You're Not Crazy - Everyone IS Pregnant

You'd think that the most popular purveyor of caffeine - Starbucks - would be free from pregnant women. You'd be wrong. Today at Starbucks I saw seven pregnant women. Seven! And last week, as I sat quietly grading papers, a group of three pregnant women sat down next to me, and started complaining about all kinds of things I've never heard of, but which apparently have something to do with pregnancy.

I'm starting to feel like the kid in The Sixth Sense , except instead of seeing "dead people" I see pregnant women. Everywhere.

Just when I thought it was Just Me - that it was like fifth grade when my mother wouldn't let me get clogs and suddenly everyone had them, or when I got engaged and suddenly cute guys were everywhere (especially in the places where there had been none when I was single)- and then I read that there really are pregnant women everywhere.

According to the CDC, the total fertility rate (birth rates for american women between 15 and 44) is the highest it's been since 1971. It's also the first time since 1971 that the birth rate is higher than the "replacement rate" - the rate at which a generation can replace itself.

Still, I can't help being worried that I won't benefit in this Baby Boom. I was never very good at science, but I do remember learning that all populations control themselves (whether it's insect populations dropping because of a cold winter, animal populations dropping because of an increase in predators, or human population falling victim to plague). I worry that maybe the worldwide decrease in sperm counts and the scores of couples I see crowding the waiting room of my IVF center are part of our population starting to control itself.

If Jamie Lynn Spears and Ashlee Simpson and ______ (you can insert names of a hundren unmarried starlets here) can't control themselves, maybe nature will take over and control the population for us.

I don't want to be part of that population control, but as I get my period yet another time, I can't help worrying that maybe I am.

Ironically, I ran out of prenatal vitamins today. I was taking them for the folic acid - and the bottle contained 500 vitamins. That means I've been trying to get pregnant for 500 days - not counting the days I forgot to take my vitamin.

I'm starting to think I should follow Jamie Lynn and her teen mother companions and throw the stupid vitamins out, drink too much and act irresponsibly. That's just about the only thing we haven't tried yet.

- L.

So Not Pregnant

Well, that ended badly.

After nine days of obsessing, riding a roller-coaster of hope and despair, and generally driving myself and my husband crazy, I got my period. It started yesterday morning as what I thought (it was a moment of hopefulness) was an encouraging sign: spotting, which can sometimes indicate that an embryo has taken up residence in the uterus. I called the nurse and asked her about it. She asked for a lot of detail about its appearance, which made for an awkward time out on the busy sidewalks of town (I hope no one was eating).

As a side note, it's more than a little embarrassing to not know what a normal period is supposed to look like by now. I mean, I thought by now I'd have moved a bit beyond the whole "Your Body is Changing!" days of prepubescence health education, but having an ovulation disorder really kills the whole idea of "typical" and "normal." Every month is a surprise, and not the kind you look forward to.

Anyway, the nurse thought that what I had in the morning seemed normal so I went about my workday, oh so innocent to what lay ahead. By the time 5:30 rolled around I was ready to go home, so I ran to the ladies room before the ride home. Since I've only done the whole two-week-wait thing once before, I was totally unprepared for the icy knife that cut into my chest when I saw that I'd really gotten my period. I just sat there, staring, for a few minutes until it sank in. It was over.

At least it had the decency to wait until the end of the day, so I could go home and have a proper breakdown. The sadness of this kind of loss -- and even when there isn't anything there to begin with, it still registers as a loss -- is startling and suffocating.

Of course I assumed the worst -- now I have luteal phase defect on top of everything else. Because I wasn't having enough fun with the PCOS and anovulation. But the nurse I spoke with today said the doctor is unmoved by this news. Apparently these injectable drugs shorten the luteal phase in the majority of people, and though nine days is a bit shorter than they'd like, they're not all that concerned. They're going to give me progesterone following my next IUI to try and lengthen the cycle. Oh -- and that medication? Comes in suppository form. Because, you know, my hoo-ha hasn't been having enough fun with all the other goodies, like ultrasound wands and catheters. It was just waiting for the addition of a nice, big glob of goop twice a day to really get the party started. Good times.

The next cycle starts tomorrow with a baseline ultrasound and another round of gonal-f. Maybe that's why I'm not jumping out the window. "There's always next time" must be the motto of infertiles everywhere.

-J.

The Seven Stages of Fertility Treatment

Okay, so here's what went down. I went in last Saturday morning for another ultrasound/bloodwork. By then, I had eight follicles, five of which were big enough that they had to be taken into account, including one at 19 mm. My doctor had said that five would be the most he would consider moving forward with for the IUI, so I went and spoke with the nurse. She dropped the "m" word -- multiples -- and made sure we were aware of the risks. But as she also pointed out, they've been trying to get me pregnant to no avail, and this seemed to be a good opportunity.

I got a bit stressed about the multiples warning and did some thinking as we left the office. I do want a baby, but I don't want five, and certainly not at once. But the nurse spoke with my doctor and called back later that afternoon, with instructions to take just half the dose of HCG to trigger ovulation that night at 9 p.m. It seemed clear that we should go for it, and with the dosage halved to mitigate the threat of high-order multiples, I felt better.

Luckily, Saturday night brought us to an event in New Hampshire with our friends Chris and Robin, who just happens to be a nurse. Having only used the Gonal-f pen for injections previously, I found the whole mixing the HCG powder and using a real syringe more than a bit daunting, so at 9 p.m., me, my husband and Robin trekked out to the car for a celebrated Saturday evening pastime: subcutaneous injection to stimulate ovulation. Thirty-six hours later, at 9 a.m. on Monday morning, I had my first IUI. And that brings me to the Seven Stages of Fertility Treatment:

1. Euphoria. I just had a fertility treatment! Washed sperm are swimming around in there just jonesing for a rendez-vous with my ripe egg.

2. Confusion. Wait, that's it? I'm just supposed to go about my day now? Shouldn't I do something else, like stand on my head or keep my legs in stirrups all day?

3. Disappointment. I thought there'd be something more dramatic about this. I can't tell what's going on in there and I don't feel that excited about what's going on anymore.

4. Delusion. I am going to have to stay calm for the next two weeks. No snapping at people, yelling at people on bikes who get in the way of my car. No feelings of anxiety, worry, sadness, anger, negativity allowed. My body must be a temple for conception to take place.

5. Doubt. I don't feel any different. My boobs are sore but I can't tell if that's from poking them a hundred times to see if they're sore. I bet it didn't work.

6. Pessimism. Damn it! What if it didn't work? Yet another failure to add to the long list.

7. Hope. But actually, there's still a chance! In less than two weeks, I'm going to get a call from my favorite nurse going something like this: "I'm so happy to be the one to give you this wonderful news. You're pregnant, and we can tell there's just one (or two) in there!"

Repeat #s 6 and 7, alternating, thousands of times per day. That's about where I'm at right now.

-J.

The Long Race

Okay, so I was a little loopy yesterday. Anyone would be. This week has been the definition of "emotional rollercoaster," and I truly am exhausted from all this thinking about follicles. Here's where I am right now: Yesterday's results showed that I have four follicles on the right side, all at about 12 mm. My estradiol level is in the 200s, which the nurse said is "perfect" for where I am. They had boosted my gonal-f to 112.5 iu on Monday and kept me on that dose last night and tonight. Going back in the morning for another ultrasound/bloodwork round.

One thing I've learned is to stop asking for and/or listening to the ultrasound technician's read on the situation. With all due respect to them -- because some of them are great and very professional -- they are not doctors. Yesterday, the tech asked me if my ovaries were very sore, because "you have a lot of follicles." I immediately spiraled into despair -- clearly, we were back in the same situation again.

I asked to speak to a nurse when it was over, and she talked me down from the ledge. I have four in the lead, and if they stay in the lead I'll be good to go. I also spoke with my doctor yesterday. I just really wanted to hear what he was thinking. He said he, too, is concerned that I seem to either overrespond on the higher doses or respond too slowly on the lower ones. But it's entirely possible, he said, that these four follicles will make it to the finish line before the others get big enough. He said he'll trigger (take the HCG shot to trigger ovulation before an IUI) with up to five follicles. Anything beyond that, he said, and the risk of multiples is just too great. For now, we just play the waiting game. It takes a lot longer to get to the end when you're on the lower doses.

Today I'm feeling...well, I don't really know what I'm feeling. I go from optimistic to despondent in a matter of minutes. I'm just really hopeful that we can actually get to another opportunity to get pregnant. After all the hard work (and sometimes it really does feel like work) of the last few months, I've only had one opportunity (in late Dec./early Jan. when I ovulated on Clomid) to get pregnant. One. I'd be grateful for more. On that note, I'm really considering converting to IVF if I overrespond this cycle. Like my follicles, I'm eager to get to the finish line.

-J.

An Update from Follicle Hell

This is how I could go crazy:

Ultrasounds every day
Follicles too big, too small
too many, not enough
All follicles all the time
Start seeing follicles everywhere
Follicles start talking -- taunting me

In the event of the above, will somebody please make sure my room at McLean's is stocked with plenty of magazines and lots of salty and chocolatey snacks? If I go crazy, the diet is so over.

-J.

Calling the Insurers OUT

As I've said before, I'm angry. And now I have an outlet for that anger - an outlet that absolutely, really and truly deserves it. The insurance industry.

I met with my doctor on Thursday, and he told me that he wanted us to start IVF right away - that at my age (37, 38 in May) and with our test results, we'd likely have a 40% or higher chance of getting pregnant on the first IVF try.

But we can't do IVF right away. Instead, because my insurance mandates it, we've wasted three months on Clomid and IUIs, and are now going to have to waste two more months on FSH and IUI. So I get the worst of IVF - injecting myself in the stomach every night - without the benefit - the high success rate.

Why?

Because my insurance company, like many in Massachusetts, blatantly violates the law and puts all sorts of limitations on infertility coverage. Apparently the insurers sat down with fertility experts (including my doctor) fifteen years ago, and asked them what their different treatments were. And, fifteen years later - a thousand years in fertility treatment improvement - the insurers are still requiring the same protocols.

In 2008, this is like iTunes suddenly refusing to allow downloads: "Welcome to iTunes! From now on, you can only buy 8-track tapes here!"

I live in a state with some of the best doctors and hospitals in the world. But because of the insurance industry's stupidity, I might as well be getting treatment at a small clinic in a developing country.

And the most infuriating thing is, IT DOESN'T SAVE THEM MONEY!! If they had let me go ahead with IVF right away, they wouldn't have had to pay for all the doctors' visits, ultrasounds, blood tests, medications, IUIs and other expenses over the past four months.

I am going to do something about it.

The law in Massachusetts is crystal clear: health insurers who cover pregnancy-related expenses must cover all medically necessary costs of infertility diagnosis and treatment. ALL.

My insurer - Harvard Pilgrim (I have a PPO plan) - is violating this law. My doctor says that IVF is medically necessary - and my insurer says, "too bad."

They also put caps on coverage - 6 IVFs. And age (when the woman turns 40) will trigger all sorts of requirements - for example, they can cancel a cycle if my test results aren't equal to their mandated levels.

What I want to know is this: if a pregnant woman is having her seventh child, do they refuse to cover her hospital costs?

"Sorry! You've had six kids - that's our limit!"

Do they kick 20 year olds out of the hospital five hours after giving birth?

"Well, you're young and strong, so we only cover you for five hours of recovery!"

Do they refuse a pacemaker in a 70 year old because even though the technology exists to make his heart beat like a 30 year old's, it's his age's fault that his heart is old?

If my eggs are old, but technology can make them act young, isn't that just like a pacemaker (or Viagra, or eyeglasses, or hearing aids or knee or hip replacement)?

I'm sick of the double standard, and I'm not too embarrassed to fight it. The insurers seem to be banking on a few things:

* infertile couples are just too ashamed to take their plight public
* the insurer can take up to 90 days to review a claim - so if my doctor told them that he wanted me to go directly to IVF, we'd waste three months - so I might as well do the FSH and IUIs
* once a couple does become pregnant, they want so badly to put this all behind them that they won't take up a battle against the insurance companies
* people won't learn their rights and will just assume a denial is a denial and there is nothing that can be done about it

Well, as my friend Lyle would say in a southern accent that can make any swear sound like sugar, "I call bullshit on that."

I am calling bullshit. I have already written to two state senators (one of whom called me back and was furious and is going to look into all of this, and is going to work on the currently existing bill in Massachusetts - Senate Bill 599 - which would change the law's definition of infertility from inability to conceive for 12 months to inability to carry a child to term - because the definition currently allows insurers to refuse infertility coverage for 12 months after the cruelest fate of all - a miscarriage for a couple who has fought so hard to get pregnant).

I am going to find a class of plaintiffs, and I am going to fight the insurance companies.

I may have spent my most fertile years getting a law degree, but now I am going to use that law degree to get the fertility coverage that is legally mine.

- L.

It's All a Mystery. Period.

Sex and the City fans: Remember when Charlotte was with Trey, who had "performance issues?" In one scene, Charlotte berates him and his obsession with his “John Thomas.” “That’s all you ever think about!” she screams. “Be careful, don’t say anything bad around it, don’t want to make it unhappy!”

That’s how I felt last week about my period. All that waiting and it never came. I tried thinking positively. Tried not thinking about it at all (impossible). Tried visualizing, coaxing, reasoning with it. Nothing. I tell you, I have never thought so much about it in my life. And I’d be happy to go back to not thinking about it at all. It’s unpleasant, and it’s boring.

All the thinking mattered not a bit. Turns out, contrary to what we’ve been taught, it’s just fine that it didn’t come. I went in for bloodwork on Saturday and got the green light to start another cycle of Gonal-F. My hormones reflected the beginning of a cycle and my uterine lining was thin – good conditions for ovulation induction. I asked what the doctor made of the fact that I didn’t get my period. “He’s not really sure what to make of it,” said the nurse. Comforting. But I was getting the green light for another go at it, so arguing about whether or not I’d gotten something not-so-fun seemed sort of beside the point. It’s a mystery that will have to go unsolved.

They started me on 75 IU of Gonal-F, which is half the dose that caused the follicle overload last month. For some reason I’ve found myself feeling more anxious this time – about the needles, the dosing, etc. But I’m working through it. Went in on Wednesday for bloodwork and ultrasound and I had only two follicles this time, both at 10mm. They cut – that’s right, cut – the dose based on that. I’m now on 37.5 IU, the lowest possible dose. I guess the idea is to recruit a couple more follicles and then grow them at a slower rate than last time, while keeping my estradiol level under control (this is the hormone that indicates the rate at which your body is developing follicles -- it skyrocketed last time). I’ll go in for another round of bloodwork and ultrasound tomorrow morning.

Last night, as I was explaining the above to my husband, something strange occurred to me: Some people just have all of this stuff happen naturally. Follicles grow, one starts leading and eventually is released. All on its own. No drugs telling things what to do. Their body just works.

To me, that is the biggest mystery of all.

-J.

I realized that in my last entry, I was complaining about...complaining. So - enough complaining. How about something positive for a change? No, I'm not pregnant. But last week in my Mind/Body Class, we talked about reframing negative thinking. In addition to spending 75% of our daily conversations on negative topics (let's face it, we have more fun joking with coworkers about That Jane and her New Office and how She Thinks She's So Great than we would talking about how nice it is that our assistant always makes sure the water cooler refill is changed), when dealing with infertility, it's pretty common to have a constant negative loop playing in your mind.

For me, the hard part is trying to stay hopeful (if you think you'll get pregnant, you will sort of thing) while not getting my hopes up to the point where I'm really let down every month. And I can't help it - negative thoughts creep in all the time.

Here is the exercise that we did, and I highly recommend it:

Write down three frequent negative thoughts.

My three were:

1) It won't work for us ("it" being IVF or IUI or anything)
2) It's my fault because I'm fat
3) Maybe this means that my husband and I aren't supposed to be together

I feel the worst about #3, but I share it with you because several of the women in my group told me that they had the same thought! And almost half of us had either #1 or #2 - so if you were thinking any of these things, you're not alone.

Next, ask yourself the following questions about each of your negative thoughts:

1) Is this thought true?
2) Where did I learn this thought (where did this thought come from)?
3) Is this thought logical?
4) Is this thought contributing to my stress?

For me, thought #3 was not true and not logical, was contributing to my stress - and I guess it came from not being able to find any logic or make any sense out of why, when so many abusive, neglectful and hateful people can have children, my husband and I can't.

I'm still working on dealing with thoughts 1 and 2.

The next step was to reframe the thoughts. For #1, it was pretty easy: how will I know the technologies won't work for us? They might not work, but they might work! We have good numbers, no known problems, and have a good chance of having an assisted technology work.

With number two, I decided that my weight is one of the very few things in this whole that I can actually control. And while it's probably irrelevant, why not take control?

Now I have reframed thoughts to combat my negative thoughts:
It won't work becomes it might work.
I'm too fat becomes I'm doing something to try to lose weight and get into better shape.
Maybe we don't belong together becomes Thank God we have each other - no one could help me through this in the way that my sweet husband has.

- L.