Eat, Pray, Love

I am one of those people who really likes to read the book before I watch the movie.  And, if you have been reading my blog, you know that Derek and I are all about making a big change in our lives lately.  So, it should come as no surprise to you all that this book/movie are of great interest to me.

So, a couple of weeks ago, I picked up the book Eat, Pray, Love by Elizabeth Gilbert.  I must say that I am thoroughly enjoying it.  I just finished the "Eat" section and have recently started the "Pray" section.

For those of you who know nothing about this book, Elizabeth Gilbert goes through a divorce and then decides to spend a year visiting Italy, India, and Indonesia and she writes a book about her experience in each of these 3 countries and how the time she spent in each of these countries shaped her in some way.

I don't want to spoil anything for anyone, but a passage of this book really spoke to me.  I dog eared the page and I have returned to it several times to read it again.  I think it will speak to all of you as well, and I wanted to share it.

Elizabeth and her ex-husband never had children.  As she reflects on the differences between her sister and herself and the massive changes in her life caused by her divorce, she reflects on her place in the family.

To create a family with a spouse is one of the most fundamental ways a person can find continuity and meaning in American (or any) society.  I rediscover this truth every time I go to a big reunion of my mother's family in Minnesota and I see how everyone is held so reassuringly in their positions over the years.  First you are a child, then you are a teenager, then you are a young married person, then you are a parent, then you are retired, then you are a grandparent - at every stage you know who you are, you know what your duty is and you know where to sit at the reunion.  You sit with the other children, or teenagers, or young parents, or retirees.  Until at last you are sitting with the ninety-year-olds in the shade watching over your progeny with satisfaction.  Who are you?  No problem - you are the person who created all this.  The satisfaction of this knowledge is immediate, and moreover, it's universally recognized.  How many people have I heard claim their children as the greatest accomplishment and comfort of their lives?  It's the thing they can always lean on during a metaphysical crisis, or a moment of doubt about their relevancy - If I have done nothing else in this life, the at least I have raised my children well.

But, what if, either by choice or by reluctant necessity, you end up not participating in this comforting cycle of family and continuity?  What if you step out?  Where do you sit at the reunion?  How do you mark time's passage without the fear that you've just frittered away your time on earth without being relevant?  You'll need to find another purpose, another measure by which to judge whether or not you have been a successful human being.  I love children, but what if I don't have any?  What kind of person does that make me?

I know that she isn't necessarily speaking of infertility, but she might as well have been - which is obviously why this spoke to me.  This describes to me the panic each of us faces every day that we worry about what happens if we don't ever make it to parenthood.  You can substitute family reunion with class reunion or birthday party or any other event where people gather, and it would still ring true.

We all wonder what our lives will be if we never make it to parenthood.  I hope we never have to find out.

The "Big Spill"

Yesterday morning, as I was getting out of the shower, I slipped on a wet tile.  And not just one of those little slips where you catch your balance shortly thereafter...I am talking about the kind where you flail around as gravity pulls you closer to the earth.  Quickly.

I hit the ground with a thud, knees first, wrist second, rolling over onto my back with arms and legs pointing up into the air.  Why on my back with my lady parts flashing all around?

You may recall the pictures I posted of our newly remodeled bathroom not to long ago.  Well, the shower has a large piece of glass instead of having a shower curtain or anything like that.  As I was neared the floor, I did my best to point my body away from that glass.  Even though it is tempered, I didn't want to count on the fact that it wouldn't break and impale me.  (That would have been a bad way to start out a Wednesday morning, huh?)

Derek rushed up to me to check on me and help me up.  But I must have been pretty funny looking; lying naked on the floor...He has been telling me I went "Down like James Brown" for the last 2 days.  It has actually been quite humorous.  Painful, but humorous.

I have always said my middle name should have been "Grace" because I have none anywhere else...

Things with EA Aren't Always as Bad as They Seem

Things today were much better than yesterday.  Thank you all for your kind thoughts and comments.

Having some time to discuss the situation with Derek face to face was just what we both needed.  It gave us time to process the possibility of going through the process and ending up with nothing to transfer.  Up until that point, we had never really considered that outcome, even if the possibility is slight.  In addition, our conversation last night helped us to identify the way to phrase our questions to get the information we were really looking for.

I have never been the kind of person that thinks fast on their feet during an emotionally charged conflict.  When the punches start rolling, my emotions override my ability to think fast enough and I always walk away thinking "What I should have said was..."  This fact about myself didn't help the conversation yesterday, either. 

Today, I put in another call to the donor coordinator.  Although I don't know the number of embryos in the set we are using, I do have some more definitive information.  I was also able to phrase some questions in a format that allowed me to find out additional information without actually finding out specifics.

Hypothetically, if we start with 15 embryos in this set, they will start by thawing 2 or 3 to get our 2 to transfer.  Should the first few not result in 2 viable embryos, they will continue to thaw until they reach the 2 embryos for our transfer, even if they exhaust ALL 15.  The only situation that would result in having only 1 to transfer would be if all 15 were thawed and only 1 survived.

Should the situation actually result in no embryos to transfer, we would still remain at the top of the EA list and would be offered the next set of available embryos.

In addition, I did find out that they will accept a donation as small as 1 embryo, but they will inform the recipients of the small number as this may effect their decision.  (Between the lines, there are more than 1 or 2)

The embryos in the set we are using have been used by previous couples, although I don't know the exact thaw rate or the outcome of these attempts.  They are also fairly positive that after our transfer, there will be enough embryos left to pass on to several other couples.  (Between the lines, there are quite a few in the set)

The embryos are from an egg donor cycle where the eggs were strong and healthy.  These cycles result in strong, healthy embryos and the donor coordinator feels the risk of walking away without at least transferring something are very small.

The only question I didn't get answered deals with the financial side of things should there be nothing to transfer, we are still at the top of the list, and the next set becomes available.  The donor coordinator doesn't deal with those details so I will have to call the financial coordinator back to ask that question.

We did find out for certain that there is no coverage for an EA cycle through our insurance.  The remainder of our IF coverage will go to cover the medications and the other items not included in our cycle fee.

I am still hopeful that Derek's company's adoption assistance plan will recognize embryo adoption as a type of adoption.  We will just have to see how that pans out.

Complications and a Downward Spiral

So, today I went to the RE for a Saline Sonogram*.  While I was there, the financial coordinator handed me my Embryo Adoption Financial Agreement.  The price of the procedure didn't really shock me much.  Nor did the timeline for payment being due.

A couple of the items that were in addition to their base fee were a little surprising (for instance, the baseline ultrasound.  How the hell is THAT not covered?)

But the biggest shocker was a statement regarding the 1/5 refund of the price we get if there is nothing to transfer.  I raised my eyebrows and questioned the financial coordinator.  She stated that even if they don't transfer anything, they have already performed several services included in the price.  Since my donor coordinator hadn't even MENTIONED a possible non-transfer transfer, I hadn't even considered this disastrous outcome.

After having time to process this information, I began to question some things regarding the whole process and began making some calls.

The financial coordinator hasn't been a big help at all.  She can't really answer any questions about the process itself.  That and she said that this doesn't happen very frequently.  (Ummm, I haven't been known to have the best luck reproductively, forgive me for being overly cautious).

The donor coordinator has been even less helpful, unless you consider a panic attack to be just what I needed.  Now that I have this pearl of wisdom about the "refund", I want more details about how the process works.  For instance - how many embryos are there in this set we are pulling from (she can't tell me) or how many transfers have already been performed from this set (once again, her lips are sealed), or how many will they thaw to get our embryos (no definitive answer received yet).  The more questions I ask, the less she can answer.  I really just want to know that they will do everything in their power to ensure that I don't walk home, once again, with an empty uterus and an empty savings account to boot.

And as far as "mum" being the word - if we do proceed and this does result in a healthy baby, then won't they tell us how many babies have resulted from these embryos so that we have (and perhaps the sexes) so that we can warn any future child about marrying their biological siblings?

But back to the transfer of "None" and the hysterics at hand - I mean, call me crazy, but I want to know that if there are 15 embryos in the set, they will attempt to thaw all 15 to get my 2 since I am paying for it.  And if all they get is 1, then they tried.  I want reassurance that they don't look at the 15 and see that they could "sell" these embryos to 5 couples and limit each one to 3 embryos and end up with 25K rather than the 5K they would have if they used them all for us.  But since they won't tell me how many there are in the damned set, how the hell do I know that they aren't taking advantage of us and saying they thawed 3 and that was all they had?  And either she just is beating around the bush in answering me or I am just not asking the right damned questions because I still don't have my answers???

So after all that frustration, I talked to Derek about this new information.  He is having a stressful day for an entirely different situation.  So one question leads to another and I end up standing on the bridge** outside my office crying and wondering why it has to be so damned difficult for us to have a family.  Once again sending questions to God about why we can't just get pregnant the good old fashioned way.

Derek did make some calls to the insurance company to see if the process will be covered.  He is also checking into some adoption benefits at work to see if Embryo Adoption qualifies for the assistance.

Hopefully tomorrow will bring some more definitive answers all around.

*I was a virgin at this until today.  Everything looked fine.  But standing up afterwards?  This must be what it feels like when your water breaks.

**Don't worry, it isn't one of THOSE bridges and I wasn't about to jump.  It is a footbridge over a creek.  The bridge leads from our main parking lot to the overflow lot.  And since I share my office with someone else and there are 4 women in the room beside me, crying at my desk is not an option.

Cancer and You - Volume Two (and other random thoughts)

So today was my annual appointment with my OBGYN.

Sidebar - Why didn't someone remind me just how much I despise the OBGYN's office????  I had forgotten just how terrible it was to be the only non-pregnant woman in the waiting room (unless you count the woman who was way past childbearing age who was there with her preggers daughter).  I mean, seriously?  Couldn't they segregate the place - you know, have a pregnant waiting room and a non-pregnant waiting room?  The pregnant waiting room can be filled with magazines regarding babies and pregnancy and the likes.  The non-pregnant waiting room will have People and Entertainment Weekly.  Ahhh, bliss.

So, as I am sitting in my lovely paper gown that opens in the front with the oh-so-fashionable paper drape over my lap in the exam room that must be as cold as the Arctic Circle, doc enters room and wants to converse with me before my exam.  Now I don't know about you all, but I have a problem conversing with my doc I see once a year when I am not hiding behind layers of actual fabric.  He asked how things were going, I giggled nervously and told him we were officially infertile.  (No shit, Sherlock.  Don't you think he already knew this LAST year when you saw him after the 2 failed fresh cycles?  Did you really think he thought you stuck yourself with all those needles just for shiggles?)  Then I filled him in on our Adoption plans that were now superseded by the Donor Embryo cycle in October.

He added the additional STD cultures to my PAP with no arguments.  He suggested adding the HPV virus testing to the PAP as well (sure, what is another test at this point???) and sold me on the benefits of knowing your risk for cancer is much lower and not having to have a PAP but every 3 years if you are negative for HPV.  (Really?  3 years before I have to put my feet in stirrups again if this FET doesn't work?  And you think you need to SELL me on this?  Where do I sign???)

Sidebar #2 (or 5 if you count the other random thoughts in italics already in this post) - Maybe the non-segregated waiting rooms were actually part of his plan to convince me to have the HPV test added to my cultures)

Anywho...

So, I followed up the HPV cancer conversation with my burning questions regarding ovarian cancer.

Basically, he indicated that my risk is indeed greater due to all of the risk factors I had read about on google. (Delightful.)  He explained that hyper stimulating your ovaries is probably what causes the majority of this increased risk - not necessarily the meds themselves.

The good news was that he didn't think the risk was great enough to schedule me for surgery to remove my ovaries (Ahem, they really aren't doing me any good, doc.  Remember at the beginning of this appointment when I told you I am officially infertile???  Well, it isn't because of my hubby's swimmers...If you were asking me for my uterus, we might have a problem.  But Dr. C is prescribing replacement hormones for anything those bitches would be providing, so if you want to rip them out, by all means...No wait, you are right.  No need to get all jumpy there.  After all, everyone gets pregnant after they adopt or give up, so perhaps I should hold on to them for a little longer.) 

His suggestion?  Birth Control.  (Perhaps I stuttered earlier.  I know I was having a hard time speaking clearly since I was naked.  Or perhaps you didn't hear that part of the conversation because you could see through my stylish paper suit and my rockin' hot body was distracting you.  Regardless, I really want kids...Birth Control will really F*#K with that "OOPS" baby after we just relax.)  He indicated that being on birth control early in life may have offset some of the risk I have taken on by all of our efforts to expand our family.  He also suggested that perhaps I should spend about 5 years in my 40s on BC to lower my risk some more.  (Glad I didn't have to explain to you the fact that I wasn't ready to hang up my hat on my child bearing years just quite yet.)

So, all in all AND in all seriousness, it wasn't all bad news.  I am glad I asked about the increased risk and I will definitely plan on adding some sort of BC to my life after we finally become parents.  (Maybe even the kind that keeps Aunt Flow from visiting.  I think that bitch and I have spent plenty of time together.)

A Double Dose of Cancer

I debated internally whether or not to share this information with all of you - because I didn't want to alarm any of you.  But, because I love all of you dearly and I felt I needed to post.

I am not a doctor, nor did I stay at a Holiday Inn Express last night, so if this information speaks to you, you should consult your physician.


Cancer #1 - Your Baby/Child
IMO - this is nothing to freak out about.  I wanted to share the info so that you could judge for yourself.  Or, so that if someone who loves you happens to mention this fact to you in passing, you will have already read the information.  Knowledge is the key, right?

My Mother In Law has watched several of her loved ones suffer from or die with cancer.  And, as some of you may remember, she recently battled the disease herself and is currently in remission.  But any time that she hears the word "Cancer" in a news headline, it is a huge cause of concern for her.  Understandably so, right?

Well, shortly after we found out we were at the top of the donor embryo list, she let me know that she had heard a story that indicated children born from IVF have a higher risk of cancer than children conceived naturally.  She admitted that she didn't know much about it, but urged me to look into it before making up our minds about moving forward with our donor embryos.  I did consult Dr. Google to see what he had to say.

Basically, the article indicates that there is a **slightly** higher risk for childhood cancer in children born through IVF.  It cites that the increase isn't due to the process, but is more like due to the advanced age of the mother's eggs and also due to the genetics the parents are passing along to the child.  The figures about percentage vary from article to article based on the way they calculate the percentage.  However, if you are interested in reading more about it, you can read the medpagetoday article or the article in Time online, or you can google it yourself.

To me, the best part from either of these articles was the last paragraph or the article in Time. 

Even if the study had confirmed IVF as a risk factor, experts say the level of increased risk is not enough to deter parents from undergoing the treatment. While IVF may bump up a tiny risk of childhood cancer, without it, many infertile couples may not have a baby at all.

It almost seems as if the person writing this article really understood the pain and suffering of infertile couples, doesn't it?

Cancer # 2 - YOU
After the bomb  my MIL dropped, I was sitting in the waiting room for 2 hours at a Dr's office (taking one of my staff members for stitches from an accident on the job) and there wasn't really anything but People Magazine in espanol or medical type magazines to read.  And believe me, peeps, looking at the pictures isn't as fun when you don't know the celebs or when you can't read the captions.  So, medical magazines won.  And what I read has caused me to come home and do some further googling.

Not only does your status as an infertile mean that your child could have a higher risk of cancer, it means you are possibly at a higher risk of ovarian cancer. 
From what I am reading, it would appear to me that we infertiles may have risk that increases exponentially - several of the bullet points spoke to me.

These articles cite the following items indicating increased risk:

• A woman who has had children has a lower risk of ovarian cancer than women who have no children. The risk gets even lower with each pregnancy.
• Using the fertility drug Clomid® for longer than one year may increase the risk for developing ovarian tumors, and the risk seemed to be highest in women who did not get pregnant while on this drug.
• Fertility drugs seem to increase the risk of the type of ovarian tumors known as "low malignant potential" (LMP tumors). If you are taking fertility drugs, you should discuss the potential risks with your doctor.

The first study that I read (in that medical mag) mentioned only Clomid.  However, it made me wonder if all of my days on Clomid or Femara or (oh heavens) Gonal F and Menopur was going to increase my risk of ovarian cancer even more - after all, if Clomid increased your risk, wouldn't all fertility drugs (especially these that made you ovaries resemble bubble wrap) increase your risk?  My Googling did bring to light this statement from cancer.org.

However, women who are infertile may be at higher risk (than fertile women) even if they do not use fertility drugs. This may be in part because they haven't had children or have not used birth control pills (which are protective). More research to clarify these relationships is now underway.

So, the increased risks may not be in association with the drug, but the disease of infertility.

Other good news I found?

• Using oral contraceptives (also known as birth control pills or "the pill') also lowers the risk of ovarian cancer.  So, ladies, all those months on the pill prior to finding out we were infertile weren't "wasted time and money".  They could be offering you some lower risks of ovarian cancer.  In addition, all those BCPs you popped for your IVF cycles did more than just get you ready for a transfer.
• Both aspirin and acetaminophen have been shown to reduce the risk of ovarian cancer. Once again, all those baby aspirin you took during your IVF cycles, good stuff.  And the acetaminophen you popped for those painful periods or to combat those lupron headaches?  More good stuff.
• A study of women who followed a low-fat diet for at least 4 years showed a lower risk of ovarian cancer. Now all those diets you have gone on to loose all of that infertility weight also offer you an added benefit - not only can you fit back into your skinny jeans, but you are combating ovarian cancer...

Okay, so those last 3 I may have been searching for a lighter side of things.  I don't like to just post doom and gloom stuff.  And dry wit is part of why you all love me.

But seriously, if you feel that you want to read more about your possible risks, you can read a couple of articles at Mayo Clinic or at cancer.org or you can talk to your doctor.
I know that when I go next week for my next round in the stirrups, I will be asking my OBGYN about it.

The Timeline - How Does October Sound???

So here is the schedule for our FETw/DE:

August 17 - Have annual PAP completed, include STD swabs
Cycle Day 6-10, Complete Saline Ultrasound
Complete Counseling required by RE
Fill out and Submit Consent Forms

Beginning with September cycle (around September 6), start BCPs.
FET cycle will include Lupron (yuck!)
Complete Baseline U/S and begin progesterone & estrogen supplements
Complete mid-cycle blood work about a week later
Complete Lining Check U/S
Estimated Transfer Date - OCTOBER 20
BETA (hopefully with a BFP!!!) on approximately October 30.

Granted, things could change a little bit, but this is our approximate timeline for now.  Since today is August 11, that means a little over 2 months from now!!!  It will be here before you know it.