Plan for the Future

The Plan

There are some thing in life that I'm adamant about having a plan for.  Like the time in Greece where Bean and I took a bus three hours to a tourist spot only to find they were closed for the day.  I ended up crying on the side of the road because we didn't have a hotel room and I didn't want to take the bus back.  That trip should of had a plan.  And there are some things in my life that I'm "whatever" about.  Like my college degrees, none which I use and I still have no idea what I'm doing with my life.  

So what's the plan if Femara doesn't work?  Femara is shown to have better success in PCOS, especially after Clomid has failed.  But it is not 100%.  I have a little knowledge about my insurance, cost of meds, IUI and pills vs. injectables.

In NH:

• I was seen by an outside provider (base didn't have someone to deal with infertility)
• Since I did so horrible on Clomid I was getting switched to injectables - Gonal-f, which would cost me about $500 since I would be on a low dose at first
• Trigger shot - $50
• IUI, with all the blood work and ultrasounds - $2-2.5k
• Total Out-of-Pocket - $3,000

In WA:

• I was sent out to a local Army Hospital, where they do have fertility doctors
• I can do Clomid+injectables, or Femara+injectable (but not straight injectables) - The meds for this piggy back cycle would be free
• Trigger - free
• IUI - $200
• Total Out-of-Pocket - $200

My insurance will not cover straight injectables.  But they will cover a cycle mixed with pill form fertility drugs.  This is stupid and I don't really get it.  Something about funding.  So even it I do get injectables I'll still be taking Clomid or Femara, even if it does nothing for me.  This is just to make them happy.  Or I could pay the full price of the injectable.  This is at least until I make it to my IVF date, then it will be all injectables.  

They also talked about possible doing ovary drilling.  

Met

My Patriot Nails

I haven't had any bad side effects from Metformin 1000mg ether.  The worst of it is during the morning when I first wake up I am nauseous.  Usually if I eat like half a granola bar and fall back asleep I am fine.

Fourth of July

Happy 4th of July America!  Bean and I are going to eat some unhealthy non-organic, non-glute free fast food, drink Mike's Hard Lemonade and be one of those crazies that sets fireworks off.  Hopefully we will not hurt ourselves or set anything on fire in the process.  It will be some stupid fun, which I think we all need right now.

-Selbe

My Doctor is an Asshole

IUI for June, and probably July, canceled.  After a few phone calls my day became pretty lousy.

I started spotting last Thursday right before my RE appointment.  Appointment went well and I was given the impression that when CD1 hit that I would call up and start Clomid CD3.  They even gave me all the paperwork with instructions on what number to call, when to take it, and what CD my other appointments would be on.  

The RE quickly mentioned about seeing a high risk OBGYN at some point.  She NEVER mentioned it was required to start CD3 Clomid.

I thought we were all set for the IUI.  Since I was spotting I assumed that would be sometime soon.

I normally spot before AF.  Usually just a few hours or a day.  Then it becomes heavy so nothing new there.  But I spotted all of Thursday, Friday, Saturday and Sunday.  Yesterday it stopped and nothing today ether.  That's weird for me.  I have never spotted for that long and then nothing.  The heaviest flow I got was maybe to fill a quarter size spot on pantiliner.  That's after wearing it all day.

I got concerned and called up the nurses line this morning.  This was first day they were open after the long weekend.  I had one simple question.  I spotted for four days then nothing.  Should I start Clomid anyways, do Provera or just keep waiting? 

The nurse told me that probably was my period.  I haven't had AF since April 1st and my lining was 15mm on last weeks ultrasound.  That was NOT my period.  She was confused by 15mm, so I said 1.5cm.  She then said, "oh you mean 1.5mm."  No fifteen, a whole fifteen millimeters!  I might be American but I do know some metric.  Trust me, 15mm lining and 60 days since my last AF means a lot more blood than a few pantiliners.  There is more in there.  

She then tells me she can't give me the Clomid or even the basic Provera until I have my first appointment with the high risk OBGYN.  Umm ok, but that's not what the doctor told me last week.

I'm told to call the appointment line to book a visit with the OBGYN.  I called it, they said they don't schedule appointments for that office by the appointment line.  Ok?  They gave me the number for information so they can give me the direct number for the OBGYN.

I called information and the operator rattled off a bunch of numbers off quick because I could write them down.  I had to ask three times.

Call number four was to the OBGYN clinic.  The start of the conversation was the basic myself telling them I need to book an appointment.  She quickly asked, "when your due date?"  I explained about the Clomid and needing a check up appointment.  She asked me when my due date was again.  Seriously?  I again explained about fertility drugs and bad cervix.  She then told me I had a wrong number and asked where I was calling.  I told her ADC (which I guess stands for high risk OBGYN, somehow).  Yup, I got the right place.  So she asked my due date again.  Then I'm put on hold while they look for my referral.

Quiet tears began running down my face.  I'm frustrated and being pushed off from office to office.  I was also lead to believe this IUI was soon rather than later.

They came back on the phone and told me the next available appointment was July 11th!  I began crying hysterically.  They won't even think about starting me on Provera 'til this appointment.  I'll be CD102 at this point.

Bean had to grab the phone and talk to them.  They were able to get me in June 26th but that's the best they could do.

I was stuck, what am I going to do?

Bean left a message at the RE letting them know how unhappy we were about the treatment.

I called up a little while later and the nurse still said no Provera, no Clomid, no IUI 'til I have the appointment on the 26th.  They are still discussing it with the doctor.  

First off, they NEVER said the appointment with the high risk OBGYN was required before starting fertility treatment.  They have never even seen my cervix in person, only what the last RE made notes of.  I discussed it the cervical cerclage with my last RE and OBGYN.  They told me it MIGHT be needed.  And the OBGYN said they wouldn't even be able to tell 'til an ultrasound at 12 weeks.  I'm not even PG, I don't see the point in rushing me off to an OBGYN now.  And if it is such an urgent matter then why is the next appointment six weeks away?

The nurse began telling Bean all the things that could happen if my cervix fails.  I could miscarry or do into labour early.  Then all the health problems the baby would have if born at X number of weeks.  I would have deal with those thing alone while my husband was deployed.  How would I deal with a dead or blind baby?  

This has gone too far.  I called up for one simple question and I got this.  If I didn't worry about PG before, I do now.  

I cried off and on for hours after this.

I have Provera left over from before that I started taking tonight.  I mentioned last September how I save medication because I don't trust doctors.  Odd that!  I don't know what else to do.  I can't move on with the Clomid even if I have AF or not.  But I also can't sit here without AF for much longer.  The surgery in October showed the abrasions in my uterus from holding onto the lining for too long.  Plus the heavy flow with clotting can be painful.  It's just not healthy sitting around doing nothing.  I'm sorry for going behind the doctor's back and "prescribing" it to myself.  But I asked for the drug nicely and I know what's best for myself.  

After my high risk OBGYN on June 26th I then had to make another appointment with the RE about three weeks after that.  If this is the case I'm going to ask for Gonal-F instead of Clomid.  It's what my other RE wanted and I have no faith in Clomid anymore.   

Since it looks like no Clomid or IUI this cycle I went to the vitamin store and stocked up on herbs that are supposed to be good for fertility.  The list to balance out my hormones:

• Vitex 1200mg daily - I've been taking this since September.  Though it worked before it has since stoppe since my MC.  But at this point I have nothing left to loss.
• Dong Quai 1130mg daily
• Maca 300mg daily 
• Red Clover Blossom 800mg daily
• Milk Thistle 175mg daily

To induce my period:

• Provera 10mg daily
• Vitamin C 6000mg daily

-Selbe

Behind the Glass

I think I'm going to have to be induced with Provera again.  It's a little upsetting.  The side effects are not the bad for me.  It's frustrating that I have to keep coming back to it.  I took it last April, then July, August and March.  I have extra here that I could take right now, but I'm saving it and holding off.  With my next RE appointment two weeks away they'll probably want to run more tests on me.  If I take the Provera now and it works quickly (probably not) then I could miss the specific testing days and have to wait another cycle for testing.  I'll just tough it out.  I'm about CD41 today and my cervix goes hard to soft over and over again.  My menstrual cramps are gone.  It seems so odd to have them so strong, then nothing.

I've been looking online for information about this doctor's office.  They seem to like to start women on Clomid before going to injectables, even if she has had no success on it before.  I did five rounds of Clomid last year, however I was never monitored via ultrasound.  Because there was no monitoring there was also no trigger shot.  With my past of not ovulated on Clomid 150mg, Dr. H wanted to get rid of Clomid all together and move me to Gonal-f (injectable) and Ovidrel (trigger).  I'm not sure that the new doctor will have the same opinion.  Clomid is not the worst thing in the world.  The side effects are not ideal, and it's not a needle.  It's just kind of territory that was already covered.  

I had a dream the other night about not being able to get the needles into my skin.  Ether my skin was leather or the needle was dull.  I just kept stabling myself over and over again in the stomach.

Attempt at Running

I went running today for the first time even pretty much.  I had a gym membership back in NH.  It's a chain gym so they are all over the US, except here.  I tried looking into a different gym here but so far the only one I like is double the price I was paying before.  This gym does have classes and other benefits that my old one didn't so I'm sure it's worth the extra money.  I just haven't come to terms with spending it yet.  I'm told I can get a free membership to the YMCA but it's a few towns over.  And an extra 10 minutes of driving time is probably going to used as an excuse for not going at all.  

I decided since I am new here and haven't seen much of the town that I'd just walk around and see it all by foot.  Which lead to running.  I'm not much of a runner.  I refer to myself as the fat kid.  I'm slow and have no coordination.  I'll see where it takes me.  My back and legs already hurt so that's good.

Still Standing

A couple people in the last few days have directed me over to Still Standing Magazine.  It's a new website launched this month about infertility and loss (pregnancy or infant).  I added myself to their monthly blog list.  They don't have too much on there yet but it does have promise. 

Behind the Glass

I did see this article, No Mother’s Day For Me, on Still Standing that mentioned Mother's Day is like sitting outside a candy store and watching everyone inside have fun.

This is interesting because I always describe it as similar.  I feel like I'm in grade school and everyone is allowed to go out for recess, but not me.  I got in trouble or didn't do my homework or something.  I have to stay inside.  Sitting next to the window I look out all my friends running around and having fun.  I wish I could be out there with them except I did something wrong and have to complete my punishment.

  

Only thing now I'm all grown up.  I'm infertile and still standing behind the window watching everyone have fun, smiling.  They are all so happy.  I can't figure out what I must have done wrong this time, what the cause of my punishment is.  How I can make it up?

I'm stuck behind the glass.  I can't find a way to the other side.  I sometimes pound on it, very few people hear me.  I am alone with tears running down my face.  Every once and awhile there is some hope, but it doesn't stay for long.

I feel like everyone I know is given something I want so much so easily.  It's just handed to them with little or no effort, sometimes they didn't even want it to begin with.  They go along with their pregnancies with little or no complications.  Their baby is perfectly healthy.   It's not like the car we want with all the features.  Or the new TV.  The want is something different.  We try and try and try, over and over again with so much hope.  Month after month, year after year.  Just hoping if this herbal tea, different drug or break from it all together works.  Then a miracle happens.  Only to find out the heart stopped, we go into labour early or the our baby is born stillborn.  We are left with nothing again.

This Mother's Day I will be behind the glass just like many other women struggling with infertility and the loss the their baby.  I will be alone and probably will not talk to anyone that day.  I will not be getting a handmade card, flower or chocolates.  Or even be getting a "Happy Mother's Day-to Be".  My child is no longer alive.  I would have been 25 weeks, 1 day on Sunday.  Any effort I have ever made at being a mother means nothing.  I will be forgotten, my baby will be forgotten.

“Happy Mother's Day”

It comes around every year;

but when you have empty arms,

it's very hard to hear.

It's a day to celebrate a mother,

for all the trials she overcame;

and a reminder to an infertile

of her loneliness and shame.

But what really makes a mother,

Is it just conception and birth?

Or is there something more,

that shows a mother's worth?

It's putting your child first,

in everything you do;

it's sacrifice and determination,

and love and patience too.

An infertile woman makes all her plans,

around a child not yet conceived;

she loves them even though they aren't here,

more than she ever could have believed.

She appreciates and understands,

what a blessing that children are;

she works hard for just a chance,

that motherhood is not that far.

All odds are stacked against her,

and yet she still has hope;

everyday is another struggle,

finding ways to help her cope.

So even though her arms are empty,

she can still be a mother too;

So say a special “Happy Mother's Day”

for those waiting for their dreams to come true!

- Saw this on a forum yesterday

-Selbe

Post-Op & Planning Appointment 11/3

The Surgery:

It went well.  I recovered quickly and he didn't even look at my stomach at the appointment.  I guess the stitches (?) is suposed to fall off or go away on it own.  I've never actually had stitches before.

RE talked about the same things from the pictures before.  

Right Fallopian Tube:  Eh but he's not too concerned the risk of an ectopic pregnancy.

Uterus:  I have an hyperplastic endometrium.  Not too much of a concern though.  The biopsy of it came back normal.

"a condition of excessive proliferation (cell growth) of the cells of the endometrium (inner lining of the uterus.)...

...result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones which ordinarily counteract estrogen's proliferative effects on this tissue. This may occur in a number of settings, including obesity, polycystic ovary syndrome, estrogen producing tumours and certain formulations of estrogen replacement therapy." - Wikipedia

Cervix:  I also have cervical stenosis as "very little normal cervix was remaining" and it was a bitch to dilate.  This was already assumed for awhile.  My cervix is scarring over and the opening is very narrow.  This is why cramps are so painful to me and my HSG was a trip from hell.  It's complements of my LEEP in 2005 and 2009, but mainly the second one.  It's a rare risk of having a LEEP done but of course my body loves to be "rare".  I forgot to ask Dr. H about the possibility of having an cervical cerclage put in if I do get PG.  The actual thought of having my cervix stitched closed terrifies me so we will put that thought off for awhile.  FYI a cervical cerclage is used in women that have a incompetence.  The cervix begin to dilate way before it should, maybe times due to the weight of the growing baby.  It results in miscarriage or early labor.  The cervix is stitched closed around 14 weeks and the stitches are removed around 37 weeks.

Ovaries, left fallopian tube and vagina are all good.  Fuck something semi works.  

What's Next?:

I have CD21 Progesterone BW next Monday.  I need to have at least a 3.3 to have ovulated, even if it's a crappy ovulation.  No 1.7!  A 10 is ideal for a non-medicated cycle.  (It was 15 when I was Clomid or if I'm on any other drugs.)

And then I need to decide, ovulation or not.  No ovulation then Provera will be my buddy again.  

Source

Dr. H began talking about doing an IUI (intrauterine insemination).  It's a couple types of shots and then Bean's sperm is poured into my uterus once I've ovulated.  My cervix hates me and I fear having another tube stuck up it, even though the RE assures me it is much smaller than the one for the HSG.  The cost is between $2000-2500 which will not include my meds, an additional $500.  But spending $3000 does not 100% get me a baby, only about a 17% of one.  So odds are I'll need multiple which is $3000 each cycle/month.  

And then there is IVF.  We are not even going to get into that because each cycle costs $12,000.  Again no 100% guarantee.  But if I buy two (results in BFN) then the third if free.  How nice of them!  If I spend $24k I'd better get a lot for free, along with a free crib, stroller and all the other stuff.  We can just pretend like this doesn't exist for now, like the cerclage I'll probably need.

My insurance will NOT cover any of my meds used for an IUI or IVF.  In fact they will even refuse to pay for basic U/S and BW.  They want no part of it.  (Then again my infertile ass is expensive, I don't want to pay for me ether.)  But they will cover my meds for timed intercourse (TI).

So for TI it is the same meds and monitoring as an IUI.  Except when I ovulate I have sex like a normal person, you know penis in the vagina, no tube of sperm in the uterus.  I'd like it to be as normal as possible.  This has a lower success rate but then again it's a lot cheaper.  

The meds I'd use for the TI (or IUI) are:

Gonal-f RFF Pen 450 IU @ 75iu/day - Daily injection used for ovulation induction (OI) with FSH hormone from CD4 for a week or two.  This makes my ovaries produce lot 'o eggs.  This is much like Clomid but for those who don't do so well on it.  I can't wait to stab myself in my stomach!

Ovidrel - Once injection of HCG hormone for my ovaries to drop all the eggs.  I'll be monitored with several U/S to see when my eggs have fully matured with Gonal, then this shot is used.  

I might be on Progesterone also to reduce the risk of MC since my body doesn't produce enough of it on its own.

The injectables come with a higher risk of multiples.  I'm pretty sure it made Bean worry a bit when the nurse said that.  But it's a 10% chance of twin, and much lower for triples and so on.  She let him know there wouldn't be six which I'm sure he was picturing in his head.  To be honest we are both pretty excited for twinkies!

Decision:

I'm going to see what the Progesterone comes back as.  If it's good then I'll hang out on Vitex and hope to be normal for awhile longer.  Or I'll move to TI with the injectables.  If it's too low then I'll definitely be moving to TI.

I'm not ready for IUI.  We have the money but I feel I haven't had enough time having natural sex to have given it a good shot.  I've been having unprotected sex for over a year but very rarely have my ovaries actually released eggs.  And a couple my age only has 20% change each time with perfect timing.  

I'm also waiting to move since our new home (hopefully) has an Army base that does IVF at a discounted rate and includes the drugs.  

Bean is most likely going to be sent back out to sea in the spring.  I can do IUI and IVF while he is gone with his frozen sperm.  I'm going to use the "fresh" stuff now.

If TI works:

I'll have BW for check my betas (PG test) 14dpo after each TI cycle.

I will stay at my RE until 8-14 weeks before being sent to an OBGYN.  My first fetal U/S will be at 6 weeks, then one or two more at a later date before going to the OBGYN.

-Selbe 

CD19, 4dpo