need some help getting there.

Mother’s Day

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I expected this Mother’s Day to be challenging for me given my miscarriage just a week before. I was correct; I found myself overwhelmingly sad at a few points during the day. In the shower I thought about how excited I was for this to be my “first” Mother’s Day. In the car on my way to my in-laws I thought about how the last time I was there I was pregnant. That thought is probably the one that sneaks through most often. Two weeks ago I was… but now I’m not.

And it most often hits me when I’m in the car alone. That is occasionally problematic for my 35-minute morning and evening commutes. A few evenings ago when I was driving home from work and I thought about how I wasn’t excited about the rest of the year because I wouldn’t meet my baby at the end of it. Those are the thoughts that floor me and cause a waterfall of tears, wherever I am. Those are the thoughts that pop up, me having no control. Those are the thoughts when a simple distraction doesn’t cut it. I suppose I’m fairly lucky in that those thoughts haven’t come too frequently. Those that are debilitating are pretty few and far between.

That’s not to say that I don’t think about where I am now every day. It’s not erased. I’m just working on moving forward. For us, that means that we plan to try to conceive again when we’re given the all clear from the doctor. Trying again will hopefully mean another success, this time with a much better outcome. Moving forward means something different for everyone.

But I’m weary. Will I be afraid to acknowledge another pregnancy until I’m in the safe zone? Maybe. Will I be anxious through my first ultrasound, terrified that the conversation will be the same? Maybe. I will want to embrace the joy and excitement that conceiving a child brought me just two months ago. I want that, but am unsure right now if that can reasonably be my reaction the second time around. I just don’t know right now. And I suppose that’s okay. What I do know is that holding off longer than necessary isn’t what’s best for us.

Just keep swimming.

Thanks, Dory.

On the seventh and twenty-seventh

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On April 7th, the morning of my last post, I found out I was pregnant. I cried and laughed and cried. My husband and I celebrated and talked about names. The next few weeks were filled with telling our families the wonderful news and pinning nursery furniture to a private Pinterest board.

On April 27th, I found out I was no longer pregnant. I cried again. Going into our first pre-natal appointment that morning I was both nervous and excited. My biggest concern was that the doctor would say there was more than one heartbeat. While I knew (and know) that I would be incredibly blessed to have twins, the idea is still a bit scary. But our doctor didn’t say there was more than one heartbeat. In fact, there was none; there was just an empty sac. We left our ultrasound unsure of what would come next. There were two possible outcomes, following a blood draw… 1. That I simply wasn’t as far along as we thought (one day shy of seven weeks), despite having had IUI during my ovulation. Or 2. That the pregnancy wasn’t viable and I would miscarry.

I didn’t go back to work that day. I knew I wouldn’t be able to focus on writing about accounting or banking. The only thing on my mind would be that tiny seed-sized embryo that had a due date of my brother’s birthday — December 15th (eight days after my own).

That afternoon I received a call from my doctor with the news. One of the last conversations a woman ever wants to hear. My hormone levels hadn’t progressed in about a week and a half, and my pregnancy — my little Christmas baby — wasn’t viable.

Yesterday, I had a D&C surgery to expel the embryo from my body, as I hadn’t shown significant signs that I would miscarry naturally. It was one of the hardest days of my life, as I’m positive it is for any woman who has to physically have something so important taken from her too soon.

I’ve been through plenty of death — I unexpectedly lost my stepfather nearly four years ago to a heart attack — but nothing has ever felt quite like this pain. I think each loss in one’s life is a little different. This one has left a tightness in my chest and a hole in my heart. There’s nothing I ever wanted more in life than to be a mother. I still do, but this will always be a part of me.

After being rolled out of the OR and into recovery yesterday, I apparently told my doctor that the next time I came to that hospital it would be to have a baby.

Over the last few days it’s hard not to question a lot of things. I question why I haven’t gotten the job as mama yet when a woman across the country can give birth at work and then tie up her helpless child in a plastic bag like trash. But there will always people have what I would like and yet make horrifically awful, selfish decisions with what they’re given. Life will never be fair.

I know a few of you reading here have experienced this rollercoaster of emotion — from the day the second line on the stick appears, to the day you’re no longer with that joy — and some, even more than once. My heart breaks for you as it does for my own Christmas baby. Experiencing this more than once must be excruciating, and I have so much respect for those of you that have and continue to get out of bed in the morning. I’m not sure I could.

For now, my husband and I will grieve for our Christmas baby. Then, soon, we’ll continue to apply for the jobs we really want — of mama and daddy. Hopefully without a dampened spirit, and only enthusiasm for the day we again see two pink lines.

I’m listening

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Probably one of the most important lessons I’ve learned about fertility over the last two-plus years is to listen to my body. Only a few years ago I likely would have thought this concept to be too new-agey for me, and in a way, it is. But when your month, every month, consists of testing things, prodding and then waiting, it’s natural to become hyper-aware of your body.

My husband and I tried to conceive naturally for nearly two years before we sought assistance. I was pretty well convinced when we first starting fertility testing that the doctors would find something wrong with me. Somewhere, in the back of my mind, I knew that to be true. Early on in that process, we got some mixed results which had be concerned. These red flags all but convinced me that I was right. I was so very thankful to be wrong. The red flags largely turned out to be caused by ultrasound shadows. By the time sat down with our fertility doc, our infertility was unexplained. My husband and I fell into that mysterious 10-15% of couples where there’s no discernible cause to have not conceived naturally in two years.

Less than a week after meeting with our doctor, we began the Clomid + IUI plan that we’re currently on. A friend of mine, when I mentioned that course of treatment mentioned that Clomid didn’t work for her, and she felt strongly about that very early on. She heeded, “listen to your body.” It’s great advice, and words I paid attention to.

In our most recent Clomid + IUI cycle, my OPKs never picked up an LH surge (this had also happened the previous month, and I missed the window for IUI because I never saw a positive OPK). But, I had all of my typical ovulation symptoms. Over the course of about 18 hours, I went back and forth with the incredible staff of nurses that I work with at our clinic, along with my husband, to decide if we should proceed with this month’s IUI. There are always a lot of factors to consider in fertility treatments, and, too often, cost is a major one. Our medical insurance does not cover fertility treatments, so we’ve paid for our visits and procedures over the last several months out of pocket. This cost is significant to any couple that doesn’t have a hefty savings to fall back on, as it has been for us.

So, a serious concern in deciding to move forward with this IUI was, obviously, cost. Without an LH surge detected, I had no firm indicator that I’d ovulated. It was more of a risk to decide to move forward with an IUI (and timing it, essentially, blind). I listened to the advice of the nurses that have gotten to know me, and that of my husband (who, ultimately said, “uh, I don’t know…”). And then I listened to my body. My body said, in her sassy way, “girl, you’re trippin’… you ovulating! Go make that baby!”

I’m happy that I listened, no matter the outcome. For now, though, to be continued….

VBA and a heartfelt thank you

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versatile-blogger-award

My fellow hopeful mama, Conceiving Baby, has honored me by naming me worthy of the Versatile Bloggers Award. Thank you so much! While I’ve been blogging for a long time, I’m new to writing about infertility and sharing this deeply personal topic.

This is also an opportunity for me to say thank you to those that read my story and share your support. Knowing that there is a community of women online who are experiencing the ups and downs along with me en route to becoming a mama has been so important in alleviating some of the alienation infertility can cause. For those of you that I know personally, I also thank you for sending me your love and support after reading my posts. Writing has always been my creative outlet and I am so grateful to utilize it again as I ride this emotional roller coaster.

Now, back to the VBA… Now that I’ve posted the award and thanked Conceiving Baby for the nomination, on to seven facts about myself:

1. As I mentioned, I’ve always enjoyed writing and telling stories. When I was in second grade, each child in my class was required to write and illustrate a “book,” that was then bound by a teacher’s aide using cardboard and contact paper. While the assignment may have been to write one, I fell in love with the experience and created more than 10.

2. I wrote a novel. In 2009, I participated in National Novel Writing Month (NaNoWriMo) and completed my first full-length novel in one month. It was one of the most creatively demanding things I’ve ever done, and I was thrilled just to have finished. I’ve read it only once since I finished. Maybe someday I will even edit it!

3. When my husband and I first met, I knew we’d get married.

4. If/when I have a daughter, she will be named for my great-grandmother, who is the kindest person I’ve ever met.

5. My husband and I never went on a honeymoon. We wanted to visit Italy (he’s half Italian), but instead moved from New York City to North Carolina a few weeks after our wedding.

5b. Because of the move, we spent five of our first seven weeks as newlyweds more than 500 miles apart.

6. Most people would identify me with red/auburn hair, but I’ve also been blonde and brunette, and even had black hair briefly.

7. My dog, Odin, was named for the character in Norse mythology and Marvel comic book lore (Thor’s father). He’ll turn a year old next week and I can barely remember a day when he wasn’t one of the loves of my life. Few things make me happier than him wiggling his butt when he’s happy to see me. I am very much looking forward to making him a “big brother.”

I nominate the wonderful bloggers MamaCravings, Seeking Little C and Baby Momma Drama for VBAs. Thank you for sharing your infertility story with me and some many other hopeful mamas!

Fatty McButterpants

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I have a brother eight years younger than I… we’re the best of friends, and I really helped to raise him. He’s now an amazing, hard-working man that I am very proud to call my brother and my friend. When he was about eight years old, he started to put on some weight. This continued for a few years, and then he got into weight-lifting as a teenager. He got ripped. Still is. He’s won many weight-lifting competitions. When we look back at old photos of his awkward years, we call him “Fatty McButterpants.”

As a kid, I was the opposite. I was very active as a cheerleader (I can hardly even believe that now!) — jumping, tumbling, lifting and whatnot — and was always a thin, healthy size for my small stature (I’m 5’2″). Then college happened, I discovered gourmet cupcakes and binge-watching DVDs, and the rest is history. Gone were my days of size fours.

I’m a big believer (pun intended) in ending the era of fat-shaming (one of my favorite bloggers, Brittany Gibbons, is an incredible advocate and a daily inspiration in reminding me my weight isn’t going to stop me from doing awesome things). Trying on a bathing suit is likely to send me to cry on the floor of my closet with a half-gallon of cookies and cream ice cream. I’m absolutely an emotional eater. My scale fluctuates depending on my stress level and if I’ve discovered a new flavor of pop-tarts.

I’ve asked my fertility doctor if my weight is negatively affecting my ability to conceive. She says it’s not (other than a low thyroid issue that I’m also on meds for). But there’s a lot of information out there that says it could be. My focus, especially since we started trying to have a baby, has been getting healthier, making better choices. Only spending half of my Saturday binging on Netflix and the other half taking my dog for a walk or heading to the gym. Eating a banana or a protein bar when 3:00 hits instead of driving to Duck Donuts. I succeed in this about half of the time. I admit I have a lot of work to do.

What has caught me off-guard, though, has been my weight gain on Clomid. While it may be working great in helping my body produce healthy round follicles, I’ve noticed in the last few weeks that it’s causing some roundness in other places too. Probably seven or eight pounds of round. Which means my pants no fit.

Other than the unfair pregnancy-like symptoms I’ve written about before, I thought I’d been experiencing Clomid relatively unscathed. One hears so many horror stories, after all. But now that I’m smack in the middle of month four, it’s become clear there’s some scathing. Another eight pounds on an already Umpaloompa-ish body is not cute. Particularly as swimsuit season approaches here in the South.

It’s difficult to rectify the feelings I have about weight gain with knowing that it’s caused for a “good reason.” I worry about how much harder it will be to take the weight off postpartum, when there’s a lot less time to think about being active and not grabbing for the Oreos, because, ya know, I’m then responsible for an infant. That’s going to be rough…

I pretty much just fat-shamed myself, huh?

Image from Amazon.com