Things are Good, in the Important Ways

I had yesterday's doctor appointment.

The good news: based on a manual exam, my cervix is long and closed, and my uterus feels fine.

The disappointing news: I didn't get to have an ultrasound, or even a doppler because the OB said 9 weeks was too early to pick up a heartbeat, and she didn't see any need for an ultrasound.

The bad news: the OB was completely condescending and rude.

I've been to this office before, and always had very good interactions with my gynecologist, but he wasn't taking new OB patients, so this was one of his partners. D and I wanted to discuss with her the timing of our move to Chicago and our insurance concerns. We'll be moving in my 11th week, and then I'll have my old insurance in Chicago until I start my new job August 18, which is close to 14 weeks. I'm still trying to get some more information on the insurance options, so I'm are starting to learn a little more about the plans, but it's still proving to be difficult. So it's possible if I see a doctor in Chicago before I get my insurance is set up, I might not be able to see the same person again, and I'll probably be responsible for any out-of-network costs. I am also considering getting a nuchal translucency test (guess I'll get my ultrasound that way!), which would be a little late by 14 weeks, but maybe a little early here in NC since I'll just be 11 weeks. I was hoping to get some advice from this OB about when and whether or not to take the test, but she was pretty much completely unhelpful in that regard. "It's a parental decision. I can't tell you whether to do it or not." So if any of y'all have any thoughts about the test, feel free to share, although we are currently trying to schedule on in NC for 11 weeks, 1 day.

While she was not willing to give any advice about the NT test, she was perfectly willing to lecture me about insurance and my priorities in life, and what better time than when I'm sitting in the exam room with my pants off? When I tried to explain to her my concerns with insurance and whether they would cover ulstrasounds, she not only dismissed the concerns, but then proceeded to go on about how people shouldn't even really expect insurance companies to pay for things besides catastrophic events, it's HMOs that have spoiled us all into thinking that insurance should cover regular medical care. And what does it really matter to me anyway, because I should know that children are very, very expensive. (Insert finger wagging here.) 18 years from now, when I'm paying that child's college tuition, paying for an ultrasound out of pocket will barely be a drop in the bucket. And if I was so worried about the timing of the move to Chicago, I need to just change the time that I'm moving. House closings are just "social events" and they are changed all the time. If my priority is getting an NT scan, then changing the dates of two house closings, the mover's pick up and drop off dates should really be quite simple. And I should realize how nice she was to spend the last fifteen minutes discussing these issues with her, because she could have just said she didn't know how insurance would work and left (I wish!) To top it all off, she then turned sweetly to D and asked, "So what kind of work are in and what will you be doing in Chicago?" I guess me as the pregnant lady am clearly designated as careerless.

Who are these doctors and where did they learn their interpersonal skills? I was so pissed by the time she walked out of the room, I was shaking and practically in tears--not that it actually takes too much these days to reduce me to tears, good and bad.

The other good news: I'll only have to see this doctor once more.

Dr. Thoughtful Rocks!

I've spent a lot of time comparing my old clinic to the new clinic, and, really, the new clinic has come up better in practically every way in terms of how they treat patients. Even the weird Dr. Cheerful with whom I had to have an embarrassing conversation about D's preferential times for sex, was willing to work with me to make this cycle work for me as an individual. The thing that has been really fantastic is the care they've put into making each patient feel like an individual person. Dr. Thoughtful called after I did Low and Slow #1 to get a game plan in place in case the cycle didn't work, because she would be going on maternity leave. So while I really didn't see her for my successful cycle, she's been keeping track of it all. After the second beta showed my numbers were doubling nicely, she called to offer congratulations and left her number to call her if we had any questions. Now, after I had the successful ultrasound at 7 weeks, she send us a personal congratulatory letter to both D and me, which was even personal enough to wish us luck with our move to Chicago. Now that is thoughtful! Such a change from my former clinic, where I got a post card from "The Dream Team" congratulating me on my pregnancy a week after I had finished my beta tests because my numbers never doubled, then fell to nothing. Not so much thoughtfulness going on there.

I have also gotten an earlier appointment with my OB here, after calling them about spotting and light bleeding and wondering whether that would qualify as a "medical necessity" to get an ultrasound. They decided I should come ASAP and see a doctor, who would make this determination, so I have an appointment tomorrow. I feel a little sheepish, because I probably don't really need this appointment at all, and it's only been two weeks since I last saw a doctor and got the good ultrasound. But I also feel relieved because I do have questions, and I think having this appointment will help for peace of mind. Don't be alarmed if I don't post tomorrow--I've got evening plans and the appointment's in the afternoon. I really am going into this thinking everything's going to be okay. I think since I called, not a drop of blood has been seen.

Meanwhile, I've been quiet because I've been busy, and also rather cranky and tired. After getting home late because I was on a search committee, I whined at D about packing, complained that the toilet still looked dirty after he cleaned the bathroom (normally I tell him, "thank you"), and yelled at him not to eat the pita bread, because dammit, that was going to be MY breakfast. Finally, last night I slept like a log, and didn't actually get up 56 times to pee, so I'm feeling a little better today. After dinner, my mouth suddenly feels like the Sahara desert, so it's all I can do not to down glass after glass of water until bedtime, while earlier in the day, I practically have to force liquids down my throat because they seem so unappealing. This clearly is contributing to the peeing problem. D, fortunately, still seems to be holding up with me around!

Insurance

Thanks for all of the kind comments about my worries and predicament. I have decided:

1. I should be able to for more week without an ultrasound, or this is going to a LONG pregnancy indeed! Whether or not I can make it the next three weeks will depend on what kind of bleeding I have.
   
2. I intend to call the doctor's office in advance, tell them I've have some bleeding and spotting, and I do believe that will qualify as a medical necessity, based on what your stories here. And if not, I think an ultrasound is probably around $300 bucks or so, so I will just pay for it.

I do find my insurance policy rather baffling. Now, they didn't cover anything during my IVF cycles, but for time intercourse cycles, they did cover the ultrasounds. And from reading the booklet, it seemed like the ultrasounds should have been subject to coinsurance and deductible, yet when I look at my statements online, they are covering them in full, and I am not even paying a copay for the doctor's visit! I'm still waiting for some sort of big bill to suddenly come my way. Rachel may be correct in that the way they code "ultrasound" may vary quite a bit, and perhaps only the first ultrasound that confirms a pregnancy is considered the ultrasound, and others are coded with the types of tests or the anatomy scan they support. I wish there was some way to actually understand insurance, and be able to definitively look this stuff up, but there is not. I have no idea how to be an informed consumer in the health care world, at least in the U.S.

And all of this will be moot, because I will be going on a different insurance plan in a little over a month. It would be nice, I'll tell you, to know what that insurance plan is, so I can start looking up doctors, but that is also turning out to be a big mystery. There appears from the benefits website, to be three plans I could sign up for. One of them is a traditional plan with big copays, coinsurance, and deductibles, and the other two are HMOs. However, if you try to look up doctors part of the HMOs, it looks like no doctors are part of plan, so something clearly must be wrong there (unless they are REALLY sucky, I would assume they wouldn't offer the plans if there are no doctors that are part of them!). To add additional confusion, D asked his future colleagues about their choice of plan (he and I will be at the same employer), and they all are on a different PPO that doesn't appear to be an option when looking at the online benefits information! I am hoping all of this can be squared away when I start my job and attend a benefits orientation, which will be August 18. So there is not a lot of advance prep work I can do in that regard. The uninformed, and now irritated consumer must soldier on in the dark. I do predict more insurance confusion in the future!

In other news, I had my last quartet concert today. We've been doing the retirement community circuit, but some of these places have some pretty damn nice concert halls and draw a good crowd, so it's been a lot of fun. It feels sad to be leaving the group, I think it was a very special bunch of people, and I don't know that I'll ever have an opportunity to play with a group like that again. I suppose it's good to get all of these transitions done with at once, because it's hard to say what my ability to play the clarinet in the future will be like, after I give birth to MC. A trade-off I'm certainly willing to make, so I am also thankful that I've been able to play with the quartet for the past three years. It's provided me focus, accomplishment, and whole lot of fun.

Sometimes, Mom Knows Best

I didn't really expect myself to be so tense about this pregnancy. So worried, so scared it wouldn't work, so full of dead baby thoughts. But here I am. On Wednesday, I had another minor episode of bleeding, like I did in Anaheim, it was just a slight rush of red, only enough to cover my liner, then things slowed down and I haven't had any bleeding since, but the worries returned at full force. This all despite being told by the RE, if it's not heavy bleeding, it's okay. I have an appointment with an OB on July 31, but that of course is still three weeks away. I only get to see this OB once before we move, so my medical care is feeling a choppy too. When I called the OB office to schedule an appointment, I asked if I got an ulstrasound. They said I could have one, but I should contact my insurance, because some plans will only cover two ultrasounds during pregnancy.

Yesterday I called insurance to inquire about this, and they told me they only cover ONE ultrasound during pregnancy. So my 7 week pregnancy confirmation ultrasound, that's it on coverage. They will only cover more if the doctor can prove medical necessity. I was pretty shocked. Maybe I've got the wrong idea here from reading blogs and talking with people, but it seems like people generally have even more than two ultrasounds during pregnancy! I'm only on this insurance for another month, so in the end, it's not a big deal, but somehow I came away from that phone conversation in near hysterics. Here I am, terribly, irrationally worried about my pregnancy, and I can't even get an ultrasound? I don't know if my bleeding would count, but I certainly don't think "mental health of mother" qualifies as "medically necessary." I'm just debating paying for the thing out of pocket, because I could really use that peace of mind. God knows I've paid for enough other stuff out of pocket, but somehow, I thought those days were over.

Like any irrationally worried daughter, I decided to call my mother, and asked her how many ultrasounds she had when she was pregnant with my brother S twenty years ago, and it was 4! I also confessed my terrible fears of losing this pregnancy, and she assured me it was normal. My mom had three of the most uneventful pregnancies on this planet, but she said she lived in fear each time. With S, she had CVS testing (she was 41 when she got pregnant), and had an episode of bleeding following the procedure. She was convinced she had caused a miscarriage, and even wrote a letter to her unborn son saying goodbye. Well fortunately, 20 years later, my brother is still around, but the experience was so powerful for her that she decided not to us the original name she had picked out for him. I had no idea how close she felt to losing my brother. The conversation made me feel better, that I'm not the only one with these fears. It was also interesting listening to her talk about the differences of care with S and with my older brother. With my older brother, there was no ultrasound, and the OB actually found the heartbeat through a contraption strapped to his head, because the skull was supposed to magnify the sound waves or something! It's a big difference from 1972 to 1987!

So I am going to try to be calm and positive about all of this. I have placed a new tracker on my sidebar, because this pregnancy's going to make it! D and I have also chosen a nickname for our embryo: MC. MC is our Mystery Child/Miracle Child/Master of Ceremonies who will run our lives after birth. It seems fitting enough. Well, MC, only 223 more days to go!

Barren Bitches Book Brigade: The Empty Picture Frame

For the latest installment of the book club, we read The Empty Picture Frame by Jenna Currier Nadeau. Jenna may already be familiar to some of you as a fellow blogger, but her story actually was new to me. I think her personal blog has join password-protected, as the site mentioned in the book, http://www.inconceivablejourney.com/, has the look of a website, if not quite abandoned, not really being updated either, and references I've found to her blog no longer work. I'm sure someone out there (perhaps the author, even) can fill me in on this. Her bravery in writing this book, going on Oprah and being willing to enter public spotlight is more than I think many of us would be willing to do, so I can understand the need for a little privacy.

Depending on where you are on your IF journey, how did this book affect you? For example, if you have a child/ren after IF was it easier or harder to read? If you are in the middle of your IF struggle did the book help or hinder? Give me your thoughts on how you were affected reading the book no matter where your IF journey has taken you so far.

This book reminded me a lot of an earlier book club title, Waiting for Daisy, by Peggy Orenstein. Both books were personal memoirs of infertility and loss, but with one very important distinction: while Orenstein wrote from the perspective of having successfully completed her journey with the birth of her daughter, Jenna wrote while being in the thick of things. It's much more difficult and painful to be writing from that unresolved situation because you leave yourself open to others questioning your choices. If you have a child in the end, as Orenstein did, you can question your choices and your means, and how you behaved during that difficult time period, but you have your ends and it becomes worth it. But if you are still reaching for goals, then people seem to feel they have the right to tell you what to do - give up, relax, try this, do that. Jenna wrote the book when she is in at a crossroads: ending treatment for now, but still actively pursuing parenthood, just deciding how to do it.

When I first started reading this book, I felt like I was at a crossroads myself. While I can say I'm pregnant now, at the time I didn't know, and was going through my second low and slow stimulation protocol. Just six months before, I had completed treatment with my first RE, which was stunning mostly for being unsuccessful and dangerous to my health. While no doctor has ever said, "there is really nothing different we can offer you," I did feel like I had reached the end of the line with IVF at my former clinic. I debated for some time whether to switch doctors and finally did so, and was pleasantly surprised to find there was another protocol out there that could be helpful, that wouldn't give me OHSS. But I didn't have a lot of faith in actually getting pregnant via this protocol, it was mostly a vehicle for me to say, "well, I've fought the good fight and now I have to decide how I want to move forward, but any babies in my future will probably not biologically be mine."

In the middle of reading this book, I discovered the protocol did work, and now I was pregnant. My perspective shifted considerably, especially when reading Jenna's description of her own pregnancy. I had wanted this for so long, and reading of someone else's miscarriage made the possibility all the more scary for me. At the same time, I loved that I could relate to Jenna's feelings toward her own baby - it's a little like I joined the club. Even though I know if things don't work out, there will be a terrible price to pay, I'm still grateful to have had the opportunity to get this far with my own child. I understood what Jenna said, when she wrote, "I experienced a miracle, even for too brief a time."

On page 134, the author talks about the failures bringing repeated pain to their families. In what ways did your treatment affect your extended family?

This last year has brought the greatest heights and depths of emotions for me and my family. I've given my mother a few more gray hairs with my hospitalizations, but I also felt a profound sense of loss and of letting other people done when the transfer was canceled for my final IVF and the FETs both resulted in failure. It wasn't logical, I don't know that my family or D's family even felt the same the way, but I just felt so responsible for things not working. And the longer the process went on, the more uncomfortable I felt it got, because it seemed like it was time for me to move on, to enjoy all of the things life did have to offer me, but I was stuck. This past Christmas and winter was so hard, I can't even write about it now without feeling teary about it. I felt like a lead weight dragging everything around me down.

Most difficult has been dealing with my SIL's, R's pregnancy. I'm not very forgiving of myself on that one, even though I'm trying to show compassion for myself, and know that it was hard to be excited when it served as a reminder of everything I didn't have. Now that I've shared with family about my pregnancy, people's excitement has just been overwhelming. Sometimes I feel like I don't really deserve it, given how unenthusiastic I felt about R's pregnancy. If the best I could manage was such a lukewarm and perhaps even perceived hostile response, why should people treat me any differently? It still feels awkward.

The last chapter is a guide to the fertiles reading the book on how to respond and not respond to a situation. Some of the reactions and commentary has happened to many people. What was the best reaction you got to your story and what was the worst?

My ability to absorb well-meaning, perhaps, but misguided advice, has always been tempered by who it's coming from. I'm able to cut a lot more slack toward strangers or people who don't know my situation very well from those who know me more intimately. My former boss was well-versed on my fertility treatments, since I decided to just come clean with her when I started clo.mid cycles, in case I had a number of ultrasounds and needed to miss work. So she knew the whole story, from when I cried in her office from too much clo.mid affecting my ability to think straight, to visiting me in the hospital for my first OHSS, to following my decision to move on to IVF, and so forth. I switched jobs, but at first I kept her informed. Then several months after I had been gone, I had a failed FET cycle, and remember being at a party and telling her how things were still not going well. "You should just adopt, then you'll get pregnant!" I shot her a look of disbelief, but she persisted. "It's true! It happened to X!" I tried to take it as a benign misguided comment, but it really hurt my feelings, because it came from someone who knew so much and had been supportive. I felt like it was her way of telling me to move on and get over with it, and I haven't felt as ready to share additional information with her since then.

My SIL, R, also really hurt my feelings when she shared the news of her own pregnancy. Obviously she was very caught up in her own moment, but she too knew of the whole saga from very early on. She knew I was in a middle of an FET cycle, and although I hadn't shared the exact date of my beta, she called the same night I had gotten a BFN from an HPT. She decided it would be best just to pretend that I had never been through any treatment and hadn't already endured years of BFNs and a chemical pregnancy, and just blithely announced her pregnancy in great joy. I don't want to rain on others' parades, but a simple, "I'm sorry that you are still trying" or "I realize this news may remind you of your own losses" would have meant a lot to me. Even though we have spoken about it since to clear the air, it's still hard for me to completely move on from that pain.

On the best side, a few simple but very touching things have been the best for me: "I'm sorry, that sucks" from D's friend learning that all of our IVF cycles had failed. Getting flowers from my friend on the day of transfer. D spending the night with me in the hospital--twice. Another friend responding to my feeling that I had let the world down by not getting pregnant on my last FET cycle, saying, " The rest of us out here are concerned about you, not some theoretical child you could have some day." Most touching of all was my cousin's offer to be an egg donor, should I end up needing one. It was a completely unselfish offer, made in the vein of, "Isn't that would any cousin would do for another if needed?" These pregnancy hormones are making me cry when I think about all of the love in the world has directed at me!

Hop along to another stop on this blog tour by visiting the main list at Stirrup Queens. You can also sign up for the next book on this online book club: Eat, Pray, Love by Elizabeth Gilbert.

Sharing the News

D and I decided with our families, we would just go ahead and spill the beans. First off, my parents and D's parents already knew about the positive betas, so there were no surprises there, although they were waiting impatiently to hear from me yesterday. Then my mom determined she would absolutely burst if she couldn't tell her mom, so I said I would call Grandma. My grandmother was already well-versed in my IF treatments, and she had talked to her sister about them, so when I met my great-aunt for the second time in my life, we unexpectedly had a conversation about infertility. Then my Grandma thought I should call my aunt and uncle, since they live in the same town as my grandparents and would want to hear the news. It sounds like a lot of people, but it's a small family on my mother's side, and, for better or for worse, from them no secrets are kept. Then D thought he might as well tell his grandmothers, and his aunts and uncles. So we're leaving it at that, but I'm still keeping mum around my coworkers and most of my friends.

Everyone we talked to was overjoyed to hear the news, particularly one of Josh's grandmothers, who, when we got some static on the phone, shouted, "Even's the telephone's excited!" It's rare to hear her so happy, but she's already planning her trip to Chicago to visit us and the new baby. There were a few other comments that did push a few buttons for me and D:
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D's Dad: Aren't you glad that you got pregnant the "normal" way?

Me: I really don't like the use of term "normal." I don't view IVF as "abnormal" and I think saying that this is "normal" implies that IVF babies are somehow lesser or worse. I would have been absolutely thrilled to have gotten pregnant on my IVF cycles. Frankly, I don't really care how I got pregnant.

I think what he meant was more, "wasn't it nice that this procedure was less invasive, didn't make you sick, was gentler on your body, etc. and still worked," but I'm not about to let people use the word "normal" in regards to methods of conception.
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D's Grandma (the other Grandma): Well, your child is just going to be so smart! With the genes of you and Samantha, you're going to have a little genius on your hands!

D: We don't know that our child will be smart. It could have autism, it could have Down's, it could just be stupid. And we'll love it anyway. Let's not start putting expectations on the kid before it's born. (Go D!)
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My Aunt: I was thinking that the move to Chicago would be the best thing for you in terms of getting pregnant, because you'd have some good doctors available. But now you won't need that!

Me: Um, there are a lot of good doctors around here. My first doctor just wasn't flexible enough in his drug protocol. (I know I's in the South, but them's two damn good medical schools right here and more PhD's then y'all could shake a stick at! We ain't that backwards!)

But really, everyone was so kind and happy, I'm glad we let my family and D's family know. So the cat's out of bag, at least in part! It feels so good to be sharing good news for a change!
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As an aside, since Katie asked about bleeding, the doctor thought it was most likely a little blood from my cervix. Apparently, the cervix becomes very "vascular" during pregnancy, so the additional blood vessels can be prone to light bleeding, perhaps, as one of you suggested, from the progesterone. As long as I'm not having cramping or heavy flow, he didn't see it as anything to worry about.

Time to Take Away the Question Mark

I know you're all waiting for the news. I just got back from my appointment.

D and I said it would be "0,1, or 2."

The answer: 1 healthy embryo, measuring 7 weeks, 0 days, right on schedule. Heartbeat at 144 (I think).

I'd scan the pictures but really they look like a uterus with two little blobs: one for the embryo, one for the sack. Still, I love them. They're my first tangible proof my child.

I'm so in shock, much more so than after my positive betas. It feels so unreal. It makes me cry in amazement. Now I can really say I'm pregnant, no ifs, ands, or buts. Wow. D will get to be a dad after all.