CD4

Um, hi! It's me! You know, the one who wrote all about how she wasn't going to do IVF, and didn't know whether she got her dream job, and didn't know when she was going to start treatment again, and then disappeared for a week? Yeah, I'm back. And, as you can see from my brilliant post title, I'm on day 4 of a new IUI/injectibles cycle.

I still haven't heard what's up with Dream Job, but mentally I've already moved on. (I talked to my friend who is also up for the job and it looks like they've started calling in more people for final interviews, so apparently my dazzling personality did not overcome my other shortcomings.) I have a line on a consulting gig that would start this winter, after my current gig runs out. We still have our good insurance, for three more months anyway, and I was desperate to stop taking the pill that Dr. SF's people put me on for the IVF prep (it was not my usual pill and it made my skin horrible and I bled EVERY SINGLE DAY that I was on it).

So Friday night, my husband and I talked and talked and talked, and then we said "Fuck it" and I tossed out the pill packet. Got my period Sunday, and went in yesterday for Day 3 bloodwork and u/s. 75 IU of Gonal-F yesterday and today, back in tomorrow for more bloods and u/s. And probably every day for the next week and a half, if past history is any indication.

I'm feeling pretty Zen about this cycle. I think. I can now admit that I was terrified of IVF and am relieved not to be doing multiple shots a day, relieved not to have to brave the PIO, relieved not to be writing a $750 check for anesthesia and signing a credit card authorization for the $1,000 cryopreservation charge.

When my husband and I were talking Friday about how some days we're totally on board with having a second child and others we are SO NOT, I expressed for the millionth time my frustration that we're not able to just go off birth control and see what happens, that we HAVE to make a decision and a concerted effort to conceive another child. And my husband said, also for the millionth time, "Well, this is just how it is for us, and we just have to deal with it."

And finally, this week, something clicked and I got it. See, I have a friend who is in a tough situation not of her own making, and there is absolutely nothing she can do about it. Nothing. And she complains about it, as she is totally entitled to do, and I am there for her to give whatever support she needs. But sometimes I just want to tell her, in the kindest way possible, "Look, this is how it is. You can keep complaining about it and continue to be miserable, or you can try to find a way to be happy, given the limitations of your situation." (I do not tell her this, because I am chickenshit.)

Yesterday I realized: This is just like me with IF. The reality of my life is that I am infertile. I can keep complaining and wishing things were different, or I can move on and make the best of it with what I have.

I don't know why, but I never GOT IT like that before. Maybe I was too wrapped up in my own misery, or maybe I just needed to do a lot of mourning and healing before I was ready to think this way. But I have done plenty of mourning in the five years since I first started trying to get pregnant. And I'm ready to move on.

(DISCLAIMER: I am not saying that ANYONE ELSE but me needs to move on. I respect other people's grief and bitterness over infertility 100%, and I also realize that it's a hell of a lot easier for me to move on from IF pain when I'm on the other side with a child.)

I've been feeling a new sense of lightness since coming to this realization. It's nice. It didn't make last night's shot any easier, but it's making this cycle in general feel a little less fraught.

Oh, PS, just in case there wasn't enough going on right now, my husband suddenly has an opportunity to start his own business. Not sure if it's going to happen or not--there are a lot of steps that need to be taken and a lot of research that needs to be done. But we do like our stress over here, preferably in very large helpings.

A bigger wrinkle

We will not be doing IVF. And not because of my job situation (more on that later), and not because of insurance woes.

Last Thursday, we had our IVF class, after which we signed the 8 million release forms required and had a bunch of tests (STD screening and general bloodwork for both of us, cultures and saline sonogram for me, SA for my husband). In addition to all the fun injection practice, the class featured a video tour of the embryology lab, so we could see where the magic happens, learn about all the safeguards in place to prevent this, and see real footage of fertilization, ICSI, assisted hatching, and the other fun procedures that take place there. And while I, the ART nerd, found the whole thing fascinating, it was too much for my poor husband.

Longtime readers may recall that my husband is the product of 12 years of Catholic schooling. He was an altar boy, a Eucharistic minister, and at one point even contemplated joining the priesthood. He is no longer a practicing Catholic, is passionate about science in all its forms, and is a supporter of reproductive rights and advanced reproductive technologies...for other people. But he was already squeamish about the idea of freezing embryos (highly likely for us, since even if we only had 2 decent embryos, we would only transfer one at a time), and the sight of a needle sliding into a defenseless egg, well, frankly, repulsed him.

I told him that ICSI and AH were highly unlikely to happen for us, but that was beside the point. Over a long lunch following the clinic trip (hey, we had the babysitter until 3, why not?), we hashed it out. IUI and ovulation induction don't bother him because they just seem like giving nature a little boost, but seeing that video, and signing all those forms, made him realize that IVF is simply outside his comfort zone. And I can't say that I was particularly surprised, given the minor discomfort he'd expressed in the past.

Obviously I'm not going to push him into anything he's not comfortable with. So after a few more days of mulling it over, we decided to try a few more (carefully monitored) Gonal-F IUIs. I talked to Dr. SF yesterday, and he said I can go off the pill at any point and we can start. (I told him I'd stay on the pill one more week while we await the resolution of this job situation.) Looking at my last cycle, he feels that we went maybe a little too slow, that even though we had the desired result of one follicle, I probably could have used a little more juice. But we don't want to replicate the 2006 cycle where I got pregnant with Bat Girl, because that one was too fast and came too close to overstimulating me. So we're going to shoot for something in between. Still aiming for one follicle, but with a little more power behind it.

I am OK with all of this. Really. I don't feel resentful toward my husband. I had my own doubts and fears about IVF, and I've spent way more time thinking about it than he has. I know that the whole concept wasn't truly real to him until we went through the rigamarole of cycle prep--he needed all of that to really drill down to his core feelings. I'm a bit nervous about doing more IUIs, but at least it's something I'm familiar with. Honestly, I'm a little relieved.

Now I'm just twiddling my thumbs waiting to hear about this job. The folks at Dream Job are suddenly MIA. I was supposed to get a call Monday or Tuesday for a final phone interview, but they never called. If I had to guess what was going on, I would say that after my interviews last week, they called in at least one other person for a final round, and are stringing me along while they determine the outcome. At this point, I'm so burned out by life in general that I almost don't care anymore. Which is sad. The good news is that either way, I will be happy with the outcome. I'll be happy if I get the job, because it's a great job and I would be excited to work there and have a regular paycheck again. And I'll be happy if I don't get the job, because I can proceed with treatment guilt-free.

I think that's all for now. Oh, unless you know anyone in the Big City area who needs a bunch of Lupron and PIO?

Quick note

I really appreciate all the comments, y'all. I totally agree that getting/being pregnant should not prevent a company from wanting to hire me, nor is it their business at this point anyway. That was my rationale for wanting to go ahead with it anyway, and why I had no problem starting a cycle while interviewing.

The problem is that this new accelerated timeframe would mean starting Lupron more or less simultaneously with accepting a job offer (should that happen), and starting stims around the same time as starting the job. My newfound hesitation is not so much to do with professionalism or lack thereof as it is about not really feeling like I could handle the pressure of starting a new (really huge, very high responsibility) job and doing my first-ever fresh IVF cycle simultaneously. If I'm overwhelmed by stress, I have to think that can't be good for either my work performance or my reproductive performance. Not to mention my mental well-being and the happiness of everyone around me.

I had two hours of interviews today and was supposed to have another round tomorrow but that's been rescheduled for Monday, which is of course the day I'm due to start Lupron. So: We're going to go to our IVF class Thursday and have all the testing done, sign the consent forms, etc., just so we're ready. And we're going to explain the situation to Dr. SF and tell him that I'd like to hold off on Lupron for one week (I just have to take the pill for another week, I don't think that's a big deal) so we have a little breathing room to assess the situation. Once my neck unknots a bit and my breathing returns to normal, I'll be able to think about it a little more clearly.

Ack.

Because I cannot think clearly enough to compose coherent sentences/paragraphs, I present my Monday in bullet points:

• Called Freedom Drug to confirm delivery of my meds--in case you're curious, that's 2 courses of doxycycline (1 for me, 1 for husband), 1 Lupron 2-week kit, 7 tablets of Medrol (I think that's for in case they end up doing micromanipulation like ICSI or assisted hatching, which I think is unlikely but whatever), and 2 vials of the dreaded PIO. They're going to try to get insurance to cover at least some of it, but I was pleasantly surprised to learn that even if I end up having to pay out of pocket, the total will be "only" $314.39. Yay! (And yay again for stocking up on Gonal-F.)

• Got a call from Dream Job--they loved me in the interviews, but have some reservations about one particular issue, and so they want me to come in for one more round of interviews, this time to meet with two new people and a second 1-hour round (third if you count the initial phone interview) with the CEO.

• Basically, I was given to understand that if I nail these interviews, the job is mine.

• The one particular issue they have reservations about is one that I personally know to be my weakest suit. In my most confident moments, I consider this to be an area in which I am merely very competent (as opposed to my brilliance in every other aspect of my work life). In my weakest moments, I feel that this is the weak link that dooms me to a life of mediocrity and/or failure.

• It is incredibly nerve-wracking to know that whether or not you get a job hinges on whether or not you can prove yourself in your weakest area.

• It is incredibly distressing, as useful as it is, to get feedback that basically confirms your own harshest assessment of yourself.

• So much so that I freaked out on the phone to my husband when I called to tell him about this and ended up crying on my cell phone in the middle of a busy Big City sidewalk. Nice.

• Approximately 50% of the freakout was interview-induced, the other 50% was the IVF issue coming up again. Because it's now clear that the decision on this job may come very quickly--may come this week, since I've got my series of interviews tomorrow and Wednesday. May come, in fact, before I start Lupron next week.

• As I was freaking out on Third Avenue, my husband pointed out that maybe I have a little too much on my plate, what with the job thing and the IVF, and maybe we should consider holding off.

• Cue round 2 of hysterics. Panic about cost, insurance, "but I'm not getting any younger!", "if we don't do it now we can never do it!", etc.

• The thing is, if I had already started the IVF protocol when offered a job, I would be OK with continuing, as per my last post. But what if they offer me the job this week? Could I really handle the pressures of a new job and the stress of IVF--not to mention the side effects of the drugs, etc.?

• I have been trying to come up with a zoo-related analogy to illuminate all this, but I fail. But this job involves being head of a small but growing zoo with a very large penguin division (click the link if that doesn't make sense to you).

• If I think about it, as long as the meds will keep (and I checked, the Gonal-F pens have an expiration date in 2011), it wouldn't be terrible if we waited until next year to do IVF. Yes, it would be expensive without insurance, but if I had a job we might be able to make it work.

• But I want a baaaaybeeee noooooooow!

• (Not really. But I do like the idea of BG and her theoretical sibling being around three years apart.)

• At any rate, now I am starting to lean toward holding off--assuming I get an offer before next week, that is. If I don't, all bets are off.

• I realize that is in complete contradiction to where I was going in my last post.

• I am confused.

• I am going to lock down and just keep my head focused on the job stuff for the next couple days, and worry about the IVF stuff later. Or I will try to do that, anyway.

Another wrinkle

I think the interview for Dream Job went fairly well. I actually ran into a former coworker of mine there who was also interviewing--we seem to go for the same jobs all the time. I'd be genuinely happy for her if she got it, so I'm rooting for at least one of us to make it.

They claim they will make a decision soon. Unfortunately, I'm guessing they won't make a decision by the 23rd, which is when I'm due to start Lupron. See, I was thinking that if I had already been pregnant when offered a new job (if the IUI had worked), I'd just tell them and roll with it, trying to negotiate a decent maternity leave as part of my package. On the other hand, if I hadn't started IVF yet, I'd wait 2-3 months to give myself time to get settled into a new job before diving into ART--also because it doesn't seem quite right to start trying to get pregnant immediately after starting a new position.

But with the possibility of getting a job offer while in the early stages of a cycle, I'm in an ethical and practical tangle. What makes sense? Do I delay starting (easy to do now, since I can just take the pill for an extra week or two) and wait to see what happens? Do I put it off entirely? Do I just go for it and damn the consequences? And what does one do if one is offered a job, say, a few days before retrieval, or while in the middle of stims?

There's a new wrinkle in all of this, too. (Apologies in advance for the eye-glazing tedium of all these insurance details.) Yesterday I got a letter from my former employer, through whom I still have our health insurance (and am eligible to continue through May). To cut costs, at the end of this year they are canceling the HMO plan we're currently on and switching everyone to a PPO plan. From what I remember from when I was selecting health insurance back when I was hired, this plan has NO infertility coverage. It also covers 85% of maternity expenses after an initial copay. That's compared to my current plan, where I pay $25 for the initial OB visit, $250 for the hospital stay, and that's it.

Considering that my first pregnancy involved at least 25 office visits with ultrasound, 3 hospital ultrasounds, one emergency L&D visit, and a c-section with 4-night hospital stay, with the hospital bill alone coming to more than $20,000, I'm thinking that 15% of my maternity expenses could add up to quite a large chunk of money.

I can find other plans open to the self-employed with better maternity coverage, and they'll be comparable in cost to the $1400/month or so that I'll have to pay for COBRA (my continued insurance from my former employer) once the government subsidies run out in November. So if I get pregnant, clearly we'll be switching. And probably even if I don't get pregnant.

But none of the plans available to us have infertility coverage--I remember this from the last time I was self-employed and TTC, and it's why I got a full-time job in the first place. And even if I get Dream Job, it's a very small company (like, less than 25 employees) so I would bet money that their health insurance doesn't cover infertility either. Without insurance coverage, we might be able to afford an injectible IUI or two (I'm guessing with meds, they'd run around $4000 each, given how closely I was monitored last cycle), or maybe an FET, but we couldn't possibly pay for a full fresh cycle without dipping into our retirement accounts.

In essence, if we want to do IVF and have it covered by insurance, we have to do it now. That would get me through beta by November 1, and maybe we'd have time to do an FET before the end of the year if needed.

So from a financial standpoint, it makes sense not to delay. This is also mixed up with all sorts of weird emotions, like what I felt (fear, excitement, nausea, panic) when we got the 35-page IVF prep handbook from the clinic and the pages and pages of consent forms, or what I felt (anger, frustration, jealousy) this morning at the farmer's market running into two moms with children more than a year younger than Bat Girl whom I hadn't seen in a while and who are now quite obviously pregnant.

I don't know. We're going to go to the class next week, and I'm going to get all the meds (which I hope will keep in the fridge). Hopefully by the time I'm supposed to start Lupron I will have some clarity on this.

What was that about health care reform???

OMG, part 2

I just went to check meds pricing at Freedom Drug, which is where my clinic called in my prescriptions. And I am REALLY glad I stocked up on Gonal-F during my IUI cycle. Those 900 IU pens that cost me a mere $25 copay each when covered my insurance? For a cash-paying customer, $717. Ugh. I still might need to get another 300 IU pen ($239) at the end of stims, but I am really glad I have two pens sitting in my fridge and don't have to front $1434.

OMG

Spoke to the IVF coordinator yesterday. We went over the protocol and scheduling, and Holy. Shit. This IVF business is uh, really really complicated. (Quick recap: 2 weeks of BCP, one week of BCP plus Lupron, one week (or until period arrives) of Lupron only, 10-12 days of stims, trigger, retrieval, transfer, 2 weeks of PIO, then beta, then???) Don't even get me started on how horrified I was when I realized that I would be doing a full SIX WEEKS of injections, or that my doctor prefers to keep patients on PIO (not progesterone inserts) until a positive beta, at which point one MIGHT be allowed to switch to inserts if bloodwork is OK. I really, really need to talk to Dr SF about this, because while I get that PIO allows much more dosage control, I seriously don't know if we (my needle-phobic husband and my needle-phobic self) can survive doing two weeks of IM shots.

So. I started BCP, and next Thursday we're taking the IVF class (where we will learn how to do the IM shots THAT WE ARE NOT GOING TO DO SO HELP ME) and having infectious disease testing, cultures (me), semen analysis (husband, obviously), genetic testing, and possibly root canal and IRS audit as well.

Meanwhile, husband is starting to wonder why we can't just try another IUI or two instead. I told him that lord knows I don't WANT to do IVF, but rather than muck around with cycle after cycle where we have at best a 20 percent chance of success (and probably a lot less, given the variables in our situation), while I inch further and further into "advanced maternal age," I'd rather just go for something where the odds are a lot better and we and the doctors have a lot more control over the situation.

Although, it just occurred to me: What will we do if this doesn't work, and we've exhausted our IVF coverage? can't think about that now...

Aaaand meanwhile, I had just about given up on Dream Job (it's been more than two weeks since my last contact with them, which in my world usually means nothing good), but they called me today and want me to come in tomorrow for a final interview. They told me to be prepared to be there for as long as two hours. Eek!

Soldiering on

Thanks so much for all your comments and emails. I just downed a huge bowl of pasta and a beer while watching the pilot of GLEE, so I'm feeling much better, at least for now. You can blame any incoherence in this post on the carbs/alcohol/Journey high.

I've been going through major emotional ups and downs since Saturday. Saturday night I broke down crying to my husband, but the low point was this morning, when I had to go in for my day 3 bloodwork in preparation for starting our IVF cycle. Obviously I just didn't want to be there, and for some reason I had to wait forever to get my blood drawn, and I kept thinking how I had hoped that today I'd be sitting there waiting to get a blood draw for my beta, and how instead I was facing down another cycle of daily injections and blood draws and bruised flesh and I basically started crying right there in the waiting room of my clinic.

Then there was the absurdity of the fact that my delay at the infertility clinic was making me late for a play date with my daughter's best buddy (his mom and I have been friends since they were newborns and we were in a moms group together), and that the thing I hated most about having to go in for monitoring every day for a week was that I got cheated out of my mornings with Bat Girl, when the morning before I leave for work has always been our time.

And you know, I call bullshit on this whole primary IF vs. secondary IF pain Olympics. It doesn't make it any easier, already having a child, and it doesn't make it any harder, knowing what I'm missing. The quality of the pain is entirely different, but both hurt like hell. (OBLIGATORY DISCLAIMER YES I KNOW THERE ARE PEOPLE WHO DON'T HAVE BABIES OR GONAL-F OR ARMS AND LEGS AND THEIR LIVES ARE SO MUCH WORSE THAN MINE.)

All I can do is keep moving forward. I started BCP today, and will be on it for at least 2-3 weeks. My IVF coordinator will be calling me this week to go over the schedule. So, here we go.

I have so many more thoughts banging around in my head but I can't get them out right now. Maybe I should rewind and watch that "Don't Stop Believin'" number again.

Should have just waited

Spotting started last night. Period arrived this morning, bringing as a special hostess gift cramps like I have never experienced before.

11dpiui. Fuck.

(And no, it is definitely not implantation bleeding. Trust me, ça c'est le déluge.)

I just couldn't wait

On Tuesday (7dpiui) I was 100% convinced it had worked. No good reason; I had a lot of achy stretchy sensations in my lower pelvis, which I remembered from last time, though it didn't feel quite the same.

On Wednesday (8dpiui) I was 100% convinced it hadn't worked. No good reason; the bloating is basically all gone now, though I did still have an achy sensation in my uterus when I did a lot of walking (I've been doing a LOT of walking this week. I realized that it was a way of compensating in advance in case I do get pregnant and can't go anywhere or do anything for 9 months again).

Today (10dpiui), even though I knew it was too early, that a negative would tell me nothing, that things could change, I just couldn't wait any longer. So I tested this morning.

Negative. Decidedly so.

Again, I know it's way too early to be definitive. (Although if I had tested at this point when I was pregnant with BG, I would have gotten a positive, based on 48 hour doubling time and what I read somewhere that most HPTs detect an hCG level of 25.) So I'm trying not to be too pessimistic.

But I'm still cranky.

In which I try to ignore the state of my uterus

So last night I watched the latest episode of 18 Kids and Counting, the show featuring everyone's favorite fertile family, the Duggars. (As you know, Michelle Duggar just announced that she's pregnant again, but I am not touching that topic.)

I am not ashamed to admit that the Duggars have really grown on me. I mean, of course certain aspects are still horrifying (I remember in particular the episode where the oldest son and his wife discovered they were expecting, and they totally staged the "Honey, it's positive!" moment for the cameras--but that's reality TV for you) and I find some of their moral/religious beliefs deeply troubling, as I'm sure they would find mine. I don't like that the girls are being raised to basically only be mothers and helpmeets--of course being a stay-at-home mother is an incredibly important job, blah blah blah all-our-choices-are-valid-cakes, but it's a problem when someone is never given a choice in the first place. But I do admire the closeness and calm of the family and how they are clearly raising happy, well-adjusted, loving, responsible children.

But that's not what I want to talk about. Last night was The Duggars Go to Washington. They traipsed all over our nation's capitol, checking out the sites and volunteering at a soup kitchen. And Michelle (whose youngest is 8 months old) could be seen dragging a My Brest Friend pillow EVERYWHERE. So my question is, after nursing 18 children, does she REALLY need that thing anymore? Especially for a baby older than 6 months? Isn't it a little impractical to carry it with you all over the place?