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I am joining in with several other bloggers to bring awareness to November being Infertility Awareness Month and the cost of infertility to individuals.

I do not have an infertility diagnosis per say, but I did require medical intervention to get pregnant. I say this because I am aware that while my struggle was painful, I know many more people have been through much much worse to achieve pregnancy, and some never do.

When A and I decided we were ready to build our family we found a midwife we wanted to work with and met with her to go over our options. I’d been charting for several months and we’d recently purchased our anonymous frozen sperm. We were optimistic and wanted the process to be as normal as possible. She told us I’d most likely be pregnant in 3-6 months and supported our desire to try at home for the first three months and reevaluate then if I was not pregnant.

The three months passed and I did not become pregnant. Trying at home was incredibly stressful. The entire experience was stressful, so much so that after the third attempt my cycles went annovulatory for months. We decided to take a big long break to reevaluate while I focused on bringing balance to my life in effort to get my body back to ovulating.

We were ready to try eight months later with a new plan – in office IUIs. We stocked up on sperm from a different sperm bank this time. The first cycle try fell during a very difficult time and while the sperm sat in the tank in our living room waiting for me to peak on my monitor, it became clear I was having another stress induced annovulatory cycle. This was devastating after having just taken eight months off to regulate my body. The swimmers went back into storage for another cycle and against medical advise, I only waited out one more cycle before starting to try again.

After all this time we’d come to a pretty clear conclusion that there was a correlation between stress and my ability to ovulate (and anyone who’s done any charting, or had any medical assistance in ttc, knows there is always an element of stress involved in the timing). In an effort to combat this stress we decided we’d try every other month in order to give my body a break between months. In November 2006 – one year and one month since we’d originally started trying – we began trying again with IUI.

Starting down the IUI path brought us hope, as was the case each time we did something different. At this point we just thought, well frozen sperm does not live as long so maybe we need to do IUI just to get it into my uterus and not waste it’s lifespan on swim time. You can make yourself believe anything when ttc.

IUI alone did not work. In February of this year I asked my midwife to do a complete fertility work up. She encouraged me to call my insurance to learn what they would cover. I live in a state with mandated infertility coverage. She told me not to reveal that I didn’t have a sperm source at home. I was delighted to find out that all my testing would be 100% covered: blood work, HSG, ultrasounds. That same cycle I began taking Clomid and was monitored with ultrasounds. The timing made it so we had to wait one more cycle for the HSG, and of course I hoped so much that I’d just get pregnant and not have to have the HSG. No such luck. My first IUI/Clomid cycle did not work and I moved on to have the HSG, which showed healthy tubes.

All my tests cam back normal. There was no reason that I could not get pregnant. Unexplained Infertility is how I’ve heard it referred as. In my world this meant insurance would not cover me. Let me back up and say, my first cycle with Clomid was emotionally exhauting. I did not know if I could do it a second time. So I asked my midwife to prescribe Fermara. I’d learned about it from all the online research I’d done and heard it was easier on the body than Clomid. Well apparently it’s not really an infertility drug and the people in her medical circle were not using it so she was not comfortable using. I begrudgingly agreed to another round of Clomid. At the same time she indicated that if it turned out I needed any higher dosage of Clomid or to move on to injectable medications, I’d have to go under the care of an RE because she could not provide the level of monitoring I would need. The thought of leaving my midwife was so very sad.

IUI number five, Clomid cycle number two, first try after HSG was our magic combination. I got pregnant, and am now seven months pregnant, anxiously awaiting the birth of our child. It was a long, at times painful journey. We’d gone so far as to start the adoption process, and even had our first safety home visit while in the tww that turned out to be a nine month wait. I was starting to believe I could not get pregnant and I had mapped out a plan to document enough in office attempts so that I would be eligible for IVF coverage through my insurance by January 2008.

The pain of trying and not achieving pregnancy, having so many bumps in the road, and having to rely on so many outside people to get pregnant was horrible. I am thankful for the assistance, but it was one of the most difficult things I’ve been through. And forced us to really figure out what we wanted. There were times when we discussed not having kids – thinking maybe it was not meant to be and envisioning what life would be like as just us. We had to explore all options. I could not have made it through this process with out the all the love and support of A and my family.

So what did it cost us? I did not keep track of it all precisely, but I estimate in the end we spent about $10,000 on sperm, medication, OPKs, and Fertility Monitor sticks. We were fortunate enough to work with a midwifery practice that did not charge us for IUIs. Not one dime. And some how all my ultrasounds (I believe 13 over the year and a half – I had some prior to Clomid for various reasons) were covered. All my IF testing was covered. $10,000 isn’t all that bad when I consider that many people do pay for the IUIs and the ultrasounds, or the more expensive IF medications (Clomid is pretty cheap). But it’s still a lot of money for us. I don’t know how far we would have gone, or how much we would have spent.

We’re so happy to be pregnant and we really want two children. We will try for our second child when the time is right, but I am not sure we’ll go to the same extremes. By this I mean, we’ll use the protocol that got me pregnant, but I am not sure we’ll be so open to venturing down the entire path that lead us to this pregnancy. I think we’ll be quicker to count this blessing and call ourselves a family of three. It was hell, and I am not willing to relive it.

Yesterday I felt crampy, period crampy. Usually in the days before my period, I get dull cramps in the wee hours of the morning. Today, the same cramps palgued me around five am. So much so that I could have taken ibuprofen, if only I weren’t so lazy and didn’t want to get out of bed.

Instead, I lay there, knowing I am not pregnant. Sad. Tired. Really so tired, not because it was 5am (I went to bed at 9:30), tired of this. Tired of all the emotional work. The start of my cycles, the drugs, temping, the ultra sounds, the opks, the monitor, the phone calls to the midwives, the iuis. Tired of thinking it could work, tired of spending two weeks waiting for the news I so desperately want, tired of never getting that news. Tired of crying.

I am so tired of having so many people involved in this process. They are all great, but I am not sure I have articulated the added stress. I hate to inconvenience people, and that’s what I do every month. I need to be fitted in, when I need it. Not because I am a bitch, but because ovulation has its own schedule. I am sick of fighting with the receptionists at the MWs office, me insisting I need to speak to a MW today. I am tired of buying sperm. $7,000 and counting. SEVEN THOUSAND! And that does not include, all the sticks: monitor, opk, and pregnancy tests. Nor the monthly storage fees. And you know what, seven thousand dollars is nothing compared to what we’ve paid emotionally. I bet we’re into the millions now.

I know it isn’t over till I bleed, but I am not a fool, I know my body. I know all too well which days leading up to bleeding I: break out, start cramping, and have sore breasts. How couldn’t I, I’ve been charting for eons. And then there’s that holiday tomorrow. A holiday I’ve never really cared about. Always recognized my mother, but kind of thought it was a weird holiday, so why am I so sad that it’s passing? Yet another holiday that makes me sad. Just like the previous two Christmases. It’s the passing of time, these holidays are like anniversaries that remind me I am still not pregnant. And I had really hoped for the ultimate mother’s day gift this year.

I may need a break. I don’t want to take a break. Breaks are part of why this is taking so effing long. I will try again next cycle since it’s the third cycle post HSG and thus my last extra fertile cycle, not that that’s made any difference so far. Then I may need to take the summer off.

Check.

Well it was so much more low-key than I thought it would be. I pictured the lady opening closets and looking under sinks. She walked through the first floor, counting smoke and carbon monoxide detectors. There was more of the same when we went up stairs, except she was also measuring the bedrooms. Her measuring device was soooooo cool. She’d hold it to one wall and a laser beam would show on the opposite wall, and the measurement showed up on the device! I need one of those. With our current configuration we could have seven children, if we moved our bedroom to where it used to be, we could have eight. One or two is just fine with me; I don’t fancy packing them in like sardines.

After touring our home she quickly reviewed her checklist and gave us some ideas for further safety measures. In the end we passed with flying colors. But we can’t start the MAPP classes until what feels like forever- late summer or early fall. Our schedules just don’t mesh with the times they are having the next two sessions (A.’s school and me being away for July). Lucky we’re professionals when it comes to waiting.

I am excited, and a little nervous. Starting this process, and having the visit today made me feel like no matter what, if we want kids, we will have them, even if we don’t carry them. There are kids out there, and we are making our way to them. It’s exciting and overwhelming all at the same time. After trying for so long, there is a part of me that has begun to think about life with out children. Part of me sunk into that idea and with that came more doubt about ever getting pregnant. When you (I) can’t get pg and have no control, you (I) lose hope. Starting the adoption process gives me hope, for the first time in a long time. As long as A or I don’t do anything crazy to get some criminal record, then we will have a child. We will. Do you know that this is the first thing I’ve felt like I have any control over since we started ttc? It is. I’ve felt out of control since September 2005. That’s a long freakin’ time, no wonder I began to lose hope. Now I’ve got a shred of hope back, and of course I still think I’m currently getting knocked up. For 5dpo, I am doing great!

 

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Tell me what you know…

I am calling my MW this week to find out what my diagnosis is. It seems as if I am unexplained since all the effing IF testing came back fine. We need to start thinking about meds for the next cycle. I do not want to do Clomid again, but will if she won’t prescribe anything else. I’ve heard Femara is good and the side effects are not as bad as Clomid. But I’d be lying if I didn’t tell you that I am really considering injectables. Lo and Co’s story is enough to make anyone want to move on to them! But before I go there, I want to know what to expect. So please do spill. Cost? Side Effects? How often do you inject? Where do you inject? Anything else?

How does the HSG increase fertility?

1) It may effect a mechanical lavage of the tubes, dislodging mucus plugs.
2) It may straighten the tubes and thus break down peritoneal adhesions.
3) It may provide a stimulatory effect for the cilia of the tube.
4) It may improve cervical mucus.
5) The iodine may exert a bacteriostatic effect on the mucous membranes .
6) Ethiodol decreases in vitro phagocytosis by peritoneal macrophages. If the same effect occurs in vive it could decrease macrophage activity and thus aid fertility by inhibiting the release of cytokines and decreasing phagocytosis of sperm.

Above info found at this website.

I wasn’t going to post a long drawn out story about my hsg, because I thought it would just be boring, so I created the shorter list style post. Since then, I’ve realized several things. 1) I had a somewhat different experience form those in blog land as well as Fertility Friend land and 2) we owe it to each other to demystify this “scary” test. I warn you now this is a graphic post. I speak of blood and use the word vagina a lot. So here goes:

I’ll start at the very beginning; HSG stands for hysterosalpingogram and its purpose is to evaluate a woman’s uterus and tubes. Achieving pregnancy is compromised if there is blockage in the tubes. A gynecologist and radiologist are present during the procedure, which usually takes place in a hospital.

My test was scheduled for more than two months, and there was a chance I wouldn’t have to do it, had I gotten pregnant last time around. I was really nervous about the test because all I’ve ever heard is that it hurts like hell. In the days leading up to the test I did not think about it, for fear of obsessing and working myself up. The night before the test I had a nightmare that I could not find the hospital (a joke, because I am all too well acquainted with my hospital). My sleep was interrupted all night as my slumber thoughts were invaded by my fears.

My partner, A. took me to the appointment. Entering the hospital, I knew little about what would happen. Partly this was my own fault. I was so nervous about the procedure that I did not fully inform myself of what to expect. Once we made it past registration (no small feat at my hospital), we waited in the radiology waiting room. Not long after a very nice nurse came to get me and brought us to the exam room. Now if you’ve been following here, you know I spend a lot of time in stirrups, so naturally I was expecting to enter a similar exam room. The one word I would use to explain the room I entered: horror. This was a large room, with huge equipment – radiology equipment, dozens of aprons to shield bystanders during procedures (my wife was hot in her apron!), large gloves (not sure what for). The exam table was long with a thing-a-majig above it that slides and is used to transmit the image onto the screen that was hanging from the ceiling. The nice nurse who brought us in handed us off to caring nurse.

Caring nurse directed me to the bathroom and had me undress. I came back out and that was when I realized the table was hard and there were no stirrups. My wife had a rant about how this is misogynist, but I’ll leave that one up to her if she wants to post about it. I sat and wondered how the hell this was going to work. The gynocologeist entered and started prepping everything. I was taken aback by the formalities. The nurse called her “doctor” as she did the radiologist as well. I am not used to the medical establishment, as I call my midwife by her name. The formality was odd to me.

As the gyno started prepping I noticed a tray, wrapped in blue hospital paper. She opened it and I was horrified at the number of instruments. I told her so. She assured me she wouldn’t be using them all, that the tray comes pre-packed. I found that odd, but whatever. Then she takes a needle and goes on to tell me that it’s a really long needle but that’s just because it has to go deep into my vagina. Somehow this did not make me feel any better about the needle size. She told me the needle was used to inject novacaine (something I have since learned is not standard procedure, but I think helped). I’ll say it again, I was terrified, I wanted to tell her no needle, no novacaine, but my fear paralyzed me and I was not really in a place to argue the procedure.

The gyno had a great sense of humor and used it to try to put me at ease (but since the xanax I’d taken was barely taking the edge off, humor sure was not going to cure me). She said to me, “there are no stirrups on this table so the only way I’ve ever been able to do this in any respectable way, is to have you put your feet on my shoulders.” My feet. on. her shoulders. Am I not in a HOSPITAL?! I did as she said. And she began inserting object upon object into my vagina, but first she opened me with the largest speculum known to womankind and apologized about the size- it was a by-product of the pre-packed tray phenomenon. It hurt going in, but she was then able to get everything all set up, and it felt the same as an iui feels to me- a little crampy, but nothing too bad. My vagina, cervix, and uterus were prepped and ready, and she took the speculum out. And oh my god did it hurt. This was the only part that seemed cruel, I could no longer fight the tears, I just let them flow for a few seconds and it helped…I got a lot of the anxiety out and was ready for the next step. Through the whole thing A. held my hand, as I squeezed hers and she reminded me to breathe. The gyno said that would probably be the worst part for me and the caring nurse said it was the equivalent of me delivering an 8 lb. baby, I am not so sure about that, but she was trying to make me feel better (and it was in the context of her telling me that one of her kids was 8 lbs. at birth- and yes I did ask if she had children).

Caring nurse slid me up so I was under the contraption that would read the dye. I was feeling a lot better and now we were just waiting for the radiologist to come in. He entered and was a goofy older man, he never did introduce himself. It’s kind of weird, some dude is checking out my uterus and we never really met. Once the gyno and the radiologist were ready the gyno injected the dye. I felt the rush of the dye as it was released, and my eyes were glued to the t.v. screen. I had no idea what I was looking for, but I figured if I saw the dye move forward and fast, then I was in the clear, so to speak. It did and I felt no pain at all. From what I’ve been told if there is a block, the dye can be quite painful.

Once the test was over caring nurse pushed me back to the end of the table and the gyno began extracting the catheter and other things from my vagina (I really have no idea what she had in there). There was this one thing she was calling an “acorn” that she could not get out. Having no idea how big it was, I thought to myself, It’s okay, just let me go home, I’m sure it will fall out by itself. And then after trying with her hand and a tweezer thing (which pinched me)she told me to go into the bathroom and see if I could push it out. Excuse me?! Caring nurse helped me to slowly get off the table, for the first time I saw tons of blood and the extent of instruments that were used, and she ushers me to the bathroom. I get in there and have NO idea what I am supposed to be doing. I sit on the toilette and blood comes out. Not knowing what it is I am trying to push out, I am not sure if it fell into the toilette or not. But soon I realize there is nothing but water and blood in toilette. I am faced with two options. I could tell her I got it out and go home or I could open the bathroom door and tell her I have no idea what I am supposed to be doing, I did the latter.

She came in and verified that it did not fall into the toilette. Yes, a total stranger looked into a toilette that I had just bled into. She told me to squat and bear down, while she stuck her hand up my vagina to get it. This took a little maneuvering and she told me I was doing great. Good to know. It took her a few moments, but she got the “acorn” out and it I felt really dumb for thinking I wouldn’t have known if it had fallen into the toilette – it was the size of The Keeper. No lie. She left the bathroom, I cleaned myself up a bit and got dressed.

The whole thing felt very surreal. I have never been so vulnerable in front of a medical professional. I think I felt even more vulnerable because my experience with my midwife is far more holistic and I feel in control, where as the doctors, they take control. The gyno wrote me a prescription for an antibiotic and sent us on our way. From start to finish, we were in that horrible room for about thirty minutes, but it felt like forever.

In the end the test itself was not bad. But maybe I misunderstood what was so bad for others, maybe they too struggled with the set up more than the dye squirting. I was so terrified of experiencing pain when the dye was released and had no idea that all the prep work would cause so much discomfort. I wanted to share this, my experience, because I really could have benefited from knowing just what was going to happen. I was too scared to inform myself because I’ve read and heard so much about how horrible this test is. I know it’s cliche, but knowledge is power, and had I known the set up would be so difficult, I would have been better prepared for the experience. While this was the most invasive test I’ve ever had, it was over quickly and the doctors and nurse attending could not have been better or made me feel any more relaxed (well they could have put me out…). I really wish I knew caring nurse’s name because I would send her a card thanking her. She was really great.

Go ahead and ask questions if you’ve got them. I don’t want this test to be a scary mystery to anyone.

Check.

I had the damn hsg this morning. Here is what I learned:

  1. The people working at the registration desk are incompetent and lied to me.
  2. The medical staff at the hospital are all super awesome!
  3. Part of the procedure involves a shot of novacaine, that means a needle, yes a needle went into my vagina, folks!
  4. The shot of novacaine did not hurt, but still, why didn’t anyone tell me I’d see a needle?
  5. The gynecologist performing the procedure was under my midwife’s care for all six of her pregnancies – yup, a gyno using a midwife, even more reason that I am sticking with my MW for as long as I can. (I won’t be able to use her if we move onto stuff like IVF.)
  6. Large speculums hurt.
  7. Having your partner hold your hand and remind you to breathe is the only way to get through the procedure.
  8. It was not as bad as I thought it would be – the large spec was the worst part.
  9. Seeing your uterus on a t.v screen is weird.
  10. But, most importantly, my tubes are CLEAR!

That is all I have to say about that!

You’d think I’d be used to the ‘day you know you’re not pregnant’ feelings by now. Each month it’s like a new wound, reopened, complete with emotional pain. Each time it feels like the first time. It never gets any easier, if anything it gets harder. And, each time, my determination to win kicks in. After crying for a little while, and feeling like the biggest loser for even longer, and grumbling about how much money this costs us, and watching our house down payment fund shrink more and more, I come back with a renewed hope that NEXT time it will work. A. asked me yesterday, how I keep going? Honestly, I’ve put too much effort into this to walk away now. If I lose this battle, I’m going down fighting, knowing I did everything I could to win.

Sometimes A. takes issue that I put my feelings out on the internet before telling her (what can I say, I am introvert…). After reading my post she asked what I thought about her trying. This has been widely discussed, just not in recent months. Honestly when it has been discussed recently, I was not getting the message that she wants to try. Her being in grad school further complicates the issue. So whether or not she will try and when still remains to be seen, but should be added to plan #6,201.

I have lots of feelings about A. trying. Most of them are tangled in a web, and I could not begin to get at them when she asked me how I feel about it. It really is better left tangled. But, what I did realize, for the first time, I am not (as) sad about not being the bio mom, not being pregnant, as I have been in the past. I would rather her have our baby than adopt a baby. There I said it. I still want us to have a somewhat bio child. And if it means A. has it, then so be it. Three months ago I was not in this place. The idea of giving up pregnancy made me really sad. All the adoption talk has changed a lot. I’ve danced with the idea of raising a child that we have no connection to. I’ve done a lot of work to get to a place of moving forward with the process (and we still are) and it is totally still a viable option, but we are a two uteri home, and how can we let one go unused? Some folks can, but I hope we don’t.

There is no way on Earth that I am pregnant. Not this time, and not the previous six tries. Seven failed attempts, four iuis, one Clomid cycle, and I start to think this is a huge waste of our time and resources. We have no sperm left, I hate how Comid makes me feel, neither of us really think I’ll ever get pregnant…and we’ve devised yet another game plan.

I will have the stupid HSG, during my VACATION, in two weeks. I’m taking this next cycle off, due to travel around ovulation. We’ll spend our tax refund on baby juice (how many thousands of dollars have we spent buying sperm?). I will try at least three more Clomid/iui cycles before making any more changes (this will put me at seven iui cycles, four with Clomid). After that we’ll see if:

  1. I want to pursue any further interventions (I said I’d never do iuis, or Clomid…and now I wonder how far I will go…and I really don’t know if I would do IVF or not).
  2. I may stop ttc all together.
  3. I may take a break for the summer (remember, I don’t work in the summer, and spend my days at the beach on Cape Cod, so iuis do present a challenge, or at least a really long drive).
  4. We’ll move to adoption.

Technically we’re already doing #4. Part of the current plan is to start the adoption process, while I am still trying, and go with which ever one works out first. We are mostly looking at adoption through foster care. I’ve referenced MARE numerous times before. We don’t know a lot about adoption, and we don’t think we can afford adoption through an agency. If you’ve used an agency, PLEASE share!

The MARE option provides the opportunity to adopt children from with in our state (a great thing if the child does want to keep any contact with family — in some cases, the children express an interest to remain in touch with siblings or grandparents—and we’d also be open to adopting a sibling group, maybe up to three). Because the children are in foster care, and placing them in a permanent home is in the best financial interest of the state, the adoption process is free, which of course is very appealing after already having spent thousands of dollars ttc.

It’s a lot to wrap my head around. I spoke with a friend yesterday who lost her own infertility battle (four IVFs) and has since adopted through foster care. I feel so fortunate to have someone I can talk to who’s been through it all, and has come out on the other side. She does not judge and she gets it. I started telling her we are looking into adoption and she got sooooo excited, but then I was waffling back to the part where I am still pumping meds into my body and trying. And she said, “you’re at the point where you want to know you’ve exhausted all your resources. You don’t want to look back and wonder what if I tried…” For her it was what if the fourth IVF worked? When it didn’t, she knew she was done. I don’t know when I’ll be done. But I feel good about ttc while pursing adoption. Everything will happen as it is meant to and the child we’re meant to mother will find us. We can’t control it, we need to open up and let the Universe deal the cards.

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